This month, the UN General Assembly was back in session in New York City, with the massive traffic gridlock we had happily forgotten during the pandemic. Many feminist friends and activists were in town. I was especially pleased to sit down with the brilliant Sheena Hadi, the Executive Director of Aahung, an organization based in Karachi, Pakistan that works to advance the sexual and reproductive health and rights of men, women and adolescents in the country.
Aahung’s mission is a brave and ambitious goal, given the complex context of Pakistan. Speaking frankly about bodily autonomy and gender equality—to children no less!—in a conservative religious environment is fraught (as Texans can attest). Pakistan registers at the low end of the UN Human Development Index and the UN Gender Inequality Index, with low female workforce participation, low use of modern contraceptives, and low female representation in electedoffice. Pakistan also has one of the lowest literacy rates in the world for men and women alike (62%), with only 50% of women able to read and write. Pakistan’s powerful military and wealthy landowning families control much of the economy to serve their needs, and the 30-year International Monetary Fund policy of tying its loans to severe cuts in government services such as health, railways and education has further hampered the country’s ability to set policy priorities and develop. To make matters worse, Pakistan, which hascontributed at most 1% of all global carbon emissions, has been devastated since August by catastrophic floods covering a third of the country, mostly in Sindh province, displacing an astonishing 33 million people.
Yet Pakistan has many assets: it is youthful (35% of the population is aged 0-14), has a rich history and culture, as well as a (still) free press and independent judiciary. It is at once beautiful, vibrant, chaotic and energizing. I was charmed by its people, and challenged by its contradictions and injustices when I visited in November 2017.
Despite this context (or maybe because of it), Aahung (founded in 1995) and Sheena (Executive Director since 2008) persist in their work. They have achieved remarkable outcomes over the years, based on their strategic sense of what is possible and their deep knowledge of local conditions. Aahung has become the reference organization in Pakistan on teaching children life skills in and out of schools, and training medical students on sexual and reproductive health and rights. In 2018, Aahung reached agreements with the education authorities in two provinces of Pakistan, Sindh and Balochistan (a combined population of 60 million people), to begin the integration of their life skills curriculum in public schools.
I spoke with Sheena on September 22, 2022, in New York. I edited the conversation for the purpose of brevity, and added a few clarifying comments in brackets.
FG: Sheena, it’s so great to see you again. Before we start, are your family and staff safe from the floods?
SH: Yes, yes, they are. But we have a lot of partners we are very concerned about, because the majority of our work is in interior Sindh.
FG: We will get back to this terrible subject, but I want to speak about the longstanding work of Aahung first. Your Life Skills Basic Education (LSBE) program, which might be called comprehensive sexuality education (CSE) elsewhere, is, by your own account, rights-based and focused on gender equality. Could you explain what that entails, what’s the approach?
SH: It might be called comprehensive sexuality education elsewhere, although I don’t think we’ve gotten to the “comprehensive” part, and we’ve got to be transparent about that. The basic approach of life skills is really looking at the child or the young person as someone who is in need of information about their body, about relationships, about their social environment, and the skills they need to navigate that, to make better decisions about their health, who their friends are, what their relationships look like, how they can resist violence and pressure. When they need to seek help, where do they go for that? The more I think about what we’re doing with life skills or CSE… it’s really about the well-being, mental health, social health of the young person. And it started with adolescents and we’ve expanded it to the earlier years because we realized that with adolescents it was often “too little, too late”.
If you don’t have a connection with your body, and you don’t know what’s happening when you’re going through puberty, and you don’t recognize violence for what it is, how can we say that someone is well? If you can never speak about pleasure, or about consent, how can you be in a positive place? It has so much less to do with just “sex ed,” and so much more to do with holistic development.
FG: Are you saying your entry point is well-being and rights, rather than a focus on sex and the consequences of sex?
SH: Yes. For starters, it’s not like we’re talking with five and six-year-olds about sex. But we are talking to them about consent, through play. When a friend says no, or when you don’t like the way someone touches you or handles you, how do you start to vocalize that? And that, ultimately, has a lot to do with sex later on! but that’s not what we’re talking to children about, or even necessarily adolescents. We can’t talk that freely about sexual behavior in Pakistan, right? But a lot of what we do is really the foundation.
FG: And when you say you are not fully comprehensive, what is it that you can’t freely talk about?
SH: A big emphasis of what we talk about is on gender, and what gender-transformative means. We look at how the life of a girl or the life of a boy is shaped very differently, particularly in very patriarchal societies like Pakistan. We can do a lot with that. We can also talk about puberty and development, health issues. For example, we talk about child marriage and forced marriage, about gender-based violence. But when we get to the actual sexual behaviors, that becomes very challenging in schools. For example, talking about contraception, sexual diversity [LGBTQ issues], which is still very stigmatized. So, we haven’t been able to get to that comprehensive part yet. Out of school, yes, when we have adolescent groups we work with, we do. And we’re trying to find ways to create safe spaces digitally, so that there are places where young people can go to, where these conversations can happen, where they feel safe and get answers to their questions. But in schools, we’ve not been able to do that yet.
But that doesn’t mean we are not able to figure out how to do some of the foundational work. Why is sexual diversity a problem? It is because we were not willing to accept anything that’s “the other,” right? So even, if you can get that across, if you can get this concept of acceptance and inclusion across… it’s just expanding the understanding by the young person, that I’m not going to ostracize or stigmatize. If I feel there is something that’s different about me, it’s not necessarily immoral or bad. That’s the stepping stone, and then we find other ways to speak about it more specifically, in other contexts.
FG: Connect the dots elsewhere, or support the young person to connect the dots themselves, right?
FG: When the pandemic began in 2020, you were, at that point, rolling out the LSBE curriculum in public schools on a fairly large scale. Can you go back to 2018-2019, and tell me what happened then, that made this momentous development possible?
SH: Well, that work had been slowly unfolding since 2005, when we started moving into schools. And there were a lot of barriers. But we were chipping away, adding five [schools], adding ten pilot schools. Usually because something had happened in the school they needed to address. We were taking those models, evaluating them, to see what the outcomes were. And continuing to add on. In 2010-2011, is when we first started talking to the provincial government of Sindh about this, saying we want to scale up, and we have the evidence for that… But the first set of pilot studies in 2010 got shut down because of the floods that happened that year. Not as bad as those today, but still. In 2013, we started talking to the government again, and again, some pilot studies were started.
That was when the backlash happened… We got stuck in a political battle over the work. The political party [in power] that signed off on doing the work with the schools, there was a right-wing political party [in opposition] that got wind of that, and used that to say: “Look, they’re promoting sex education.” Absolutely fake news. The topics we were supposed to be teaching, which were never there… all fake news.
So again, we stopped [chuckles]. And at that point we thought, this is going to be a waste of time and money, because the government is going to keep pulling back. So, we did this extensive mapping exercise to look at who are we really talking to, who are the champions in the system that are going to stay, how do we keep communication lines open with them, how do we build a friends and supporters network so the next time we know who to call, who in the media can stand up for us, talk about us?
And that’s when we realized that we were doing curricular change all wrong. Really! [laughter]. We had produced all this material and handed it to the government: “This should be taught…” but when we went into the depths of how the Education Department really works, down to who is making the plates in the textbook mill where they are printing the textbooks, who tells them what needs to happen and how? We realized [LSBE] is not going to be this additional topic that’s going to be taught. We realized that instead, we had to develop a whole framework, to be integrated into the curriculum. And so, we spent two years, going through every single textbook from grades 6 to 9, every subject, and looking at every place that could accommodate life skills. For example, there was already a chapter on human rights in the Grade 6 social studies syllabus. Taking that and saying: “That’s our entry point.” This is where we break it down, explain what human rights are, how do we tie that to bodily integrity?That’s really what we did, across the entire curriculum.
SH: And also looking at content we really wanted removed. There was a lot of gendered [sexist] content that had to go or be replaced. And all that took us about two years.
FG: So, it was a complete rethinking of what was taught to young people?
SH: Yes. And there was another reason for doing that, which is, if it’s a subject that’s added, it’s a subject that’s easily removed. If it’s integrated, you can’t take it out so easily.
And then in 2018, we had this case that went global, an 8-year-old girl called Zainab, who was raped and murdered [by a neighbor] in Punjab [province of Pakistan]. It was a social media frenzy, in the news non-stop. That became the entry point to put some pressure on the government to respond. And to say that it’s not going to happen through protection policies, it’s going to happen through awareness-raising [about sexual violence] for children and families. And because we had everything ready, we’d gone through all that background work, the process was really quick then. The Chief Minister [of Sindh] said: “Of course, it’s got to happen quickly, let’s do this! Why have we been sitting on this for the last ten years?” And so, we got the Memorandum of Understanding and the content approved, and officially put it into the provincial curriculum in Sindh. And we also got interest from Balochistan, and signed a memorandum with them as well.
Now the tricky point was getting from that point of leadership approval, to what happens after that. All the steps that come after that. That’s when we got caught again in the pushback of those who didn’t want to approve it. Opening a textbook and finding content missing, and trying to figure out what happened? Nobody knows. Was a plate removed during printing? We don’t know. So, we say that we got about 50 to 60 percent in that we wanted. And we are still doing the advocacy work around the remaining 50 percent. And at that point, COVID came and schools shut down. Government schools were shut down for at least a full year. Many went online, as best they could, but we don’t have the technological capacity to do this well in Pakistan, so a lot of schooling was lost too.
FG: What persistence! It’s incredible. Given what’s already gone in, can you already monitor to see whether that content is making a difference for young people?
SH: No... That’s the eternal push and pull between quality and scale. In 2019, we trained an enormous number of teachers. We trained 450 master trainers ourselves in Sindh province, in tandem with the Provincial Institute of Teacher Education…
FG: That’s huge!
SH: It was huge, it was exhausting! It maxed out our human resources [laughs], and then the trickle down happened to 7,000 teachers. But then, how do you know where those teachers are, when they’re teaching, who’s in the classroom, that’s a whole other thing. Our advocacy point in this is: we’ve got to get this training into the teacher prep work, pre-service [in teachers’ college]. That’s also our approach with medical students. Doing this later on, you have to undo too much. Doing this training pre-service, you get more sensitive teachers, more communicative, and also able to push back on this ridiculous system of rote learning we are still using. Even that helps kids, with critical thinking, analytical thought.
We haven’t figured out exactly how to monitor that kind of scale. Working with partners who have more reach, or tap into technology with feedback coming directly from students? Those are options.
FG: What aspects of this curriculum that made it in, do you feel might be most impactful for adolescent girls?
SH: The gender content. Just the idea that there is gender and [biological] sex, and that those are two different things. That gender is a social construct, and all that comes with that. When we’re working on some of the skills, we’re also talking about gender. For example, for girls, “Do you get to make decisions? Who makes decisions for you?” The conversations about violence and harassment, what it means to feel safe and unsafe. And then some of the activities around how you create safety networks yourself. I know when we work on child sexual abuse with the younger age groups, one of the things we do is tell the children: “Name your three safe people that you can turn to if you feel in danger.” Because in the moment, there’s fear, there’s panic. But that’s why we practice fire drills, so you know where to go when you’re in a panic. If you are a girl and you are being harassed, what are the steps, beforehand? That can make a difference in their lives, going to school. Because the mentalhealth issues that come with every day feeling unsafe, feeling fear…
FG: You work with both boys and girls. How can you work with the boys, so they stop being the “oppressors”?
SH: It is hard, it is hard. I feel we need to do more. We need to do more concentrated work on power with boys. And we know, from around the world, that girls respond to CSE or LSBE more positively than boys do.
FG: And at an earlier age.
SH: At an earlier age. The girls “get it.” They want more of it. But of course, when we’re talking to boys and saying, this is the power given to you by society, and this is how we want you not to use it, and how we want you to redirect it and use it in a more positive way, that’s going to create some tension. And we have all these social factors bearing on them, this toxic masculinity, all this violence, all this sexual frustration coming in, all these myths and misconceptions about their bodies as well… It’s not that it can’t happen. It’s just that the approach has to be different. We have gravitated to working with girls—understandably, because that’s where the greatest vulnerability lies—but we do need to look more at how we can work with boys and with this issue of power. Not just gender. Power is really what we’re trying to address.
FG: And boys are also subject to that power—the power of masculinity, the expectations of being the tough guy, the provider, the man in control. That is very oppressive for young boys. But of course, as you say, they also have all the privileges that come with being male, so unpacking that is hard.
SG: Yes. Especially if you’ve grown up in conditions that are often violent. Even if you haven’t grown up with violence in the home, which you often do, it’s violence in the streets, around you, it’s violence amongst your friends. And that just becomes a way of life. It’s what you accept as normal. It’s the same way as for girls, accepting to be victims of violence becomes normalized, in some awful way. So, for boys, becoming perpetrators of violence becomes so normalized. Undoing that and getting boys to recognize how it’s beneficial to them to share that power and space and respect—that doesn’t necessarily come so easily and so quickly. That needs work.
FG: And does that require male role models and male teachers, or can it be done with female teachers?
SH: So, we actually have a lot of male teachers in the rural areas in Pakistan, because women are less able to move about and be teachers in rural areas. Getting them on board, getting community leaders on board, and also not doing this purely academically. So we’ve seen it really have an impact when we, for example, do drama with students, so they can act these things out, communicate them in different ways, a lot of that interactive learning, play-based learning, through sports. It can’t just be an academic type of learning.
FG: One of the issues young people might come to you with is abortion. Now it’s not as controversial in Pakistan as it is in other contexts, but still, how do you deal with that?
SH: Ah—well, abortion is interesting in Pakistan. It’s not a political issue like in the US. It’s an ethical issue, but it’s not a political issue. This gives us more flexibility to talk about it, especially since it’s happening on a large scale—it’s two million abortions a year, according to the Population Council, which is a lot. We can only make assumptions about why, because we haven’t done enough research to understand what is going on. But I think we can assume that modern contraceptive methods are not meeting the needs of women. Whether that’s an access issue, or a method issue, a choice issue, whatever it may be, it’s not doing what women want it to do. And we also know that because, on average, everybody wants one less child than they have. People want 3.1 children on average, and they have 4 on average. And we know that the way women are planning their families is through accessing abortion for unwanted pregnancies. And part of the reason we haven’t talked about it as much as we’d like to, is because there is this stigma on talking about abortion as a form of family planning.
FG: Is that stigma from Pakistan, or does that come from the international community?
SH: I think it’s more from the international community.
FG: Is it a US export? [the US right-wing has been driving the narrative that abortion is not a form of family planning since the 1970s, to block US federal funding for abortion services at home and abroad]
SH: Yes. And it’s just the reality that it is a form of family planning, and women turn to it for that. The role we at Aahung have played around abortion is to keep destigmatizing it—with medical students, with nurses, with doctors. We have run value clarification workshops. Our interest is that, if a woman goes to a doctor and asks for a safe abortion, it’s either provided with respect or a referral is made. That’s what we’re interested in. So that she doesn’t go and get it by some other [unsafe] means, because she will! And we know that the world over, right?
FG: Yes. And you can’t really talk about this in school, right?
SH: No, but out of school, yes. And we have referrals for call centers [for abortion services], that we keep circulating.
FG: Now, getting back to the floods… how are you coping?
SH: Our partner organizations in interior Sindh are trying to manage the situation. It’s overwhelming. I’ve been asked so many times on this trip: “How is everything in Pakistan?” and I don’t really know what to say, because even at the national level, we haven’t quite figured out what this means. The scale is not something I—and many others—have been able to really digest yet. Because there are so many ramifications. It’s not: the water will eventually recede and everyone can go home. No, because they don’t have homes, and their livelihood is gone, their crops are under water, their livestock is dead. We’ve had entire new lakes created in the interior [of the country] from this. Bridges and transport systems are gone. The rebuilding is one part of it, but the cycles of poverty that we’re going to see, and what that means across the board, is what is difficult to digest. And we were already struggling. It’s not like we were in a great place! There was already a lot of inflation, a lot of political and economic instability.
The way we’ve been thinking about it at Aahung is, everybody’s got to take pieces. There is no way anybody can figure out this problem entirely. So, if you’re a large humanitarian organization, you know what you’re doing right now. You’re setting up camps, you’re getting food and water, getting people to dry land… Our role is supporting partners who are calling out for certain things they’re seeing right now. For example, a partner lets us know they’re seeing a massive number of UTIs [urinary tract infections] right now, because there’s no clean water, and it’s extremely hot still. People are very dehydrated. So, we said, okay, we can do some training on UTIs and how to manage them. This kind of training for our partners on the ground that might not have that kind of expertise, but have field workers out there.
And then planning for phase two of this. We’re probably going to see schools permanently shut down in some areas. Many of them are just serving as shelters right now. How long that lasts, we don’t know. So, taking some of the LSBE programs out of schools, how we make sure they keep running, and how can they be tailored to the immediate needs right now? For example, menstrual health, the child marriages that are going to come out of this, that’s inevitable. How do we get into those things that we know, from previous disasters, are going to happen?
FG: Is this situation affecting adolescent girls particularly?
SH: Yes, yes. The main thing we saw when we were in flood-affected areas is that there are no sanitation facilities. This immediately raises questions of privacy, of violence. And everyone is in those shelters together, there are young girls, adolescent girls there. The chaos associated with that, that there are no clear boundaries—that is causing a lot of concern, because it obviously brings up the issue of violence against women and girls.
The other thing we’ve been trying to do is getting some of the relief organizations who perhaps don’t have a background in women’s health and rights, to recognize some of these complexities on the ground. For example, a large organization partnered with a corporation that makes menstrual pads. This is part of their relief kits for women. And I’m glad corporations are also involved, for sure. The problem is, the communities where they’re taking their pads to, don’t use menstrual pads, and have no experience with them. It’s just waste and thrown out as waste, with all the plastic and the packaging. Women and girls don’t want to use them. They use cloth. And so, perhaps clean cloth and detergent is the way to go there. And the menstrual pads, there are settlements in northern Karachi, which are more urbanized and perhaps have more experience with them. Mapping communities, understanding their needs, speaking to women and girls—that’s part of how you do the effective relief work. That’s where Aahung is able to contribute.
FG: Has the international community responded to this crisis?
SH: Sadly, not what anybody had hoped for. I’ve had colleagues in other parts of the world say to me, we’re having to dig out this information, search for it. Pakistan is not the main headline. And when you see the numbers, 33 million displaced people, it’s not on the scale of earthquakes and other disasters here or elsewhere. We’re talking about a seventh of the population of the country who are homeless. That hasn’t got the kind of coverage it needs. And this is also an opportunity to talk about climate justice happening in front of our eyes! Our glaciers are melting. It needs to be highlighted. Today it’s Pakistan, tomorrow elsewhere. I don’t know why it’s not a bigger deal than it is in the news.
FG: Does the fact that Pakistan is currently in a political crisis also play a part in that? That there is no clear voice coming from the government?
SH: Yes, definitely, it doesn’t help. There’s been a lot of internal unrest about the political transition [that took place in April]. And this political instability also causes a lot of mistrust. Even if the government was doing something right, there would be a lot of mistrust about it, because there are just too many enemies. I think civil society organizations, by and large, are pretty good about coming together, being able to figure out, “Well, I’m doing this, and what are you doing, where are you geographically and what’s needed?” And we actually have not been able to rely on the government to do that mapping and coordination for us. We’ve taken things into our own hands. We’ve seen, for example, that there are no contraceptives in one area, so a large reproductive health organization comes in and says, we can get contraceptives to that area.
And while you have a lot of banding together, of goodwill and support from private actors, civil society, individuals, who are doing fundraising, and going out there and doing what they can, that state-led intervention is missing. And at some point, when we talk about scale, it really has to come back to the state. There is only so much that private actors or civil society can do. Ultimately, it’s got to be the state that does this kind of planning and response. Frankly, we’re fed up with incompetence, with corruption, with disorganization.
FG: Going forward with Aahung—what does it take to keep doing this work in spite of the obstacles?
SH: We were asked this question the other day in a workshop, and many responses were: “Because it’s my passion...” My response was: “Well, because I am in a position where I can. And so, how do you not do it? It’s part of my fiber now. If you can do something, how do you not do it?! I don’t know how to not do it, anymore. That’s the thing [laughter].
And for me, it’s sometimes still about the small wins. It doesn’t always have to be about the thousands and the millions. There is the one life you impact. That keeps me going.
FG: What would be one of those stories, of one young person who came to you to say, thank you Aahung?
SH: Oh, we have so many! We recently had video conversations with girls. The stories weren’t: “I was being sold by my family, and you came in.” It’s not the savior stories, so dramatic! [laughter]. It’s a 12 or 13-year-old saying: “I don’t think that I’m unclean because I’m menstruating. Why shouldn’t I go places, and why should I be hiding in my room and not communicate with anybody? I should bathe — (because there is this myth that one shouldn’t bathe when one is menstruating). I owe that to myself.” These kinds of things—that’s going to impact the rest of your life! That means, when much more dramatic things are happening to you, you have that backbone, that self-esteem.
And of course, the more dramatic cases come as well. We’ve had a number of girls who’ve been pushed out of school, who go find that safe person, and they can come in and speak to the family and negotiate. But still, for me, it’s seeing that little spark pop up. It’s amazing.
FG: I remember when we went to visit one of the schools in Karachi, we met girls and their mothers. One of them was finishing her secondary course and was going to get married. Pretty young, still, and she said she learned so much with Aahung. For example, she learned what should go into a marriage contract, and that she shouldn’t give up her right to divorce, and that she should have the same rights in divorce as her husband. So, she asked her mother, “What is in your marriage contract?” And her mother said, “I ran to my room and looked, and saw that I had given up my right to divorce.”
SH: Right, it was scratched out.
FG: Yes. “And I made sure that when my daughter signs her contract, things are different.” Wow! Just that! If he’s abusive, she can divorce him without having to go through cumbersome procedures. That will make a difference in her life.
SH: Yes! And even with that example, there will be all this pushback. If she does try to divorce, there will be all these barriers, and the system will be against her, and all that. That’s all true. But if we don’t start with girls, with young people themselves―the center has to be about girls, their voices, empowering them.
Of course, it takes a whole additional environment. You can’t expect a 14-year-old girl to navigate these huge barriers, social, policy barriers by herself. But if we don’t start…
Also, just to talk about girls as rights holders is still such a novel thing. So far, in the mainstream development sector, it’s always: “Well, we do certain things for girls because we want an output. Let’s make sure girls don’t get married, because we want to decrease maternal mortality, improve our indicators, we don’t want infant mortality and would like to tick those boxes.” It’s not about the girl. Even in the education sector, why isn’t there a movement about girls’ education for their own sake? Instead, it’s always because “they’ll be better mothers, responsible community members, they’ll vaccinate their children, add to our GDP…” What about the girl just having a right to education?! There is that instrumentalist approach to everything that we do with girls! What if their output was just that they can realize whatever potential they have? And not to serve some state purpose.
FG: That’s the feminist perspective to education! It’s for us, for ourselves, because we are worth it, we deserve it, and have those rights.
SH: And it’s still, sadly, radical just to think in those terms, to think of girls as independent actors, with their own human rights.
FG: Yes [laughter]. Radical and beautiful, and a hundred percent what you believe in!
If you want to contribute to Aahung’s brilliant and bold work, you can make a donation in the US via the iCare platform (and get a US tax receipt) here
If you want to give to the humanitarian relief efforts for victims of the flood, the Karachi Relief Trust has been on the ground from the beginning. They are also on the iCare platform
In solidarity with the amazing team at Aahung, and the people, and especially the adolescent girls, of Pakistan,