he day I got my first period is a horrible memory. I was in fifth grade when I suddenly started bleeding at school. I had no idea what it was or why it was happening. When my mother saw the bloodstains on my white uniform, she started crying and locked me in a room without an explanation. I was an only daughter with two older brothers. There was no one to tell me what was going on. My mother gave me the necessary supplies and told me not to say anything to my brothers or father, as if I had committed a sin,” says Manahil Sarfraz, a media student. “Even now, I’m forced to pretend I’m fasting during Ramazan when I’m on my period,” she says.

Despite this large adolescent population, discussions on reproductive health, particularly menstruation, remain highly discouraged in Pakistan. Pakistani adolescents, especially girls, have poor access to education and health services related to puberty. This leads to low self-esteem and insufficient knowledge about the physiological changes they experience.

Menstruation has significant implications for the legal and social status of girls. Under the law, the onset of menstruation marks a girl’s transition to adulthood, making her subject to legal consequences for sexual activities. Culturally, menarche often signals the imposition of seclusion and other social restrictions. The silence surrounding menstruation persists across all social settings, reflecting deep-seated taboos that hinder open discussions about reproductive health.

A report published by the Sustainable Social Development Organisation, Addressing Mensuration Taboo Among Adolescent Girls in District Rawalpindi highlights that many girls in Rawalpindi still have limited knowledge about menstruation, with some viewing it as a ‘disease’ or ‘weakness.’ The school curriculum does not adequately address menstrual health, leaving girls unprepared for proper hygiene management. Misconceptions are widespread, with some girls linking menstruation to a woman’s character and others seeing it as something unclean or shameful.

“Reaching out to the girls was challenging, initially. Many were hesitant and uncomfortable discussing menstruation. However, the SSDO used creative methods to make them feel at ease. By allowing the girls to share their thoughts anonymously by writing on paper airplanes, we ensured they could express themselves without fear of judgment,” says Maryam Nawaz, a program director at the SSDO.

Asifa Jamali, a behavior change communication officer, says, “In Balochistan, menstrual health and hygiene management (MHM) is a deeply taboo subject, especially in rural areas. Women and girls are often reluctant to discuss menstruation. This leads to serious health issues. Despite efforts to raise awareness, the situation remains challenging, particularly in rural regions. Even after numerous MHM sessions involving girls and their mothers, they still feel too shy to discuss menstruation openly.”

Addressing menstrual health is crucial not only for the well-being of adolescents but also for promoting gender equality in education and challenging societal norms.

Menstrual health among adolescents in Pakistan is a complex issue, influenced by shifting social, cultural and economic factors. There is a significant gap in comprehensive menstrual health education, particularly in rural areas and marginalised urban communities. This lack of education contributes to misconceptions and poor hygiene practices, posing serious health risks such as reproductive and urinary tract infections. Addressing menstrual health is crucial not only for the well-being of adolescents but also for promoting gender equality in education and challenging societal norms.

Uzma Yaqoob, an Aurat March organiser, tells The News on Sunday, “the stigma associated with women having control over their bodies is not limited to curtailing their participation in political, social, cultural and economic settings. It also includes denying women the power to manage their reproductive health. Attaching stigma and shame to menstruation and discouraging discussions or seeking menstrual health care is yet another way to control women’s bodies and autonomy.”

Menstruation is perceived as a private matter, not to be discussed openly. Due to this notion of secrecy, adolescent girls often lack accurate knowledge and awareness regarding menstruation. Studies indicate that many girls are unaware of menstruation before their first period, associating it with anxiety, fear and depression. The situation is worse for girls who are not enrolled in school, as their avenues for obtaining knowledge are even more limited. There is a belief among some communities that menstruation marks the transition from girlhood to womanhood, shifting the focus from education to marriage.

Dr Zari Ashraf, a gynaecologist from south Punjab, says, “Social media has become a source of awareness, especially in cities, but the situation in rural areas is dire. I’ve conducted many camps in rural areas and found that girls still lack information about their bodily changes. The first bleeding scares them, as they think something is wrong with their bodies. Many myths surround menstruation. Some consider mensuration a ‘dirty’ thing that could affect other family members, so the girls are not allowed to go to the kitchen, cook food, sit near their family members, etc. Some mothers don’t teach their daughters about hygiene. Many can’t afford sanitary pads, so poor hygiene leads to health issues.”

“Talking about menstruation is still taboo,” says Amna, a university student. “Some boys in the university tease girls with words like ‘period’ and ‘Always.’ I find it irritating. Menstruation is a natural body change, part of puberty. Boys also go through puberty, but girls never shame them for it.”

Male behaviour towards menstruation too is often informed by a lack of understanding of the very real, physio-psychological impact of it on women. Most men know that for some days in a month, women get to bleed but do not relies that it can be painful and cause emotional changes. This lack of information and the socio-cultural aspects prohibit discussion.

“If proper information is disseminated, women can better support themselves and other women during menstrual days,” says Dr Aisha Laraib, founder of Conversation for Change, an NGO.

The writer is an investigative freelance journalist contributing to national and international news media outlets