Social stigmas and the adolescent experience of Yemeni youths [Archives:2008/1184/Reportage]
Wojoud Mejalli
and Nadia Al-Sakkaf
For The Yemen Times
Being a conservative society, Yemen attaches many stigmas to issues regarding puberty. As a result, many Yemeni youths reach adolescence with no clue about how to deal with the changes in their bodies, also often accompanied by changes in temper and psychology.
The onset of menstruation is accompanied by social pressure on girls as they go from being children to women. Different types of pressures accompany boys' advance into manhood, although contradictory to females, this typically means more freedom and more respect for their will and opinions.
Most Yemeni youths obtain information about adolescence and reproductive health from either television, the internet or their friends.
“I still blame my mother for not talking to me about the physical changes our bodies experience during puberty,” says Nadeen Mohammed, adding, “I also blame schools for not giving us special courses to understand our bodies and how to deal with these normal changes.”
Research on youths' sexual and reproductive health published by American University in Beirut in 2006 investigated these issues among youths aged between 10 and 24 in the Arab world and Iran.
In this research, associate professor of family Jocelyn DeJong and regional youth advisor Golda Al-Khoury commented that the rapid increase in access to education and exposure to the global media has widened generational gaps between parents and their children and altered the ways in which young people receive information.
Although studies show that young people would prefer to learn about puberty and their health from their parents, many parents are reluctant or ill equipped to provide this information.
“Because of the taboos we have in our family in which a girl can't talk about reaching puberty or discuss it, I had a very a serious disease affecting my kidney,” Asma Sa'eed recounted, “I had bloody urine, so I told my mother that I was bleeding and she said, 'It's ok, just use what I told you [referring to sanitary pads].'
“She didn't even discuss the details with me, simply assuming that it was my period. I kept telling myself that it was OK and that the blood was because of my first period. Two days later, I fainted while on my way to school. At the hospital, they told my family that I had a disease that would've killed me had they not rushed me to the hospital.”
Because of this incident, Sa'eed says her parents became more open to discussing sexual and reproductive health.
Lack of accurate information about sexuality and reproduction reflects a wider public policy reluctance to provide sex education in schools. Although sex education increasingly is included in curriculums in several more advanced Arab countries, teachers often are too embarrassed to teach it.
Nadeen Mohammed remembers being shocked and frightened when she got her period for the first time. “When I saw the blood, I couldn't stop crying because I thought I'd hurt myself.”
Misconceptions
According to Sana'a University gynecology professor Dr. Marwan Shuja'a Al-Deen, puberty often begins among Yemenis at age 10; however, the physical changes become more obvious in boys between ages 13 and 16 years, and between ages 11 and 14 for most girls.
He notes that many wrong concepts accompany puberty, especially regarding women, because their bodies experience regular monthly changes. For example, many Yemeni mothers believe that bathing or playing sports during menstruation is dangerous and could affect girls' bodies.
“I learned about puberty and what it was like to become a woman through talking to my friends and my mother. The first thing my mother told me when I got my first period was, 'You should never shower when you have your period or you'll face much more trouble than you'll ever know.' Since then, I've followed her advice and never asked why,” says Nuha A., who, as a student at the Sana'a University's College of Medicine, knows that what her mother taught her is inaccurate.
Al-Deen clarifies, “It's perfectly fine to do the same activities during menstruation as on other days. In fact, some North American and European sportswomen actually report that they perform better than usual around the beginning of their period because they seem to have extra energy and maybe a bit more aggression than usual.”
He adds, “Playing sports also seems to help relieve some premenstrual symptoms.”
Another misconception among Yemeni girls is that having their period makes women fragile, vulnerable to disease and they can't donate blood.
Al-Deen explains, “Many girls worry about the loss of blood, believing that it's too much and it makes them weak. I've personally received so many questions and worries about this, to which I simply reply that this loss is mostly blood, but it also contains mucus and other tissue from the lining of the uterus.
“Although it sometimes seems like a lot of blood, it's usually less than 100 milliliters. For example, if you weigh 50 kilograms, you have about 3.5 liters of blood in your body, so losing 100 ml. during a period won't cause any health problems because this blood loss will quickly be replaced by the bone marrow's blood-forming cells.”
Of course, this doesn't rule out those cases where heavy menstrual bleeding isn't normal, which, according to Al-Deen, is a medical problem that needs to be addressed accordingly.
As he explains, “If too much blood is lost, a woman can become anemic [not having enough red blood cells], so she may need extra iron in her diet (e.g., from foods or iron tablets) to help her blood create cells to replace that lost blood.”
Although the average age of puberty for Yemeni girls is between 11 and 14, some may get their period as young as age 9, while others may experience delayed adolescence. Some consider a girl getting her period early as a sign of maturity and readiness for marriage.
However, the opposite also is true, with parents beginning to worry if their daughters don't get their periods at the same ages as their peers.
Ola'a Yasser recalls, “I remember my family awaiting something from me, actually anticipating and questioning me often about whether I'd had my period yet. When I finally got it as I was nearing age 15, I saw the relief on their faces.”
Adolescence and boys
The 2006 research on youths' sexual and reproductive health was based on both published and unpublished literature, in addition to interviews with 51 key informants working mostly at NGOs and international agencies in the region.
Except for Tunisia and Iran, few national government programs address youths' sexual and reproductive health, coupled with the fact that there's a lack of population-based data to guide such programs.
While a strong emphasis on the integrity and strength of the family unit does have a protective effect, young people lack access to information.
“As a boy, I eagerly awaited puberty so I could prove that I'm a man and have a say within the home and everywhere else. So, I began shaving the hair on my legs and underarms so I'd have more hair on my body and I began pretending to have a strong voice when I was 13. However, I later realized that over time, my body really was changing and I started freaking out,” Ahmed Saleh recounts.
Saleh received his knowledge about adolescence from his older brother, who also told him about the real-life responsibilities of becoming a man. “I realized that being a man doesn't just mean your voice changes; rather, it's the ability to handle a situation well and being responsible,” he says.
However, Osama Mohsen experienced his puberty differently. “For me, growing up was a disaster. I suddenly had a strong voice and my body started growing hair in new places. I felt ashamed and didn't talk to anyone until my friend told me such things are normal and that I should be happy because I'd become a man.”
Regarding the changes most boys experience during puberty, Sana'a University gynecology professor Dr. Asma Ahmed explains, “The first signs of puberty in a boy can show anytime between ages 9 and 15 as he starts growing taller, getting stronger and developing greater muscle mass. The testicles and penis also begin growing larger and it's common and quite normal for one testicle to be larger than the other.”
She adds that body hair begins growing in the boy's pubic region, on his legs, underarms and face, further noting that some men continue growing and developing body hair into their 20s.
During this time, an adolescent boy's face, shoulders and back become oilier, which often causes acne. Boys also should wash their hair more often in order to avoid certain diseases and conditions.
Because a boy's sweat glands become more active and produce sweat that smells different from children's body sweat, this can create body odor, so in order to reduce this smell, they should bathe daily and use a deodorant.
Ahmed notes, “Once they develop a coarse or harder voice, many boys feel ashamed and begin avoiding contact with others in society, not realizing that the voice gets deeper in puberty, which sometimes is known as the voice 'breaking' due to the ups and downs in its tone. However, nothing really breaks – it's just called this because the voice box [the larynx] gets bigger.”
Although it's a normal process of the male body, one of the most common issues adolescent boys are ashamed to talk about is nocturnal emissions or “wet dreams,” which are an ejaculation of semen – not urine – that dampens the sheets or clothing. They are perfectly normal and cannot be controlled or stopped. Girls actually undergo a similar process, but not as much as boys.
Ahmed explains that, “Another embarrassing situation that most boys experience is erections that sometimes occur when they're nervous, excited or simply for no reason at all, and these can make them embarrassed. Other people usually don't notice them as much you do and they go away within minutes.”
She adds, “A second experience is that some adolescent boys' breasts may grow slightly or feel tender. This also is normal and a reaction to hormones in the body. It will go away.”
STDs and reproductive health issues
Adolescents represent 11 percent of the Arab region's population. They also are one of the social groups most susceptible to armed conflicts, sexually transmitted diseases and HIV/AIDS, gender and age discrimination.
According to research on young Arabs published by the American University in Beirut, taboos regarding discussing sexuality remain a key constraint, while data on unwanted pregnancies and abortions, violence against women and STDs/HIV/AIDS are limited.
Such cultural taboos limit youths' access to sexual and reproductive services and information.
The high social and religious value placed on virginity means that unmarried young women risk judgmental attitudes and stigmatization by health workers if they attempt to obtain contraception.
The 2006 research concluded that sensitivity surrounding youths' sexual and reproductive health has limited the knowledge base, particularly regarding their perspectives and needs, which could help to inform legislation, policies and programs.
Appropriate sex education could be strengthened by working with both parents and teachers. Special attention is needed in designing programs to reach the most vulnerable youths. Above all, government commitment is required to translate small-scale models within the region into national programs that improve the welfare of all young people.
Since the 1994 international population and development conference in Cairo, governments have pledged to improve adolescents' sexual and reproductive health by providing integrated health services, including contraception for sexually active adolescents and health education.
Most world regions still fall well short of these recommendations, especially regarding unmarried youths, but those in Arab countries are particularly underserved.
The Second Arab Women's Development Report published in 2003 and entitled, “Arab Adolescent Girls: Reality and Prospects,” confirms this conclusion, illustrating the situations of female adolescents in seven Arab nations (Algeria, Bahrain, Egypt, Lebanon, Morocco, Tunisia and Yemen).
The report maintained that the current circumstances surrounding Arab female adolescents generally aren't conducive to building their futures as autonomous individuals. Additionally, it found a serious lack of preventive health care and information about reproductive and sexual health in the countries studied.
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