CHANGES IN THE GIRLS’ AWARENESS ABOUT REPRODUCTIVE HEALTH AFTER PREMARTIAL EDUCATION BY THE PREMARTIAL COUNSELING CENTER IN GARMSAR CITY, IRAN

CHANGES IN THE GIRLS’ AWARENESS ABOUT REPRODUCTIVE HEALTH AFTER PREMARTIAL EDUCATION BY THE PREMARTIAL COUNSELING CENTER IN GARMSAR CITY, IRAN

Maryam Rezaeyan ¹ and Habibeh Morteza ^{* 2}

Faculty of Nursing and Midwifery ¹, Islamic Azad University Branch of Borujerd, Lorestan, Iran.

Semnan University of Medical Sciences ², Semnan, Iran.

ABSTRACT: Awareness of reproductive health is rights of humans and lack of accurate notification will lead to numerous complications.Pre-marriage is one of the best times to training of these issues. Therefore, this study was done in order to evaluation the effects of premarital education on the girls’ awareness about reproductive health. In this semi-experimental study, 152of womens that participated in courses at marriage counseling center were selected with consecutive sampling method in Garmsar city, Iran in 2012.Data were collected by a questionnaire containing demographic (contains two sections: demographic characteristics and reproductive health) in two stages of pre and post of test. Data were analyzed using SPSS software. According to the findings of this research, the average of girls’ age was 22.41± 3.22 and 55.3% of them, had college education and 53.9% of them were housewives. The mean score of awareness about reproductive health before the education, was 12.81±33.3 that increased to the 17.81±. 2.587after training and this difference was statistically significant (p= 0.000).As well as level of satisfaction of participants (92.1%) was very good.The findings of this study showed that premarital counseling programs effected on the girls’ awareness about reproductive health, and participants were satisfied for the manners of holding course using of teaching aids.

Premarital counseling, Education, Reproductive health, Girls’ awareness

INTRODUCTION: Marriage creates a family, result in proliferation and generation survival. In monotheistic religions, especially Islam with a special sanctity, if marriage done with sufficient awareness and requirements, it may have significant effects on personal and social health. On the other hand, physical, mental and social health of the young couples is related to family health and creating a healthy generation. The young couples build the future of any country. The community health depends on physical, mental and social health of the young couples.

The root of many major health problems such as population growth, infant and child death, genetic abnormalities and soon should be sought in the pre-marriage and prepregnancy period. ¹ Premarital education programs show initial promise in improving couple communication and preventing deterioration in relationship well-being. ² Sexual and reproductive health (SRH) is vital to individuals, couples, and families in order to ensure healthy reproduction, achieve better communication between couples, make healthier sexual decisions, and participate in the social development of their countries. ³

Adolescents, a vulnerable populations have multiple sexual and reproductive health problems including gender inequality, sexual coercion, early marriage, polygamy, female genital mutilation, unplanned pregnancies, closely spaced pregnancies, abortion, sexually transmitted infections (STIs) including HIV/AIDS. Lack of access to appropriate health care and access to information and communication are the most important factors hindering their health care. ⁴ Benefitting from premarital consultation services makes the man and woman start their shared life with more awareness and equipped with enough knowledge in their relationship and their would-be spouse and also the significance and goals of marriage. ⁵ Previous studies on Iranian couples have shown that sexual issues are the underlying causes of many marital conflicts and that unsatisfying sexual relationships are one of the main reasons for divorce in Iran. ³

Another study in Tehran found that 66.7 % of divorce plaintiffs attributed sexual problems, such as sexual desire disorders and sexual arousal disorders, as their grounds for divorce. ⁶ Furthermore, couples with higher level of education usually have as much lower divorce rate than those with less education. Though, they also tend to marry several years later than the average person. More education affords them a higher standard of living; they are less likely to marry because of pregnancy or against parental opposition like teenagers might do. ⁷ Therefore, premarital care (PMC) is the promotion of the health and well-being of a woman and her partner before pregnancy; it is considered as the primary preventive approach for couples planning for conception; it can identify and modify behavioral, medical, and other health-risk factors known to impact pregnancy outcomes through prevention and management. ⁸

There are various study conducted to assess the knowledge level of adolescents towards reproductive system and organs and awareness regarding sex knowledge on adolescent girls (16-20 years) found that awareness regarding HIV/AIDS among adolescent girls is very low, adolescent girls also back adequate knowledge about sexual matter and contraception which results in early pregnancy, increased risk of STD infections, maternal morbidity and mortality and unsafe abortions. ⁹ Many researcher emphasized on the importance of premarital education. Studies in Iran have demonstrated positive effects of sex education on sexual and marital satisfaction and on reducing marital conflict. ¹⁰ Sexual satisfaction is an important predictor of marital satisfaction, and a correlation between sexual satisfaction and marital satisfaction is evident. Further, marital satisfaction is associated with well-being, happiness, professional achievements, and success in social interactions. ^{11, 12, 3} The findings of one researcher suggested that appropriate educational contents should be designed and implemented based on sexual and reproductive health needs. ¹³ Also, research showed that the couples attending the classes address the pre‑marriage counseling as a pleasant and satisfactory experience.¹One study also revealed that the majority of participants had poor sexual knowledge and attitudes regarding different aspects of sexual health. ¹⁴

One researcher who reported that half of the study sample would be having low level of knowledge, by considering differences of 15%, 20% and 30% in the risk factors associated with the low level of knowledge. ¹⁵ The results of one study showed pre-marriage education meaningfully improves misbelieve about marriage among girls (P<0.0001).¹⁶ Equally, results showed that pre-marriage education had no meaningful effect on general health of the girls. One researcher reported, insufficient female youth reproductive health services (222 cases, 55.2%) and low knowledge about reproductive health (222 cases, 55.2%) was the main barriers of the female youth reproductive health aim. ¹⁷

The Ministry of Health and Medical Education of Iran  and WHO pointed that the maternal mortality ratio per 100,000 live births has dropped sharply to 37.4 deaths in 1997 from 91 deaths in 1989 to 26 deaths in 2005 in Iran. 11 Iran’s family planning program is one of the most successful throughout the world. ¹⁸ With respect to the increasing divorce rate in Iran and the probable role played by sexual dissatisfaction in the breakdown of marriages, the Ministry of Health recently aimed to improve the educational content of the premarital education programmes ¹⁹. Therefore, this study was carried out to assess the effects of premarital education on the awareness about reproductive health, in girls admitted to the premarital counseling center in Garmsar city, Iran.

MATERIAL AND METHODS: This research was an interventional semi-experimental study. 152 number of girls admitted to the marriage counseling center were selected with consecutive sampling method in Garmsar city in 2012. In this investigation, data were collected in two stages of pre and post of test. Questionnaires of pre-test (included, demographic and reproductive health questions) was completed before starting of educational class. Holding of this premarital counseling class was conducted by a trained midwife and using of teaching aids such as poster, maquette, PowerPoint and educational film for two hours. Educational content included anatomy, physiology of the reproductive system, menstruation and its health, pre-pregnancy care, sexual function, contraceptive methods and common female cancer screening. Content of Power Point slides was prepared by marriage program expert of city on the basis of the above headlines mentioned and after approval by the health deputy of Semnan Medical Sciences University experts were put in authority of the consultant of marriage class for teaching.

Furthermore, educational films of necessary informations about marriage were queriesed. At the end of class, educational packages included pamphlets of premarital counseling and book of marriages and romantic and social relationships, were donated to the samples. At the end of class, post-test questionnaire included two. The questions of reproductive health and satisfaction of the class was completed by samples. Ranges of reproductive health scores were from zero to twenty and satisfaction scores were between zero and eight. That it was divided in three groups: poor (0-2), medium (3-5) and good (6-8).At the end, in order to analysis of the data, SPSS statistical software was used.

RESULTS: The results of this study showed that mean and standard deviation (SD) of samples age was year of 22.41± 3.22 and the highest percentage of frequency was related to the age group of 18-23 years (52%). So that 55.3% of the samples had academic education and job of most of them was housekeeping (53.9%). Based on the findings, the knowledge score of the studied samples before education was 12.18± 3.3584 that after education this score increased to the 17.81±5873, and this statistically difference was significant (p=0.000) (Table 1). Comparison the mean scores of the samples' awareness before and after education based on the variables age, job and education levels, did not show statistically significant differences (p>0.05) (Table 2). The results also showed that 92.1% percent of the participants had good satisfaction for holding of this class (Table 3).

TABLE 1: MEAN SCORES OF AWARENESS BEFORE AND AFTER EDUCATION OF GIRLS ADMITTED TO MARRIAGE COUNSELING CENTER

TABLE 2: COMPARISON OF THE MEAN SCORES CHANGES OF AWARENESS BASED ON THE DEMOGRAPHICS VARIABLES OF THE GIRLS ADMITTED TO THE MARRIAGE COUNSELING

TABLE 3: THE SATISFACTION OF THE EDUCATIONAL CLASS IN THE GIRLS ADMITTED TO THE MARRIAGE CONSULTATION CENTER

DISCUSSION: The results for this study showed that the level of knowledge about reproductive health after education was increased, and this difference was statistically significant and satisfaction of the classes holding was good. This is probably due to the training of girls by professional experts in the counseling center of Garmsar. Therefore, premarital care is the promotion of the health and well-being of a woman and her partner before pregnancy; it is considered as the primary preventive approach for couples planning for conception; it can identify and modify behavioral, medical, and other health-risk factors known to impact pregnancy outcomes through prevention and management. ⁸

In this case, resent empirical evidence supports the hypothesis that these premarital education programs improve the quality of couples' relationship and interpersonal skills. ²⁰

Consistent with these results, results of one study showed that mean score of awareness, index of reproductive health, reproductive health and family planning were significantly different (P =0.000) before and after training but the mean score of thalassemia awareness before and after the training showed no significant difference. Additionally, they reported that the mean scores of knowledge on reproductive health, after the consultation program was statistically significant (P<0.001). ²¹

Researcher found that adolescents who participated in a sex-education courses were more likely to have fewer premarital pregnancies. ²² Consistent with these results, also other studies emphasized on the knowledge of adolescent girls regarding ovulation, first sign of pregnancy and fertilization improved by 37.2% (95% CI = (35.2, 39.2), P <0.001). ²³ Moreover, they reports that girls’ awareness regarding the importance of diet during pregnancy improved from 66 to 95% following the intervention. The results for another research, showed that sexual health education in premarital counseling leads to improving of girls’ awareness.⁵ In one research, health education of youth corps members was significantly effective in improving their level of knowledge, attitude to sickle cell disease and screening uptake. ²⁴ They reported that post- intervention, the level of knowledge of sickle cell disease increased (64.1%), attitudes improved in most aspects considered and the proportion who knew their genotypes increased (11.9%) significantly only in the intervention group. Results of one test, showed that 83.2% of the couples had poor knowledge, 16% average, and 0.8% had good knowledge before the intervention. After the intervention, 60.4% of couples had poor knowledge, 31.6% average and 8% had good knowledge. ¹ Their results also revealed that the difference in mean scores of knowledge and attitudes regarding reproductive health, family planning, genetic diseases and disabilities was statistically significant (P < 0.001).

In one study in order to evaluation of premarital counseling class quality from the viewpoint of trained couples showed that 4.4% was weak, 49%was medium and 46.6% of participants evaluated that this class was good. ²⁵ However, in another study there was no significant difference in terms of sexual satisfaction and marital satisfaction. But in this study, marital satisfaction had significant correlation with sexual satisfaction (? = 0.55, ?<0.001). ¹⁹

Finally, the majority of studies were consistent with this study. Overall, results for this study showed that the duration of training, the choice of educational content, the use of various teaching aids (Power Point, educational videos, posters, etc.) and holding of individual classes for couples and enough opportunities for asking questions, and answering had the significant effect on the effectiveness of education and satisfaction from the class's quality. Strengthening of educational centers at the time of marriage, life skills education and creation of counseling centers and after marriage services that have been emphasized by the leader are effective in increasing of consolidation of family. The findings of this study showed that premarital counseling programs effected on the girls’ awareness about reproductive health, and participants were satisfied for the manners of holding course using of teaching aids. The authors are indebted to assistances of health network of Garmsar, health center of number three of Garmsar and the coach of marriage consultation of Garmsaras well as all those who assisted us in carrying out this study.

CONFLICT INTERESTS: The authors declare that they have no conflicts of interest.

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    How to cite this article:

    Rezaeyan M and Morteza H: Changes in the girls’ awareness about reproductive health after premartial education by the premartial counseling center in Ggarmsar city, Iran. Int J Pharm Sci Res 2017; 8(1): 277-81.doi: 10.13040/IJPSR.0975-8232.8(1).277-81.

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