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Introduction: A Confusing Beginning
Pakistan's approximately 40 million adolescents, like untold hundreds of millions the world over, receive mixed messages about sexuality. At home, many of them learn that sex is shameful. Their parents fear that providing even the most basic information about reproduction will unleash their sexual desires. Yet on television, teens see sex used overtly to sell items like deodorant and chewing gum. In their neighborhoods, especially in the cities, many are exposed to pornography or perhaps to a poverty-stricken neighbor who must sell sex to feed her children. Many of their peers may experiment sexually, while their teacher skips the chapter in their biology textbook on reproductive processes out of embarrassment or shyness. Religious leaders seldom discuss sex, and when they do their emphasis is usually on the dangers of premarital sex. Furthermore, as Pakistani boys and girls undergo physical changes, the world around responds with a new set of expectations—expectations of roles and responsibilities that are defined strictly on the basis of whether they are male or female. Along with the hormonal changes that accompany puberty, how can these adolescents be anything but confused about their bodies and their sexual feelings?

Addressing Gender Inequality in Adolescent Life Skills Education: Aahung's Experience in Pakistan

Surveying Boys and Girls
In 1998 my organization, Aahung, began conducting research among adolescents in Karachi's low-income communities to assess their knowledge, attitudes and behavior regarding sexual health in order to prepare our life skills curriculum. We interviewed young girls and boys aged 12 to 19 on the subjects of bodily changes, drug abuse, gender-based discrimination, sexual abuse and violence, and health-seeking behavior. The girls spoke of the terror and trauma of their first menstruation. Not having any information prior to the experience, some girls didn't know what was happening, and a few told us that when it happened to them, they thought they were bleeding to death.

Accompanying this confusion and fear regarding their bodies was a strict segregation of the sexes. Girls told us that all of a sudden they were forbidden to play on the streets or even talk to boys and men. This sometimes led to being removed from school. When asked about what happens to a girl when she starts to grow up, a girl told us that her father forbade her from standing in the doorway of her house because he felt that girls should not be seen. Often, girls are entirely prohibited from leaving the house unaccompanied. As you can imagine, such restrictions pose barriers to seeking care from qualified health practitioners. For example, it's common for a girl to take medication on the advice of her aunt or mother. At the same time, girls said they are expected to cook, clean, and become a caretaker, not only for their younger brothers and sisters but for the rest of the family as well, in preparation for marriage. Once a suitable match is found and her parents can afford it, she will be married off—often with little say.

In our experience, it is not uncommon for a 16-year-old girl to be married to a man 10 or 15 years her senior, without any prior knowledge about sexual intercourse. As you can imagine, her sexual debut that follows is not a result of informed choice.

Boys, on the other hand, told us that they are encouraged to take greater responsibility for household finances and protection of women in their household. Nocturnal emissions—unlike menstruation—are not seen as requiring management. Hence, parents often give boys even less information than girls about their bodies and sexuality. But because of the greater freedom boys enjoy, compared with their female counterparts, they tend to explore their sexuality more freely. They can watch pornographic videos rented from the corner shop, their friends and peers display sexual virility by harassing women on the streets, and premarital sexual experimentation is common. However, they too experience a great deal of shame, misinformation, and guilt surrounding sexuality. Many of the boys we spoke with have sought "cures" for perceived sexual weaknesses, caused in their opinion by masturbation, nocturnal emissions, and same-sex sexual activity.

Socially imposed gender roles dictate that girls show no sexual feelings and obey their parents' decisions regarding their lives. For boys, masculinity is measured by how much money they earn and the control they can exercise over the women around them. A man's honor is intrinsically tied to his ability to protect the girls and women in his family from the sexual desires of other males.

These gender-biased values seriously compromise adolescents' freedom to think critically and develop into healthy and responsible adults. For both boys and girls, the repression of sexuality and the attendant ignorance result in low self-esteem. Girls often feel that they do not have a right to be involved in decisions regarding their marriage. Boys feel that their honor would be at stake if their sister were to exercise her right to continue her education or seek employment. This uncertainty, guilt, and confusion often leads to unsafe sexual practices, which leaves girls especially vulnerable to sexually transmitted infections, including HIV/AIDS, and depression. This ill-preparedness is not only a health risk, it often renders girls victim to sexual violence.

Aahung's Life Skills Curriculum
The life skills curriculum developed by Aahung, in partnership with Save the Children UK, seeks to raise adolescents' awareness of sexuality and reproduction, build their self-esteem and confidence, and increase their access to quality sexual health services. The program rests on our commitment to create a world where every individual is free from discrimination and able to live with respect and dignity. We also believe that each and every one of us has the right to education and health, and to define our roles, values, and identities.

Entitled "Aware for Life," the curriculum consists of ten participatory lessons for girls and boys aged 13 to 15. The lessons, which can be implemented over a period of weeks or daily depending on the flexibility of the school's curriculum, take about an hour to complete. They consist of role plays, case studies, group work, and self-reflection. Although boys and girls are in separate classes, as is typical in government and most private schools, the issues girls and boys cover are the same. We simply use different case studies to maximize their relevance to boys and girls.

Provoking Thought
We have made a special effort to ensure that the curriculum and our methods are sensitive to issues of gender. For example, the lesson entitled "Equality" includes a case study about a girl who is sexually harassed by some young boys on her way to school. Upset and frightened, she tells her younger brother who, in turn, reports the incident to his father. He then prohibits his daughter from going to school. The list of questions that follow provoke classroom discussion about a person's freedom of movement and education, and the violation of that right in the name of honor and respectability. It also generates discussion about whether girls are at fault when they face unwanted sexual advances.

Another lesson explains the rights and responsibilities of a husband and wife in marriage, such as the wife's right to financial compensation at the time of marriage and the equal right to seek divorce. Through a group discussion, girls learn that their consent is required for the legal validity of a marriage and that the legal minimum age for marriage is 16. One 14-year-old girl who attended the sessions at the St. Francis School said, "I have the right to get an education, and to make my own choices. If my parents want me to marry someone who I don't like, then I will say no through my mother or elder sister. It is my right to choose a man with whom I think I will be compatible."

Training teachers to use this curriculum remains a formidable task. School administrators are hesitant to commit resources to this activity. Teachers, all too commonly overworked and underpaid, are unwilling to give time. School curricula sometimes cannot be adjusted to include a subject outside of the standard curriculum. Aahung continues to face these challenges. But slowly we have begun to identify school administrators who are sensitive to adolescent sexual health issues. We have begun to develop strategic linkages with government bodies responsible for introducing change in the school curriculum.

Transformation is Possible
In cases where schools have been ready and teachers have come forward, we train them to implement the curriculum in six days, which includes a practical training with adolescents. Support visits after the training provide further guidance for those lacking the skills or confidence to implement the curriculum. Our experience shows that teachers who are sensitive to human rights and have had prior experience with participatory methodology are more able to implement the curriculum effectively. Therefore Aahung recommends a greater investment in teacher training. Even with this limited intervention, teachers' attitudes can change. One female teacher told us, "This feeling of being a man or a woman has disappeared for me. We are all humans, and we are equal."

A 15-year-old boy hailing from a conservative background said to us, "There aren't many educated people in my family. Pathan women aren't allowed to study, but if I have a daughter then I definitely want her to study because this is her right."

The project evaluation revealed that the curriculum enhanced knowledge regarding puberty and sexual and reproductive health. It also increased adolescents' self esteem, and improved relationships between parents and students, parents and children, and boys and girls, by opening communication channels. A 15-year-old boy told us: "I [now] help my mother in clearing the table and also ask my brother to help." Another one said, "A girl also has the right to get an education, go to the doctor, and should speak up if someone is harassing her. The only difference [between me and her] is that she is a girl and I am a boy."

Conclusion
It has taken seven years for Aahung to identify pertinent sexual health issues facing adolescents, develop an educational intervention that addresses these in a culturally relevant manner, and begin to build a network of service providers raising awareness for youth. Our plans for the next five years include building strategic partnerships with both non-governmental organizations and government so that some day adolescent sexual and reproductive health information and services will be integrated into public education and healthcare.

In a world where gender roles are deeply entrenched, change is slow. But boys and girls respond positively to programs that challenge these roles and promote gender equality and respect. They eagerly embrace the idea that all persons have a right to education and health, and readily understand that human dignity entails the right to be free from sexual coercion and to control one's sexual life. They see these changes as essential for a better future. Transformation is possible.

Thank you.

This speech was part of Adolescents at the Crossroads, a panel presentation on adolescent sexuality education organized by IWHC in cooperation with Aahung (Pakistan), Action Health Incorporated (Nigeria), the Youth Coalition, the United Nations Population Fund, the World Health Organization, and the World Bank, during the UN General Assembly Special Session on Children (May 8-10, 2002).

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