ISSN: 2474-1353 Barseghyan et al. Int J Womens Health Wellness 2019, 5:107 DOI: 10.23937/2474-1353/1510107 Volume 5 | Issue 4 International Journal of Open Access Women’s Health and Wellness RESEARCH ARTICLE Assessment of Reproductive and Sexual Health Literacy of Women in Armenia Mariam Barseghyan, MD, MS1,2*, Hayk Barseghyan, PhD3,4, Gardenia E Nahigian, BA5, Eric J Vilain, MD, PhD3,4, Elena Sagayan, MD, MPH2,6 and Michael S Wilkes, MD, MPH, PhD1 1School of Medicine, University of California Davis, USA 2Armenian Health Care Association of the Bay Area, USA 3Children’s National Health System, Children’s Research Institute, USA 4 Check for Department for Genomics and Precision Medicine, George Washington University, USA updates 5Center for Genetic Medicine Research, University of California Davis, USA 6Department of Women’s Health, Kaiser Permanente, USA *Corresponding author: Mariam Barseghyan, MD, MS, University of California Davis School of Medicine, Sacramento, CA, USA; Armenian Health Care Association of the Bay Area, Mountain View, CA, USA Abstract to correctly identify a disease as an STI entity respective- ly. Overall knowledge of human papilloma virus (HPV) as a Background: In Armenia, women’s health and reproduc- cause of cervical cancer was low among both groups, with tive choices are limited. According to the World Health only 7% of general population and 31% health profession- Organization (WHO), the incidence of cervical cancer in als being able to link HPV to the risk of developing cervical Armenia has risen from 11 to 14 per 100,000 women in cancer. Most participants correctly identified PAP smear as the last 15 years [1]. The WHO also reports that poor a method of cervical cancer prevention; however, only 11% knowledge about HIV prevention contributes to low rates of general population and none of the surveyed health care of condom use and thus year-to-year increasing rates of workers believed that HPV vaccination can prevent cervical HIV particularly among migrant male populations, people cancer. Most respondents (88%) used no mode of contra- who inject drugs, men who have sex with men and sex ception. Among those who used contraception, condoms workers in Armenia [2]. Our study sought to obtain data were the most common method (22%) with 5% of respon- exploring knowledge of Armenian women around issues dents using oral combination pills. Nearly third of all respon- related to women’s health, specifically sexually transmit- dents marked having had at least one abortion. ted infections (STIs) and cervical cancer while also as- sessing their contraceptive choices. Conclusion: In this study, we identified a significant defi- cit of knowledge regarding reproductive health, specifically, Methods: Study consisted of 173 female participants (med- STIs and cervical cancer modes of prevention and methods ical personnel and general respondents) from villages of of effective contraception. Furthermore, the poor knowledge Armavir and Lori Marz in the Northern Armenia who com- of these subjects was shared by medical professionals. Im- pleted confidential self-filled and validated surveys in Arme- provements in the area of health education are needed to nian. Questions covered demographics and addressed risk promote safe sexual practices proven to decrease the risk factors, symptoms, and modes of prevention of STIs and of STI exposure, support HPV vaccination campaign and cervical cancer as well as contraceptive choices of wom- use of modern methods of contraception. en. Respondents’ answers were tabulated, and common themes identified. Comparison was made between general Keywords population and health care workers level of knowledge on Armenia, Cervical cancer, Sexually Transmitted Infections specific topic. (STIs), Contraception, Reproductive and sexual health lit- Results: Both general population and medical personnel eracy demonstrated lack of knowledge of diseases classified as STIs, with only 13% and 41% of respondents being able Citation: Barseghyan M, Barseghyan H, Nahigian GE, Vilain EJ, Sagayan E, et al. (2019) Assessment of Reproductive and Sexual Health Literacy of Women in Armenia. Int J Womens Health Wellness 5:107. doi.org/10.23937/2474-1353/1510107 Accepted: November 05, 2019: Published: November 07, 2019 Copyright: © 2019 Barseghyan M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Barseghyan et al. Int J Womens Health Wellness 2019, 5:107 • Page 1 of 8 • DOI: 10.23937/2474-1353/1510107 ISSN: 2474-1353 and only a small fraction receives treatment or pre- Abbreviations ventative therapy [2]. Research shows that STIs have STIs: Sexually Transmitted Infections; HPV: Human Papil- been disproportionally affecting young adults and that loma Virus; IUD: Intrauterine Device; PID: Pelvic Inflamma- tory Disease measures taken to focus on educating youth about the means of STI prevention have been effective in reducing Introduction infection rates [6]. Steps toward improving the knowledge about STIs In a modern-day Armenia, topics concerning re- and cervical cancer, as well as measures of their pre- productive health, sex and sexuality are still only vention, have been undertaken in Armenia over the re- whispered about. Women’s health and reproductive cent years which included addition of sexual health ed- choices in Armenia reflect lack of reproductive and ucation in the public-school curriculum as is discussed sexual education in the country and poor access to a above. In addition, multiple nongovernmental organiza- full range of reproductive services. According to the tions (NGOs) and community organizations have sought Article 5 of the Armenian Law on Reproductive Health to develop sexual health educational resources and fa- and Rights to Reproduction, adolescents have right cilitate health screenings for STIs, cervical cancer, and to sexual and reproductive health education provid- HIV for patients in cities and rural areas. Nevertheless, ed by professionals in public schools and other edu- given continuous increase in the incidence of STIs and cational institutions and organized and implemented cervical cancer despite measures taken, deeper exam- by executive bodies in education and healthcare ser- ination of the problem was deemed to be necessary vices. Adolescents also have a right to receive confi- with a particular concentration on rural communities dential and easily available medical consultation and since these regions are frequently omitted from similar assistance for their reproductive and sexual wellbeing studies. Hence, our study sought to obtain data explor- [3]. Part of reproductive and sexual health education ing the extent of knowledge of Armenian women as well is covered in a such courses as biology and classes as health care representatives in areas related to repro- called “Healthy Lifestyle” and “Safe Activities” as part ductive and sexual health. of the “Preliminary Military Preparedness” course [4]. However, despite the law, there is no structured Methods and regulated educational program that covers the This community based cross-sectional study sought necessary topics related to reproductive and sexu- to evaluate the state of knowledge of predominantly ru- al health. In part this is due to cultural taboos sur- ral Armenian women regarding risk factors, symptoms, rounding these topics, lack of educational resources, and modes of prevention of STIs and cervical cancer. as well as an absence of qualified teachers or health Contraceptive choices of women were also assessed. professionals who are knowledgeable about these Survey questions addressing these topics and basic topics [5]. Thus, most people are left without reliable demographic information were designed by Armenian source of information about reproductive health. experts in women’s health. All survey questions were Despite improved access to care and implementa- translated into Armenian using common language and tion of universal screening for cervical cancer, rates for avoiding medical jargon (Supplementary Material 1 and such diseases as sexually transmitted infections (STIs) Supplementary Material 2). The survey was pilot tested and cervical cancer in Armenia remain high. According among the local Armenian team of collaborators. to the World Health Organization (WHO), the incidence Surveys were distributed in three select com- of cervical cancer in Armenia has risen from 11 to 14 munities with the help of healthcare department of per 100,000 women in the last 15 years [1]. Moreover, the Children of Armenia Fund (COAF), a non-profit, there has been a sharp increase in the number of di- non-governmental organization whose goal is to ad- agnosed cases that remain untreated contributing to vance rural communities by improving education, cervical cancer mortality. Low socioeconomic status healthcare, economic development and village life. amongst the majority of the population, male seasonal Partnered with COAF, our team visited village clin- labor migration, and lack of understanding of STIs and ics where we, alongside the COAF medical team, cervical cancer risk factors, symptoms, and modes of preformed well-woman exams while also distribut- prevention are some of the factors attributed to ampli- ing surveys to women in the waiting rooms. Surveys fied occurrence of these illnesses in Armenia. According were distributed in Armenian by