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Tag Archives: Dr Azra Ahsan

Childhood Interrupted – Child Marriage in Pakistan

Published: June 14, 2017


While there is an increased awareness about the concept of child marriage, much needs to be done at grass-root level. PHOTO COURTESY: Haseeb Siddiqui

While there is an increased awareness about the concept of child marriage, much needs to be done at grass-root level. PHOTO COURTESY: Haseeb Siddiqui

KARACHI: When Safiya was married off to a man, some 20 years older than her, she was barely 13. Her body frame was slim. She was still gaining height and had no idea about the physical demands of a marriage or motherhood. Within just three months, this resident of an underprivileged part of Karachi was expecting.

“My brother was married to my husband’s sister. It was a watta satta (exchange marriage). They waited only until the day I started menstruating after which I was married off,” said Safiya.

The birth of her first child, born premature, was an ordeal for Safiya. She received several pints of blood for transfusion as she was anaemic and she barely survived. Today, Safiya is a 16-year-old mother of two. She laughs when anyone asks whether she even prepared for the marriage and for the responsibilities of parenting.

“Does it matter now whether I was prepared for it or not? Girls have to do what they are told to do. In our social strata, this is just how it is. We are like cattle. We are born, married off to bear a child and eventually one day, we die.”

In Pakistan, according to lawyer and gender activist Maliha Zia Lari, the legal marriageable age for girls and boys in Sindh is 18, while it is 18 for boys and 16 for girls in the rest of the country.

“A marriage with a female child under the age of 16 is punishable under Section-498B of the Pakistan Penal Code 1860. In Sindh, punishments extend to girls aged 17 under Sindh Child Marriage Restraint Act,” she continued while shedding light on the legal aspects around child marriage in Pakistan.

Pakistan has recently outlawed child marriage and toughened penalties for those guilty of the crime in an effort to crack down on the practice estimated to affect one in five girls in the country. A minimum five years in prison that may go up to 10 years is the punishment, in addition to a fine of up to Rs1 million. A legislation passed by the National Assembly (NA) in February 2017, also bans forced marriage involving women from minority groups.

For a second time, the NA’s Standing Committee on Religious Affairs in the following month unanimously rejected a draft ‘Child Marriage Restraint Act’ aimed at increasing the minimum legal age for marriage of a girl to 18 years from 16.

Despite the laws and surging criticism, child marriage victims like Safiya continue to endure a cycle of lifelong disadvantages and miseries.

NA panel refuses to raise minimum marriage age for girls

Pakistan is also a member of the South Asia Initiative to End Violence Against Children (SAIEVAC), an inter-governmental body which has adopted a regional action plan to target child marriage. Yet, at the grass-root level, social attitudes remain static.

According to a Unicef report, State of the World’s Children 2016, at least 21 per cent Pakistani girls are married off before they turn 18. Now, this number on the ground is, of course, higher since a significant part of the populace in Pakistan remains unregistered. Therefore, they also do not show up in surveys. Almost 60 million children in Pakistan are not registered at birth – approximately 65 per cent of children in the country – according to Unicef.

Regrettably, the ramifications of underage marriages are also both physical and psychological.

Dr Azra Ahsan, a gynaecologist and consultant at the National Committee for Maternal and Neonatal Health, disagrees with the argument that a girl attains physical maturity at 18.

“All the organs of a woman including the genital tract continue to grow and mature until she is 18. The emotional maturity, however, comes much later. To me, a girl at 18 is still a child,” she stressed and added that marrying a girl at a tender age and then lumbering her with pregnancies and children is taxing her capabilities to the limits.

“Sexual relationship, pregnancy and childbirth are catastrophic for young girls. For them, a sexual relationship becomes a nightmare. Going through a pregnancy is a test of endurance even for grown-up women and one can only imagine what a burden it should be for a child girl,” said Dr Ahsan.

She maintained that when a fully grown baby tries to negotiate its way out through a small immature pelvis of a young mother, it becomes a harrowing experience for that child.

Man accused of child marriage sent into police custody for five days

“This not only results in a horrible agonising pain but can also cause pressure ischemic injuries to her genital tract and the adjoining organs. As a result, holes known as Obstetric Fistula appear between the genital tract and the urinary tract and/or the bowels. She then dribbles urine or stool constantly. The lives of young child mothers are literally nipped in the bud.”

For Samar Minallah Khan, an inspirational documentary filmmaker, a girl is forced to grow overnight into a child marriage.

“Child brides are at a risk of physical and emotional violence, and pregnancy-related complications. Depriving a child of education means perpetuating a cycle of poverty, violence and inequality. The very concept of a girl child as ‘someone else’s property’ prevents parents from investing in her future,” she said.

In Minallah’s experience, child marriages are mostly practised in the garb of culture and traditions. Once a girl child is betrothed, she becomes a property of the family that she is supposed to wed into. “There is no concept of documenting such [child] marriages. There are legal lacunas to determining the age of the child.”

Minallah’s documentaries mainly focus on culturally sanctioned forms of child marriages including ‘pait likhi’, ‘swara’, ‘vani’, ‘sang chatti’, ‘irjaai’, ‘addo baddo’ and ‘watta satta’.

“Not many urban Pakistanis know about the forms of child marriages and which is why more in-depth understanding and research needs to be carried out,” she explained. Minallah underlined that during January 2016 to May 2017; only over 35 cases of swara, vani and sang chatti were reported in the media.

Gender activist Lari wants Pakistanis to start talking more and that too openly about the impacts of child marriages in the society. “We need to emphasise that child marriages are void and not a real nikah. We need to provide economic incentives at community levels for families insisting them not to marry off their girls at a young age.”

Too young to marry: Police thwart child marriage in Khanewal

“Any action taken must be consistent, state-owned and sustainable,” she added while suggesting campaigns at schools and strategic intervention points for adults.

While there is an increased awareness about the concept of child marriage, few voices have also started making a lot of noise against it in Pakistan.

Designer Waqar J Khan and his team started one such campaign that made waves earlier this year with the hashtags #fashionforacause and #againstchildmarriages. The fashion shoot showed three girls dressed as child brides, juxtaposed alongside their photos in sportswear ready to take on the world.

“The purpose of the shoot is to build awareness about child marriage, and promote women in public spaces, especially the sports field,” said Khan.

Younger girls mean long birthing life, which is considered important in our culture. Lari feels that it is still a taboo to talk about women’s sexual and reproductive issues and the hush around the subject means that people do not actually see the human impact.

“The custom [child marriage] is linked to patriarchy, power and control. We hear statements like, older girls get too set on their ways as compared to the younger girls since the younger they are, the more adaptable she is.”

According to the gender activist, women in Pakistan witness several examples around them – their grandmothers and aunts – who were child brides and mothers and so they also think, if they were fine, what is the problem?

“There is a reluctance to see a girl as a child. She is seen as a woman as soon as she reaches puberty and thus must be married off before her sexuality becomes out of control”, complained Lari.

While there in a rising need to bring a change in the overall Pakistani mindset, Minallah thinks that stringent legislation, complemented by strong implementation was also required. Most importantly, supporting girls’ education is one of the single best investments a country can make to help poverty and prevent early marriages, she added.

“A girl who has completed her education is less likely to experience violence after marriage and have children when she herself is a child. Above all, she is more likely to be conscious and healthy,” Minallah concluded.

Preventing child marriage has a significant bearing on women’s education in the country. Therefore, it is important that the state must challenge unfair social norms strengthening child marriage by using legal and advocacy campaigning tools.


With additional input by Ali Rahman.

Sex Education in Pakistan – Yes or No

The question is not just whether there should be sex education for adolescents or not, but HOW

What does an 11 year old go through when one fine day, she starts bleeding in school, and she was never forewarned by her mother about menstruation? In a highly guarded and conservative setup, what does a 16 year old girl go through on the night she gets married, if she was not told even the basics? Imagine the regret of a 27 year old man who, after marriage, finds out that his reckless sexual adventures and lack of awareness about safe sex have left not just him but his unassuming wife carriers of HIV.

These are common scenarios. Time and again, incidents such as these make us realize that Reproductive Health Education is necessary. But it is an issue that remains controversial.

In a society where a girl going and buying sanitary napkins for herself or a boy asking his father about the changes he notices in himself as he comes of age might be deemed inappropriate, cultural norms make this a sensitive topic. The rampant upsurge of Sexually Transmitted Infections (STIs), Pakistan being a low-prevalence high-risk country when it comes to HIV, and commonly known incidences of sexual harassment and rape: these factors make it important for young adults know details to protect themselves against potential dangers. The question then remains how.

Dr Azra Ahsan of NCMNH (National Council for Maternal and Neonatal Health) is clear that we DO need to educate adolescents about it, and feels that the bigger question is how. “To begin with, the term ‘sex education’ should be replaced by the term ‘reproductive health education’. Using acceptable terminology, talking in a non-controversial way and using the right approach is very important,” says Ahsan. She feels it is a necessity. “It is about growing up. It is about how to deal with the changes in your body both physically and emotionally.” In Ahsan’s opinion, prominent people of society who have an impact on people as well as religious leadership should step forth and talk about it. “I have seen morning shows in Saudi Arabia that talk about these issues in a very candid manner. Why can’t we?”

It is rare that young adults are taught these facts of life by parents. It is usually a cousin, a friend or someone who is equally clueless. We may argue that children today know everything they need to through the internet, but what percentage of the children in Pakistan have access to the internet? Moreover, how reliable are the sources of information on the internet, and how equipped are young adults to discern among this plethora of information and figure out which information is accurate or not?

Iqra Amin, 17, feels that “Children in cities are much more aware. Our Biology course in O levels includes all this. It is the children and teenagers my age in rural areas and from under-privileged backgrounds I worry about. Their sources of information should be better. Parents need to step up their game and firstly get more well-informed themselves and then talk it over with their children for their safety.”

When asked whether this should be taught in school or not, Faisal Naveed, 17, has a different reason for why he thinks it should not. “In school when this subject is approached in class, it becomes a laughing matter. Cheesy jokes follow and no one takes this important matter seriously. Also, when society talks about these issues openly, it may become more acceptable to indulge in reckless sexual behaviour,” says Naveed.

For the same reason, parents and many people resist the idea of teaching sex-ed in schools. Earlier in 2009, a controversy arose when Dawood Public School for Girls, Karachi, introduced reproductive health education in a science text book which was included in its curriculum. The parents protested vehemently. “The reproduction process is something natural and children should learn it,” argued the school’s administration in face of criticism.

This incident elicited different responses. Sindh Assembly member Humera Alwani is on record supporting reproductive health education, saying “We cannot leave our children in darkness anymore.” But commenting on the incident, Naveed Zuberi, adviser to Education Minister Pir Mazhar-ul-Haq, had said that they would not allow any school to teach such courses, saying: “This is not USA or Europe, this is Pakistan and our culture does not allow us to teach these things at school”.

But experts feel that discussing in class might actually be a good idea, under guidance of a teacher or counselor, as all the students are the same age bracket and are going through the same. Therefore it makes it easier for them to digest the often tricky subjects.

Dr Badr Dhanani, dermatologist, has studied in-depth about the spread of HIV and STIs in Pakistan. He supports the idea of teaching reproductive health in schools. “The increased usage of the internet has opened avenues for mis-information.and pop up ads create sexual curiosity. Thus, in the absence of sound knowledge about sex, curious adolescents commit mistakes. Teaching children about sex in classroom would encourage them to view it as a natural, normal and healthy part of life. If youngsters learn about sex in a scientific and objective way, they would be more careful before indulging in sex secretly,” says Dhanani.

Tackling the concern that openly talking about these issues may increase promiscuity, Dhanani feels that “although we profess an orthodox society, the ground reality is different.” Thus, we assume an ostrich-like attitude and pretend these things do not happen.

Saima Rauf, an artist and a mother of two teenagers is of the opinion that “In a society that is largely not literate or aware, health workers can play an important role in increasing awareness.”

Often, people assume the umbrella term “sex education” to include limited topics. However it includes not only the basics about the male and female reproductive system, but also topics like menstruation, the physical and emotional changes of adolescence, the growing up process, sexuality, Sexually Transmitted Infections (STIs) and the avoidance of acquiring these infectious diseases by means of safe sex and use of condoms. Taboo subjects like masturbation are also touched upon.

“Child abuse (sexual) is increasing. Sex education can supply our young people  the tools to report and resist abusive behaviors, and provide them with a forum for expressing their fears openly. This will help forestall it,” believes Dr Dhanani.

Awareness about the sexual process, pregnancy, and contraception helps young people avoid getting into unwanted situations.

In 2011, Psychiatrist Dr Mobin Akhtar’s book that equated sex education with the Islamic perspective, using Quranic verses and ahadith for evidential support, was criticized. But Dr Akhtar stayed firm on his opinion that not informing young people about these issues can leave negative psychological impacts and in fact hinder them from practicing Islam correctly. His book quotes examples of how the Prophet Muhammad (pbuh) was open to answering questions pertaining to what Islam permits and what it doesn’t when it comes to sexuality.

The question, then, we can safely assume has somewhat changed. More than whether we need to give adolescents this vital information or not, the question remains how. And this has to be done softly but surely, bearing religious and cultural sensitivities of people in mind.

An edited version of this article was published in “The News on Sunday”: