Becoming a Woman in Silence: Studies on preparedness for reproductive life of young women in Pakistan

摘要

Background: According to the cultural tradition in Pakistan, young women belonging to poor families shouldmarry shortly after menarche. However, existing data show that young people, especially women, are notprepared for sexual life and have poor knowledge about sexuality and reproductive health. Many of thedifficulties young women experience are related to beliefs and expectations in the society related to theirreproductive roles making them more vulnerable to reproductive ill health.Aim: The study explores the preparedness of young women for married life (communicating with spouse,initiation of sexual activity and child bearing) and ability to negotiate in marriage with spouse on number ofchildren to have and on contraceptive use.Methods: In order to obtain an in-depth understanding of young women’s lives qualitative and quantitativeapproaches were used. Three qualitative studies using narrative and content analysis were carried out in a slumsetting in the outskirts of Islamabad city in Pakistan. Married young women (I), unmarried young women (II) andparents (III) were selected with the help of a community worker. Young married women were interviewed threetimes at different occasions. Narrative structuring was used to explore how the participants represented theirsituation. In addition twenty qualitative interviews and three focus group discussions were conducted with youngunmarried women (II). Twenty-five parents participated in four gender specific focus group discussions (III).Content analysis was used for analysis of study II and III. For the quantitative study (IV), a subset of 1803married young women aged 15-24 years was drawn from a nationally representative adolescent and youth surveyconducted in Pakistan in 2001-2002 by the Population Council. Regression models were used for analysing thefollowing outcomes: reported agreement with spouse on the number of children to have, current use ofcontraceptives, intention to use contraceptives in the future and the time elapsed between marriage and the firstcontraceptive use. Key co-variates of interest were variables that measure the involvement of young women intheir marriage as having a say in selection of spouse, mobility outside the household, social role and decisionmaking in their homes.Results: The main theme in all the qualitative studies was ‘socialisation of young women into submissiveness’.For the married young women two themes were identified a) submissive-accepting andb) submissive-victims. The married young women who belonged to the accepting group lived under compromisedconditions but described themselves as satisfied with their situation. Women belonging to the victimized groupexperienced physical and verbal abuse for their inability to cope with the duties of a wife, caretaker of the homeand bearer of children. Their situation was compounded by the power dynamics within the household (I). For theunmarried young women the main theme identified was security lies in obedience. The two sub-themescontributing to the main theme were socialisation into submissiveness and transition into adulthood in silence(II). The theme and the sub-themes illustrate the situation of young women in a poor setting in Pakistan. The maintheme identified in the study with the parents was ‘Good parents’ strive to raise ‘innocent daughters’. The threesub-themes contributing to the main theme were: a daughter - a responsibility and a burden, social and sexualinnocence and parents’ roles in the preparation for marriage. The theme and the sub-themes illustrate how theparents saw themselves as responsible for raising ‘innocent daughters’ and arranging good marriages (III). Thequantitative study on the married young women showed that having a say in the selection of spouse at the time ofmarriage was significantly associated with agreeing with spouse over the number of children to have, intention touse contraceptives and the time between marriage and first contraceptive use. These relationships existed aftercontrolling for education, socioeconomic status, mobility outside of house and decision making in the home (IV).Conclusions: In a culture of silence around sexuality, young women’s socialisation into submissiveness lays thefoundation for the lack of control over their future reproductive health (I and II). The parents realised, though, thatbringing up daughters for marriage requires not only obedience, but also building confidence and knowledgeduring their childhood (III). Women who had decision making freedom in their parental home carried this abilitywith them into marriage in their new home and were better able to negotiate about their fertility (IV). Knowledgeabout reproductive life could prepare young women better for the future life and give them more control of theirfertility. Innovative interventions targeting women need to challenge current societal norms of womanhood topromote the upbringing of confident and knowledgeable young women.