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Tag Archives: Sexual and reproductive health

So who should talk to the 20-somethings about contraception?

Published: January 27, 2016

The world is realising that due to cultural norms, adolescents and young people often do not discuss contraception with their elders or family members. PHOTO AFP

They can curse in each other’s presence, break traffic signals in unison and smoke together, and they may at times act macho and show off their romantic escapades. But young men, like their elders, do not readily open up about reproductive issues. Parents or teachers do not discuss subjects of a sensitive nature with them. While it is the same with adolescent and young women, they are comparatively more open to confiding in each other and getting guidance.

But it seems the world may be in for a change in attitude. Young men, all over the world, are stepping up to take part in reproductive discourse.

One such young man is Hamza Moghari. He is still reeling from the long journey from Deir El-Balah in Gaza, Palestine, to Bali, Indonesia. And the reason why he is there is that he has the guts to talk to his peers about difficult subjects like contraceptive choices and reproductive health. Hamza has seen more violence and difficulty than he deserved to in his tender age of 22 years. Coming to the International Family Planning Conference (ICFP) 2016 is a dream come true for him.

“This is the first time I sat on an airplane. I nearly never came,” he says, sharing the long journey of how he first reached Jordan from his home in Gaza.

He explained that he was sent away and told to go back due to lack of a no objection document, but he stayed near the border and went back the next morning, and was finally let into Jordan from where he flew to Bali.

A tad bit shy by nature, he confesses that the most difficult subject to talk about with boys his age is sexuality. Yet it seems that the world is realising that due to cultural norms, adolescents and young people often do not discuss these issues with their elders or family members. With their own age group, if they feel safe enough, they can talk about the typically hushed topics too. Y-PEER, a youth network of young people from more than 700 non-profit organisations and government agencies in more than 50 countries initiated by the United Nations Fund for Population Activities (UNFPA), uses an integrated approach to work with young people on subjects like gender, contraception and reproductive health. This year the thrust of all the discussions at ICFP was how to involve youth in the process. Half of the world’s population today, which is over 3.5 billion people, is under 30, mostly living in developing countries. They need guidance on these matters and silence may not be feasible anymore.

“If you’re not on the table you’re on the menu. How do we bring the youth on the table to talk about family planning?”

This question was put forth by Katja Iversen, CEO of Women Deliver, at the ICFP.

Pakistan is currently the world’s seventh most populous nation, according to the registered number of Pakistani, 199,085,847 in July 2015, as per the CIA FactbookContraception is thus an important subject that should be included in the nation’s narrative at all levels. In Pakistan too, this working via youth strategy has found a foothold.

One such initiative is Chanan Development Association (CDA). What started as a small theatre group is now an organisation that is youth-led and works for the youth.

Muhammad Shahzad, the executive director, has in tow young leaders wherever he goes. At the ICFP, too, he is watching out for and introducing proudly bright young people from Pakistan. One of them is 24-year-old Qaisar Roonjha, who says working with and for people his age is something he just has to do. His organisation, WANG (Welfare Association for Young Generation), is youth-led, and its primary focus is to struggle for a fairer society. Important buzz words like Youth Development, Women Empowerment, Mother and Child Health, Young Girls Education, Gender justice, Peace Promotion, Youth Development and livelihood security are all highlighted on the WANG website. From Lasbela in the perilous province of Balochistan, Qaisar has come a long way.

“I have met at least 40,000 young people all over Pakistan in the last five years,” he says with pride.

He shares that the toughest subject to tackle while talking to young people in Pakistan is gender equality.

“They still seem ready to discuss contraception. At least the married ones do. But seeing women as equal partners is difficult,” adds Shahzad.

Qaisar, whose video was selected for a competition held by organisers of the ICFP, attended the high profile conference in Bali as a moderator.

Ayesha Memon, an MBA student and youth leader from Hyderabad, also won the same recognition for her video, and addressed groups of interested activists and experts at the ICFP.

“Young people need to come out of their boxes; we should not assume things can’t change.”

Sharaf Boborakhimov is no novice at engaging with his peers on some of the trickiest subjects, which especially boys never openly talk about. Originally hailing from Tajikistan, he currently lives in Sofia, Bulgaria. This graduate in International Economy joined Y-Peer in 2011.

“What we do is provide safe spaces to youth where they can talk about sensitive subjects to people their own age. The peer-to-peer methodology works in tackling these subjects. We choose each word very carefully. We have to memorise manuals to know what to say and what not to and how to approach a subject.”

He has a close eye on the Syrian crisis, has Syrian friends, and has worked in Jordan closely with Syrian refugees who have made the Zaatari Camp their permanent home.

“We specially trained couples so that they could go back in the camps and train others. The refugees are just like any other couple. All they want is peace. They are depressed and frustrated no doubt. But in them I see a vision and a hope for a better tomorrow. They need guidance about contraception too.”

Theatre-based peer education, in Sharaf’s view is most effective for youth, whether they are refugees or not, the same strategy Chanan begun with.

“Since 2009, we have recruited some 50,000 young people for Y-Peer who work with us to educate their peers in important matters like sexual and reproductive health rights and also contraception,” Shahzad shares, adding that Pakistan was the first country in Asia Pacific that introduced UNFPA’s Y-Peer program in the region in 2009.

They are working with youth across 135 districts spread all over Pakistan including its toughest regions. In Pakistan, 65 per cent of the population is under 29, and 40 per cent fall into the even narrower age bracket of 10 to 24 years, says Shahzad.

“A big focus of our work is to engage with policymakers,” he says, sharing that Chanan was part of the National Task Force of 2009 for youth policy development, and is hosting the National Secretariat for Y-Peer in Pakistan.

For Hamza, the journey started by working for a local Palestinian organisation called Palestinian Family Planning and Protection Association (PFPPA). He is studying to get a degree in nursing.

“There are two million people in Gaza. The blockade is continuing since two years. Aid and medical help is almost impossible. Unemployment in my people is 70 per cent; among the youth it is 55 per cent. The healthcare system is fragmented. Very few people are able to reach the government-run healthcare centres.”

“In shelters that he has worked in, two to three thousand people were staying in one school. That meant each classroom was housing at least 50 people. Men, women and children, all strangers for each other, crammed into one room. With no food and water at least for the initial days till help started trickling in. Do you think family planning is a priority for them on a hungry stomach?”

In difficult situations and at such a young age, to be taken seriously and sensitise people about contraception is an uphill task. But these young people have realised that their generation’s reproductive choices will shape future demographic trends. They are thus helping their peers make informed decisions.

We need to stop treating menstruation as a ‘fault’

Published: May 28, 2015

The bloody taboo refuses to be broken. Recently, an urban affluent woman was overheard commenting that advertisements for these products should be banned. PHOTO: FARAHNAZ ZAHIDI

“So what do you do when you… you know… have your monthly period?” I said to my domestic helper, after my mouth-gaping-open-in-shock reaction was over and I found my voice.

For an urban woman, what she was telling me was unthinkable. I was truly scandalised that many women in Pakistan’s underprivileged parts walk around with no sanitary cloth or napkins when they have their menstrual period. Others do use folded pieces of cloth, she told me, but even then the hygiene conditions she was describing were hardly satisfactory.

The year was 2010. Pakistan had been hit by one of the worst natural disasters in the country’s history – floods that affected the lives of some 20 million people. My friends and I were collecting donations and sending them off to remote villages and affected areas. Those working on ground were asking us to send dry food items, bedding, medicines, clothes and basic items like soaps and sanitary napkins.

“People here are breaking out into skin infections due to the stagnating dirty water. Women need their supplies for menstrual hygiene,” was the message we got.

Yet, here was a Pakistani woman hailing from a rural area, educating me in a basic reality – that even if we did send sanitary napkins, would those women, for whom even seeing a midwife in pregnancy is a luxury, know how to use it?

But then, realistically, is menstrual hygiene even a priority to ponder about for people living below the poverty line, unable to even get two square meals? It is all good, noble and convenient for me and my likes, to sit in our comfortable homes in the cities and talk down to poor women about how filthy is the way they handle something so basic. The reality is they have not had the exposure, nor the access to things we take for granted.

As the world celebrates Global Menstrual Hygiene Day on May 28, how far is Pakistan, in reality, from providing its female citizens the means to go through a natural physiological process with dignity?

Research points out that almost 50 per cent of Pakistani girls in rural areas and underprivileged circumstances miss school during their menstrual period, and absenteeism in school can improve drastically if they have access to protective material and proper toilet facilities at school. Yet, sanitary cloth and napkins remain not a basic need but a luxury for Pakistan’s daughters who cannot afford them, or are simply unaware. The problem becomes even gorier when faced by displaced women living in slums, camps for IDPs or in nomadic setups.

To go through their monthly cycle hygienically and in a dignified manner, girls and women need access to water and proper sanitation. Privacy is needed to change; water and soap is needed to wash their hands and the cloths if they are using those, and means to either dispose used materials or a private place to dry them in case of reusable cloths.

Poverty, however, is not the only issue here. The bloody taboo refuses to be broken. Recently, an urban affluent woman was overheard commenting that advertisements for these products should be banned. Giving credit where due, advertisements for sanitary napkins are actually now more decent than many other ads, and are actually more educative in nature in an attempt to raise awareness.

A two-pronged approach will, therefore, have to be adopted to help women of Pakistantriumph against the lack of a basic human right. For starters, they will have to be educated about the health-related consequences of not maintaining menstrual hygiene management(MHM). As a society, we will have to learn more about it. Systems have to be evolved for disposal of the waste cloths and napkins to not make it an environmental hazard, as well as let women have the dignity to dispose it respectfully.

Secondly, access to products that help women at a low cost is something we need to think about. Whether it be clean cotton or rags, or affordable napkins, women everywhere should have the right to procure them and use them. We need more initiatives to address the problem.

It is time the world stops treating menstruation as a fault for which women continue to pay a price by facing embarrassment and helplessness.

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.