understanding health issues among adolescent females in a northeast province of afghanistan

157 Pages·2015·1.63 MB·English

by  Amina Davlatshoeva

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Doctoral Dissertations Dissertations and Theses
Spring August 2014
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Amina Davlatshoeva
University of Massachusetts Amherst
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Davlatshoeva, Amina, "UNDERSTANDING HEALTH ISSUES AMONG ADOLESCENT FEMALES IN A
NORTHEAST PROVINCE OF AFGHANISTAN" (2014). Doctoral Dissertations. 69.
https://doi.org/10.7275/6trg-ks60 https://scholarworks.umass.edu/dissertations_2/69
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UNDERSTANDING HEALTH ISSUES AMONG ADOLESCENT FEMALES IN A
NORTHEAST PROVINCE OF AFGHANISTAN

A Dissertation Presented

by

AMINA DAVLATSHOEVA

Submitted to the Graduate School of the
University of Massachusetts in partial fulfillment
of the requirements for the degree of

DOCTOR OF EDUCATION

May 2014

Education

Educational Policy and Leadership
© Copyright by Amina Davlatshoeva 2014

All Rights Reserved
UNDERSTANDING HEALTH ISSUES AMONG ADOLESCENT FEMALES IN A
NORTHEAST PROVINCE OF AFGHANISTAN

A Dissertation Presented

by

AMINA DAVLATSHOEVA

Approved as to style and content by:

____________________________________________________
Cristine Smith, Chairperson

____________________________________________________
Sharon F. Rallis, Member

____________________________________________________
Aline Gubrium, Member

________________________________________________
Christine B. McCormick, Dean
School of Education
DEDICATION

To my parents Saifullakhan Davlatshoev and Muminamoh Lalbekova
for envisioning my pursuit of the highest mountains of wisdom
and
for encouraging me to climb distant mountain peaks
to reach the summit of my education.
ACKNOWLEDGMENTS
I would like to thank my adviser, Cristine Smith, for her many years of support,
encouragement, thoughtful guidance, and practical realism that have kept me
grounded throughout my educational endeavors. I am very grateful to Sharon Rallis
for her thought-provoking ideas on conducting research in different settings and her
enormous encouragement to see the nuances of qualitative research. My thanks also
go to Aline Gubrium for sharing her insight into drawing out women’s voices
through their stories and her encouragement to unfold my personal story in this
thesis-writing journey. I am thankful for the committee and for its graciousness in
helping me understand the deeper levels of my work.
I would also like to extend my sincere thanks to Barbara Gravin Wilbur for
her amazing promptness with administrative and paper clarifications. To Linda
Guthrie, thank you for your clear guidance regarding graduate-student
requirements and milestones. Noah Finley, the skill and level of engagement you
brought to the editing process was an absolute gift. Thank you.
I have not forgotten the hospitality and support I received during my visits to
Talokan, Afghanistan. Thank you, Gary Moorehead (Marigold Field Director),
Amanullah Shaban, and Sharara Aman for your hospitality, personal interest, grace,
and engagement (as demonstrated through your daily reflections about Talokan and
life in Afghanistan).
I wish to extend my warmest gratitude to Urakorn (Toon) Fuderich and her son,
Christopher Fuderich, for their provision of home and family and for their enormous
love, support, and generosity. Thank you!
v
My deep gratitude extends to Michael and Carol Greene, Dr. Don and Lissa
Lundgren, and Evie Hopkins for their care and faithfulness in keeping me in their
thoughts. A very special thanks goes to Debbie Knight. Thank you from the bottom
of my heart for walking with me throughout this journey. I am very privileged to
have such family here in Amherst, MA.
I thank my friends and colleagues for their encouragement through e-mails,
Skype messages, and e-cards from around the world: Anzurat Akobirshoeva
(Tajikistan), Governor Halim Fidai (Afghanistan), Shahzad Jivani (London, UK)
Tasnim Herani (Canada), Tayib Jan (Pakistan) and Rehana Naz (Australia). To the
many others I have not mentioned here, thank you!
My heart is full of gratefulness for my brothers, Ozod, Farid and Akmal— three
strong pillars in my life. Words cannot express the depth of my gratitude to my
Grandma for listening to my dissertation tales and for sharing her stories with me.
My family and friends, it is your encouragement and belief in me that gave me hope
and enabled me to stay focused and complete this journey.

vi
ABSTRACT
UNDERSTANDING HEALTH ISSUES AMONG ADOLESCENT FEMALES IN A
NORTHEAST PROVINCE OF AFGHANISTAN

MAY 2014

AMINA DAVLATSHOEVA, R.N., MEDICAL COLLEGE, TAJIKISTAN

B.SC., KHOROG STATE UNIVERSITY, TAJIKISTAN

M.Ed., AGA KHAN UNIVERSITY, INSTITUTE FOR EDUCATIONAL DEVELOPMENT,
PAKISTAN

Ed.D., UNIVERSITY OF MASSACHUSETTS, AMHERST

Directed by: Professor Cristine Smith

The purpose of this study is to develop a deeper understanding of the health
issues facing adolescent females (ages 18-21) in rural, northeastern Afghanistan.
Incorporating participant observations, in-depth interviews, and narrative inquiries,
this study seeks to illustrate adolescent females’ perspectives on health issues.
To achieve this goal, ten adolescent females were interviewed in rural,
northeastern Afghanistan during 2010. The participants were between 18- and 21-
years old. The one-on-one interviews were conducted in a multiple-response format
and were structured around three research questions:
 How does a young female’s understanding of health issues shape her
identity in northeastern Afghanistan?
 In what ways do the narrative stories of Afghan females link to issues
such as education, health, and family dynamics?
vii
 In what ways are the narrative stories of Afghan females linked to their
cultural beliefs about health?
The participants were asked to discuss their perceptions of life, health, body
image, illness, and related topics. The participants struggled to articulate answers to
these questions, but their personal narratives and body language vividly illustrated
the issues they struggled to express. Their narrative responses are reduced in this
study to produce a dynamic perspective on adolescent females’ perceptions of
health issues in northeastern Afghanistan.
During the course of this study, it became apparent that:
1. Family influences shaped the participants’ social world. They relied upon
their families for daily communication, information, and moral and
emotional support.
2. Despite this social dependence, the participants demonstrated a marked
reluctance to discuss health issues with their mothers or with other older
females in their households.
3. The participants rarely connected health with its traditional meaning (i.e.
physical or mental well-being). For them, health was related to a good
life—free from stress and care—and education.
There is still much more to learn about adolescent health in rural Afghanistan;
yet an understanding of these cultural constructs of family, health, and education is
necessary to pursue further inquiries. This study’s findings provide the groundwork
for future research and discussion—and, ultimately, a deeper understanding of
adolescent females’ perceptions of health in rural Afghanistan.
viii
TABLE OF CONTENTS

Page

ACKNOWLEDGMENTS .......................................................................................................................... v
ABSTRACT ............................................................................................................................................... vii
LIST OF TABLES .................................................................................................................................... xii
ACRONYMS AND DEFINITIONS OF LOCAL LANGUAGE USED ...........................................xiii
CHAPTER

1. INTRODUCTION ........................................................................................................................ 1
Purpose......................................................................................................................................... 1
Problem Statement .................................................................................................................. 1
Research questions .................................................................................................................. 3
Significance ................................................................................................................................. 3

2. REVIEW OF LITERATURE ON ADOLESCENT GIRLS AND THEIR HEALTH........ 5
Definition and concept of adolescence ............................................................................. 5
Theoretical Construct ...........................................................................................................11

Theory of Identity Formation ..............................................................................12
Feminist and Human Development Theories ...............................................13
Islamic Theories of Women and Health ..........................................................14

Adolescent Girls in Afghanistan ........................................................................................18

Historical overview .................................................................................................19
Present situation ......................................................................................................23

3. RESEARCH DESIGN AND METHODS ...............................................................................31
Research Design ......................................................................................................................31

Rationale for Use of Qualitative Methods .......................................................31

Narrative Inquiry ....................................................................................................................32
Research Setting and Context ............................................................................................34
Description of the setting when I arrived .....................................................................39
Researcher Stance ..................................................................................................................40
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