It was May 2018 when two sisters in Karachi formally set up their dream project in a bid to help underprivileged women improve their menstrual health and hygiene. Enter HER Pakistan, a not-for-profit organisation which aims to shatter the myths and taboos surrounding menstruation through programmes that educate young girls, women and the society about a subject that is rarely ever talked about.
“I was working with a not-for-profit school network in Karachi and during a visit to one of the slums, I found out that girls were being forced to miss school, and at times, even drop out of school when they started menstruating,” says Sana Lokhandwala, co-founder of HER Pakistan. “And it wasn’t just that. I also came across a lot of myths and misconceptions around menstruation that prevail in our communities,” she adds. A communication specialist previously affiliated with the news industry, Sana now runs the project with her sister, Sumaira Lokhandwala.
During her eight years of experience as a healthcare marketeer, Sumaira says she realised how sexual and reproductive health, a major component of women’s overall health, was being largely neglected in Pakistan. “Subjects as normal as menstruation are considered taboo. Thousands of women do not have access to information and facilities in order to live a healthy and empowered life,” says Sumaira.
A research by Real Medicine Foundation in 2017, a non-profit organisation working to improve the health sector in disaster-hit regions, found that an alarming 79 percent of Pakistani women were not properly managing their menstrual hygiene due to lack of information. During their fieldwork, the Lokhandwala sisters made the same observation.
Their dream soon turned into reality and HER Pakistan was founded with an objective to improve sexual and reproductive health, particularly menstrual health and hygiene, for girls and women in Pakistan regardless of their socio-economic background. To date Sana and Sumaira Lokhandwala have successfully reached out to schools and communities in areas like Old Golimar, Rehri Goth, Machhar Colony, Kemari, Lyari, Gulbai, Moach Goth, Steel Town, Malir, Baldia Town and Qayyumabad.
The initiative is running as many as three projects simultaneously, starting with the School Puberty Education Programme, which prepares adolescents, their parents and teachers for puberty and associated changes and challenges.
“The programme takes a holistic approach by training parents and teachers simultaneously, so they can ensure a safe and healthy environment for adolescents after the sessions,” explain the Lokhandwala sisters. The basic components of the session include understanding gender and gender roles, introduction to puberty, physical, psychological and social changes during puberty, hygiene management, myths and misconceptions related to puberty, body positivity, bullying and harassment and a special focus on menstruation for girls. “The sessions are mostly tailored according to the needs of the students and the schools’ management.”
The initiative has reached out to as many as eight schools in Karachi and two in Gilgit Baltistan. The founders, however, believe that this is just the beginning. They aspire to take it to schools and communities all over Pakistan.
The community education programme, Menstrual Hygiene Drives, focuses on awareness sessions through peer-to-peer counselling and interactive teaching tools. The sessions are held in underprivileged communities in which women of all ages and backgrounds meet to discuss menstruation and it being a natural phenomenon, and its hygiene management.
The organisation has also launched a digital community group – Oh My Period! The Facebook group aims to provide a safe space for women to talk about everything related to menstruation, to be able to learn from one another’s experiences and to help each other.
“The aim is to create a friendly space where anyone can talk about their periods freely and ask questions without being judged,” says Sana.
The journey wasn’t a joy ride. It came with its set of challenges. But the Lokhandwala sisters say these challenges were not strong enough to unnerve them or shake their commitment. The sisters say that they faced harassment, bullying and even death and rape threats from men on digital platforms and in the real world.
“Everything related to a female body that does not serve the patriarchal needs of pleasure and procreation is considered a taboo. Everyone loves to objectify a woman’s body but no one wants to talk about menstruation or breast cancer or women’s other health-related problems,” says Sumaira.
She says the stigma exists because the society has attached shame to women’s bodies. “It’s these taboos that have conditioned the society to view menstruation as something shameful or as something to be ashamed about. It is because of this that the way we view menstruation is going to change very slowly because of our deeply ingrained cultural taboos,” she adds.
They acknowledge the role their families and friends have played in supporting the organisation and its work. “HER Pakistan is a community-driven initiative and we wouldn’t be where we are without the support we received from our generous supporters, volunteers, partners and donors.”
“Discussing and educating people – men, women, girls and boys – about menstrual hygiene and dismissing taboos associated with it, in a patriarchal society, are things that scare a lot of people. We would be lying if we say we weren’t scared,” says Sana. “We were. But we were adamant to change the menstrual health situation in Pakistan. And we can confidently say that the change is happening.”
The writer is a human rights reporter based in Karachi. He covers conflict, environment and culture.
Stepping up in the Pacific at the expense of Pakistani women and girls
Cutting aid has a cost – and Australia should be embarrassed to take aid from other countries to give it to the Pacific.
Since coming into office in 2013, the Coalition has cut aid by 17% in nominal terms and 27% adjusting for inflation. More cuts are in the pipeline, and by 2021 aid will have been subject to a real cut of 31%.
Given that the Coalition’s justification for cutting aid was the budget deficit, you might have thought that now Australia is heading for a surplus, there might be room for increasing aid. But no – in a recent interview with the podcast Good Will Hunters, International Development Minister Alex Hawke said that the last election had been a referendum on overseas aid, that the voters had rejected Labor’s proposed aid increase, and that no aid increases were in the offing. “We’re not revisiting that envelope,” Hawke said.
The suggestion that any election is a referendum on aid is laughable. Find me a person who bases their vote on foreign aid policy. As far as I know, not a single question to either major political leader during the election campaign concerned aid.
But clearly, foreign aid is the lowest priority for the Coalition. It has been singled out. Aid has been cut by 27% since 2013, but total expenditure has increased by 18% over the same period. Answers by the Department of Foreign Affairs and Trade to the most recent Senate Estimates hearings confirmed that next year Australia’s aid-to-gross national income (GNI) ratio will fall to 0.2%, the lowest ever. Among 36 countries in the Organisation for Economic Cooperation and Development, only the much bigger United States and a few much poorer (e.g. Poland) and/or newer (e.g. South Korea) and/or crisis-ridden countries (e.g. Spain and Greece) provide 0.2% or less of GNI in foreign aid.
Because of the cuts, the Coalition has been on the defensive on aid, but that tactic is now changing. In the same podcast, Hawke noted that Australia’s aid to the Pacific was “at the highest level ever”. Likewise, at Senate Estimates last month, Foreign Minister Marise Payne stressed that the $1.4 billion Australia will be providing the Pacific this year is a “record contribution”. Hawke went further – perhaps letting the cat out of the bag, or simply saying what everyone already knows, which is that the proportion of aid to the Pacific is going to continue to “tick up”.
Under what scenario can it make sense to cut total aid, yet increase aid to the Pacific? The government has not yet been able to develop a supportive narrative. Strategic competition with China appears to be the underlying driver, but no one wants to admit it. The best that Hawke could come up with were references to the Pacific as “our backyard” and “our family”.
Given the government’s position, the opportunity cost of more aid to the Pacific is less aid to other countries. Bilateral aid to Africa has already been virtually wiped out, and aid to Asia almost halved.
I personally work a lot on Papua New Guinea and count myself as a friend of the Pacific. But the current practice of taking aid from other countries and giving it to the Pacific makes no sense.
The case of Pakistan is instructive. Australian bilateral aid to Pakistan has already been cut by half, and will be eliminated altogether next year. DFAT has no qualms in documenting that “funding in Australia’s overall aid program [to Pakistan] has been redirected to support new initiatives in our immediate Pacific region”.
What will be sacrificed by abolishing aid to Pakistan? The latest DFAT review of Australian aid noted the strong focus on gender equity of our aid to that country. Specifically, the review noted that in the last year, as a result of Australian aid, 1.7 million Pakistanis received conditional cash and food assistance (55% women and girls). In addition, nutrition supplements were provided to “117,140 women, 14,165 adolescent girls, and 212,510 children under five,” as well as “14 newly renovated, 24-hour health facilities provided reproductive health services to 12,253 women”.
Australian aid also supported 2 million more Pakistani girls going to school. All this (and much more) with only $50 million of aid – just 4% of the amount going to the Pacific.
Of course, the Pakistani government could and should do a much better job of supporting the country’s development, yet the same point could be made just as strongly of the governments of the Pacific. I challenge anyone to find benefits of a similar magnitude to those claimed in Pakistan from our much larger aid program to the Pacific. Indeed, I challenge anyone to argue that the benefits of more aid to the Pacific (already the most aid-dependent region in the world) outweigh the cost of withdrawing our support to Pakistani women and children.
One can debate whether more aid to the Pacific is warranted, but more aid to the Pacific at the expense of aid to countries such as Pakistan is a national embarrassment.
The challenge of getting family planning “right”: Professor Amy O. Tsui on sexual and reproductive health in India
With India facing a plethora of issues related to sexual and reproductive health, ranging from sex-selective abortion to rising rates of infertility, Health Issues India interviewed Professor Amy O. Tsui, PhD of the Johns Hopkins Bloomberg School of Public Health, to discuss India’s family planning, female sterilisation, infertility, female foeticide, and other issues in the field of sexual and reproductive health affecting India.
Professor Tsui, thank you for agreeing to speak with Health Issues India. First of all, could you lend an insight for our readers into the work you do?
I am a social demographer interested in population and fertility trends. As I am a faculty member based in a school of public health, I have an interest in social interventions that influence fertility levels, including marriage, abortion, and contraception. Most of my recent work has been based in Sub-Saharan African countries but I have an enduring interest in the population and fertility dynamics of South Asian countries as well. I largely collect and analyse survey data, whether of women of reproductive age, health facilities or clients.
What do you perceive to be India’s major challenges in the field of family planning?
Getting family planning care “right” at the societal level is a challenge for many countries, including the United States. Globally sexual and reproductive rights are often politicised and remain contentious even as contraceptive use becomes widespread. India faces several major challenges in family planning, the first of which is the prominence of female sterilisation as the most used contraceptive method and one promoted by the government. Although other methods are available (condoms, pills, IUDs [intrauterine devices, or the coil] and recently injectables), female sterilisation accounts for three quarters of contraceptive use. As a result, a second challenge is expanding contraceptive method choice, including vasectomy. Even though India has a history of providing the latter in the late 1970s, today while slightly over one third of married women are using female sterilisation, fewer than 0.5 percent report their spouses having a vasectomy. Other than condoms, there is relatively little use of other methods, especially for spacing births. A third family planning challenge for India is ensuring equity in couples having informed choice for all family planning decisions, whether to prevent unintended pregnancies or to achieve desired ones. Presently the more privileged segments of society enjoy access to such information and means.
Can you identify an area, or areas, where India has made progress in the field of family planning in the past few decades?
Two areas come to mind, firstly India’s progressive record in legislation on elective termination of pregnancy since 1971, amended further in 2002 and, secondly, the transition in norms around family size to where the average women of childbearing age now has just over two births (2.2) and wants just under two births (1.8). Given there are nearly 370 million Indian women of reproductive age today and each has a mother who likely had two or more times that number of births, this transformation of fertility across just two generations is quite profound. Women’s capacity to manage their reproduction has definitely improved. Regarding access to safe abortion, there is still progress to be made but the MTP [Medical Termination of Pregnancy] Act in 1971 preceded the legalisation of abortion in the US by two years. It is easier today for low-income couples to obtain medical abortion pills discreetly from private health providers in India than in the US. I suspect that with more constrained choice of contraceptive methods in India–largely condoms and female sterilisation–some women have felt it necessary to seek out abortions to end unintended pregnancies as a consequence.
Can you identify any current programmes targeting female empowerment, fertility, or sexual and reproductive health which are making a difference in India?
Certainly the Government of India’s national family welfare program, which is the oldest in the world, and implemented through the states has had a major impact on couples’ fertility levels, through the promotion of female contraceptive sterilisation use. While by no means perfect, the government’s universal primary education scheme, along with parents’ own investments in private schooling for their children, has led to a dramatic reduction in the proportion of women under age twenty with no schooling. In 2015, the National Family Health Survey of nearly 700,000 households found 31.0 percent of females with no schooling compared to 41.5 percent ten years before. For female welfare, education and access to birth control are powerful drivers of empowerment.
I have brought in two colleagues into this conversation. We are collaborating on analyses of the National Family Health Survey data from 1992-93 to 2015-16 — Dr. Abhishek Singh and Dr. Kaushalendra Kumar from the International Institute for Population Sciences in Mumbai. They note several government programmes, such as Beti Bachao Beti Padhao, Sukanya Samridhi Yojana and Pradhan Mantri Jan Dhan Yojana which have particularly targeted the girl child and women. BBBP focuses on states and districts in northern India where the child sex ratio at birth is very imbalanced (in favour of males) and seeks to raise awareness of gender equity. SSY encourages parents’ savings for young daughters’ education and marriage expenses. PMJDY has helped open bank accounts with no minimum deposits required to enable females and males to access modern-day financial services more readily. While these are all relatively recent initiatives under Prime Minister Modi, they have the potential to significantly improve educational opportunities for girls and women (and thus their employability) and transform their resource base. It will take time before the full impact of these schemes can be appreciated but they are steps in the right direction.
India’s sex ratio is heavily skewed, with far fewer girls and women than there should be. What drives this imbalance?
Imbalanced sex ratios, in the sense of more boys than girls being born over what is naturally expected, is a problem in China, South Korea, Taiwan and other places in Asia, although not to the extent as is observed in India. Social norms around male roles in society sustain the desire of couples to ensure a male heir among their offspring. Patriarchal customs can protect land ownership with only males having property rights. At the same time social norms evolve around female roles, such as high dowries commanded to marry daughters off, which lowers the value of females and enhance that of males.
Paradoxically, as India’s fertility rates reach replacement level (2.1 births per woman on average), the demand for sons appears to be increasing. It also appears to be strongest for first births and among the better educated females and wealthier couples. The challenge here is to reduce felt pressures by couples to bear sons and also expand opportunities to females to achieve economically and politically on par with males.
Sex-selective abortion is illegal in India but continues to be practised. What do you perceive to be gaps in the legislation allowing for this practice to continue?
This is a very difficult situation to enforce because private conversations of couples around foetal sex are impossible to monitor and health providers are not permitted to facilitate any type of prenatal sex selection decisions of clients. While authorities will need to persist in enforcement where possible, the eventual solution requires a social re-valuation of sons and daughters until parity in gender value is achieved. The norms around son preference are changing and vary geographically across India; but private decisions can still aggregate up to revealing concentrated imbalances in sex ratios at birth at the national level.
As sex selective abortions are continuing to occur despite being illegal, could factors such as providing information to the public help in reducing cases?
I suspect the public is quite aware of gender preferences and discriminations against females. It will be important for social influencers, whether in government or civil society, to promote gender equality and neutralise longstanding opinions about the lesser rights and value of females. One transformative source of influence on public beliefs and opinions is mass media, particularly television and film and their associated celebrities. Positive modelling of the value of females and their lifelong contributions can gradually and permanently alter peoples’ beliefs and behaviors. India has tremendously talented actors, actresses and film producers who could appeal to the social conscience with strong visuals, story lines and re-balance gender preferences. This and continuing education of each generation can correct misguided thinking and actions.
Unsafe abortions are commonplace in India. What are the reasons behind this?
It is very difficult to estimate the number of abortions, both unsafe and safe, in most countries. A recent study estimates nearly sixteen million abortions in 2015 with only one-fourth happening in public health facilities. Another study in nine Indian states suggests that as many as two thirds of induced abortions are unsafe. There are a number of reasons why unsafe abortions appear commonplace – the sheer number of them given unplanned pregnancies resulting from unprotected sex, the legal status of abortions and relatively easy access to abortion means outside of the public sector, and the modest levels of contraceptive use for birth spacing, driven primarily by use of condoms, which have high failure rates. If a woman is not ready for permanent contraception and has limited knowledge of and access to other birth control methods, she is likely to experience an unplanned pregnancy and seek resolution with an abortion. Medical abortion pills are readily available from pharmacies and other private retailers. However, unless proper counselling and monitoring of the use of pills are provided, which often are not, such access is considered “unsafe”.
Lastly, even though a legal procedure, induced abortion often carries social stigma. Females are embarrassed to report seeking and terminating a pregnancy which means they often resort to informal abortion care or unsafe means.
Infertility is on the rise in India. What are the factors contributing to this?
I think the apparent rise needs to be first examined in terms of whether it is voluntary or involuntary childlessness that is increasing. Possibly it is both. Infertility has as its causes both male and female factors—semen quality, uterine structural issues from pelvic inflammatory disease, exposure to environmental chemicals and toxins and stress for example. A first challenge is to properly measure the prevalence of these conditions in males and females by which careful analyses can be conducted to determine the patterns and causes.
How do you evaluate the Indian government’s approach to issues such as in-vitro fertilisation and commercial surrogacy?
I am not knowledgeable enough about the Indian government’s approaches but certainly a comprehensive national family planning program will address couples’ reproductive intentions, whether to space, limit or have desired births. This includes addressing infertility issues. Denmark’s public health system, for example, supports assisted reproduction services (in vitro fertilisation) for women irrespective of marital status and sexual orientation and the proportion of births assisted with IVF is rising.
In regard to family planning, is there a disproportionate focus on sterilisation, and female sterilisation in particular, as the primary method of family planning in India?
I would say yes. One finds few countries in the world, particularly with populations as large as India’s, where permanent contraception occupies such a prominent role as a means of birth control. Female sterilisation is favoured in Central America and China, but women there also use other methods. While female sterilisation is a terminal use status for many Indian women, they appear not to access other contraceptive choices as readily if they wish to space births. Striking is the extent to which female sterilisation has become the birth control option for less educated and low-income women.
Do you feel the emphasis on sterilisation occludes access to other mechanisms of family planning such as contraceptive devices (e.g. condoms)?
The government’s Family Welfare program has recently introduced two spacing methods – Chayya, a once a week oral contraceptive pill, and Antara, a three-month injectable contraceptive. These offer protection against unplanned pregnancies to breastfeeding women and require minimal attention to use. These help complement the other government-sponsored methods. In addition, the government has been promoting immediate postpartum IUD insertions so that women can leave the birth facility protected with a highly effective method. With major surveys such as the National Family Health Survey conducted every few years, it will be possible to monitor the uptake of the new methods and observe how the family planning intentions of couples are being realised.
Finally, do you have anything you wish to add?
Nearly one in every five women on this planet is Indian (seventeen percent). Each of them deserves to be born a wanted daughter, be educated, live a healthy productive life and be a contributing member of society. India should not squander this human resource, which can potentially help accelerate the country’s future economic growth.
Amy O. Tsui, PhD is a Professor in the Department of Population, Family and Reproductive Health of Johns Hopkins Bloomberg School of Public Health and a senior scholar of the Bill & Melinda Gates Institute for Population and Reproductive Health.
Her research interests include family planning, fertility, and related health issues in developing countries and her current research is on the effects of various family planning and health service delivery models on contraceptive, fertility, and sexual health outcomes in sub-Saharan African and other low-income countries. She obtained an MA degree from the University of Hawaii in 1972 and her PhD from the University of Chicago in 1977. Among her honours are the Champion of Public Health award from the Tulane School of Public Health and Tropical Medicine, 2005; the AMTRA Award, JHSPH, 2006-07; the Golden Apple Award, JHSPH, 2009; and the Carl S. Schulz Lifetime Achievement Award, Population, Reproductive and Sexual Health Section from the American Public Health Association, November 2010.
Does Sexual Wellbeing Lead to Better Life And Leadership Skills? This Sextech Company Wants To Find Out
The connection between sexual well-being and mental and physical health has been recently attracting more interest. Sexual wellness brands -many of which endure constant advertising censoring– advocate to position sexual health and wellness as part of the health conversation, to make it more accessible to all.
A rich body of research confirms that sexual satisfaction affects relationship satisfaction, which is key to earning potential. For example, in one longitudinal Harvard study, the data revealed that fulfilling relationships are the key to happiness, health and longevity. And not only that: Those with the most fulfilling relationships earned an average of $141,000 a year more at their highest earning point.
This study, however, was focused exclusively on male subjects, and it inspired a recent study conducted by sexual wellness company Womanizer (WOW Tech) in partnership with The What Collective, a women-centered organization founded by dot com entrepreneurs Gina Pell and Amy Parker. The former co-founders of Splendora (acq. by JOYUS) recently hosted a gathering called The What Summit at the secretive and exclusive Skywalker Ranch. The survey was completed by over 200 high-earning attending women. 80% of respondents were ages 35-64 and in director, management and C-suite positions.
The preliminary results showed some interesting insights: More than 50% of respondents perceived that having a healthy fulfilling sex and relational life would positively impact all other aspect of their lives, including their careers.
The Deficit in SexEd Addressed By Wellness Brands
When it comes to sexuality only 3% of respondents said they had learned at school or with their families. The majority cited the following sources of sex education: peers and friends (34%), magazines and books (28%), and the Internet (10%). In fact, 77% of women who received some sex education stated that it never mentioned that sex should be pleasurable and 70% say there was no discussion about consent. Additionally, 62% state that they have experienced shame around sex and sexuality.
Global expenditure on wellness products and services is on the rise, highly driven by women, and the women’s empowerment movement has added to the conversation issues such as the orgasm gap between men and women, and the right to body autonomy and pleasure of women. This context creates an opportunity for Sextech and Femtech businesses to create innovative solutions to educate and offer resources in underserved categories for people of all ages. Both industries have been estimated at $30 and $25 billion, respectively.
Stephanie Keating, Head of Marketing of WOW Tech, which comprises Womanizer and We-Vibe, said: “Womanizer partnered with The What Summit to facilitate conversations amongst women about pleasure and all that it brings our lives. For many women, experiencing self-pleasure builds confidence, comfort, and agency – yet 75% of us were not taught that sex should be pleasurable. Traditional sex education has failed us. For too many women, pleasure is associated with shame. That limits us in so many other aspects of our lives. The conversations that Womanizer and our experts are having with women free us to talk to each other about this essential part of our lives.
Personal Fulfillment As A Source Of Confidence And Wellbeing
When asked about the impact of their personal sexual wellness in other areas of life, the majority of women believed that feeling fulfilled positively impacted how they showed up in other areas of their lives. Specifically, 51% stated that this translated into a positive impact on their professional lives. Many respondents pointed to the correlation between fulfillment and “confidence”, “lowered stress”, increased overall “happiness and motivation”, feeling “empowered” and “powerful”, and the positive correlation with overall “well-being”.
Emily Morse, Doctor of Human Sexuality, relationship therapist and author, says “Sexual wellness impacts body image, confidence, … These factors can put a strain on our mental health. If you are not connecting with your partner, it is going to affect your day to day life. Additionally, being able to ask for what you want is a skill that translates into other areas of life.”
Sexologist and relationship expert, Dr. Jessica O’Rielly, PhD, said: “Sexual fulfillment, relationship fulfillment and life fulfillment are all positively correlated. It follows that investing in your relationships and sex life (however you define it) and fulfilling those needs leads to greater self-assurance, improved mood, increased motivation and even greater assertion skills — all of which can benefit your career.”
Educators, researchers, entrepreneurs… The business of sexual wellness is a growing one and the merger of Womanizer and We-Vibe, which is about to become the largest sexual wellness toy manufacturer, approaching $100 million in sales, wants to push forward a healthier narrative around sexuality: “ Our flagship products were created to help women achieve personal sexual fulfillment and their pleasure potential. WOW Tech’s mission is to be the premier provider of sexual health and wellness products — products that enable people all over the world to increase the satisfaction of their personal and sexual well-being,” concludes Keating.
Almost a decade ago, I heard a story about a villager that stuck with me for quite a while. I was in my sophomore year of my psychology degree back then, and my novice brain was quite struck by the story of a teenage villager who screamed at the top of her lungs every time her husband tried to touch her. She had been married for four months, but due to her reactions, no physical intimacy had been initiated.
Initially, the mother-in-law and the women of the house laughed it off, terming it as mere shyness, even though the girl’s entire body would shake and tremble for hours and it looked like she had endured a disaster. After a few attempts at physical intimacy, the husband did not use any kind of force to coerce her into the act.
Assuming the girl screamed because she didn’t like her husband, she would be questioned about why she had agreed to the marriage in the first place. She claimed that she loved her husband and enjoyed spending time with him, but not the physical intimacy. She claimed that no one had neither explained nor prepared her for this and hence she was clueless about this aspect of a marriage.
According to her:
“I thought that marriage was what I saw in the Star Plus soaps; wearing cool clothes, dining out, doing shopping and such things. My first night was the most terrorising experience of my life and I hate how nobody informed me about this.”
Our professors assessed her and concluded that there was no form of asexuality or intellectual disability present; she was simply not prepared.
Marriage holds a lot of importance in a patriarchal society like ours, more than it should. Our entire lives and career choices revolve around marriage. A lot of people, particularly women, are forced to give up their identity, life goals and dreams, just to be married by a particular age. Considering all this then, it is quite ironic how sex education is not provided to people before getting married, neither is there any demand for pre-marriage counselling in the country.
In my clinical practice, I have come across the dire consequences of lack of awareness and sex education. Fear of physical intimacy, or genophobia, is a commonly occurring phenomenon that I have observed during my practice. There are a lot of women who have this phobia in such extreme forms that it inhibits them from consummating any or most form of physical intimacy through the entirety of their marriage.
A senior of mine once narrated a genophobia case to me. Dr Niazi* was an established medical doctor who had been working in the field for a very long time. She had been married for over a decade and disclosed to my colleague the reason for her frequent absences from work and distress. She was on the verge of getting divorced and quite contrary to everyone’s belief, not having any children was not the root cause of it.
“Would you believe me if I tell you that an accomplished female doctor like me, a mature woman in her late 30s, has never been physically intimate with her husband? Because I’m so afraid?”
She further added that despite of every possible cooperation on part of her husband, she was unable to let go of this fear.
Similarly, Miss Sheikh, a girl in her mid-20s, encountered the fear even before getting married. She had three different surgical procedures done in her life for various illnesses and yet she believed that physical intimacy would be more horrific than that. In this case too, the husband was extremely supportive.
However, there are many cases in which the spouse is unable to understand the situation and marital rape becomes a norm as we are neither culturally sensitive to consent nor very aware of this phobia. There are a lot of instances when patients have a hard time coming to terms with being diagnosed with such a condition, or that such a condition even exists.
Even when the husbands are understanding and not forceful, they do fail to identify this as what it is: a form of anxiety disorder. Couples believe there is no solution for a condition such as this and the best they can do is visit a urologist and ask for tips to improve their foreplay or approach to physical intimacy. Whereas, the actual treatment is counselling.
The very reason for genophobia in our society can be seen through a cultural lens. Though it is true that the reasons for this phobia are rooted in a form of sexual abuse, particularly sexual abuse as a child, but most of the women I have come across have genophobia without an adverse life experience.
Furthermore, the practice of arranged marriages makes it more difficult since there are expectations of consummating the marriage on the wedding night. How could it not scare an already fearful, anxious woman? Genophobia is only a natural reaction in such a scenario.
The treatment of genophobia has a fair prognosis. If an adverse sexual experience is involved, it is treated as a product of trauma. In cases where no adverse experience is involved, we work with systematic desensitisation and cognitive behavior therapy as a treatment plan. Considering the cultural inconsideration surrounding sex education, the patient is also educated about their own anatomy in relation to this. Therapies such as Sensate-focus are also used with couples to improve and overcome the situation together.
Shame and shyness are so inclusive in our culture that they breed a care-avoiding attitude in our women regarding their most intimate issues. We shouldn’t be shaming women about these issues and instead encourage them to seek help.
(*Names have been changed to protect identities and doctor-patient confidentiality.)
I remained silent, mostly out of curiosity. She continued and said,
“It happened when I tried to get intimate with him; not with a stranger but with him, my own husband.”
“What exactly do you mean?” I asked bewildered.
“He hadn’t come home from work and I was missing him. Aroused, I approached him, thinking he’d appreciate that. In return he gave me a stern look and said, what is wrong with you? Why are you behaving so immorally?”
This was expressed with a dejected and forlorn look on her face. Naturally, this would affect any wife.
Surprised by her story, I tried to convince her that Pakistani men were neither this judgmental nor as narrow-minded.
“No that’s not the case. A man may approach his wife whenever he wants, because he is the husband, but when his wife wants to exercise the same right, she is immediately labelled as immoral,” she replied angrily.
“Perhaps, your husband has some sort of psychological knot in his head.”
I responded, in an effort to try and figure out the reason behind his strange behaviour.
“If this sort of mentality is prevalent in all men, then it’s safe to say that the entire male population in our society has psychological issues – not just my husband.” she added.
I was honestly beginning to get a bit impatient and bothered by her generalised accusations. How was she finding it so easy to blame all men for her husband’s fault?
“What do you mean?” I asked out of politeness.
“Just so you should know Mr Shahid, newly wed brides are instructed by elder females in the family to show deliberate ‘self-control’ during intimacy, especially in the early days of marriage. Now isn’t that an example of unfair moral policing? The slightest expression of natural desire towards one’s own husband is enough to declare a woman as morally corrupt. Isn’t that completely absurd?
Women are also human beings and have feelings, just as men do. They also need comfort and pleasure like any other human, regardless of their gender. How can anyone associate this with one’s morality and character? It makes no sense.” She added.
After listening to her, I figured there may be some truth in what she told me. It really couldn’t have been based on imagination.
So, in order to evaluate her accusations and stereotypes, I asked an elderly man whether it should or is considered ‘incorrect’ for a wife to initiate intimacy with her husband.
“How can it be wrong? She has every right to. There really is no objectionable element in such behaviour, but during these 40 years of my marriage, my wife has never done this. Not even once.”
Concluded the elderly man with great pride.
That satisfaction on his face validated my colleague’s heartfelt allegations.
To further probe into this warped mind-set, I discussed the matter with one of my friends. He handed me an old book on morals, traditions and ethics and advised me to read the chapter “Azdwaaaji Zindagi kay Adaab” (Ethics of married life). I didn’t even know such a book existed!
A close friend of mine recently had an STI (sexually transmitted infection) scare. Despite being in excruciating pain, she was scared to ask her husband how she got the infection. After a few days of discomfort and suffering, she consulted a doctor who put her mind to rest by confirming that she had a yeast infection because of diabetes. But during this whole episode, I was surprised to find out how ignorant she was about sexual health.
First, she was adamant that she couldn’t get an STI from her husband because he was absolutely fine, which is irrelevant and factually incorrect because some STIs are asymptomatic – meaning the person who has the infection don’t show any symptoms. Second, after ruling out her husband, she suspected getting the infection from a toilet since it was shared between her and a relative. This wasn’t the first time I had heard an absurdly naive theory about how people get STIs in Pakistan. I remember the days when I was working for a trade association and was told by a colleague that people get HIV, STIs and even diabetes by using public toilets! Yes, someone said that and that someone wasn’t illiterate. That person was an accomplished professional and an independent woman.
Several years later, now that I am working for the healthcare sector in the UK, I observe how young people are educated about these potentially serious and deadly diseases. Let me clarify a few things particularly for the crowd that proudly claims: Pakistani kids do not have sex before marriage so they don’t need sex education.
What they teach here in the UK isn’t just about sex; they call it relationships and sex education for a reason. Secondly, young people in Pakistan do exhibit some risky behaviour before marriage – be it in a serious relationship or with a random stranger. I don’t think I need to elaborate on how young boys are often dared to experiment with transvestite street performers. Even if we were to believe that the Pakistani youth does not indulge in sex before marriage, they do get married and trust me the advice given by elders (for marital bliss and expression of physical desires when someone is getting married) is often not the best advice.
Boys are not told that some girls are born without a hymen and girls are not given the courage to say no to their husbands during intimacy when they are being disrespectful. Expressing your carnal needs is looked down upon if done by a woman and deemed natural if done at the most inappropriate hour by a man. I have known people who accidentally lost their virginity because no one told them when to stop physical advances by someone they weren’t in a serious relationship with. And the cherry on top is that we always assume that it’s only women who can be physically abused.
In Pakistan, we are embarrassed to talk about sex because we think of it as filthy and unnatural. But the truth is that the experience could contribute positively to one’s mental health if done respectfully and with the right person. The ‘no sex talk’ policy only results in ignorance which is often confused with innocence and purity. In today’s world, you don’t want your children to be ignorant about sex because people will (and they do) take advantage of that. They will hurt your children physically, mentally and emotionally.
Imagine a scenario where a spouse tells their better half that they don’t like certain things about their partner’s physical appearance. Surely we change, adapt and improve for the people we love but some things are beyond human control, such as a physical feature. Wouldn’t you all agree that such conversations could be detrimental to not only one’s confidence but to the relationship as well? So how can we stop marriages from falling apart without blaming women liberation and western influence? We must educate our youth about respecting their partners and it being okay to expect the same in return.
Also, protecting one’s health (including sexual health) is a basic human right. Why is it generally acceptable in Pakistan for men to have sexual encounters outside their marriage and bring several diseases home? Why aren’t they taught how to be safe and also protect their partners? Why can’t their wives be assertive about their own marital rights?
Case in point: The friend who was too scared to talk to her husband about her STI scare because she didn’t want to upset him.
I think we, as a nation, are pretentious and have double standards when it comes to intimacy. Why do we cringe while watching a condom advertisement on television but are perfectly okay to watch vulgar dances in movies? Why do we have these stigmas, fears, misconceptions and misinformation about sex and sexual health? Surely, our religion is practical and in no way oppressive or unreasonable.
Our double standards about sex and sexual health are evident when we look at the statistics. According to UNAIDS, 100,000 people were living with HIV in Pakistan during 2015. In 2014, an 11% increase was reported in mortality rates from HIV/AIDs in Pakistan and if you want to learn further about STIs/STDs then read this article published in Express Tribune.
I am a mother and I do plan to teach my children how to love themselves and their bodies. Anyone telling them that they are inadequate or ugly doesn’t deserve to be a part of their lives. I will teach my children their rights about fertility, safety and pleasure. I will tell them that they have to prioritise their own health and well-being in all circumstances that no relationship is worth compromising your own mental or physical health. I will give them the confidence to say no and to be okay with their feelings.
But for those mothers who are not in a position to do all of this, why can’t a trained professional deliver lectures to youth in colleges and universities? If it is so shameful, perhaps have separate lessons for different genders and sexual orientations. What is so taboo about healthy relationships and physical health? Would you rather have your child learn about sex at the right time by the right person or would you let them go out and discover things on their own (which might result in life-altering damages)?
Gay ‘Chemsex’ Linked To Rise in HIV Cases in Europe
Chemsex parties, when people get high and have sex for days with a number of partners is gaining popularity in Europe, which has led to a rapid spread of HIV.
During chemsex, people use drugs such as crystal meth to enhance their arousal and pleasure, NBC News reported. Rusi Jaspal, a professor of psychology and sexual health at De Montfort University in the Britain who studies the spread of HIV and the chemsex scene, says the mix of drugs and sex increases the spread of viruses in groups subject to HIV, like the gay community.
“People are not scared anymore of HIV,” Ignacio Labayen de Inza, a chemsex expert who works at U.K. clinics said, according to NBC News. “Many people I see say they think ‘it’s only a matter of time anyway, so I might as well have some fun.'”
In a U.K. study, 30 percent of HIV positive men surveyed said they had participated in chemsex in the past year.
Men have a far greater appetite for sex and are more attracted to pornography than women are. This is the timeworn stereotype that science has long reinforced. Alfred Kinsey, America’s first prominent sexologist, published in the late 1940s and early 1950s his survey results confirming that men are aroused more easily and often by sexual imagery than women. It made sense, evolutionary psychologists theorized, that women’s erotic pleasure might be tempered by the potential burdens of pregnancy, birth and child rearing — that they would require a deeper emotional connection with a partner to feel turned on than men, whose primal urge is simply procreation. Modern statistics showing that men are still the dominant consumers of online porn seem to support this thinking, as does the fact that men are more prone to hypersexuality, whereas a lack of desire and anorgasmia are more prevalent in women. So it was somewhat surprising when a paper in the prestigious journal P.N.A.S. reported in July that what happens in the brains of female study subjects when they look at sexual imagery is pretty much the same as what happens in the brains of their male counterparts.
In a prevailing society of silence and taboo on adolescent’s natural desires or habits, the assumption-based project of sexual ignorance appears to have failed its grade in streamlining the youth’s sexual well-being and state of mind. In the contemporary era of helicopter parenting where parents pay attention to every aspect of their children’s lives, they somehow neglect or struggle to discuss and educate their teenagers about the one aspect of life – natural and beautiful habits of reproduction, as they frequently feel ashamed, or too shy to speak about its progression. However, this wrong approach of neglecting household education in sex-related growth has resulted in severe impairment in the mental and physical aspect of a young adult’s sexual health, as this deprivation of knowledge has often led to people’s high school and college life to be driven with unwanted or uncontrollable sexual desires, which could potentially harm both life’s conditional growth and career’s prospects.
When human species are living within the realm of adolescence, i.e., from the age group of 15- 21, the human body experiences a hormonal outburst; which explodes into a range of emotions, affecting many aspects of life such as personality, emotions, feelings, sexuality, self-acceptance and personal belief. It is within this region of growing existence, where teenagers (adolescents) find themselves stuck in the web of vulnerability, due to imbalances in sensation and life’s intentions.
During this phase of hormonal imbalances, teenagers require critical assistance, as similar to how cruise-ships navigate past rough seas with the crucial aid of anchors and other facilities during long journeys, the social-human vessels, i.e., adolescents require additional anchors called parental support and guidance, to prevent them from sinking beneath the ocean of strenuous difficulties within life. This representation of parental streamlining requires careful and delicate crafts of care to not just extrinsic standards of living such as academics, or sociability, but it also requires a matured approach towards explaining, some of the crucial and delicate functions of intrinsic life such as sexuality in a responsible manner.
If the educational discussion of sexuality remains boycotted between both generation of adults and adolescents, then the entire stand of guidance based on academics, physicality or sociability could fall into hindsight, as though parental advice on academics and sociability play a key role in one’s holistic development, the negligence of sex education from parents could damage teenagers and young adults’ lifestyle and entire existence. Why? It is because this negligence has seen adolescents taking a leap of pleasure through self-sex education by indulging in several life-destroying activities by being sub-consciously manipulated by stress imbalances and curiosity caused by hormonal activity.
Today, thousands of parents have been blinded by the innumerable ways where their children often attempt to educate themselves sexually and participate in several pleasurable activities (stress relieving). The most common scenario for pleasure is in person; where youth enjoy sexual indulgences with unwanted and unfamiliar people by making college life a sexual paradise, where people visit unwanted attractions such as HIV, hepatitis, other Sexually transmitted diseases, teenage pregnancy, and relationship issues. Additionally, the internet is also another pleasurable hub where adolescents follow daily educational illustrations, carried out through webcam sex on Appear, Skype, Facetime, and many other portals. The reasoning for why these practices are carried out is due to sub-conscious possession and self-hypnotism based on curiosity whose original purpose of sexual relations, hasn’t been established by parental advice and intervention (the emergence of dangerous addictions).
Consequently, the aftermath of repercussion faced by victims of sex-related education-turned-addiction often results in the need for parents to dive deep down into treacherous waters, to find their incapacitated teenagers or young adults who drowned after being wrecked by their inability to fight off addictions. This wreckage is a result of the burden formed by shame, depression, unbearable sensitivity, and self-inflicted guilt, which ultimately causes suicides, illnesses, and family damage. Eventually, this slow realization has been a norm due to a variety of factors, such as weak generative guidance from parents and growth of taboo related ignorance.
Therefore, as parents in a sensitive and complicated world, it is essential to maintain a standard of personal respect and dignity in public, but it is also even more important to value personal space and expose private and intrinsic vulnerability (sex education) to teenagers (15-16 and above) and young adults. Conclusively, as we continue to nurture the youth, we need to realize that though different people will have different opinions regarding sex education, I believe that with the constant rise in adolescent irresponsibility in sexuality, sex education should not be considered taboo in families, instead, it should be taught with the most responsibility. As not only, will its inculcation prevent the youth from going astray, but it will also help them genuinely recognize their maturity and responsibility in life. Ultimately, parents should realize that sexuality is not a self-learned subject for adolescents, but a sensitive subject which without intervention could destroy, but with care could flourish in the purest form.
“ I believe that, if parents genuinely value their children’s lives and future by doing whatever it takes for the child’s growth, then they should abandon the substantiation of taboo-related excuses of shame when discussing the crucial aspect of sex education, and instead consider it as the one significant lesson which forms a tight rope between the balance of success and a slip of failure into darkness.”DISCLAIMER : Views expressed above are the author’s own.
Author: Rohan Keni I am a 19-year-old student hailing from Goa, India. Over the years, I was raised in Dubai and have recently relocated to Missouri, USA to pursue a degree in. . .