RMF Pakistan’s Menstrual Hygiene Management (MHM) research studies conducted in the provinces of Punjab and Balochistan in conjunction with Columbia University, New York have been a success. The key outcome of the studies’ findings is to develop the Pakistan Girls’ Puberty Book. For this book to be applicable to the diverse cultural landscapes of Pakistan, it is imperative that data from the provinces of KPK and Sindh be added to the book.
Therefore, the same research protocol is now being replicated in the province of Sindh. This research expansion has been funded by UNICEF, and the aim of this extension is to collect data to include the diverse social and cultural norms and practices of the country.
The Ministry of Education in each province of Pakistan has collaborated with RMF, encouraging this baseline study that aims to describe, via ethnographic approach, the local cultural understandings and meanings of menarche in urban and rural Sindh as experienced by adolescent, school-aged girls.
By means of comparative case studies, this study also aims to explore ways in which local cultural meanings about menarche/menstruation interact with sanitary technology, school design, and peer group relations that often lead to intolerable menstrual-related stigma, causing young women to drop out of school.
The third aim of this study is to utilize adolescent young women’s own recommendations for improving the pubertal and menstrual management-related guidance of adolescent girls. This is envisioned to be addressed through the development of a girls’ puberty book in Pakistan.
UNICEF, having pioneered the initial research and interventions on Menstrual Health Management in Pakistan since 2012, understands that the next step is to raise adolescent girls’ awareness of their own bodies and selves. The Pakistan Girls’ Puberty Book is based on similar UNICEF supported projects in Tanzania, Ghana, Ethiopia, and Cambodia. This research also forms part of UNICEF’s global WinS/MHM project that aims to strengthen evidence-based advocacy on MHM in 10 different countries.
Three approaches will be adopted:
• Ethnographic observations
• Key informant interviews with adults
• Participatory group activities with adolescent young women aged 10-19
The selected site for the urban school is Government Girls Primary/Elementary School in Sehrish Nagar, Qasimabad of District Hyderabad. The rural school selected is CGHS High School, Baberloi in District Khairpur.
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.