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A study of Sexual Health of Young Women In Pakistan
– Reported, January 13, 2012
Whereas many aspects of reproductive health discussed in this review are becoming accepted areas for research, sexual awareness and behavior is probably the least studied. The threat of HIV/AIDS worldwide has prompted a series of small-scale studies on this and other sexually transmitted diseases (see following section), but this research in Pakistan is highly selective in favor of small high-risk behavior groups. Studies investigating the sexual awareness and behavior of married and unmarried adolescents are virtually nonexistent.
One reason for this is that sexuality, while recognized in Pakistan as a healthy part of married life and even encouraged by religious teachings, is still subject to extreme legal and social controls. That is, sex outside of marriage is a crime against the state (Hudood Ordinances 1979). Suspicion of such sexual relations is cause for women, in particular, to be immediately killed by customary law (karo kari in Sindh,for example) or, at the least, to cause a familys reputation to be tarnished and a girls future prospects ruined. Whereas womens sexuality and the control of it by male elders or husbands is a foundation of social values and norms in Pakistan,men, on the contrary, are understood to have sexual desires that may or may not be satisfied by their wives. Possibly for these reasons, there exist a few more research findings on male than female sexuality.
In Pakistan, as in many developing countries, women and men are marrying later. Some international researchers conclude that adolescent premarital sexual activity must be increasing because of this longer gap before marriage warn that the evidence across countries of increased premarital sexual behavior is still inconclusive.
There are other specific issues, however, which merit further research. For example, the question of whether sex within marriage is always consensual has barely been examined, particularly when one partner may be considerably younger and less empowered than the other. (Mensch et al. 1998) Pakistani law does not recognize rape within marriage as a possibility. Since over 20 percent of all adolescent girls ages 15-19 surveyed in the 1990-91 PDHS were ever married, a large group of young women are sexually active, and at the same time vulnerable to exploitative power dynamics with their husbands. (NIPS/IRD 1992) One Indian study found that married adolescent girls experiences of sex have been initially very negative.
The unpleasant reality of nonconsensual sex and the extent to which adolescents outside of marriage are subject to abuse and rape is also necessarily an element of adolescent sexual behavior. (Mensch et al. 1998) There is more information on sexual violence in Pakistan than there is on mainstream sexual behavior, perhaps reflective of a growing negative trend in this society.
Unfortunately, adolescents are particularly vulnerable to unwanted sexual experiences.
More is known about the cost of female sexuality in Pakistan than its reality. This is true of married as well as unmarried women, young and old alike. The concept of honor, which binds families, communities, and society into intricate webs of interdependency and territories, is premised upon control of people and their lineage. Essential to the honor system is the sexual control of women, and in this regard the virginity and unblemished reputation of unmarried girls is of critical importance. As girls enter puberty and become of marriageable age, they find their mobility and access to opportunities such as education and employment severely curtailed, all in the name of preserving their (and their communitys) honor.
If a girl violates social norms and is discovered to have engaged in sexual relations, or even flirtation, with a boy then she will be either beaten or killed according to customary laws, or she will be vulnerable to charges of adultery under the Hudood Ordinances that may lead to imprisonment or death.
Since the cost of female sexuality is so high, so too are the fears surrounding sexuality. Women and girls interviewed in rural Punjab exhibited a morbid preoccupation with the dangers posed by the world outside their homes and villages.This arose mainly through fears of male sexual harassment, rape, abduction, and loss of reputation in case a community member observed a female speaking with a male who was not related. Although girls resented the restrictions imposed on them, they had internalized these fears and were reluctant to express any positive sentiments about their own sexuality.Yet, since so little is known about female sexual attitudes and behavior, and open discussion is so strongly discouraged, it is impossible to determine the real sentiments and activities of girls in Pakistan. Where field-workers have access to adolescent girls and enjoy their confidence, as in the FPAP Girl-Child Project,findings have formed an important part of the knowledge base of the staff but have not been formally compiled for others to access. It is not possible to confirm, for
example, if the rise in age at marriage has had any bearing upon premarital sexual activity among unmarried adolescents.
A rare study on reproductive health awareness in adolescent girls was conducted with 300 students in Peshawar high schools.A questionnaire was distributed to girls in Classes IX and X, presumably ages 14-16.
Majid concluded that teenage sexuality was not a major issue for the students, but that there was still a great need for multidisciplinary educational programs in schools to give adolescents the right answers at the right time. Certainly students clearly articulated their demand (88 percent) for sex education in schools, which belied the low level of expressed curiosity about sex. Finally, girls were shy about discussing menstruation and felt that virginity was a virtue.
In the Aahung in-depth interviews, conducted with 80 girls ages 11-19 in Chanessar Goth, Karachi, most girls felt it inappropriate to talk about their bodies, although almost all said they would tell their mothers if they experienced discomfort in their genital area.Research from other developing countries suggests a change in awareness and behavior. It is possible that trends in India, arising out of a comparable social and economic environment, may serve as an indicator of what might be happening in Pakistan. In India, roughly one in four unmarried adolescent boys ages 10-19 have had sexual relations, as reported by school and college students through selfadministered questionnaires in four small surveys. In contrast, sexual activity among unmarried adolescent girls is at a lower level. However, almost 25 percent of rape victims are under age 16, and 20 percent of all sex workers are adolescents,according to Indian government figures. Unmarried adolescents are a disproportionately large number of abortion seekers.In a survey of mainly female university students in Delhi, it emerges that women were fairly open in expressing their sexual needs, including masturbation, and few thought that intercourse required marriage first. Nonetheless, only a small minority had premarital sex or dated, suggesting that their attitudes were more open than their behavior.
Further, there was a high level of ignorance about contraception and basic sexual functioning. These findings may suggest that sexual awareness and attitudes among highly educated females here are also changing. Further, lack of information on abortion rates among unmarried girls in Pakistan must not be taken to mean that the practice is nonexistent.
Access to Information and Knowledge about Sex There is some level of demand for sex education among young people. Boys and girls are concerned not only with their own developing sexuality, but request more information about the other sex. Boys may be more open in demanding information, while girls are generally more inhibited about expressing their concerns.
The mainstream media and education system do not offer adolescents the information they need. Parents are also not a source of sex education for their children. The tacit assumption among adults and policymakers, as
well as health and family planning service providers, seems to be that young people will get whatever information they need when it is proper, that is, when they are married. It may be pointed out here that media and educational tools are not only inadequate, but they fail to obtain opinions and views from young people themselves. Tacit assumptions about adolescents needs and future aspirations may be faulty. UNFPA produced an unusual documentary in 1999 in which dozens of adolescent boys and girls across the country were interviewed, eliciting their views on a range of issues for the first time. More endeavors such as this would help projects/programs be more responsive to adolescents stated needs.
The reality of adolescents lives, which includes sexual abuse and rape,misconceptions and anxieties about their developing sexuality, lack of information about the other sex, pregnancy risks, and sexually transmitted diseases, is being denied out of fear that information will lead to an increase in premarital sex. As a result, even adolescents who are married and in need of sex education have no source of neutral information to protect their health and improve their sexual relations. Figures from numerous developing countries show that adolescents,including married girls, have little knowledge of either their reproductive health and biology or how to protect themselves from disease.
Adolescent girls are more likely to get their sexual and reproductive knowledge from women within their families. Unfortunately even this hypothesis is difficult to verify through research, since unmarried girls and young women are often forbidden to give interviews to outside researchers. The information adolescent girls do receive from the women in their families is likely to be related to menstruation, while information about sex itself may only be passed on to a girl from a female relative on the wedding day itself. There is no formal research available on unmarried girls concerns about sex or reproduction prior to marriage. However, research findings among married couples have established that womens need for sexual satisfaction within marriage is accepted by couples, and it is not necessarily the case that women always subsume their sexual needs in deference to their husbands, as is sometimes assumed.
Needless to say the formal education curriculum, including medical training, does not include sex education, although population and family planning issues are incorporated. Sexuality, apart from reproductive biology or contraception that are taught in specific settings, is a taboo subject. While the new Education Policy (Ministry of Education 1998) states that curricula at the secondary level will include additional subjects such as awareness about drugs, AIDS, and environmental issues, it still falls short from recommending a basic introduction to the facts of life. Even this effort at reproductive health education is further limited in impact because only a small proportion of all adolescents completes secondary school.The National Health Policy states that reproductive health as well as health education will be among the Health Ministrys priority programs. (Ministry of Health 1997) The discussion of reproductive health mentions that all aspects of the reproductive system and its functions will be taught, but the document does not mention sexuality. Activities will be undertaken to empower the community to work for the promotion of its own health, but clearly without basic sex education being taught to young people. This gap in curricula, combined with the fact that young people do not rely on their parents for information on sexual issues, means that
sources of information are often unreliable and exploitative.
There are some projects underway that will begin the process of sex education, although they are tentative and introductory. Neither the family planning program nor the kind of objectives stated by the government, as indicated in the preceding discussion, were incentive enough to inspire service providers to discuss sex education; however, the threat of an HIV/AIDS epidemic has forced those tackling these issues to discuss sexual relations in unprecedented detail with their target communities. For example, Aahung, the AIDS awareness program at the Karachi Reproductive Health Project, is trying to develop a curriculum for secondary schools, for both male and female students, in which sexuality and reproductive health can be taught. They are currently experimenting with modules in selected secondary schools in Chanessar Goth, a low-income, multi-ethnic community in Karachi.
The Family Planning Association of Pakistan, the largest NGO in this sector, has stated, reproductive health care also includes sexual health, the purpose for which is the enhancement of life and personal relations (FPAP 1995: 45). Although FPAP has targeted young people in a number of other projects, it is currently preparing the groundwork for a new initiative. Join In Educating Adolescents and Teenagers (JEAT) is directly aimed at addressing the knowledge and attitudes of young adults toward reproductive and sexual health, with a view to influencing their behavior in favor of the small family norm and responsible parenthood. (FPAP Youth Programme n.d.) The project has multiple components including: a) establishing baseline information on adolescents existing level of information on sexuality and reproduction; b) establishing a resource and information base on adolescent sexual health; c) developing modules on reproductive and sexual health for youth; and d) sensitizing staff on youth issues and training counselors to work with youth. The program will work with adolescents already participating in existing youth activities.
Certain other nongovernmental organizations have a great potential to become providers of reproductive health education because they have access to abroad spectrum of young people in Pakistan. For example, the Girl Guides and Boy Scouts Association, and Pakistan Red Crescent Youth Societies do provide basic health and nutrition information, but stop short of introducing sex and related reproductive health matters in their activities. This reflects social taboos that make sex education, and even associations of adolescents, threatening activities in Pakistan.
Child sexual abuse is rooted in mainstream culture and strengthened by the power imbalance encouraged between children and adults. The problem is reinforced by societys refusal to acknowledge a childs rights over his or her body and the right to live free from violence. Children lack a voice in our society, and thus are unable themselves to break the silence surrounding child sexual abuse.
Credits:
Ayesha Khan
More Information at:http://www.popcouncil.org/pdfs/rr/rr_11.pdf
