World Population Foundation Pakistan BASELINE ACTION RESEARCH Sexual and Reproductive Health and Economic Status of Adolescent Girls in Sanghar (Sindh) Baseline Action Research by Presentation 17 th June, 2010

 To determine a baseline for knowledge, attitude and practice of sexual and reproductive health indicators in the adolescent girls of two target districts of Gujranwala and Sanghar, and  To assess the demand for reliable Sexual and Reproductive Health (SRH) knowledge and services Why was the Study done? 2

Methods  Policy and literature review  KAP Survey of school going and non-school going adolescent girls  Focus Group Discussions (FGDs)  Collection of School Data Sheets  In-depth interviews with district education and health authorities  Interviews with School Management  Data analysis and report 3

District Fact Sheet Sanghar Population (1998)1,453, 028 Population (2010, est.)1,900,000 Urban Population22.13% Growth rate (p.a.)2.54% Population Density (per square kilometer)135 Reproductive Health Centers52 Basic Health Units35 Fertility Rate5 Family/Household Size7 Contraceptive prevalence rate24% Number of registered medical practitioners241 Literacy Rate30.87% Number of primary schools for girls3,280 Number of high schools for girls20 Source: Population Welfare Department, Government of Sindh, EDO (Health) and EDO (Education) Gujranwala 4

Participation Summary Geographic location: Sanghar district TotalSanghar Survey Respondents Non-School Going Girls 7626 Headmistresses/Principals interviewed 5520 Primary Stakeholders: FGDs In-depth Interviews (District Education & Health Officials) 168 5

Variables and Indicators ParameterVariableIndicator Knowledge Knowledge in Adolescent Girls about STDs % age of adolescent girls having knowledge about STDs Knowledge in Adolescent Girls about Prevention from STDs % age of adolescent girls having knowledge about prevention from STDs Desire among adolescent girls to learn about STDs % age of adolescent girls expressing demand to seek knowledge about STDs Guidance received by Adolescent Girls over body changes % age of adolescent girls having received guidance over body changes from any source Ideal age of marriage % age of girls indicating a preferred age of marriage for men and women Attitude Attitude of families towards boys and girls % of families allowing and encouraging boys and girls to have meals jointly Treatment of families with boys and girls % of families giving similar gifts to boys and girls on special occasions Attitude of Adolescent Girls on the onset of puberty Response distribution of girls Perception of adolescent girls about men's roles in household chores % of adolescent girls considering men equally responsible in household chores 6

Variables and Indicators (Continued…) ParameterVariableIndicator Practice Freedom to Choose spouse % of adolescent girls given freedom in choice of spouse Freedom to Choose a profession % of adolescent girls given freedom in choosing a profession Freedom to Choose a friend % of adolescent girls given freedom in choosing a friend Freedom to Choose type/field of education % of adolescent girls given freedom in choosing field of education Preferred Strategies of adolescent girls to support their families % girls showing a particular preference such as economic assistance, counseling, household chores Demand amongst adolescent girls for counseling in marital affairs (rights and responsibilities of husband and wife) % of respondents indicating demand for training in marital affairs Demand amongst adolescent girls for training in budget preparation % of respondents indicating demand for training in household budget Demand amongst adolescent girls for counseling in family planning (birth control, birth spacing etc.) % of respondents indicating demand for training in family planning Demand amongst adolescent girls for training in upbringing children % of respondents indicating demand for training in upbringing children 7

Variables and Indicators (Continued…) ParameterVariableIndicator Practice Desired Level of education amongst adolescent girls Distribution of responses with respect to desired highest level of education that adolescent girls have Desirable career choices for adolescent girls Distribution of responses with respect to desired career direction hat adolescent girls have 8

World Population Foundation Pakistan DATA ANALYSIS INDICATORS

Knowledge in Adolescent Girls About Specific STDs School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Knowledge in Adolescent Girls about Specific STDs 1 Hepatitis B/C 25.5%10.4%12.2% 2 HIV-AIDS 13.7%9.4%9.9% 3 Hepatitis B/C & HIV-AIDS 3.9%8.1%7.6% 4 STIs 5.9%4.2%4.4% 5 No Knowledge 51.0%68.0%66.0% Total 100.0% 10

Knowledge in Adolescent Girls About Prevention from STDs School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Knowledge in Adolescent Girls about Prevention from STDs 0 No 78.0%77.3%77.4% 1 Yes 22.0%22.7%22.6% Total 100.0% 11

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Guidance received by Adolescent Girls over Body Changes 0 No 33.3%17.4%19.3% 1 Yes 66.7%82.6%80.7% Total 100.0% 12 Guidance Received by Adolescent Girls over Body Changes

Stakeholders’ Perspective (Guidance Received by Adolescent Girls over Body Changes) 13  Teachers and mothers can play an important role of providing guidance to adolescent girls upon body changes and onset of puberty.  Discussion on adolescents’ health concerns at community and societal level is the major imperative to improve adolescent’s health general and reproductive health.

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Desire among Adolescent Girls to learn about STDs 0 No 43.1%10.4%14.3% 1 Yes 56.9%89.6%85.7% Total 100.0% 14 Desire Among Adolescent Girls to Learn about STDs

15 School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "What should be ideal age of marriage for men?" 1. Up till 20 years 8.5%10.0%9.8% years 63.8%64.7%64.6% years 19.1%17.6%17.8% 4.29 years and above 8.5%7.6%7.7% Total 100.0% What Should be Ideal Age of Marriage for men?

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "What should be ideal age of marriage for women?" 1. Up till 20 years 52.3%45.2%46.2% years 47.7%48.3%48.2% years 3.1%2.7% 4.29 years and above 3.4%3.0% Total 100.0% 16 What Should be Ideal Age of Marriage for men?

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "With whom do you share your health related issues?" 2 Mother 50.0%58.7%58.1% 4 Sister 26.9%8.6%10.0% 5 Relatives/ Cousins 11.5%7.3%7.6% 6 Friend 11.5%.3%1.2% 7 Teacher 25.1%23.2% Total 100.0% 17 With whom do you share your health related issues?

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Are girls allowed to eat together in their families?" 0 No 39.2%12.5%15.7% 1 Yes 60.8%87.5%84.3% Total 100.0% 18 Are girls allowed to eat together in their families

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Are boys preferred over girls on special occasions?" 0 No 43.1%4.5%9.0% 1 Yes 56.9%95.5%91.0% Total 100.0% 19 Are boys preferred over girls on special occasions

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Attitude of Adolesce nt Girls on the onset of Puberty 1 Nervous 54.9%40.4%42.1% 2 Shy 31.4%20.3%21.6% 3 Comfortable 13.7%39.3%36.3% Total 100.0% 20 Attitude of adolescent girls on the onset of puberty

Stakeholders’ Perspective (EDO-Health) Attitude of adolescent girls on the onset of puberty 21  Complications faced by the adolescent girls e.g. painful periods, irregular periods and infections, exist due to the fact that majority of the adolescent girls have no means to get awareness on body changes

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Do adolescent girls enjoy freedom over choice of spouse?" 0 No 68.0%50.4%52.4% 1 Yes 32.0%49.6%47.6% Total 100.0% 22 Do Adolescent Girls enjoy Freedom of Spouse

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Do adolescent girls enjoy freedom to choose a profession?" 0 No 62.7%72.7%71.5% 1 Yes 37.3%27.3%28.5% Total 100.0% 23 Do Adolescent Girls enjoy Freedom to Choose a profession

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Do adolescent girls enjoy freedom to choose a friend?" 0 No 48.0%72.7%69.8% 1 Yes 52.0%27.3%30.2% Total 100.0% 24 Do Adolescent Girls enjoy Freedom to Choose a Friend

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Do adolescent girls enjoy freedom to choose type/field of education?" 0 No 62.7%69.8%69.0% 1 Yes 37.3%30.2%31.0% Total 100.0% 25 Do Adolescent Girls enjoy Freedom to Choose type/field of education

26 Stakeholders’ Perspective Do Adolescent Girls enjoy Freedom to Choose type/field of education  School Management Committees are sensitizing the parents through community meetings about women’s right to education and its link with social and economic development of their respective families.  SMCs are taking care of school buildings, furniture and other requirements of the students

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Impact of Reaction to Body Changes on School Attendance 0 No 31.9%42.3%41.1% 1 Yes 68.1%57.7%58.9% Total 100.0% 27 Impact of Reaction to Body Changes on School Attendance

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "In girls opinion, should men have a role in household chores?" 0 No 49.0%10.4%15.0% 1 Yes 51.0%89.6%85.0% Total 100.0% 28 In Girls’ Opinion, Should Men Have a Role in Household Chores

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total "Why girls oppose any role for men in household chores?" 1 Social/Traditio nal 43.1%35.7%36.6% 2 Psychological 21.6%20.8%20.9% 3 Religious 35.3%43.5%42.5% Total 100.0% 29 Why girls oppose any role for men in household chores

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Perceptions among Adolescent Girls about Personality weaknesses 1 Lack of Self Awareness 45.1%48.2%47.8% 2 Lack of Decision Making/Probl em Solving 19.6%20.3%20.2% 3 Lack of Creative and Critical thinking 33.3%27.1%27.8% 4 Lack of communicati on and interpersonal skills 2.0%4.4%4.1% Total 100.0% 30 Perception among adolescent girls

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Preferred Strategies of Adolescent Girls to Support their Families 1 Counseling/Aware ness about rights, education and health 28.0%32.6%32.1% 2 Economic/Financi al Assistance 52.0%47.2%47.8% 3 Assistance in Household chores 20.0%20.2%20.1% Total 100.0% 31 District Distribution-Gujranwala

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Demand amongst Adolescent Girls for Counseling in Marital Affairs 0 No 23.5%14.6%15.6% 1 Yes 76.5%85.4%84.4% Total 100.0% 32 Demand amongst adolescent girls for counseling in marital affairs

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Demand amongst Adolescent Girls for Training in Budget Preparation 0 No 27.5%24.0%24.4% 1 Yes 72.5%76.0%75.6% Total 100.0% 33 Demand amongst adolescent girls for training in budget preparation

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Demand amongst Adolescent girls for Guidance/ Counseling in Family Planning 0 No 39.2%33.3%34.0% 1 Yes 60.8%66.7%66.0% Total 100.0% 34 Demand Amongst Adolescent Girls for Guidance/Counseling in Family Planning

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Demand amongst Adolescent Girls for Training in Upbringing Children 0 No 39.2%33.3%34.0% 1 Yes 60.8%66.7%66.0% Total 100.0% 35 Demand amongst adolescent girls for training in Upbringing Children

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Desired Level of Education amongst Adolescent Girls 1 Matric 41.2%10.7%14.3% 2 FA 19.6%16.2%16.6% 3 BA 21.6%21.9% 4 MA 17.6%51.2%47.2% Total 100.0% 36 Desired Level of Education Amongst Adolescent Girls

School Status of Respondents in terms of School Going 0 Not School Going 1 School Going Total Desirable Career Choices for Adolescent Girls 1 Teacher 72.5%22.7%28.5% 2 Doctor 18.5%16.3% 3 Nurse 2.0%10.2%9.2% 4 Business 7.8%46.9%42.3% 5 Educated Mother 17.6%1.8%3.7% Total 100.0% 37 Desired Career for Adolescent Girls

World Population Foundation Pakistan SUMMARY Stakeholders’ Perspective: Adolescents’ Health and Education

In-Depth Interviews with District Education Officials 39 Policies and Practical Measures—Education:  Provision of stipends and free text books.  Monitoring and evaluation mechanism to ensure that the females belonging to the downtrodden families get benefit from the stipend and are able to get education.  Consultation dialogues with teachers’ associations, SMCs, NGOs.  SMCs are sensitizing the parents through community meetings about women’s right to education and its link with social and economic development of their respective families

In-Depth Interviews with District Education Officials 40 Major Reasons Female Drop-Out:  Socio-Cultural taboos  Location of schools in remote areas  Fee charges required for appearing in examination of Board of Intermediate and Secondary Education  Sexual harassment and the fear of tendency of girls’ involvement in males.  Social mobility, lack of transportation and road teasing

In-Depth Interviews with District Health Officials 41  Health department works closely with population and education department (e.g. polio vaccination etc.)  Although the number of Basic Health Units have increased over the past few years, however, the necessary arrangements e.g. medicines, availability of doctors in rural areas have yet to be worked on.  The large number of human resource of lady health visitors can effectively be used to address adolescents’ health issues at community level.