Abstract: The onset of puberty, and specifically menstruation, is an opportune moment for reaching girls as they transition into adolescence and young womanhood. Despite the importance of this transitional period, the reproductive health community has tended to overlook the onset of menstruation and early puberty in global, national and local policy and practice in low-income countries. This paper will describe one response to this gap in attention, the Tanzania girl’s puberty book project, which was developed through participatory research conducted with Tanzanian girls in 2006-2007. An initial pilot distribution and evaluation of the girl’s book was followed by sustained efforts with local stakeholders that led to the girl’s puberty book being integrated into government level policy in education and WASH in schools, and over 140,000 copies being disseminated. The Tanzania girl’s puberty book project has implications for girls’ health and education policy across low-income countries, and is being adapted for Ghana, with plans for developing an Ethiopia book in 2012.