Meet Ayesha Amin, the woman who’s challenging menstrual health stigma in Sindh, one baithak at a time
Growing up, like any other girl in Pakistan, I was told at a very young age to never say the words “period” or “menstruation” aloud in public. Shame and embarrassment surrounded every conversation I had about periods, something that is a regular occurence in the lives of half of our country’s population.
Whispering whenever the topic would come up, even among my friends with uteruses in school, I was always discouraged from having any meaningful or healthy conversation about menstrual health. Hiding pads, smuggling them to the washroom as if I was holding an illegal object and discreetly asking female classmates to check if there’s a stain on my shirt are some universally shared experiences for many women.
Slowly and gradually, I began unlearning my own discomfort around conversations regarding menstruation and started realising how important it is to openly and freely engage in discourse surrounding reproductive health and period poverty.
Period poverty is commonly understood as a lack of access to menstrual products, education, water, sanitation and hygiene (WASH) facilities, and waste management. Studies show that an estimated 500 million people are affected by period poverty globally. In Pakistan, inflation is at an all-time high, and there is a serious lack of awareness and sanitation facilities.
“In any gynaecologist’s clinic, 80 per cent of the issues are related to periods,” gynaecologist and writer Tahira Kazmi said. Despite it being it such a prevalent issue in our society, there is a dearth of resources and even conversations about it.
In a conversation with Images, Amin recalled how her journey began. She had always been interested in the field of reproductive health and switched from a corporate business background to pursue a masters in social policy at the University of Pennsylvania. “I remember a time when I was conducting research. Most of my research was around women’s access to sexual and reproductive health and rights in South Asia and I could not find enough data,” she said.
This pushed her to start doing focus groups upon her return to Pakistan, initially “just out of curiosity to learn more”. “So I started doing focus group discussions in my own community. I was born and raised in Kotri, Jamshoro.” Her mother working in public health as a doctor helped her in this regard. The curiosity to know more led her to arrange focus groups that then began to be referred as “baithaks”.
“It [baithak] is a very common word. If you see in grass-root communities, the idea is people coming together and sitting and it’s mostly men,” she said. “They meet in the evening and discuss political affairs, they discuss daily life. When women started calling these [focus groups] baithaks, they were transformed from focus group discussions into safe spaces.”
Amin used to be accompanied by her mother and sister-in-law since both of them are doctors. “We were having them at, let’s say, a lady health worker’s house, or a public school in the evening. This transformed from us just going there to understand their challenges to women asking questions since access to doctors is a huge issue in these communities.
“Their first question to you would be, ‘ap doctor hain? [are you a doctor?]’ and if you say yes, they will ask you so many questions about pregnancy about their health. So for example, you know, girls were asking questions around menstruation, around what we know as PCOS, they did not know what it is but they would ask about period irregularities. These [discussions] became safe spaces for women to come together.”
This is how Baithak started. “We felt there was a need [and] I was passionate about it. I came back with this intention to work in area,” she added.
Besides the main focus of Baithak on menstrual health, they work on family planning to let “women to know what what their options are when it comes to family planning” and where they can get help and services from etc. Their work on period poverty includes providing girls and women with ‘dignity’ kits and menstrual kits.
They also focus on climate and gender how the climate crisis impacts women. “During floods, we led drives in providing kits to girls and women.” She added that the policy around climate crisis response is gender-blind. “It does not account for the needs and challenges that girls and women go through during the floods or during climate [disasters].”
If you read the National Climate Change Policy of Pakistan, there is a very “vague” component of gender in it, Amin pointed out. It barely takes into account the nuanced ways the climate crisis furthers the marginalisation of women based on their gender and instead focuses on agricultural and livestock aspects.
The policy is more concerned with how their livelihood is impacted as many women work in the agricultural sector. Despite the UNFPA publishing a number of reports on how many women flood survivors are pregnant and need urgent attention, the country’s climate policy does not talk about reproductive health at all.
“Imagine, during the floods [there were] women who are pregnant, who lost their homes had to now give birth on roads, and many also also lost their children. Then they were going through postpartum depression in this setting,” she said.
Safety issue of women was another big problem that was completely overlooked in the policy. “We met so many women who were talking about their safety concerns. There were no bathrooms in the flood shelter or camps.” Given the shame and stigma around female bodies, girls had to wait the whole day to go and discreetly change their pads, or even pee in the dark, Amin added.
Then there were a number of cases of harassment and attacks. “We heard a lot about animal attacks during the night. This is because there were no bathrooms and they had to go out in the dark. These are very nuanced gender challenges that the climate crisis policy does not account for,” she said.
The floods worsened the already limited ways women in most parts of the country dealt with menstruation. For example, women who normally use a cloth instead of pads could wash and dry it after every use under normal circumstances. However, during the floods, the lack of clean water made it nearly impossible for them to wash the cloth properly. They were forced to wash the cloth in the stagnant (now dirty) rain water.
“Women had so many complaints about infections and rashes and then they could not go to a doctor in a medical camp and say we have rashes on our ‘private’ parts. That is again so stigmatised,” she lamented.
Pads versus pads
Last year when the floods came, a debate emerged on social media that whether pads should even be given to women in rural communities since that could go against their traditional practices. Many people, ironically living in cities and urban areas that were least affected by period poverty or floods, argued that since rural women are used to using cloth, it is useless to give them pads.
I brought this up with Amin to know what her take was. “I’m glad that you brought it up because this narrative affected the work we were doing. On social media, a lot of people were like ‘who are you to decide what is dignity for women?’ and ‘why are you imposing pads [on these women]?’ We did live sessions to share the ground realities with them.
“Our work is based on understanding the needs of girls and women as opposed to going and being like ‘ye lain pads lein [here, have some pads]’. Girls refused to take cloth from us because where would they wash it?” she said.
“This, of course, varied a lot across communities. Firstly, this narrative that rural women everywhere are the same is wrong. There is a lot of diversity. We have worked with communities that didn’t even use underwear. And there are some communities that exclusively use pads. Again, there is no data on this,” Amin shared.
“Based on our work for the past four years on menstrual equity, we learned that younger girls do not prefer using cloth because it is uncomfortable and their mothers prefer cloth because it has become a part of their lifestyle.”
In flood camps, there were no toilets. When you use a cloth, you have to wash it after every two hours, whereas you can use a pad for six to eight hours depending on your flow, she said. In the scorching heat at the camps, using cloth was also causing rashes. Washing and drying it was another issue.
“Women that only used kapra, we told them that ‘see, this is a pad, this is a cloth and this is a pad made up of cloth. You have the choice to use whichever one you prefer’ while also telling them the functionality of each,” she said. This helped the women to make an informed decision.
She recalled that women were not taking cloth or cloth pads because disposable pads made sense under those conditions. “I still have so many of them [cloth pads] left because they weren’t taking them.”
“Our work included teaching them how to use them too. We put them on underwears to show them,” she narrated before adding that it’s also not like every woman opted for pads. “It varied, but if you had seen the ground reality, no washroom, no water, no privacy… we asked them how they were washing their cloths and they would say they go during the night and put it to dry and then pick it up next morning before it gets bright. They were drying the cloth over bushes,” she said, hinting at the possibility of diseases.
Not only does this form of criticism hinder the work of Baithak and other NGOs, it also affects the kind of donations they receive. “Already, no one, gives money for pads. For example, if a person has to donate Rs10,000, they’d most likely want to donate for education or food. These are important issues, of course. But the thing is that menstrual products are also a necessity.
“The [criticism] affected our donations. People were asking why are you giving [pads]? We had to counter that narrative that no, the ground reality is very different,” Amin emphasised.
She narrated an incident that now humours her. Someone asked them why they were giving people disposable pads when they produce so much waste. She laughed and said, “Okay, we people that live in cities, we produce the most amount of waste, we contribute to the climate crisis. These people are taking the brunt of our lifestyles.” She said that in this vulnerable stage, a lot of misinformation and false narratives affected their work.
Talking about the P word
I wanted to know how Baithak talks to young girls and helps them overcome their hesitancy to talk about periods. “Initially, even we did not know how to talk about it right. So, we learned from the communities, the focus group discussions that we had. Our approach is to make it fun — destigmatise the whole idea. We have storytelling, “Once upon a period” is something we do. When you got your first period, where were you? How were you feeling?
“In these sessions, we have three generations present — daughter, mother and grandmother. And in many ways, all of their experiences are similar. So we tell them that see, in your generation, you were also afraid when you first got your period, your daughter was too. This means that there needs to be a change [and intervention],” she said.
Their sessions are “very reflection-based”. They have another interactive activity where participants play Chinese Whispers to illustrate how period myths are created. They do their best to not have a passive delivery and make it as engaging as possible.
“We also go back to these communities. We keep going back to the same communities and you can see the progress. The next time we go, new participants come and they tell us that they had heard [about us] from their friends or relatives since their communities are very closely knit.”
She said that it makes girls feel in control of their bodies and empowered. For example, their exercise to explain the menstrual cycle help girls understand why they feel certain emotions and pain at certain times of the month. “It makes sense to them,” she added.
It is interesting to note that most of the criticism they receive is from people who have access to health facilities and resources. “Unfortunately, all the criticism we get is from people who have access to social media. Women from communities [that they work with] really enjoy our sessions,” she said.
“We never tell them ‘okay, now talk to your brothers or fathers about periods’. It’s about having the choice of doing what you are comfortable doing. The idea is that at least talk to your daughter about it. Consult a gynaecologist, because going to one itself is considered a taboo. Our purpose is to help them make informed decisions,” she stressed.
It’s also not like women in these communities agree with everything. They do show reluctance about certain things such as period myths. Older women, she said, do say, “I did that and my periods stopped” but generally, she found them “receptive to listening”.
Funding is a huge problem according to Amin. “Everyone at Baithak, including me, works on a volunteer basis but the thing is that if we want to expand, which we are doing now, we need money to sustain it…I wouldn’t say no one wants to donate because people did donate during floods but most people do not want to donate for a cause they cannot relate to, when they think it’s not important.” In Pakistan, very few organisations would give grants for menstrual health, she said, it is difficult to receive funding from organisations as well.
Bringing men into the conversation
Last year, Baithak started a programme called Men for Menstruation that focuses on teaching young boys about how puberty impacts male presenting bodies. “It [the session] was such an amazing space. We had young boys and a male facilitator to talk to them about puberty and everything. We taught them about the menstrual cycle. There were also married men there.
“No one talks to boys about puberty. Since we work on gender based violence, and no one is talking to them about puberty and they have access to adult films, they have so many unrealistic expectations. We also see so much harassment and eve-teasing because no one is talking to boys when they reach a certain age and are going through so many hormonal changes,” Amin pointed out.
The major reflection they received from the male participants was that they always believed menstruation is just a process, but through the session they learned its more than that. “So they talked about how they can support their sisters, their mothers when they’re menstruating, you know? Like, during Ramazan, how women pretend to fast,” she added. This session took place in Karachi. They haven’t, so far, engaged men in grass-root communities yet but it is something they plan on doing in the future. They have a session planned for men in Umerkot in June.
Working with the communities instead of for them
They always have lady health workers or social workers — who are familiar with the space and people they are engaging with them. This is a key aspect of their work. For men too, it is very important for them to make the space as comfortable as possible for them to overcome the hesitancy, shame and stigma.
Language is another way for them to connect with their participants. The terms used in each locality vary and it’s crucial to talk in a manner that is accessible to the local communities. Since Amin and her mother speak Sindhi, it helps them communicate and interact with their participants.
“One thing is going there and telling them that you should do this and that. For example, even for pads, we never go to there and tell them that you should only use pads. We tell them if you use a pad, these are its health standards. If you use a cloth, then this is how can wash it.
“The idea is that, as activists or as grassroot organisations, our role should be to give them information and let them decide for themselves. You shift the power back to the communities. You trust the communities. You trust that they can make best decisions for themselves,” she emphasised.
The men that accompany the women in the local communities do imply to Baithak that “the women are jahil and uneducated” and the NGO should talk to the men instead.
This makes it paramount to bring women into the conversation and empower them to choose for themselves. “Women are very capable of making the decisions. OK fine, they’ve not had access to education but they have lived experiences,” she asserted. “Our job is to give information.
“Even when it comes to family planning,” she added, “If you look at the language used around it earlier, it used to be population control, now it’s called population management. Because when you say control, you come off as an authoritative figure like the government or an INGO that you have to do it. As opposed to saying these are your options, you will get so and so benefits of this, now make your own decision.”
When I asked how parents feel about sending their children to these sessions, she said that is a huge challenge. “There was this project we did about sexual and reproductive health and rights advocacy training. And there were girls who had to head back out because they did not want their families to know.”
When working within communities, the girls have their mothers present with them. “It is a very protective environment. There are mothers and lady health workers present. In schools, they take permission from the administration,” she said.
“But yes, in the training sessions, where young people sign up, whoever has the deciding power chooses [if they attend or not]. When we did M for M, we were expecting more participants because we were very excited for it, but the turn out was lesser than we expected.”
Speaking at the UN
When Baithak learned that this year’s theme at the Commission on the Status of Women (CSW) was innovation and technological change, and education in the digital age for achieving gender equality, they believed that this was something they are doing currently.
Baithak is working on AI-powered voice assistant called ‘Gul’. Its purpose is to educate people about menstruation and answer any questions they might have regarding it whenever they want. All one needs is access to the internet and to have an account on WhatsApp. Right now, Gul communicates in Urdu and Sindhi since these are the languages most spoken among the communities that Baithak works with. The name of the AI bot is gender neutral and can be found across languages and regions in the country, according to Amin.
“We manifested it [speaking at the UN],” she recalled. She’s a part of the 30 for 2030 Network — a network that comprises of gender equality champions driving dialogue, action and positive change. They nominated Amin for CSW and she was selected to speak at one of the formal sessions there.
She noted that it was important for Baithak to be represented there because they work with grassroot communities. When people talk about technology, groups that aren’t very tech savvy or don’t possess digital skills are often left out of the conversation. Their main purpose of being there was to take the voices of grassroot communities to the UN.
But with a huge platform also comes a huge responsibility, especially for Amin. She said that being able to talk at the UN on one hand expanded the opportunities the NGO gets but on the other, there was a responsibility on her to do well and bring funding and resources for her team and the communities she works with. “You owe it to your team […] and the communities. You feel ‘Now, I’m more responsible. I’m accountable to them. Now, I have to do something to make things easy for them,” she said.
One of the many people she learned from and was inspired by during her visit was a speaker that works on data. “I found that very interesting and exciting.” Since she has a background in social policy, she has alway been excited about how one can use data. This encouraged her to focus on collecting more data in Pakistan to design the NGO’s programmes. “Right now, there’s very little data available and there are inauthentic sources,” she explained. “That is something I am interested in exploring.”
Header image: Baithak/Instagram