"In Pakistan, as in many developing countries, poverty is intrinsically linked with poor sexual and reproductive health (SRH)...Low levels of knowledge about SRH are a major barrier to people accessing SRH services, and information available to the Pakistani population remains limited, with women and young people being particularly marginalised."

To assess, understand, and respond to this situation, Marie Stopes Society (MSS) conducted a baseline knowledge, attitudes, and practice (KAP) survey to explore awareness of sexual and reproductive health (SRH) and rights among Pakistani youth in 4 districts: Hyderabab, Mirpurkhas, DG Khan, and Multan. This 20-page report presents findings from that research - in short, Pakistani youth have little access to reproductive health information - and suggests one communication-centred approach to reach both young people and the people who serve as sources of information in the community.

Specifically, face-to-face communication was used to obtain qualitative data for this study. Interviewees included representatives from local government, local religious leaders, health providers, and representatives of local print media. Two focus group discussions (FGDs) were conducted in each district among 16- to 46-year-olds, one with married men and one with married women. A questionnaire was then developed, which was administered in face-to-face sessions with 398 married men and women aged 17-60. This report presents the findings from that survey process which relate specifically to adolescence. Examples of findings include:

• Three quarters of male respondents reported that they liked the changes they experienced during puberty; in contrast, 47% of girls reported feeling anxious, especially surrounding first experiences of menstruation (menarche). This is perhaps in part associated with social restrictions imposed by parents: 25% of women were told to remain in the house during their menstrual periods.
• Only 13% of female respondents reported having received information about puberty prior to menarche. However, 94% of females sought information and advice after menarche (usually from female relatives), whereas only 16% of males sought advice at any stage during puberty (usually from male friends). MSS claims that, as a result of participating in the research, many FGD participants reconsidered their views on the provision of information to young people, such as by agreeing that giving information about menstruation to girls, prior to them experiencing menarche, could be beneficial.
• While 58% of male respondents stated that women should be married by, or at, the age of 18, only 41% of female respondents agreed (over a quarter of females felt that the ideal age for women to marry is over 22).
• In short, there continue to be strong cultural barriers to the discussion of SRH issues, and traditional values related to gender threaten to impede the provision of information to, and attitudes about the SRH of, girls, in particular.

In response to these findings, MSS has developed a strategy for involving community members and young people in efforts to raise awareness and open up discussion through advocacy sessions that are culturally sensitive and that are strengthened through the support of local leaders: Community Advocacy Networks (CANs) and, for young people, Youth Advocacy Networks (YANs). As many SRH topics are considered sensitive, separate sessions are held for girls, boys, and parents through the CANs and YANs. Initially, the topics discussed are often quite broad (e.g., "general well-being"), as MSS finds that it takes time to build rapport and for the participants to feel comfortable discussing SRH. Often, community members help to identify particular topics in advance to be covered. CAN and YAN facilitators try to make the sessions informal; at the end of each session, they leave time in case participants wish to ask the facilitator questions in private which they did not feel able to ask in front of the whole group. At CAN discussion sessions held with parents, facilitators emphasise the importance of providing accurate information to young people. In both CANs and YANs, facilitators stress the health benefits of delaying the first child, while also dispelling common myths such as that using contraception before the birth of the first child can make a woman infertile.

The YANs are led by trained young people, as MSS has found that adolescents in the community find it easier to talk to people their own age about SRH issues. This training focuses on providing accurate SRH information to peers, as well as details on how to access SRH counselling and treatment services. To cite one example of a YAN approach, YANs integrated SRH awareness raising sessions into events such as sports activities for girls designed to mark World AIDS Day in Multan.

MSS explains that gaining backing for the formation of such groups from key community members, such as Imams and Nazims, has been crucial to ensure the success of the activities hosted by the CANs and YANs. In some communities, Nazims attend as "chief guests" and distribute certificates to participants. "In one community, the sentisising of key figures to the benefits of providing SRH information led local Imams to offer land to be used for ongoing CAN work", such as regular information and discussion sessions among communities. "These sessions are breaking the silence on SRH topics" among young people, their parents, and members of the community.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.