Thank you to our editor, contributors, and authors for helping put together a comprehensive supplement to the Journal of Adolescent Health, placing early findings from the Global Early Adolescent Study in context and setting the stage for further research on measurement of gender norms among young adolescents internationally with regards to health outcomes. Special thanks to the funding agencies and institutions who supported this work and whose generosity has allowed release the supplement online with open access.
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New Study Finds Boys and Girls in Countries Rich and Poor Enter Teens With Damaging Gender Stereotypes Firmly Set
Researchers say 15-country investigation shows adolescent interventions should begin with preteens to avoid health risks of “gender straitjackets” that include abuse and suicide
Washington, DC (September 20, 2017)—Whether you are child in Baltimore, Beijing, Nairobi or New Delhi, the onset of adolescence triggers a surprisingly common set of rigidly enforced gender expectations that are linked to increased lifelong risks of everything from HIV and depression to violence and suicide. That’s the key finding from a groundbreaking 15-country study released today by the Global Early Adolescent Study, a collaboration between the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO) as a collection of articles in the Journal of Adolescent Health.
It Begins at Ten: How Gender Expectations Shape Early Adolescence Around the World is the most comprehensive analysis to date—and the first to draw equally from high-, low- and middle-income countries—of how children on the cusp of adolescence perceive growing up as a boy or girl. Public health experts across the globe collaborated to learn how an assortment of culturally enforced gender stereotypes long associated with an increased risk of mental and physical health problems become firmly rooted between the ages of 10 and 14.
“We found children at a very early age—from the most conservative to the most liberal societies—quickly internalize this myth that girls are vulnerable and boys are strong and independent,” said Robert Blum, director of the Global Early Adolescent Study based at Johns Hopkins University. “And this message is being constantly reinforced at almost every turn, by siblings, classmates, teachers, parents, guardians, relatives, clergy and coaches.”
The findings emerged from a series of comprehensive interviews conducted over the last four years with approximately 450 early adolescents matched with a parent or guardian (totaling nearly 900) in Bolivia, Belgium, Burkina Faso, China, the Democratic Republic of Congo, Ecuador, Egypt, India, Kenya, Malawi, Nigeria, Scotland, South Africa, the United States and Vietnam.
Blum said the work shows a need to rethink adolescent health interventions, which typically focus on youth 15 years or older, so that they target a much younger age group.
“Adolescent health risks are shaped by behaviors rooted in gender roles that can be well established in kids by the time they are ten or 11 years old,” said Kristin Mmari, DrPH, associate professor and lead researcher for the qualitative research at the Global Early Adolescent Study. “Yet we see billions of dollars around the world invested in adolescent health programs that don’t kick in until they are 15, and by then it’s probably too late to make a big difference.”
The Perils of Outfitting Adolescents with a “Gender Straitjacket”
The conversations conducted by the researchers revealed that, around the world, young boys and girls are outfitted with “gender straitjackets” at a very early age, with lifelong negative consequences that are particularly perilous for girls. The researchers found that gender-based restrictions rationalized as “protecting” girls actually made them more vulnerable by emphasizing subservience and implicitly sanctioning even physical abuse as punishment for violating norms. They observed that “in many parts of the world” these stereotypes leave girls at greater risk of dropping out of school or suffering physical and sexual violence, child marriage, early pregnancy, HIV and other sexually transmitted infections.
For example, the researchers found boys in both New Delhi and Shanghai talked about being encouraged to spend time outside of the home in unsupervised exploration of their environment, while girls said they were advised to stay home and do chores. Shaming and beatings for those who sought to cross the divide was reported by girls and boys in both cities. In all but one city, Edinburgh, Scotland, both boys and girls were clear that it was the boy who had to take the initiative in any relationship. Across all settings, young girls reported a constant emphasis on their physical appearance and their bodies as their key asset.
“In New Delhi, the girls talked about their bodies as a big risk that needs to be covered up, while in Baltimore girls told us their primary asset was their bodies and that they need to look appealing—but not too appealing,” Mmari said.
The researchers noted that their findings bore out conclusions from previous work that “during adolescence, the world expands for boys and contracts for girls.”
For Boys, Big Risks for Following or Challenging Gender Expectations
But the researchers note that boys do not emerge unscathed. They point out that the stereotypes they learn in early adolescence—the emphasis on physical strength and independence—make them more likely to be the victims of physical violence and more prone to tobacco and other substance abuse, as well as homicide. Also, when researchers examined attitudes about gender roles among young adolescents in China, India, Belgium and the United States, they found a growing acceptance for girls pushing against certain gender boundaries, but almost zero tolerance for boys who do.
In all four countries, it appeared to be increasingly acceptable—to varying degrees—for girls to engage in certain stereotypically male behaviors, like wearing pants, playing sports and pursuing careers. But the researchers report that “boys who challenge gender norms by their dress or behavior were by many respondents seen as socially inferior.” Both boys and girls told researchers that the consequences for boys who were perceived as adopting feminine behavior, like painting their nails, ranged from being bullied and teased with harsh epithets to being physically assaulted.
“We know from research studies and programmatic experience that unequal gender norms can be changed, but this takes carefully planned and implemented interventions that target both young people and the environment they are growing and developing in,” said V. Chandra Mouli, MBBS, MSc, co-director and scientist at the Adolescents and at-Risk Populations Team, Reproductive Health and Research Department, World Health Organization.
Mmari noted that while many of the gender stereotypes documented in the study are not surprising, the fact they are so common across cultures and economic status—
and ingrained in children at such a relatively young age—is unexpected. She said the research could help shape new initiatives that foster greater awareness of the health consequences of gender stereotypes and focus on the critical “transitional” years of early adolescence.
Blum rejects the argument that in many parts of the world, gender stereotypes are just part of the traditional culture and are not amenable to change. He noted that, while they still struggle with rigid concepts of gender, in places like the United States and northern Europe, attitudes have changed dramatically in just the last few decades. For example, Blum pointed out that until 1979, only a few states in the United States had laws against marital rape.
“Change can happen, but it requires political will and a variety of interventions,” Blum said. “It also requires the knowledge that children pick up on these gender mythologies at a very young age and they proceed to play out in a variety of ways—often damaging—for the rest of their lives.”
Global Early Adolescent Study
Over the past six years, an international consortium of fifteen countries has been working on the Global Early Adolescent Study (GEAS). The GEAS aims to understand how gender norms are formed in early adolescence and how they predispose young people to subsequent sexual and other health risks.
As children move into early adolescence and start to develop into young men and women, they also start to take up social roles that are linked to masculinity and femininity. The roles they take on have huge implications for their own health and well-being and that of people around them. Hence, this is a critically important period to study.
The GEAS has generated valuable information from fifteen countries around the world, and developed a tool kit to assess gender norms in early adolescents.
The GEAS is led by the Johns Hopkins Bloomberg School of Public Health in conjunction with WHO’s Department of Reproductive Health and Research/Human Reproduction Programme.
GEAS Latin America Dissemination Meeting Report
By José Ortiz Segarra, GEAS Ecuador
On June 5th and 6th 2017, the GEAS Latin America Dissemination Meeting was held in the auditorium of the Faculty of Medical Sciences of Cuenca University, Ecuador where the results of the first phase of the study in Latin America were presented by the Ecuador and Bolivia research teams.
The first phase of the GEAS in Ecuador was carried out by the Faculty of Health Sciences at the University of Cuenca with funding from the National Secretariat for Higher Education Science and Technology (SENESCYT) in cooperation with Ghent University and UNFPA.
Representatives from the World Health Organization (WHO), Pan American Health Organization (PAHO) the United Nations Population Fund (UNFPA) Ecuador, Save the Children, UNICEF, Ministry of Public Health of Ecuador, Municipality of Cuenca, and students and professors at the University of Cuenca participated in this important event.
This event consolidated the researcher teams and strengthened the support of local and international donor institutions. It also motivated students and teachers to become actively involved in the second phase of the research.
Bolivia Dissemination Event
On August 10, 2017, in the North Auditorium of the Social Sciences building of the University of the Valley (UNIVALLE), Beni, Bolivia, results from the first phase of the Global Early Adolescent Study conducted in Cochabamba, Bolivia were presented.
The GEAS is a study comprised of 15 countries helping to understand the factors in early adolescence that predispose young people to sexual health risks and promote healthy sexuality, in order to provide the necessary information for the promotion of sexual and reproductive health.
The first phase of the GEAS in Bolivia was conducted by the Institute for Human Development.
Representatives from the Pan American Health Organization (PAHO); the United Nations Population Fund (UNFPA) Bolivia; Save the Children; UNICEF; and the Departmental Education Service attended the dissemination event, along with the mayor of Cochabamba and UNIVALLE medical students and teachers.
This event allowed our research team and advisers initiate strategic ties for the participation of Bolivia in the second phase of the GEAS and also promoted the participation of students of the medical professions at UNIVALLE to become actively involved in the second phase of this global project.
Join the Global Early Adolescent Study on September 20, 2017 at the National Press Building for a special celebration of the publication of a special supplement of the Journal of Adolescent Health on this date.
We are excited to be joined by authors Kristin Mmari, Deb Tolman, Xiauyun Zuo, and Bamidele Bello, who will describe their methods, analyses, and findings.
Stay tuned for registration details.
Questions? Study Coordinator Lydia Animosa.
Last week the Global Early Adolescent Study team in Assiut, Egypt held a dissemination meeting to coincide with the International Association of Adolescent Health (IAAH) Middle East & North Africa regional conference in Cairo.
Study PI Dr. Robert Blum opened the meeting with a history of the Study and an overview of the primary activities of Phase 1. Dr. V. Chandra-Mouli of the WHO Department of Reproductive Health and Research situated the Study in the wider adolescent reproductive health context and touched on its programmatic implications.
Joined by stakeholders and representatives of WHO regional office, UNICEF country office, International Development Research Centre (Canada), USAID, Population Council International, Ford Foundation, Save the Children, PLAN international, the Swedish Embassy, the UNFPA country deputy, Drosos Foundation (Egypt), Zanaty Co. (Egypt), and Tadwein (Egypt), Dr. Omaima El-Gibaly, site-PI, and Drs. Ghada Al-Attar and Manal Darwish, field coordinators, described the findings from their work in Assiut and led a discussion session.
Special thanks to Salina Mostajabian for live tweeting the event, and to everyone who attended for your attention and dedication to the health and well-being of young adolescents in Egypt, MENA, and beyond.
Will you be in Copenhagen for the 2016 Women Deliver conference May 16-19? If so, please join us for an interactive workshop and breakfast on Thursday, May 19 from 6:30 AM - 8 AM at conference room B4, Bella Center. Brief description here. RSVP appreciated but not necessary. For details or questions, please email Lydia.
The GEAS informational panel discussion over breakfast to be held at the International Conference on Family Planning will now be held on Tuesday, January 26, 2016 from 7:00 - 8:15 AM with breakfast beginning at 6:45 AM, at the Westin Hotel in Nusa Dua, Bali. This event is free and open to people interested in adolescent sexual and reproductive health, particularly those working with NGOs.
Discussion will cover the preliminary findings of the GEAS from a methodological perspective, incorporating voices from multiple study sites and partners.
The period for online registration has passed, but if you are interested in attending, please email Anna at email@example.com.
Note: the breakfast will be held in the Medan Room.
As the GEAS nears the end of phase 1 (piloting of the toolkit is underway), we have been brainstorming ways to effectively communicate the need for investment in young adolescents worldwide.
While Bob and Anna were "stuck" in Bali last month for the youth pre-conference to the International Conference on Family Planning (which had been postponed due to a volcano eruption), they, perhaps inspired by the (surprisingly) clear skies and warm breeze, conceptualized a video contest for help youth make their voices heard, and to tell supporters, in their own words, why the GEAS is significant.
After discussing and refining the idea with our partners, we are excited to launch a competition to capture the voices of young adolescents on the issues of transitions into adolescence and their stories and experiences of becoming an adolescent. While we have quotes and stories from the narratives of 900 young people around the world that we have collected, we feel that nothing could better capture our work than to hear directly from young people. A few important things to know:
- This is not research
- Contestants do not need to be part of the study
- Winners will receive $50 and an opportunity to be part of a GEAS Youth Advisory Committee
If you work with an organization that serves youth, please help us get the word out. If you can help resource-limited youth produce their video submission, all the better! Click here to see the submission rules and guidelines.
If you work with adolescents internationally, we welcome you to apply to serve as a judge. If you are interested in volunteering in this capacity, please email Rebkha Atnafou at firstname.lastname@example.org.
For more information or to submit a video, visit the page dedicated to the competition.
Thanks to all who contributed to volume 2, issue 2 of The GEAS News.
In this issue:
- Understanding Our Youth, Building Our Capacity
- Visiting a Family in Cape Town
- Toolkit Development: Update
- Fruits of Our Labor: A Conversation
- Adrenaline Rush at 1st Local Advisory Committee Meeting, Assiut
- Tapping Hidden Gender Biases through Cross-Cultural Vignettes
- Uncovering Contradictions in Cuenca
- A Mobile Platform: Learning from PMA2020
- On the Horizon
***As you may be aware, a volcano caused the postponement of the ICFP in November. It has been rescheduled for January 25-28, 2016. The GEAS breakfast will be rescheduled as well. More information to follow!***
The Global Early Adolescent Study and the World Health Organization will host a discussion on Tuesday, November 10th from 7:00-8:15 AM with breakfast being served starting at 6:45 AM. To join, please register by November 3rd, and kindly share the word with friends and colleagues who may be interested in attending.
The event is free and will cater to individuals and NGOs interested in promoting early adolescent sexual and reproductive health. Discussion will cover the preliminary findings of the GEAS from a methodological perspective, incorporating voices from multiple study sites and partners.
Last month, advisory committee members and investigators from each of the fifteen GEAS sites met at the World Health Organization in Geneva, Switzerland for a week of information sharing, discussion, training, and decision making.
The blue sky over Geneva must have been very concerned about our comfort, for it made sure that temperatures were in the triple digits (Fahrenheit) throughout our stay. Our gracious hosts at the WHO took care that we didn’t get too comfortable, treating the team to some of the grounds’ most lovely and delightful accommodations.
During one exercise, we listened to quotes from narrative interviews from China to Belgium and many countries in between, then broke into groups to discuss what we found most surprising, what commonalities we saw among sites, what differences, and how these understandings might move the GEAS closer to addressing its primary research questions.
I immersed myself in GEAS that week, taking detailed notes and speaking with advisers and investigators whenever possible. As a new member of the GEAS team at Hopkins, the meeting was the perfect opportunity to meet each of the collaborators face to face and to get to know not only their needs as investigators, but their interests and stories as well. I am very grateful that I had the opportunity to spend a little time with the passionate and dedicated people who are the GEAS.
Contributed by Lydia Animosa, Research Program Coordinator
The use of a single national figure fails to capture the complex patterns and inequalities in early childbearing that occur within countries, as well as the differing contexts in which these pregnancies occur. Further disaggregated data that examine patterns and trends for different groups are needed to enable programmes to be focused on those most at risk. This paper describes a comprehensive analysis of adolescent first births using disaggregated data from Demographic and Household surveys (DHS) for three East African countries: Uganda, Kenya and Tanzania.
The study initially produces cross-sectional descriptive data on adolescent motherhood by age (under 16, 16–17 and 18–19 years), marital status, wealth, education, state or region, urban/rural residence and religion. Trends for two or more surveys over a period of 18–23 years are then analysed, and again disaggregated by age, wealth, urban/rural residence and marital status to ascertain which groups within the population have benefited most from reductions in adolescent first birth. In order to adjust for confounding factors we also use multinomial logistic regression to analyse the social and economic determinants of adolescent first birth, with outcomes again divided by age.
In all three countries, a significant proportion of women gave birth before age 16 (7%-12%). Both the bivariate analysis and logistic regression show that adolescent motherhood is strongly associated with poverty and lack of education/literacy, and this relationship is strongest among births within the youngest age group (<16 years). There are also marked differences by region, religion and urban/rural residence. Trends over time show there has been limited progress in reducing adolescent first births overall, with no reductions among the poorest.
Adolescent first births, particularly at the youngest ages, are most common among the poorest and least educated, and progress in reducing rates within this group has not been made over the last few decades. Disaggregating data allows such patterns to be understood, and enables efforts to be better directed where needed.
The purpose of the study was to help girls, communities and Plan to understand the key issues that adolescent girls face today – in their own words. The study had three objectives:
I. To empower adolescent girls and boys;
II. To help Plan’s field staff learn more from adolescent girls and boys about the issues and improvements needed to directly benefit these youth; and
III. To report data and analysis about adolescent girls’ and boys’ perceptions of their own empowerment and gender equality at school in order to provide senior decision makers with credible information to impact change.
The research process aimed to combine social action with social research, by placing explicit value on girls’ and boys’ views. It focused on girls and boys themselves as valuable social actors whose opinions and aspirations matter. In so doing, the methodology builds on emerging good practice from across the development sector.
In order to achieve the three study objectives, the methodology used structured participatory methods to generate a mixture of quantitative and qualitative data. The quantitative data allowed participants’ perceptions to be easily summarised and compared (within strict limits). The qualitative data, generated through participatory focus group discussions on findings from the quantitative tools, provided detailed insight into how participants viewed the issues on a personal level and the underlying factors beneath their perceptions to contextualise the findings from the quantitative study.
The research process yielded substantive results across all three objectives, notwithstanding inherent challenges. Notably, the research process created safe spaces for adolescent girls and boys to share their views on girls’ empowerment and gender equality at school. The study demonstrated that actively listening to girls and boys opened up critical opportunities for them to take more charge of their own development. The study generated findings that can be analysed at local, national and international levels, and can inform strategic decision-making by development agencies, including Plan. There is great potential to influence programme practice: the findings show great promise to empower field managers to respond with greater focus to the most pressing issues of adolescent girls localised at community level.
The study participants were girls and boys between the ages of 12 and 16 from the 11 countries who lived in identified communities and had some level of participation in Plan’s on-going activities. Due to this purposive approach to sampling, different findings might be generated if the study was repeated with adolescent girls and boys who live in more remote rural areas than those targeted in the study, or do not attend school, or do not participate in Plan’s development projects. The findings of this study cannot be taken as representative of any wider population.
11 Plan Country Offices involved in the study: Bangladesh, Benin, Cameroon, Ecuador, Egypt, Liberia, Nicaragua, Pakistan, Paraguay, Uganda, and Zimbabwe. Thank you to the 21 Plan Programme Units that participated in the study, along with the 60 communities and 95 schools involved.
Sexually objectifying messages about girls and women are common in U.S. popular culture. As a consequence of exposure to such messages, girls may develop “internalized sexualization,” or internalization of the belief that sexual attractiveness to males is an important aspect of their identity. We hypothesized that internalized sexualization is associated with behavioral and psychological consequences, including sexualized clothing use, body surveillance, and body shame. In two studies of early adolescent girls (total N= 330, age range = 10-15), we found that girls with higher levels of internalized sexualization wear more sexualized clothing (Study 1) and show higher levels of body surveillance and body shame (Study 2) than girls with lower levels of internalized sexualization.
Of the world's 1.2 billion adolescents (10-19 years), India is home to the largest number globally, about 243 million. However not much is known about the health of young adolescent girls (11-14 years) in India who enter puberty with substantial nutritional and health deﬁcits. Identifying early adolescence as a “gateway” moment, the Saloni pilot study is a randomized control trial (RCT) to improve nutrition, hygiene and reproductive health behaviors in 30 schools in rural Uttar Pradesh (UP), India. A prevention model that includes Sadharanikaran, an ancient Indian theory of communication, guided the development of the intervention. The Saloni strategy includes a 10 session in-school intervention based on compassion, self efﬁcacy, emotional wellbeing, peer, and parental support,packaged in the form of short, easy-to-use instructional modules. A diary designed to engage adolescent girls is provided to each girl. The cluster RCT was conducted from January 2010 to October 2011 with adolescent girls (11e14 years of age) in Hardoi district. The trial is a two-level, nested RCT with the unit of randomization being the block with 15 schools in the intervention arm and 15 schools in the control arm. A sample of 1200 girls was randomly selected. The intervention had a signiﬁcant impact on more than 13 preventive health behaviors. About 65 percent girls in the intervention group had adopted 13 or more health behaviors at end line compared 4.5 percent in the control group at end line and 5 percent at baseline. Behavioral impact was demonstrated in all three areas of nutrition, hygiene and reproductive health. The study provides evidence that early adolescence is indeed a “gateway moment” to build nutritional and health reserves.
BACKGROUND: School-based comprehensive sex education programs can reduce early adolescents’ risky sexual behavior. The purpose of this study was to assess the effectiveness of a 3-year comprehensive sex education program in delaying vaginal sex for middle school students and whether the family component of the intervention contributes to its effectiveness.
METHODS: This longitudinal evaluation followed a cohort of 6th graders (N=2453) through the end of 8th grade. The design used random assignment of 24 schools into treatment and comparison conditions. The analysis included multiple-group logistic regression to assess differences in delay of sex between intervention and comparison groups.
RESULTS: In schools where the program was taught, 16% fewer boys and 15% fewer girls had had sex by the end of 8th grade compared to boys and girls at comparison schools. Completing family activities during the ﬁrst year of the program predicted delayed sexual debut for boys.
CONCLUSIONS: Theory-based, developmentally appropriate, comprehensive sex education programs that include parent involvement can be effective in delaying vaginal sex for middle school students. Parent involvement is particularly important for boys, as family activities may encourage parents to talk with their sons earlier and more frequently.
Four additional countries have joined the Global Early Adolescent Study bridging Latin America, Francophone Africa and Southeast Asia.
Vietnam Joins GEAS Phase #1: Through support from the Vietnam office of UNFPA, Hanoi, Vietnam is officially part of the GEAS. The UNFPA gender program coordinator, Hien Phan, said “the issues that are the focus of the Global Early Adolescent Study are of critical importance for Vietnam.” Vu Manh Loi PhD and the Institute for Sociology will serve as the site PI and study base. Professor Vu received his PhD in sociology from the University of Washington and has an illustrious reputation leading many studies of youth in Vietnam including both SAVY 1 and 2— the Survey Assessment of Vietnamese Youth undertaken in 2004 and again in 2009.
Burkina Faso and the Democratic Republic of the Congo join GEAS: With support anticipated from the Gates Foundation, two Francophone countries of sub-Saharan Africa will join Malawi, Kenya, Nigeria, and South Africa. Their engagement will begin in early 2015. The Burkina Faso team will be headed by Georges Guiella of the Institut Supérieur des Sciences de la Population (ISSP) of the University of Ouagadougou. Discussions are currently underway with colleagues in Kinshasa to identify the lead researcher in the DRC.
Bolivia to join GEAS: Through support from Save the Children and UNFPA, Bolivia will join the GEAS in 2015. Bolivia will be the first Latin American site for the GEAS; and the study site will be in Cochabamba. Dr. Edgar Valdez will serve as the site lead. Dr. Valdez is the director of the Instituto para el Desarrollo Humano
After being part of an international and national training in qualitative fieldwork, after translating and back translating informed consents and interview protocols, searching for interviewers and calling people to convince to participate in the international research project on gender socialization, the rush stopped. Suddenly I found myself in front of you. All the things I heard, I read, I said, they all came together to that one moment when we looked in each other’s eyes.
I was there–where I had to be–and you were there because you wanted to. Maybe you were curious about the questions I would ask? Or maybe your mother convinced you that it was important to participate? Most important: you said yes. And I imagine I was as excited as you were to be there together and to start this new adventure. I wondered… Would I be able to capture the thoughts you were willing to share with me?
Then you started talking…. My first interview–the first 5 minutes of many more–and you start to cry! “My dad died, and I still miss him terribly. I planned not to talk about him but I suppose you ought to know”And although you cried, I did not only feel your pain, I also felt a fire within. I felt grateful because you shared this and I got convinced to go searching for more true stories which I would handle with uttermost respect.
The loss of your dad and how you loved him, the friends you thought you had and have, the boy who is in love with you but whom you 'hate.' I see you peeping through the window of a small house on the play garden because you want to be sure if the boy you like is really kissing another girl. I smell the lasagna your sister allowed you to make for the first time in your life, and I see you leaving the store–head up high–because you bought your first clothes in an ‘adult store.’ I feel that you are a bit ashamed when somebody at school compliments your beautiful looks and hear you laughing in the park when you are discussing boys with your friends. You are honest, shy and secure. You are brave, talking to me, a researcher you don’t know and who asks all these curious questions. I feel thankful to hear all of this, to be part of these stories, your story. I am curious to hear more, eager to understand you and her and him. You are full of wonders, you amaze me! It is very interesting to hear how you perceive influence from others and how you really want to fit in. But what I love even more is how you are you: painting your nails when no girls are watching or explaining how you–if you would be a boy–at times would like to misbehave or pee against a tree, or how you say you are happy just the way you are.
Contributed by Sara de Meyer, Field Coordinator in Ghent, Belgium