SABINA FAIZ RASHID

Communicating with rural adolescents about sex education: experiences from BRAC, Bangladesh
Sabina Faiz Rashid

Background Despite conservative values in Bangladesh that condemn sexual activity outside of marriage, research indicates that about half of all young men in rural areas have had premarital sex. The figures are lower for women, who are subject to greater social control (Aziz & Maloney, 1985, cited in Caldwell & Pieris, 1999). Overall discussion and knowledge of sexual and reproductive health (SRH) remains at a low level, however, and inadequate education exacerbates an environment of misperceptions (Nahar et al., 1999a). Friends, older cousins, brothers and sisters are adolescents main sources of information, and they themselves are often ignorant about reproductive health matters. As a result, adolescents lack adequate knowledge and many engage in behaviour that put their SRH at risk. In 1995, the Bangladesh Rural Advancement Committee (BRAC) 1 set up an Adolescent Reproductive Health Education (ARHE) programme. BRAC provides ARHE classes through its Kishor Kishori (KK) schools, which are three-year schools for boys and girls over age 12 who have never before enrolled in school. Pupils come from poor socioeconomic backgrounds, and
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almost all have illiterate parents. BRAC also provides ARHE through pathaghars (community libraries) and government secondary schools. Separate classes for girls and boys are taught for an hour fortnightly in KK schools, and once a month in the pathaghars . Currently 803 schools and pathaghars teach ARHE to approximately 27 175 rural adolescents. The ARHE curriculum includes physical and mental changes during adolescence, physiology, pregnancy and childbearing, guidance about age at marriage, sexually transmitted infections (STIs), family planning, substance abuse, gender issues, male and female roles in reproduction, and violence against women and girls. In 1999, BRAC evaluated the impact of the ARHE programme in Nilphamari district. This article explores the perceptions of adolescents as they faced psychological and social changes, the programme results of ARHE, and the factors that influenced community acceptance of the programme.

Methods To evaluate the programme, researchers gathered qualitative data in three KK schools and two pathaghars in Nilphamari district. They selected

BRAC is one of the worlds largest indigenous NGOs. Established in 1972, it has three main integrated but distinct programme areas: education, micro-credit and health.

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this site because it had one of the longest-running ARHE programmes, having begun in 1995, and because it was one of the first to implement both phase 1 and phase 2 of the ARHE programme. 2 Respondents included young unmarried students aged 1315, parents, guardians and teachers. Researchers held eight focus group discussions (FGDs) with studentsfive FGDs with a total of 46 girls, and three FGDs with a total of 18 boys. The two extra FGDs for girls were needed as pathaghars have only female students in their ARHE classes. Researchers then conducted semistructured, open-ended interviews with 10 female students and 8 male students. The interview guide allowed various topics to emerge and be pursued. Male researchers interviewed the boys, and female researchers interviewed the girls. Interviewers were young since it was felt that girls and boys would be more likely to open up to someone closer to their age than they would to older interviewers. They carried out the interviews privately and individually to allow respondents to speak freely on sensitive topics. Researchers interviewed 18 parents and guardians, including mothers and in some cases aunts. They also held four FGDs with a total of 21 mothers and guardians, who had not previously been interviewed. Researchers held informal discussions with seven teachers and 16 programme staff. In addition, one researcher attended ARHE classes in order to observe the teaching style and the level of interaction between teachers and students.

found that the majority of girls did not know about menstruation before it began (Nahar et al., 1999b). Interviews confirmed that the onset of menstruation could be traumatic for girls. One girl said, I had my menses when I was 12 years old I was really very scared. I thought I was dying. Family planning was another popular topic with both girls and boys. Family planning is a sensitive subject that is rarely discussed between older women and unmarried girls in the traditional rural culture (Mita & Simmons, 1995). Boys said they particularly wanted information related to sex, including sexually transmitted infections (STIs)/ AIDS and family planning. Interviews suggested that those who attended ARHE classes became an important source of basic health knowledge for peers and family members. Girls shared their new knowledge with other girls in the village, after school and in the community library. One girl explained: We usually sit and talk together with the other girls in the village. That is when they ask me about what I am learning in class. One girl cameand I told her what I knowuse a clean cloth, wash it, and dont worry, it is naturalit is nothing to be scared of. Some girls also shared newly acquired knowledge on hygiene during menstruation with their mothers. One mother remarked, I am learning from her now. Other mothers knew about their daughters new knowledge without discussing it openly. One mother explained, I buy her soap as she said she needs to wash her things with itbut I dont say anything to herwhat is there to say? As long as she is learning all this, it is less worry for me. Girls tended to share family planning information with sisters-in-law and close friends. They said they had discussed STIs among themselves, but had not generally talked about the issue with adults.

Key findings Adolescent girls felt that menstruation was the most significant topic covered in the ARHE classes. In Bangladesh, menstruation is associated with sexuality, fertility and pollution. It is considered a shameful subject that girls rarely discuss, even with their mothers. A recent study

2 In the first phase the curricula emphasized primary health care education; this changed to an emphasis on reproductive health matters in phase 2.

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Adolescent boys also reported sharing what they had learned in ARHE classes with friends and male cousins. One boy described the eagerness of other boys who approached him for answers saying: When my friends found out I was learning all of this in the school they came and asked me a lot of questions like, how does a girl get pregnant? and why does menses [period] happen? I answered some of the questions, not all, as I dont know many of the answers. In general, the ARHE programme seems to have generated a new consciousness about reproductive health matters and broken the shame and silence surrounding girls and boys bodies. Nevertheless, the evaluation found that many adolescents who participated in ARHE still lacked knowledge of STIs, including HIV/AIDS. During FGDs it appeared that some adolescents saw AIDS as a potential threat to the community, but not to themselves. Almost all were aware of the link between unprotected sexual intercourse and STIs/AIDS, and almost all knew that condoms were an effective means of prevention. However, a majority of girls and boys appeared confused about transmission routes and symptoms of HIV/AIDS and other STIs. Both adolescents and teachers said that if a person were infected with HIV, she/he would show signs of illness. Adolescents reported that teachers preferred to focus on topics such as menstruation, early marriage and family planning, while skimming over STIs/HIV/AIDS. In part, this may reflect the shame that persists around reproductive health matters. More importantly, teachers acknowledged that their own knowledge was weak, and they blamed lack of detailed information in the curriculum. One important topic addressed during ARHE is early marriage. Although some adolescents said they wanted to choose their own marriage partners, many admitted that parents were the main decisionmakers. In Nilphamari district, many girls are married at age 1113 or younger. In one school, six out of 14 girls in the ARHE programme were already married, with two expecting their first child.
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According to the mothers, the main reason for early marriage is fear that their daughters would be raped, fall pregnant or elope. Knowledge that a girl has had premarital sex affects the social status of her entire family. Thus, families continue to practise early marriage, despite awareness of its detrimental effects on the health of girls and their babies. Many girls who participated in ARHE used their new knowledge to argue against early marriage. One girl implored her mother, S eethey are BRAC people and they say early marriage is bad. Some attitudes may be changing as parents realize the advantages of more schooling and the dangers of early pregnancy, but some mothers confided that they faced derogatory comments from community elders who said, your girl has become big now, you should get her married You are poor. What will she do with all this education? In this context, ARHE classes provide an opportunity for girls and boys to share feelings about love and romance that would have been considered unthinkable for previous generations. A common remark by girls was, Prem [love] is impure and we should marry who our parents have chosen for us. Doing prem is bad! Nonetheless, a number of adolescents said they had fallen in love secretly, in the hope of finding a partner to marry. However, these statements were always accompanied by remarks such as, There is nothing wrong with the prem as long as it is not bad prem [involving sex]. Good love was defined as leading to marriage, while impure love was defined as involving sex before marriage or a relationship that does not lead to marriage (even if it is pure). Though social norms are more relaxed for boys, they were still reluctant to share personal stories of romance with researchers. Some adolescents said that boys initiate relationships with girls through letters, and many described encounters influenced by films and television. As Pelto (1999) argues, since adolescents have few opportunities to practise heterosexual conversations, popular films provide inspiration. A few boys and girls went beyond letters

Communicating with rural adolescents about sex education: Bangladesh

and shared a kiss; one couple went into town to have a photograph taken of themselves; and another went to the cinema together. Most couples resorted to meeting secretly in the evenings, when it was dark and their families were asleep. Only a few girls and boys mentioned cases of prem with happy endings. Girls are particularly vulnerable to coercive and unsafe sexual intimacy. Many girls narratives centred on betrayal and punishment from village elders, jail and unmarried girls getting pregnant. Some centred on revenge, in which the girl was gang-raped, or had acid thrown on her face. Parents stories mirrored those of adolescents and were tinged with anxiety. As one parent said, What to do if they run off and do bad work? How will we show our face in the village? We worry about our girls! Adolescent girls spoke to researchers about their sexual desires, displaying unusual openness in a society that views women as good and pure if they are sexually passive and considers overt expressions of sexuality as shameful. One girl said, Both men and women have equal rights in the sexual relationship. If one wants to mix [have sex] then she can have pleasure from it, but if it is forced then one cannot enjoy it. Much of the language used by adolescents implied that young people are not fully responsible for their actions because they are driven by too much desire/ needs. Both girls and boys described uncontrollable urges that lead to extramarital activities, saying for example, Boys and girls get involved in sexual relations to meet their sexual needs. A number of boys admitted to masturbating regularly and saw it as something for j onno mithano (satisfying ones needs), in contrast to another study that found that boys considered masturbation a sin (Hashima-e-Nasreen et al., 1998). Some boys mentioned watching pornographic films with friends, saying, We feel good, and we sit and masturbate to satisfy our desires. Boys said that they would often rent a video player and watch the movies in the privacy

of a cousins or a friends room, or in village recreation centres. Interviews with boys suggested that this is quite a common practice. Some mothers complained about this practice in FGDs, but said they could not control their sons behaviour. In one FGD , a mother mentioned that she suspected that her son watched blue films with friends, saying, Sometimes I get angry and then they listen, but most of the time they do what they want. It appears from the FGDs that these women knew what their sons were up to but largely chose to ignore it. When asked whether her daughter watched blue films, the women looked horrified and the mother stated, They would never do such things. Boys appear aware that they have more sexual freedom than girls. While some felt that their behaviour was justified as they had more desires , many boys and girls said that girls share similar feelings, but due to social pressures ...even if she is bursting to say or do something, she will not do it. Researchers explored parents, teachers and community members acceptance of the ARHE programme. With increasing exposure to outside influences, many mothers worried that they were unable to control their adolescent boys and girls, and they felt that life skills and health education were important for their children. However, some mothers were unaware of the details of the ARHE curriculum. A majority thought that their children were being taught proiyojon (necessary) life skills to prepare them for the future, but did not know what these supposed life skills were. Boys tended to be too embarrassed to discuss sensitive subjects with their mothers, and a majority of girls discussed only the safer topics with their mothers. One adolescent explained, My parents dont really know in detail what we are being taught. We remain careful about what we say to them. Power relations also play a role. Most families of ARHE participants depend on BRAC to educate their children. One boy explained why his mother did not protest saying, She is scaredwhat if they ask me to leave the school? She doesnt want
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to anger the programme staff. Furthermore, some teachers come from rich families, with links to village authority figures. Many poor people feel uncomfortable questioning the authority of teachers, who are educated and have a higher social status. While female teachers said they have gradually become comfortable teaching ARHE to girls (saying it feels like a duty of an older sister), some are still uncomfortable about teaching boys. As a result, some teachers have held classes less frequently than BRAC guidelines require. When researchers raised this issue with two teachers, they admitted to having reservations about teaching sensitive subjects to boys. One commented, I cannot teach the boys all these things. I feel ashamed. And what will the community say if they find out?

To what extent will knowledge of reproductive health have a positive effect on their lives? This summary has been excerpted from an article that first appeared under the title Providing sex education to rural adolescents in Bangladesh: Experiences from BRAC, published in Gender and Development , 2000 (July) 8(2). Acknowledgements: I would like to thank my colleagues for their assistance during project design and data collection. I am grateful to my research colleague Nusrat Chowdhury and my husband Safi Rahman Khan for their useful comments and critical feedback. I would also like to thank my field researcher assistants, BRAC field office staff and the participants in the research for their time and patience.

References Conclusions In a strongly conservative environment, the ARHE programme provides adolescents with basic information on sexuality and reproductive health a major achievement. Community acceptance of the ARHE classes may reflect the growing urbanization of rural areas, the influence of electronic media, and increasing exposure to nongovernmental organizations such as BRAC. In addition, community involvement in the schools, power relations, uneven awareness of course content and the fact that ARHE teachers come from the community may also have helped build acceptance of ARHE by rural communities. Overall, this research highlights the importance and feasibility of ARHE in rural areas. The programme not only provides information to participating girls and boys, but also indirectly to other adolescents and adults in the villages. ARHE has broken the silence on sensitive topics. Future research needs to focus on what happens to programme participants when they marry. Will husband and wife decide on contraceptive methods together?
Caldwell BK, Pieris I (1999) Continued high-risk behaviour among Bangladeshi males. In: Caldwell JC, Caldwell P, Anarfi J, Awusabo-Asare K, Ntozi J, March J et al., eds. Resistances to Behavioural Change to Reduce HIV/AIDS in Predominantly Heterosexual Epidemics in Third World Countries. Canberra, Health Transition Centre. Hashima-e-Nasreen, Chowdhury M, Bhuiya A, Chowdhury S, Ahmed SM (1998) Integrating Reproductive and Sexual Health into a Grassroot Development Programme. Dhaka, Bangladesh Rural Advancement CommitteeInternational Centre for Diarrhoeal Diseases Research, Bangladesh. Mita R, Simmons R (1995) Diffusion of the culture of contraception: programme effects on young women in rural Bangladesh. Studies in Family Planning , 26(1):113. Nahar Q, Amin S, Sultan R, Nazrul H, Islam M, Kane TT et al. (1999a) Strategies to Meet the Health Needs of Adolescents: A Review. Operations Research Project, Health and Population Extension Division, Special Publications No. 91. Dhaka, International Centre for Diarrhoeal Diseases Research, Bangladesh.

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Communicating with rural adolescents about sex education: Bangladesh Nahar Q, Huq NL, Reza, M, Ahmed, F (1999b) Perceptions of Adolescents on Physical Changes During Puberty, ICDDR,B Working Paper. Dhaka, International Centre for Diarrhoeal Diseases Research, Bangladesh and Concerned Women for Family Development. Pelto PJ (1999) Sexuality and sexual behaviour: the current discourse. In: Pachauri S, Subramanian S, eds. Implementing a Reproductive Health Agenda in India: The Beginning. New Delhi, Population Council.

Sabina Faiz Rashid Research and Evaluation Division BRAC (Bangladesh Rural Advancement Committee) Mailing address: A23 Century Estate Bara Maghbazaar Dhaka 1217 Bangladesh

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