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Access to Electronic Thesis Access to Electronic Thesis Author: Ahlam Al-Zahrani Thesis title: Women‘s sexual health care in Saudi Arabia: A focused ethnographic study Qualification: PhD This electronic thesis is protected by the Copyright, Designs and Patents Act 1988. No reproduction is permitted without consent of the author. It is also protected by the Creative Commons Licence allowing Attributions-Non-commercial-No derivatives. If this electronic thesis has been edited by the author it will be indicated as such on the title page and in the text. Women‘s sexual health care in Saudi Arabia: A focused ethnographic study Ahlam Al-Zahrani A thesis submitted to the University of Sheffield for degree of Doctor of Philosophy 2010 Faculty of Medicine School of Nursing and Midwifery Declaration This written thesis is my own unaided work Signed……………………………………………………………………………………… Date………………………………………………………………………………………… This thesis is dedicated To my mom Khadijah Bent Omar For everything she has done for me through her life For placing her hopes and dreams in me, which I hope came true To my husband and my best friend Masoud Al-Harbi For everything he gave especially his kindness, love, patience and sacrifices Truthfully without his support this thesis would not have been possible To my lovely three children Renad, Eiad & Randa For their support, understanding and for their enduring tolerance with my work and studies over the years Their love, smile, laughter and even complaints helped me to overcome many difficulties and challenges which it was an enjoyable for me to exceed over it because they are in my life Contents ___________________________________________________________________________ Table of Contents Acknowledgements .................................................................................................................. IX Abstract ..................................................................................................................................... X List of tables ........................................................................................................................... XV List of figures ........................................................................................................................ XVI Abbreviations ........................................................................................................................ XVI Terms explanations ............................................................................................................ XVIII Chapter 1: Introduction to the study ........................................................................... 1 1.0 Introduction .......................................................................................................................... 1 1.1 Personal and professional motivation for the study ......................................................... 1 1.2 The Kingdom of Saudi Arabia ......................................................................................... 3 1.2.1 Islam and its role in establishing the KSA ................................................................ 5 1.2.2 Islam in Saudi Arabia ................................................................................................. 6 1.3 Women‘s status from an Islamic perspective ...................................................................... 8 1.3.1 Men and women are equal, but different....................................................................... 9 1.3.2 Islam and gender roles................................................................................................. 10 1.3.3 Islam and Polygamy .................................................................................................... 12 1.3.4 ‗Man over the woman‘: ―Qawamah‖ .......................................................................... 13 1.4 Women in Saudi Arabia ..................................................................................................... 14 1.5 Overview of the Health care system in SA ........................................................................ 18 1.5.1 Health care challenges and demands ........................................................................... 22 1.6 Summary of the next chapters…………..………….…………………………………… 25 1.7 Summary ............................................................................................................................ 26 I Contents ___________________________________________________________________________ Chapter 2: Literature review ........................................................................................ 28 2.0 Introduction ........................................................................................................................ 28 2.1 Sexuality ............................................................................................................................ 28 2.2 Sexual health ...................................................................................................................... 30 2.3 Impact of gender power on women‘s sexual health ........................................................... 33 2.4 Cultural and Socio-economic factors impacting upon women‘s sexual health within SA 36 2.4.1 Frequent childbearing .................................................................................................. 36 2.4.2 Early marriage ............................................................................................................. 40 2.4.3 Education ..................................................................................................................... 42 2.4.4 Teenage population growth ......................................................................................... 44 2.4.5 The prevalence of HIV/STIs ....................................................................................... 46 2.4.6 Polygamy ..................................................................................................................... 48 2.5 The Scope of Sexual Health Research in SA ..................................................................... 51 2.6 Framing the research focus and questions ......................................................................... 55 2.8 Summary ............................................................................................................................ 57 Chapter 3: Methodology ................................................................................................. 59 3.0 Introduction ........................................................................................................................ 59 3.1 Epistemological issues around qualitative and quantitative research ................................ 60 3.2 Ethnography ....................................................................................................................... 63 3.3 Conceptual underpinnings of ethnography ........................................................................ 65 3.4 Issues associated with ethnography ................................................................................... 68 3.4.1 Objectivity ................................................................................................................... 68 3.4.2 Selectivity and bias...................................................................................................... 69 3.4.3 Time consuming approach .......................................................................................... 69 3.5 Focused ethnography ......................................................................................................... 70 3.6 Methods of data collection in ethnography ........................................................................ 71 II Contents ___________________________________________________________________________ 3.6.1 Observation ................................................................................................................. 71 3.6.2 Semi-structured, in depth interviews ........................................................................... 72 3.6.3 Field notes ................................................................................................................... 74 3.6.4 Participant observation ................................................................................................ 75 Section 2: Entering the Field.................................................................................................... 76 3.7 Study setting....................................................................................................................... 76 3.7.1 KAUH Setting ............................................................................................................. 77 3.7.2 MCH Setting ............................................................................................................... 77 3.8 Gaining access ................................................................................................................... 78 3.8.1 Gaining ethical approval ............................................................................................. 78 3.9 Ethical issues within the study design ............................................................................... 79 3.9.1 Informed consent ......................................................................................................... 79 3.9.2 Dignity, privacy, and confidentiality..........................................................................
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