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Sexual reproductive health: Life lessons


Despite being a key issue, Pakistanis still whisper when it comes to sexual reproductive health. DESIGN : TALHA KHAN

“I was nine years old when I started sprouting. I was not made to wear a trainer. Mykhala (aunt) came to me and said ‘no one should know that you are growing up. I will teach you how to hide it.’” She took two big coins, placed them on my chest at the right spot, and tied a long piece of cloth over it tightly.‘Never let a man kiss you, otherwise you will become pregnant’, she said. I was nine! I recall my uncle kissing me on my cheek and me crying all night thinking now I was pregnant and God would never forgive me.” Saima*, an educated working woman from Karachi, is now 39, married, and a mother. Yet, she still feels that the way she looks at sexuality is not normal but is unable to alter her thinking. For the longest time, she could not fully enjoy physical intimacy with her husband either since there was a sense of guilt “as if it is something wrong,” she shares.

This sense of shame that society conditions into people when it comes to matters of the body starts very early on. The man at the grocery store will very deftly look away the moment a woman asks for sanitary napkins and pack them in a brown paper bag. Most Pakistani daughters will not ask their fathers to buy sanitary napkins for them. Menstruation comes as a shock to many Pakistani girls. With a still relatively young average age of marriage of women in Pakistan, many women and even men confess that they did not know enough details of the conjugal relationship till they got married. Zareen*, a USA-based doctor shares that despite having done her MBBS at the time of her wedding, her knowledge was so bookish that she knew almost nothing. “The experience was horrendous,” she says. “My ex-husband was also young at the time and his sources of information about sex had been very wrong. I think we were never able to develop a normal bond.” 

Shame shame

This halo of shame that surrounds any and everything that has to do with a young body morphing into adulthood has dire consequences. Yet, there is still immense reluctance about discussing the matter with young adults.

“Lack of awareness  pushes young people to reach out to any source of information out of curiosity,” says Maliha Zia Lari, lawyer and human rights activist. “Questioning sexuality at a certain age is a natural occurrence, but the social clamp down further fuels the curiosity. As a result, they do learn about it, but they learn it [the] wrong way.” In Lari’s experience, this leads to dangerous things like unnatural experimentation, and often with the wrong people. Even young males are exposed to the risk of contracting sexually transmitted diseases (STDs) or being emotionally exploited by ill-meaning men or women. Lari adds that this is one reason why human rights activists discourage early age marriages. “We teach people to be ashamed of our bodies, not to take ownership. A young mind has so many unanswered questions,” she says. Contrary to popular belief, research also proves that awareness about Sexual Reproductive Health (SRH) does not promote promiscuity in adolescents. In fact, it makes them more cautious.

‘The talk’

Survey of a cross section for this write-up reveals that most parents in Pakistan do not talk to their children about SRH, and if they do, the onus falls on the mothers. According to a study conducted by Marie Stopes Society in selected districts of Pakistan, the onset of menstruation was associated with anxiety in 47% girls as only 13% of them reported receiving information about puberty before the onset of menstruation.

Data from a 2013 baseline study conducted by Aahung (a non-profit organisation that concentrates on SRH) in four districts of Sindh, with adolescents as subjects, showed that only 34% adolescents would talk to their parents about pubertal issues. Nearly 49% of those questioned believed that AIDS is a curable disease, which means they were not aware of the possible dangers of unsafe sex either.

For Hira*, a mother of three, the experience was one typical for most Pakistani girls. “I came to know about puberty the day I had my first period. I went running to my mom who just told me that this happens to girls and that this is ganda khoon (bad blood) that needs to come out of the body. And I must not tell anyone about it as its one big secret,” she shares. She confesses that she learnt about feminine hygiene or issues related to puberty on a trial and error bases. “Only the basic information of how to use depilatory creams was provided, but nothing about when and where.” Her knowledge of the physical intimacy between men and women and how babies are born remained limited to that from Bollywood movies. “I thought you meet a boy, and then two roses dance together in a park, and you have a baby,” she laughs and says that she was told that “achi larkiyaan is baray mein baat nahi kartin”(nice girls don’t talk about these things).

“Once I begun menstruating, my mother would keep drumming one thing in our heads: do not commit adultery, it is one of the major sins,” shares 25-year-old Maria. Such a warning from mothers may not always be a bad idea. However, she acknowledges that her mother’s choice of words was harsh. “For the most part, I thank her for that. I have been tempted many times but never crossed a line and that has saved me from many an emotional disaster,” she admits. Maria’s idea of sex, however is so plagued by a sense of guilt that she fears she will feel guilty initially even with her husband after getting married. “It will take me time. But I would give the same training to my daughters,” she says.

Educationist and motivational speaker Abbas Hussain strongly endorses the practise of parents talking to children about SRH, albeit sensitively. Interestingly, Hussain feels that, “Urban mothers prove to be big prudes, whereas rural mothers see this very important part of human life as a part of nature. Such are the idiocies of urban life that a cow giving birth to a calf is not considered normal,” he adds.

Will daddy talk to his son?

“Fathers take very little interest in the sexual education of their children, even boys, as the common notion is uss key doston ney bata diya hoga (his friends must have told him). Men are generally shier then we think,” says Hira. “My father never talked to me about these things,” shares 20-year-old Shehryar Imran. However, he feels it is very important for adolescents to be adequately informed about the changes their bodies are going through “without having to rely on clandestine conversations with peers who also may not be fully informed,’” he says. “In order to combat the spread of STDs, it is imperative to target the root cause of the problem: breaking the unhealthy taboo surrounding sex.”

The ‘talk’ at school and choice of words

Hussain also stresses the importance of teachers’ role when it comes to SRH. “Senior teachers can play a huge role, but in this I am very clear about the gender segregation — male teachers for boys and female teachers for girls,” he says, adding that sensitive and cultural sensibilities need to be respected. He also stresses the importance of chosing words carefully. “Using the term ‘sex education’ deflects from the real issue; this term is the red herring,” he adds.

Maliha Noor, manager communications at Aahung, endorses using “culturally appropriate language.” Hence, Aahung’s successful awareness programme on the subject is called Life Skills Based Education (LSBE). “This should be included not just in school curriculum but even our medical practitioners in the making should be taught about this,” says Noor. “Often, doctors and nurses know the biological details but don’t know how to handle queries about it.” Aahung’s LSBE curriculum covers a range of issues including pubertal changes, gender discrimination, HIV / AIDS, protection from violence, peer pressure, rights within the nikah nama, and family planning. Part of the programme also concentrates on training teachers. “When students would talk to us about their issues, we would often not take them seriously and even joke about them,” confessed one of the teachers trained by Aahung. After the training, she has learnt how to handle these queries sensitively.

*Names have been changed to protect privacy.

Farahnaz Zahidi is a senior subeditor at The Express Tribune. She tweets @FarahnazZahidi

Published in The Express Tribune, Sunday Magazine, January 25th, 2015.

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About FarahnazZahidi

Journalist, writer, blogger & activist. Currently working for The Express Tribune. Focus on human rights, health, gender, peace & Islam. Idealist. Wannabe photographer. Chaai, traveling, reading, friends and motherhood.

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