Insights

A grade six student at a Government Girls School in District Buner, Khyber Pakhtunkhwa experienced her first period in the classroom. Unaware of what was happening to her, she remained seated in her seat all day long and started crying when it was time to go home. One of her friends informed the class teacher about her situation, who immediately rushed to her help and inquired after her. The girl had no idea what was happening to her and why. This is a situation faced by hundreds of girls in the remote areas of District Buner in the north of Khyber Pakhtunkhwa (KP), Pakistan. The deep-rooted cultural taboos and social norms around menstruation in the area prevent open discussion or even basic knowledge about menstrual health management (MHM). While the topic remains a taboo for fathers, even mothers feel shy and hesitant to share vital knowledge about MHM with their daughters. The fear and embarrassment around the topic deter girls and even their teachers from discussing it openly, leading to most information on the topic coming from informal sources, siblings, or friends. The lack of awareness has adverse effects on the health and education of these girls and contributes to increased dropouts and poor attendance.

The USAID-funded New Partnerships Initiative (NPI) EXPAND Human Development Activity (HDA) is implemented in Pakistan by Palladium to advance access to quality education, family planning, and health services in KP, Pakistan. NPI EXPAND HDA builds linkages with education and health departments, helps reduce drop-out rates, and supports improved educational performance through its partners.

The Adolescent Girls Awareness on Health (AGAH) campaign in Tehsil Gagra, District Buner was launched by NPI EXPAND HDA’s partner Human Development Foundation (HDF) in March 2023. The campaign focused on improving the understanding of menstrual hygiene management (MHM) among adolescent girls. Designed as a behavior change communication campaign, AGAH, an Urdu language word for awareness, took a multi-faceted approach to address the stigmas around MHM. This comprised of the development and screening of an animated video, awareness sessions, radio broadcasts, and the distribution of a health and hygiene booklet to address questions and confusions about MHM.

Before implementing the full-scale activities in the field, HDF conducted a pilot testing of the campaign with 139 adolescent girls at three government schools in District Buner. The pilot testing assessed the girls’ existing knowledge around MHM, screened the animated video, generated discussions around MHM, and gathered feedback from the target audience on the awareness sessions. The findings of the pilot testing revealed that although some girls have a basic knowledge of menstruation, a lot of myths and taboos surround this knowledge. The animated video was deemed engaging and informative by the students. The teachers also found the video to be culturally sensitive and appropriate in disseminating information about an already sensitive topic for the region.

Using knowledge as a catalyst of change, HDF implemented the AGAH campaign in 18 middle, secondary, and higher secondary government schools in District Buner. 2,890 adolescent girls were equipped with vital knowledge around MHM and provided with an opportunity for open discussions on the topic. As an initiative to sustain the AGAH campaign’s interventions, 298 teachers belonging to the target schools were trained as master trainers on the screening of animated awareness video on MHM. These teachers were instructed to train more of their colleagues on MHM at their respective schools and to spread awareness around the topic to adolescent girls joining their classrooms. The engagement of teachers aimed to create a ripple effect around MHM awareness in the target schools.

The MHM sessions were helpful in transforming hygiene practices. For instance, many girls had been using cloth as menstrual absorbents and were unaware that it needed to be changed every 3-4 hours for hygiene purposes until the session provided this crucial information. The campaign also addressed dietary myths, emphasizing the importance of a healthy and balanced diet during menstruation. This included debunking misconceptions about avoiding certain foods during periods. Girls were encouraged to continue their regular bathing routines (against the myth to avoid bathing during menstruation) and use suitable hygiene products, ensuring comfort and cleanliness during menstruation. The campaign also helped the girls to identify their medical issues related to menstruation, such as irregular cycles and iron deficiencies. Girls with medical issues were referred to healthcare professionals for further care.

The response to the AGAH campaign remained overwhelmingly positive from both the teachers and the students. The AGAH campaign broke the taboos and opened discussions around menstruation. The girls gained knowledge and became advocates of MHM, and the teachers expressed confidence that the campaign has had a positive impact on the girls. Additionally, teachers shared examples of how girls have approached them following the MHM awareness sessions and discussed their issues, clearly considering the school a safe space for their queries around MHM. In focus group discussions following the campaign, the girls who attended these sessions agreed that age-appropriate and timely information around MHM is crucial. They emphasized the need to educate mothers on the importance of this information and for more open discussions on the topic.

The campaign took a two-pronged sustainability approach where at one end teachers were trained to continue spreading awareness at individual level, while at the other end the Department of Education (DOE) was made an active stakeholder of the campaign through the review and approval of the animated awareness video for screening at the government schools. The HDF provided the training modules, resources, awareness brochures, and animated videos as resources to the DOE. The district education officer, on behalf of the DOE, formally wrote a letter to all the government schools in Tehsil Gagra, District Buner, directing the teachers trained by the HDF to conduct biannual MHM awareness sessions for adolescent girls at their schools. The schools were also directed to use the training modules developed and provided by the HDF and to share reports of these sessions with the DOE. The letter highlights how the AGAH campaign successfully garnered government endorsement on a topic still regarded as taboo in the community and ended up creating a sustained source and mechanism for awareness around MHM in the district.

The AGAH campaign highlights that education and awareness can empower and improve the lives of adolescent girls through access to basic information around MHM. By gaining the government’s trust, providing these young girls with knowledge, and breaking the silence surrounding menstruation, the AGAH campaign has paved the way for better health, education, and overall well-being of girls in District Buner.