Pakistan International Peace & Human Rights Organization
Nindo Shaher District Badin Sindh Pakistan

Boys and young men may have more access to the outside world and exposure to diverse sources of sexual information, nevertheless, they seem to be deeply concerned about elements of their own sexuality. The prevalence of misinformation, perpetrated by so-called sex clinics which seek to �cure� men of unwanted sexual habits, as well as traditional and religious taboos, exert a powerful hold on males. Since they seem reluctant to discuss their concerns and questions about their own sexuality with peers, it may be only when they marry and experience intimacy with their wives that they can lay some anxieties to rest.

Some small studies venture into the unexplored territory of young peoples� attitudes towards sexuality. Although they do not represent a wide sample of respondents, their findings can be used in developing future research. For example, young men seem particularly anxious about masturbation, homosexuality, nocturnal emissions, and infertility. In a study conducted among 188 male patients (ages 18- 30) presenting at Aga Khan University in Karachi (Qidwai 1996), 80 percent said they had masturbated at some point in their lives. Their misconceptions included the belief that masturbation causes impotence (22 percent), physical illness (31 percent), and weakness (63 percent). Strong feelings of guilt remained with 69 percent of respondents. The misconceptions were more prevalent among respondents from lower and middle-income groups. Their concerns were often exploited by sex clinics, where they would pay thousands of rupees for treatment for infertility prior to getting married, simply because they had masturbated.

A series of focus groups with adolescents in Chanessar Goth, a low-income multi-ethnic community in Karachi, were conducted by Aahung (part of the Karachi Reproductive Health Project) in preparation for developing an AIDS awareness program within the local schools. (Aahung 1999) The discussions with both boys and girls attending the Urdu-medium secondary schools revealed that adolescents exhibited a general lack of confidence and ability to be assertive, and had inadequate information about the body. Child sexual abuse, sexual harassment, drug use, and shame and guilt associated with the body were identified as key concerns that inhibited their health-seeking behavior. In in-depth interviews conducted with 71 boys ages 11-19, 18 percent said one should not talk about his body, and 11 percent said they would not tell anyone if they experienced discomfort in their genital area. Most boys believed that masturbation endangered one�s health, and commonly associated it with causing the penis to become crooked or loose.

Aangan, a community program to raise awareness about child sexual abuse, analyzed 45 letters received from young people (75 percent young males) requesting information on sexual health. (Aangan 1998) Masturbation was the most commonly expressed concern (46 percent). The letter writers feared that their future sexual performance would be negatively affected, that physical weakness, infertility, reduction in penis shape, loss of virginity, or related health problems may result from masturbation. These misconceptions are so deeply rooted in culture and tradition, that researchers may be amazed to discover the hold of some extraordinary myths. For example, male child prostitutes interviewed in the North West Frontier Province believed that among all the sexual practices they knew of, including sex with girls, sex with men or boys, sex with animals, and masturbation, the latter was by far the most sinful. In fact, they believed that if someone masturbated God would get a fever.

Young men are also concerned about nocturnal emissions (or �wet dreams�), possibly to a lesser extent than masturbation. In the Qidwai study (1996), 94 percent of respondents admitted to having nocturnal emissions and 15 percent considered them a cause of physical illness. Respondents associated dark circles around the eyes with the consequences of masturbation and nocturnal emissions.

A study in Punjab of male needs and attitudes regarding reproductive health (Raoof Ali 1999) found that men, women, and service providers all felt that men lack awareness and knowledge of reproductive problems. This included their own issues, identified as infertility, sexually transmitted diseases, weakness, sexual �debility,� and masturbation. Service providers specifically suggested that information and education begin to be provided to boys at age 14, and that services are also needed to help prevent the spread of homosexuality and prevent frequent masturbation.

The onset of menstruation may mark an abrupt change to quasi-adult status in a girl�s life in Pakistan, or it may mark the beginning of a long transition period to full adulthood. A girl�s experience of menstruation will depend on her class, educational, cultural, and social background. Under Islamic laws, such as the Hudood Ordinances, the onset of menstruation is used to determine her adult status under the law, making her liable to severe punishment for sexual activity. While the age at marriage for girls has risen over the years, in some parts of the country they are betrothed or married soon after their menses begin. In traditional communities, menstruation usually marks a stricter enforcement of purdah (segregation) norms, resulting in a girl covering her head and finding her mobility outside the home restricted, and, at worst, causing her withdrawal from school.

In a study on the transfer of health and reproductive knowledge in a southern Punjab village menstruation was �the watershed between being a girl child and becoming a woman� (Mumtaz and Rauf 1996). A girl was immediately expected to observe purdah and wear a burqa, and would be married within two to three years of her first period. Although such dramatic changes in a girl�s status do not occur among all communities in Pakistan, particularly in urban centers, the social silence maintained around menstruation that was observed by the researchers can be observed across class and cultural divides. Girls in the study relied on elder sisters or sisters-in-law for information about menstruation and its practical management.

Some practices related to menstruation are worrisome from the health and hygiene point of view. For example, Mumtaz and Rauf (1996) found that women were considered unclean while menstruating. Some were made to sleep on a mat on the floor, forbidden to bathe, and advised to avoid some foods (in the belief that certain foods would make them ill).

The Aahung (1999) interviews conducted with 80 girls ages 11-19 in the lowincome community of Chanessar Goth, Karachi, found that 64 percent of the girls believed that it was harmful to shower during menstruation. Only about half of those interviewed said that menstruation was related to a woman�s ability to give birth, while the rest were unsure whether the two were linked. Both of these studies reveal a low level of awareness about the process of menstruation. The relationship between poor hygiene practices and infections in women and girls needs to be examined in future research.

While a variety of home remedies and traditional therapies are used to manage menstrual cramps, until recently premenstrual syndrome has not been recognized as a problem. However, in a study of 1,600 women in Karachi the total incidence of PMS was 33 percent. (Shersha et al. 1991) The figure was slightly higher for married women (34 percent) than for unmarried women (32 percent). It was inversely proportional to the number of pregnancies. Complaints of symptoms associated with PMS were most frequent in the lower socioeconomic groups and among those women who lived in parts of Karachi most affected by the law and order problem.

Mensch et al. (1998) point out that more research needs to be done on customs and restrictions, particularly the health dimensions, surrounding menstruation. In a country with a cultural mix, such as Pakistan, there is a need to understand in more detail how girls from different tribes and regions manage the practical and health dimensions of menstruation. While anthropological literature, and some development literature, includes limited information on practices surrounding menstruation among different tribes, the subject has not been the focus of sustained or comparative research.

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 community�s) honor. (Khan 1998; Mumtaz and Rauf 1996) 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.5

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. (Khan 1998)

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. (Majid 1995) A questionnaire was distributed to girls in Classes IX and X, presumably ages 14-16. Their responses are summarized in Table 8. 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 (1999) 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. (Jejeebhoy 1998) 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. (Sachdev 1998) 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.