Hamid et al. BMC Public Health 2010, 10:164 http://www.biomedcentral.com/1471-2458/10/164 and cleaning as the main things that gave them personal value. They had agreed not to attend school, instead stay- ing at home out of a sense of duty and thus enabling their siblings (especially brothers) to go to school. They pre- ferred to work at home, looking after everyone else’s needs and literally serving as substitutes for their mothers. To be selfless, loyal and possess empathy for the family were important characteristics valued in their upbringing. “My mother is away visiting relatives for the past 5 days. She told me to be a good daughter and look after the family. I have been looking after my younger brothers and sisters and my father and have done rather well. My younger brothers and sisters are happy and not missing Ami (mother) ....” (15 years old) Finding security in learning obedience The young women were expected to be obedient and faithful, to defer to their parents for decision-making and to oblige their future in-laws in the same manner. All decisions regarding their marriage were entrusted to the family and the family’s (not the women’s) opinions were what mattered most. “There is a girl, who married by her own choice against her parents will. ...the husband does not work and beats her.... she used to be so pretty and now she is in such a pathetic state. I think she should have married the person her parents wanted her to marry.” (15 years old) When asked to express their aspirations for the future they were unable to enlist any wishes and showed reser- vations to elaborate. Disobedience by participants resulted in displeasure on the part of their parents, especially mothers, who stressed that their behaviour reflected their upbringing and thus disobedience reflected badly on the parents. They learnt that the sole path to being looked after and feeling secure was to abide by the rules. The young women said that they had to learn to control their tongue and exercise sabar (patience), the main compe- tencies for a successful future married life. “My mother tells me to show sabar (patience) and not to answer back. My behaviour is a reflection of my parental upbringing.” (19 years old) Young female participants illustrated the subservient role of women in society by referring to television seri- als. A young woman in a FGD referred to a serial that showed how all decision-making lay in the hands of the husband and then concluded that the woman had no control over her life. This perspective was echoed by other participants, who voiced the importance of Page 4 of 7 obeying their future husbands to avoid the consequences of divorce and being left for another wife. They under- stood the fragility of marriage and the ease of remar- riage for a man in society. Level of freedom defined by family The young women stated that their mobility both inside and outside the home was closely monitored by the elders in the family. They feared that these restrictions would continue after marriage. “My fiancé is shakki (does not trust). In the village when we visit them, he does not like it if I talk to our other relatives. I am afraid of what will happen after my marriage.” (19 years old) Adulthood transition in and into silence In the FGDs the young women discussed the challenges of menstruation and body changes, which caused dis- comfort and raised questions to which they were given few answers. They saw the onset of menstruation as the first sign of growing up and the end of childhood and freedom. They also considered this physiological change as marking the beginning of an era of confinement. Becoming a woman in silence Not prepared for their first menstruation, participants were shocked by the experience. When they approached their mothers they were told not to talk about it and only shown how to handle the bleeding. Through friends, aunts or their mothers they learnt that they were not to offer prayers during menstruation and to take a cleansing bath once the bleeding stopped. Young women felt severely inhibited in their ability to ask questions about physical and related changes and they understood that keeping silent on women’s health issues was part of being a grown-up woman. “I stopped going to school as I was afraid of having to deal with menstruation in school. No one at home asked me why I stopped and nobody at home told me to go to school either.” (17 years old) Silence around sexuality was expected and curiosity, although evoked at the time of marriage, was not addressed. Instead they learned that talking about sexu- ality and having questions about married life was a sign of having no shame. “I am looking forward to my marriage and I want to ask questions but I do not talk about this with my mother.... she doesn’t even know I menstruate. How can we talk about these things?” (19 year old) The young women either lacked or had deficient knowledge about sexuality, contraception and