In Afghanistan, Replacing Shame With Understanding on the Topic of Menstruation

Saina Hamidi, a psychological counsellor in Kabul, Afghanistan, says she was around nine years old when she first heard mention of women who bleed. Her older sister had come across one of their cousins washing bloodied clothes and told their mother about it. “I overheard my mother reprimand my sister for talking about it and tell her not to mention it to anyone else,” Hamidi recalled.

The message was clear, Hamidi added: “If we were to ever see it again, we should hide it.”

The tone of the conversation made Hamidi, now 24, believe that perhaps their cousin had done something shameful. “We both didn’t know what it really meant to bleed like that,” she said. “But between my sister and myself, we came to the conclusion that this probably happened to our cousin because she hadn’t been a good girl.” Neither Hamidi nor her sisters had any knowledge or access to information about the perfectly normal and expected physical changes their bodies were about to experience. In fact, they didn’t even know the word for menstruation or period, which in Afghanistan is referred to, on the rare occasion that it is mentioned at all, as zan marizi, which literally means “a woman’s illness.”

The experiences of Hamidi and her family are by no means isolated in this part of the world, where a prevailing pall of shame and dishonor still hovers over women’s puberty. Misinformation about the subject of women’s health and hygiene is widespread, and young women are nudged toward traditional — and often unhealthy — practices to cope with their biological development. These include everything from avoiding vegetables in the diet to not bathing for the duration of a period — a purported hedge against infertility. This, coupled with the lack of access to affordable hygiene products, has resulted not only in poor physical and mental health, but also in girls dropping out of school after they begin to menstruate.

In response, small but significant efforts to change these perceptions have recently taken root in Afghanistan. Most prominent among these is a campaign by the Ministry of Education with support from the United Nations to train teachers to help female students better understand and prepare for their periods.

“We started looking into this issue when we noticed an increasing number of girls remain absent for school across provinces,” said Mohammad Akbar Omarkhil, director of physical education and school health at the ministry. “Upon research we found out that, on average, girls from 5th to 12th grade missed about five days of school every month due to their periods.” Additionally, their findings showed that more than half of the girls were not aware of menstruation before their first period. They also revealed that 70 percent of girls did not bathe or shower during menstruation for fear of infertility, while some 80 percent were not allowed to attend social events such as weddings and funerals.

The ministry, along with the United Nations Children’s Fund (Unicef), have now created a set of guidelines to help the teachers talk about menstruation with students — boys and girls alike. In the first phase of the program, which started last May, they trained 34 master teachers, one for each province of Afghanistan, who will conduct workshops in district schools. The goal is to equip other educators with knowledge and tools to effectively discuss the science — and practical implications — of puberty with their students. The program includes an illustrated book, titled “Mina’s Story,” that introduces the subjects through fictional characters.

The program has been well-received by many, but in a region where the Taliban still holds sway and the superstitions of religious orthodoxy linger, the barriers to public enlightenment on female sexuality — or even physiology and biology writ large — are real. Still, Omarkhil is optimistic that taking the issue to the classroom will eventually yield positive results. “We realized we had to start with the teachers, and prepare them to normalize the talk around periods,” he said. “This has nothing to do with shame, this is not sickness, it is something natural.”

A new program aimed at breaking the taboos surrounding menstruation includes an illustrated book, titled “Mina’s Story,” that introduces the subject through fictional characters. Visual: Unicef Afghanistan/Hassani

The lack of information about puberty resulted in an extreme shock for Hamidi when she finally experienced her own first period at the age of 11. “I was playing outside with my friends and I felt liquid trickle down my legs,” she recalled. “I was so embarrassed, I ran home to check and when I saw blood, I panicked.” Hamidi was immediately reminded of how her mother had reacted to the mention of her cousin bleeding. “I was terrified, I thought I had turned into a bad akhlaq,” she said, using a term that roughly translates to a “person without morals.”

Traumatized, Hamidi didn’t share what was happening with anyone for three days, hoping that it would just pass. “As a child, I also didn’t use any underwear which made the experience even more uncomfortable,” she said. “However, after three days of bleeding through my clothes and enduring the pain and unpleasant sensations, I decided to reach out to my sister.”

Hamidi took her sister aside and with tears in her eyes, told her, “Look, I have turned into a prostitute!”

Her sister, who had by then had her own experience of periods, told Hamidi in hushed tones to go find “the thing that was hidden” in their mother’s belongings: a pair of simple panties, to be worn during the days of her periods. Neither her mother nor her sister explained to Hamidi what was happening to her and why it was so shameful. “Perhaps they didn’t fully understand it themselves,” Hamidi recalled. “‘You are a woman now,’ was all she told me, but the tone of her voice indicated it wasn’t something to be proud of.”

For months, Hamidi continued to use only underwear to cope with her menses. “It was very uncomfortable because the blood would still flow over onto my legs,” she recalled. Later, Hamidi started using a cloth but had to wash it every day, at times multiple times a day. “Sometimes when I didn’t have enough clean cloths, I used the wet cloth which was also very uncomfortable,” she added.

It would be another six years before Hamidi even heard about sanitary napkins. Even then, they remained expensive. “I had to use one pad the whole day,” she said.

It’s that sort of experience that the health ministry and other activists are now hoping to change. “The guidelines are essentially for the teaching staff, to equip them with the knowledge of how to deal with girls facing their first periods,” Omarkhil said. “It is also to educate the students, especially young girls, about the changes in their bodies.”

“The idea,” he added, “is to normalize the conversation around periods.”

Along those lines, the project provides girls between the ages of 7 and 14 with regular iron supplements, in all schools across provinces. “We also hope to provide hygiene products for girls in public schools,” Omarkhil said.

The illustrated book describes a story of three young Afghan girls from different backgrounds and families and their experiences overcoming cultural hurdles as their bodies begin to change. Each of their stories highlight specific issues — from family pressure to quit school to dropping out of athletic activities. And while the book is essentially for students, it also encourages parents to allow girls to remain in school and to discontinue the practice of child marriage — a common eventuality for many young girls in rural areas after they get their periods.

Needless to say, the project has attracted a lot of negative attention from the section of society that views the subject of periods as immoral. “We did face a lot of criticisms from religious scholars, and in some provinces even from the Taliban. They sent messages asking why we would choose to focus on this ‘shameful’ subject,” Omarkhil said, adding that they responded to these by engaging the local groups and roping in progressive religious leaders as ambassadors to talk about women’s health during their Friday sermons. Local tribal elders and religious leaders also held meetings to discuss the Taliban’s criticisms. “We sent a message back,” Omarkhil said, “explaining that it isn’t an unholy subject and is important for women’s health. You can kill us if you want to, we told them, but we’ve started this and plan to keep it going.”

To date, the Taliban has not responded, but more immediately daunting may well be the widespread cultural response here to menstruation, which amounts to: Don’t talk about it. So strong is the shame surrounding the subject that women at times don’t talk about it even within families, and teachers often skip the rare and brief mentions of sexual health in the standard Afghan educational syllabus.

“It is very common in provinces to ostracize a girl during the days of her period. They are not allowed to touch certain things like bread, or to cook food. At times they are locked away,” Omarkhil said, adding that in a bid to counter this, the ministry is working on a simultaneous awareness campaign that will also target boys. “Most of our efforts are directed to normalizing the narrative surrounding women’s health, and that involves the men who have the responsibility of caring for women in their lives.”

Unicef estimates that 70 percent of Afghani girls do not take a bath or shower during menstruation for fear of infertility. Some 80 percent of girls are not allowed to attend social events while menstruating. Efforts are underway to change this.

High hurdles remain, but Omarkhil is hopeful that they will be able to make a real difference. “I admit it took us longer than it should have to introduce this subject into the curriculum and focus on women’s health, but this is the start of a revolution in women’s rights and we fully intend to keep the momentum,” he said, adding a popular local saying that roughly translates as: “It doesn’t matter when you take the fish out of the water, it’s always fresh.”

For her part, Hamidi welcomes the ministry’s efforts, and she says she wishes she’d had such programs available to her when she first began to encounter puberty. She has also documented her own experience in a self-published, pocket-sized handbook titled “Anche Ku Dukharan Bayad Bedanan,” or “What Girls Should Know.” It includes basic information about menstruation, what to expect, how to live a healthier lifestyle, and other information that counters popular taboos.

“I was motivated to write this book after I realized that some of my peers who are the same age as me have little or no information of what is happening to them during their periods,” she explained.

Like the ministry, Hamidi has also received a lot of criticism for her book.

“Some people, mostly men, said I was teaching bad morals to young girls, and breaking our culture by talking openly about taboo topics,” she noted. “But to them I say that not having information is bad [and] I urged them to share this information with their sisters and wives.”

Hikmat Noori contributed reporting for this article.

Ruchi Kumar is an Indian journalist currently working in Kabul, Afghanistan, focusing on news stories from the Afghanistan-Pakistan region. She has been published in Foreign Policy, The Guardian, NPR, The National, Al Jazeera, and The Washington Post, among other outlets.

Ruchi Kumar is an independent journalist reporting on South Asia. She has been published in Foreign Policy, The Guardian, NPR, The National, Al Jazeera, and The Washington Post, among other outlets.