Reproductive Knowledge, Attitudes and Behavior Among Adolescent Males in Tehran, Iran

Reproductive Knowledge, Attitudes and Behavior Among Adolescent Males in Tehran, Iran CONTEXT: Iran’s culture and religion prohibit sexual contact prior to marriage. Due to the sensitivity of the topic, little By Mohammad is known about the sexual activity of unmarried adolescent males or about their knowledge of, and attitudes toward, Reza Mohammadi, sexuality and reproductive health. Kazem Mohammad, Farideh K.A. METHODS: A population-based study of 1,385 males aged 15–18 in Tehran was conducted using a self-administered Farahani, questionnaire. Participants were questioned about their beliefs and knowledge regarding reproductive health, and Siamak Alikhani, asked whether they had engaged in sexual activity. Bivariate and multivariate analyses were performed to identify Mohammad Zare, factors associated with sexual knowledge, attitudes and behavior. Fahimeh R. Tehrani, Ali Ramezankhani RESULTS: Twenty-eight percent of the sample reported having engaged in sexual activity. Sexual experience was asso- and Farshid ciated with older age, access to satellite television, alcohol consumption and permissive attitudes toward sex. Sub- Alaeddini. stantial proportions of respondents held misconceptions regarding condoms, STIs and reproductive physiology. Atti- tudes toward premarital sex were more permissive among respondents who were older, were not in school, had work Mohammad Reza experience, had access to the Internet or satellite television, lived separately from their parents, or reported having Mohammadi is chair, used alcohol, cigarettes or drugs. child and adolescent psychiatry, Tehran CONCLUSION: The relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contra- University of Medical ceptives pose a significant threat to the sexual and reproductive health of adolescent males in Iran. Programs are Sciences, and director, National Research needed to provide adolescents with the information and skills to make safe sexual decisions. Centre of Medical Sci- International Family Planning Perspectives, 2006, 32(1):35–44 ences of Iran. Kazem Mohammad is chair, epidemiology and bio- Young people constitute a significant proportion of the Iran- programs provide sexuality education to adolescents or en- statistics, Tehran Uni- versity of Medical Sci- ian population. In the most recent national census (1996), able youth to ask questions and correct misconceptions about ences. Farideh K. A. there were approximately 16 million adolescents aged reproductive health. Indeed, large numbers of young Irani- Farahani is a doctoral 10–19, accounting for 25% of the Iranian population, and ans lack information about safe sex and about the skills nec- candidate, London 21 million young people aged 10–24, accounting for more essary to negotiate and adopt safe sex practices. School of Hygiene and than one third of the population.1 Recently, the Iranian government has recognized the im- Tropical Medicine. Sia- mak Alikhani is direc- Due to such factors as a rapid increase in age at first mar- portance of addressing the reproductive health needs of ado- tor, Noncommunicable riage, there has been a sharp decline in the proportion of lescents and youth; it has undertaken a review of relevant Disease Surveillance postpubescent young people who are married. Between policies and approaches, and efforts are under way to de- System; Mohammad 1986 and 1996, mean age at first marriage rose from 19.8 sign programs that meet these needs in an acceptable and Zare is epidemiologist, to 22.4 among females and from 23.6 to 25.6 among males;2 sensitive manner.5 However, these efforts are hampered by Centre for Disease Control; and Fahimeh as a result, the proportion of adolescent females aged 15–19 the current lack of data regarding the reproductive health, R.Tehrani is head, Re- who had ever been married fell from 33% to 19%, a 44% attitudes, sexual behavior and related needs of unmarried productive Health Re- decline.3 These data suggest a widening window during young people. search Unit—all at the which young people may engage in potentially risky pre- This paper reports findings from a pioneering, popula- Ministry of Health and marital sexual activities. tion-based study that aimed to break the silence on ado- Medical Education, Tehran. Ali Despite this trend, little is known about the reproductive lescent reproductive health in Iran and to fill important in- Ramezankhani is assis- health needs of young people in Iran. Although some small- formation gaps regarding sexual behavior and associated tant professor of health and large-scale investigations have been conducted, these factors among male adolescents in Tehran. The study was education, Shaheed studies, due to cultural sensitivities, have avoided sensitive implemented by a multidisciplinary team of investigators Beheshti University, topics such as attitudes about sexual relations, the preva- and sought to determine adolescents’ knowledge, attitudes Tehran. Farshid Alaed- dini is deputy, Ministry lence of risky sexual behaviors, and rates of STIs. Instead, and behaviors related to a wide range of reproductive health of Research, National researchers have focused on topics such as puberty in girls topics and gender issues. It was designed to provide data Research Center for and opinions on family planning.4 that can inform the creation of programs and policies to ad- Medical Sciences of Cultural sensitivities may also be a factor in young peo- dress the sexual and reproductive health needs of young Iran. ple’s poor knowledge about reproductive health. In Iran, few people in Iran. Volume 32, Number 1, March 2006 35 Reproductive Knowledge, Attitudes and Behavior Among Adolescent Males in Iran TABLE 1. Percentage distribution of adolescent males aged 15–18, by selected social and demographic characteristics, Tehran, Iran, 2002 Characteristic % Characteristic % (N=1,385) (N=1,385) Age Communication with father on sex§ 15–16 48.3 Frequent 11.3 17–18 51.7 Rare 20.1 None 68.6 Current school attendance Day school 76.3 Communication with mother on important matters†† Night school 4.4 Easy 31.1 None 19.3 Moderate 34.0 Difficult 34.9 Type of school attended Governmental 76.6 Communication with mother on sex‡‡ Nongovernmental 9.4 Frequent 11.7 Both 14.0 Rare 25.0 None 63.3 Ever worked Yes 47.0 Has older brother No 53.0 Yes 54.8 No 45.2 Currently working† Yes 58.9 Has older sister No 41.1 Yes 56.1 No 43.9 Religion Muslim 97.7 Has access to satellite television Christian 1.5 Yes 27.0 Other 0.8 No 73.0 Religiosity Has access to Internet Religious 79.7 Yes 34.3 Somewhat religious 15.4 No 65.7 Not religious 4.9 Ever smoked Lives with parents Yes 12.8 Both 88.7 No 87.2 One 10.0 Neither 1.3 Ever used alcohol Yes 16.8 Father No 83.2 Alive 94.3 Dead 5.7 Ever used drugs Yes 2.1 Communication with father on important matters‡ No 97.9 Easy 47.0 Moderate 32.3 Total 100.0 Difficult 20.7 †Of the 647 respondents with work experience. ‡N=1,265. §N=1,270. ††N=1,342. ‡‡N=1,345. DESIGN AND METHODOLOGY least one male in our target age-group resided. All males Sample Selection aged 15–18 in these households were invited to participate Data for this article were collected in 2002 from males aged in the study. 15–18 who lived in Tehran. The rationale for focusing on We recruited a total of 1,500 adolescent males. Of these, Tehran was twofold. First, the population of Tehran con- 1,385 completed the questionnaire, yielding a response rate stitutes about one-fifth of the Iranian population and en- of 92%. Of the 115 remaining adolescents, 50 declined to compasses all of the country’s socioeconomic and ethnic participate or were not permitted to participate by their par- groups; therefore, the study population represents a het- ents, and 65 completed questionnaires that had to be dis- erogeneous group of youth. Second, Tehran is a major urban carded because of substantial inconsistency (e.g., multiple area whose population is more likely than residents of rural responses to key questions). regions to be exposed to new ideas and opportunities, in- cluding those related to sex. Questionnaire The sample was derived through cluster sampling of the The survey instrument was adapted from a core question- 22 main municipal sectors of Tehran from July to Septem- naire developed by the World Health Organization;6 it was ber 2002. Clusters were selected randomly, in proportion modified to be self-administered, to conform to cultural sen- to the estimated population of each sector, from among the timents and to incorporate insights gained from the study’s existing blocks provided by the Statistical Centre of Iran. exploratory phase. The questionnaire comprised 89 ques- From each cluster, we selected 10 households in which at tions divided into six sections: social and demographic vari- 36 International Family Planning Perspectives ables; knowledge about reproductive physiology; aware- TABLE 2. Percentage distribution of adolescent males aged 15–18, by responses to ness of contraceptive methods (especially condoms); aware- statements about aspects of reproductive health ness of STIs and AIDS; attitudes about relationships between Aspect Yes No Do not Total the sexes; and, finally, sexual behaviors and experiences. know Several measures were taken to ensure confidentiality. Reproductive physiology The questionnaire was self-administered, and interviewers A woman can get pregnant at first intercourse 43.5 18.5 38.0 100.0 asked the respondents not to identify themselves. Informed A woman stops growing after first intercourse 7.3 36.4 56.3 100.0 Pregnancy is most likely to occur in midcycle 16.9 9.7 73.4 100.0 consent was obtained from one parent as well as from the respondent; however, the adolescents were assured that nei- Condoms ther the interviewer nor their parents would have access to Condoms can be used more than once 5.3 54.8 40.0 100.0 Condoms are an effective way of protecting against STIs 42.4 10.5 47.1 100.0 their responses.

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