As a follow up to our Menstrual Health and Hygiene Management (MHM) study conducted in Punjab Province, Pakistan in conjunction with Columbia University, New York, UNICEF, having sought the relevant intellectual permissions, has collaborated with RMF to replicate the study in the Province of Balochistan and contribute to the data for the Pakistan Girls’ Puberty.
Recent research suggests that girls in Pakistan have insufficient knowledge about menstruation, have inadequate access to affordable sanitary materials, and experience high levels of fear and anxiety at menarche. In a cross-sectional survey of 1,267 girls, 60% reported limiting their movements and avoiding socializing and religious practices because of menstruation (Ali & Rizvi, 2010). Among girls not in school, 79% did not use hygienic materials to manage menstruation, and many girls described poor nutritional intake due to cultural understandings of foods to be ingested or avoided during menstruation (Ali & Rizvi, 2010). Together, these beliefs and practices lead to girls’ absenteeism from school during their menstrual period or dropping out of school altogether after menarche.
UNICEF has pioneered the initial research and interventions on Menstrual Health Management in Pakistan. In 2012, UNICEF Pakistan conducted an exploratory study on Menstrual Hygiene Management (MHM) among adolescent school-going girls in Pakistan followed with a 2014 follow up study inclusive of structured dialogue with teachers to understand the specific MHM related issues that need to be addressed, especially within the school environment. On the basis of research findings specific school WASH interventions were identified, designed and constructed in the schools which catered to the needs of menstrual hygiene management for adolescent girls. One of the key findings of this research was that girls need access to information and knowledge on menstruation and its management. On the bases of the same research a Toolkit was designed and piloted in a few schools of Punjab and KPK. The pilot project was evaluated and the findings reinforced previous findings that girls need more information and knowledge on menstruation and its management.
Based on similar projects in Tanzania, Ghana, Ethiopia and Cambodia supported by UNICEF, the concept of developing a Pakistan Girls’ Puberty Book came to the frontline. Columbia University together with RMF has already launched the research for this book in Pakistan and data from Punjab has been obtained. However for a more widely accepted and used Puberty Book, UNICEF seeks to expand the research into Balochistan due to its diverse social and cultural norms.
This research also forms part of UNICEF’s global WinS/MHM project that aims to strengthen evidence based advocacy on MHM in 10 countries through:
- Documentation of current MHM practices and the barriers girls face in schools.
- Development and dissemination of guidelines for integration of a minimum MHM package into existing WASH in school programmes.
- Engagement with national government and Ministry of Education and Health and girls’ education actors to ensure buy-in and mobilization of additional support for multi-sector involvement for MHM as well as community based approach.
Research Aims and Methodology: The specific aims of the study are:
- To describe local cultural understandings and meanings of menarche in urban and rural Balochistan through the use of ethnographic observations, interviews and participatory activities with adolescent young women and the adults who play key roles in the lives of school-aged young women.
- To explore, through comparative case studies of young women’s lives, the ways in which local cultural meanings about menarche and menstruation interact with sanitary technology, school design, and peer group relations, to create intolerable menstrual-related stigma that leads to young women dropping out.
- To utilize adolescent young women’s own recommendations for improving the pubertal and menstrual-management related guidance adolescent girls receive through the development of a girl’s puberty book in Pakistan
Three data collection methods will be adopted; ethnographic observations; key informant interviews with adults and participatory group activities with adolescent young women aged 10-19. The proposed study will be carried out in one urban (Kuchlak, Quetta) and one rural area (District Lasbella). Research will be conducted with in-school young women at a secondary school in each of the two sites, and research with young women out of formal schooling, possibly in vocational training centers in the two sites.
The intersections between menarche and education in Pakistan are still poorly understood. Nonetheless, existing reports suggest the dominance of male students in middle and high schools, and the absence of other “girl friendly” supports in the schooling environment are causes, e.g. water is rarely available in rural schools in Pakistan, with 75% of hand pumps and 28% of latrines being non-functional. Furthermore, female students lack separate, private latrines, and they often are attacked, sexually harassed, or shamed when waiting to use lavatory services, posing yet another barrier to school attendance. Female students may also have difficulty accessing sanitary materials owing to their high cost, especially if male family members make most major household purchases, as is the case in the majority of households in Pakistan. Given that menarche may be jeopardizing young women’s schooling and health in Pakistan, it is both timely and important to better understand the relationship between menstruation, education, and health for young Pakistani women, and to improve pubertal transitions.
1. To describe local cultural understandings and meanings of menarche in urban and rural Pakistan through the use of ethnographic observations, interviews and participatory activities with adolescent young women and the adults who play key roles in the lives of school-aged young women.
2. To explore, through comparative case studies of young women’s lives, the ways in which local cultural meanings about menarche and menstruation interact with sanitary technology, school design, and peer group relations, to create intolerable menstrual-related stigma that leads to young women dropping out of school.
3. To utilize adolescent young women’s own recommendations for improving the pubertal and menstrual management related guidance adolescent girls receive through the development of a girls’ puberty book in Pakistan.