The Children’s Advocate

Marcia Edwina Herman-Giddens has spent her career researching hard-hitting issues in children’s health care and has changed the way doctors think about puberty.

Marcia Herman-Giddens
Marcia Edwina Herman-Giddens has spent the last 40 years researching ways to protect and support children. (photo by Renata Schmidt)
March 10th, 2023

Marcia Herman-Giddens’ research has spanned over 40 years, and her passion for her work is rooted in her childhood. She grew up in a home split between love and what she thinks was her mother’s clinical depression.

“My mother loved me, and I never doubted that. She just … she was very unhappy, and I’ve come to have great empathy for her because she had a miserable life.”

Herman-Giddens’ own experiences with abuse have guided her research on child protection and support.

“When I became stronger and older, I wanted to help,” she shares.

And Herman-Giddens got her chance. She received her Master’s in Public Health from UNC-Chapel Hill in 1985 and her doctoral degree in 1994.

In between, she worked as a pediatric provider and professor at Duke University and became director of the Duke Child Protection Team, a clinic within the university’s medical school.

At the time, in 1986, a 4-year-old girl with vaginal bleeding was brought into the clinic. She had been referred by the endocrinology department because they couldn’t detect abnormalities indicating an early period or any other explanations for her condition.

“I remember when I did her examination,” Herman-Giddens says.

On first look, the girl appeared to have no signs of sexual violation, but when Herman-Giddens researched the issue, she realized that there was no real conclusion in the literature that indicated whether a child would have physical symptoms from sexual abuse.

“Girls were getting tossed aside because people thought nothing was wrong. It was like, Oh, nothing happened to this girl. She’s got a normal exam. She’s lying.

Research was necessary to determine what the physical effects of sexual assault on children really were. Herman-Giddens decided to fill the gap in the literature. Her study, published in 1987, was clear.

“The bottom line was that a child can be sexually abused pretty badly without leaving any physical findings.”

But then, she found yet another harmful gap.

Reevaluating the data

While gathering data about girls who had been sexually assaulted, Herman-Giddens was struck by the age of the children.

“There were many 5- and 6- year-olds that either had some breast development or pubic hair, and so I thought: Well, this can’t be normal, but what is normal? Were girls who had developed earlier than their peers more at risk of sexual assault?

A quick look into the available data showed that there was no puberty age data relevant to children in the United States in the 1980s.

The primary puberty data had been collected by James Tanner in Great Britain following World War II. Tanner collected the data from a children’s home that was also being used to develop appropriate rationing levels. Using photographs of these children from the 1940s through the 1960s, he evaluated puberty development and created what was later known as the Tanner stages — data that’s now outdated.

Enter the Pediatric Research in Office Settings (PROS) in 1990. A branch of the American Academy of Pediatrics, PROS was designed to be a conduit between researchers and practitioners — a sounding board for potential studies from clinicians and their observations. It was here that Herman-Giddens brought her concerns.

By the time she approached the American Academy of Pediatrics in the mid-1990s, Herman-Giddens had joined the faculty in the UNC Gillings School of Global Public Health and had already conducted a smaller study of girls in North Carolina. She discovered that Black girls developed earlier than white girls and incorporated those findings into the new study.

With PROS resources, Herman-Giddens was able to conduct a nationwide study of 17,000 girls. The result? A 1997 landmark paper that shook the pediatric and endocrinology fields. Herman-Giddens, not an endocrinologist herself, received quite a bit of backlash.

“It was so different,” remembers Richard Wasserman, director of PROS at that time. “The findings were so different that they got people’s attention.”

But the critique was also unfair, Herman-Giddens says.

“The controversy that it engendered was partly because I was an unknown factor. I wasn’t an endocrinologist,” she explains. “But it also stimulated other people to do more research, because I guess they couldn’t quite believe it.”

The established age for puberty onset was about 11 years old. Herman-Giddens’ presented a drastic shift, putting the age for white girls at nearly 10 and Black girls at 9, prompting others to validate the research.

Marcia Herman-Giddens

Even today, Herman-Giddens work continues to impact maternal and child health research, and the media still cites her 1997 landmark study. (photo by Renata Schmidt)

Understanding puberty is much more than defining an age. Once puberty begins, a girl’s body has higher levels of estrogen. The more estrogen exposure over a lifetime, the higher one’s risk for breast cancer and uterine cancer.

Because researchers are finding more and more evidence that puberty is occurring earlier, research into these trends becomes ever more important, according to Herman-Giddens.

“Looking at it, over the last 20 years, I have to say I feel so good about it because it has stimulated ongoing research, year after year,” she says. “To this day there are still things going on related to that.”

The catalyst for Herman-Giddens’ research was a concern over sexual abuse against girls, and while early puberty affects boys, too, it spells greater risks for young females.

Similar findings have been associated with boys, but the social implications are much different. The first stage of male puberty is enlargement of the scrotum and testes, which is not visible to others. For girls, it is breast bud development.

A girl developing early may be the subject of teasing and harassment from classmates and strangers, according to Herman-Giddens.

Renowned in her field

Researchers continue to study the shift in the age of puberty, and news outlets continue to cover Herman-Giddens’ 1997 study.

The New York Times has published several articles about her landmark paper, the most recent from May 2022. Harper’s Magazine recently released a first-person feature by a woman who had experienced precocious puberty and was part of the trend Herman-Giddens’ studied.

“I remember when my paper first came out. I think I was on the phone for three days solid. I was doing interviews with outlets all around the globe,” Herman-Giddens reflects.

While the intensity of media attention has slowed, it has not stopped. Herman-Giddens’ interview for this article was one of two she had scheduled that week. There is plenty of research to uncover.

Since publishing her landmark study in 1997, Herman-Giddens has written over 30 research papers ranging from tick-borne illnesses to child abuse homicides.

“I would say of all the work I’ve done in public health and medicine, the issue of child abuse homicides is the one I remain the most passionate about, because it is the most neglected,” she explains.

She created the Marcia E. Herman-Giddens and William D. Popper Fund for the Study of Child Maltreatment Fatalities in 2021. Popper was Herman-Giddens’ foster child. A victim of domestic verbal abuse, he was taken in by her family as a teenager after his father was murdered and his mother abandoned him.

Popper passed away in 2009 from lymphoma, but Herman-Giddens is honoring his memory by creating a fund to support research on child fatalities.

A new chapter

Marcia Herman-Giddens is now 81 years old and retired — on paper, at least. Her memoir was published in January 2023.

“I want others, especially my children, grandchildren, and great-grandchildren, to know my experiences and my truth.”

Her childhood is also guiding the next phase of her work. Herman-Giddens grew up in Birmingham, Alabama, in the height of the civil rights movement.

“I grew up knowing that my mother’s lineages were slaveholders, and they were very proud of that,” Herman-Giddens says. “I didn’t pick up those beliefs. I didn’t even start out that way.”

In 1965, she and her then husband participated in a variety of civil rights activities, including protests in Selma. Her engagement in the movement was a rejection of her mother’s values.

Her book, “Unloose My Heart: A Personal Reckoning with the Twisted Roots of My Southern Family Tree,” is dedicated to all the people enslaved by her mother’s family she could identify, yet another way she is giving a voice to those who cannot speak for themselves.

“I think I’ve had a very rich, very rewarding life,” she says. “Here I am, 81 years old, and I can’t wrap my head around that.”

Marcia Edwina Herman-Giddens is an adjunct professor in Department of Maternal and Child Health within the UNC Gillings School of Global Public Health.