Perceptions of Reproductive Health in Muslim Undergrads

Perceptions of Reproductive Health in Muslim Undergrads A MULTIDIMENSIONAL CONSTRUCT OF PERCEPTIONS ON SEXUAL AND REPRODUCTIVE HEALTH AMONG MUSLIM UNDERGRADUATE STUDENTS Abstract This study examines factors influencing undergraduate students who are all Muslims from one of the public universities in Malaysia. Data were obtained from a survey conducted among the undergraduate students (n=255). Principle Components Analysis (PCA) revealed four latent factors: the electronic and printed media, knowledge of circumcision, the Islamic values on sexuality and their prior knowledge of sexual act. Based on the views of the respondents on the roles played by curriculum, religion and media in disseminating knowledge on sex-related matters, recommendations are drawn to assist the relevant parties in coming up with comprehensive sexuality education for Muslim adolescents. Key words: sex/sexuality education, reproductive health, undergraduate student, Muslim, perceptions, Principle Component Analysis (PCA) Introduction Studies which have been carried out in Muslim societies on sexual and reproductive health are limited. Many young Muslims are emitted from the learning process to cater the cultural and religious restrictions (Cok, 2000; DeJong et al., 2007; Halstead, 1997; Nurazzura, 2007; Underwood, 2000). Very little is, therefore, known about the factors that influence the Muslim youths on sexual and reproductive health. Several studies in some Muslim countries reported that Muslim youth are not well prepared and educated in sexual and reproductive health due to some contributing factors. (Burazeri et al., 2003; GÃâ€"kengin et al., 2003; Mohammad Reza et al.,2006; Nik Suryani et al., 2007; Paruk et al., 2006). Cok (2000) described sex education in Turkey, as similar as many other Muslim countries in the world, as â€Å"there are no sexuality classes, no mention of sexuality in health courses or no sexuality textbook material in Turkish school. Other issues take priority and sexuality education is pushed aside as unimportant and irrelevant† (p.5). Moreover, he stated that Turkish Muslim adolescents are highly influenced by media especially form Europe and North America. In addition, the study on 2,227 first-and fourth -years students at Ege Univesity, GÃâ€"kengin et al. (2003) revealed that knowledge about sexual health and sexuality transmitted diseases is insufficient among their samples. In Albania, Burazeri et al. (2003) reported the mean age at first sexual intercourse 720 undergraduate students in Tirana was 17.9 for men and 18.8 years for woman. They also found positive associations of parental education and income level with sexual activity and consistent use of condoms among Albanian undergraduate students. Mohammad Reza et al. (2006) described the sex education in Iran that cultural sensitivities which may be a factor in young peoples poor knowledge about reproductive health. Furthermore, few programs provide sexuality education to adolescents or enable youth to ask questions and correct misconceptions about reproductive health. Indeed, large numbers of young Iranians lack information about safe sex and about the skills necessary to negotiate and adopt safe sex practices. In their study of 1,385 males aged 15-18 in Tehran about their beliefs and knowledge regarding reproductive health and their engaging in sexual activity, they found that there was a relatively high prevalence of sexual activity and the lack of knowledge regarding STIs and contraceptives pose a significant threat to the sexual and reproductive health of Iranian adolescent males. Hence, they requested programs to provide adolescents with the accurate information and skills to make safe sexual decisions. A study conducted by Nik Suryani et al. (2007) with undergraduate students (n=300) in Malaysia , discovered that, in general, students held a positive view toward sex and sex-related matters; however, their knowledge on sexuality education, sexual and reproductive health matters calls for attention from the relevant authorities. Findings on their sources of information on sexuality education also revealed that more could be done to help them obtain an accurate picture of sex-related matters particularly with the roles played by parents, school, religion and media in disseminating knowledge on sex-related matters. Paruk et al. (2006) presented finding on the influence of religiosity on attitude toward people with HIV/AIDS using 90 South African Muslim university students. They found that higher religiosity was significantly correlated with a more positive attitude to people with HIV. Ojo Bidemi (2008) conducted a study with 520 adolescent of Nigerian students on contemporary clothing habits and sexual behavior of adolescents in the South Western Nigeria. They found that there is no significant difference in the factors influencing adolescents dressing habits and also the fact that there is relationship between clothing habits and their sexual behavior. In Pakistan, Qidwai (2000) surveyed perception among 188 Pakistani young men, who presented to family physicians, at the outpatient department of the Aga Khan University Hospital, Karachi, about enjoyment of sexual experiences in women. He found a high prevalence of misconceptions about female sexuality among Pakistani young men. Furthermore, Hennink, Rana, Iqbal (2005) studied on knowledge of personal and sexual development amongst young people in Pakistan. They found that young women typically gain information from a limited number of sources while young men accessed a wide variety of information sources outside the home. From studies done in various Muslim countries, however, there is not enough information on factors influencing the basic sexual and reproductive health among Muslim undergraduate student as well as in other developing countries (Singh, Bankole Woog, 2005). Intervention studies are largely absent. There is a need therefore to determine factors associated with Muslims sexual perception to develop a clear understanding in student variables, the results of which may contribute to help students on their knowledge and behavior regarding to sexual and reproductive health and it will help determine best bets for programs for sex education for Muslim youths. The purpose of this study was to survey Muslim undergraduate students perceptions in sexual and reproductive health, and in doing so, to clarify the meaning of the construct itself. Thus, the study addressed the following research questions: What are the factors influencing Muslim undergraduate students perceptions towards sexual and reproductive health? This study is based on the crossed different populations and geographic regions influencing factor adolescent on sexual and reproductive health studied by Manlove et al. (2001). They pointed out that there are multiple domains in an adolescents life associated with reproductive health outcomes. By grounded on the ecological approach, individual factor, family factor, peers, partners, school context, neighborhood, community, and social policy characteristics are all associated with sexual behaviors, adolescent pregnancy, and STI. However, this study only looked at certain dimensions which comprised (1) individual factor (religiosity, knowledge of reproductive health and attitudes and belief about sex); (2) school context (curriculum); and, (3) media. The authors, therefore, hypothesized that there are four influencing factors of undergraduate Muslim students perception on sexual and reproductive health: (1) school and tertiary curriculum support, (2) Islamic values on sexuality, (3) electronic and printed media, and (4) students prior knowledge on sexual and reproduction health. Significance of Study Results of this study are pictured to provide empirical data on factors influencing perception on sexual and reproductive health among Muslim undergraduate students that have not been fully studied. Thus, the results of this study are expected to help in the understanding of students perception towards sexual and reproductive health and sex education which is promoted by several factors. The findings are beneficial to understand and determine the success or failure of factors influence and the implementation of sex education in Islamic higher learning institute as perceived by students. Such information can help to improve the strategy in order to accomplish the sex education particularly for Muslim youths. Method Research design In this study, the survey method was employed. A questionnaire was selected from Nik Suryani et al. (2007) measured these relationships. It consisted of two parts. The questionnaires were distributed randomly to a sample of undergraduate in the International Islamic University Malaysia (IIUM). Population and sample The population is the undergraduate students in IIUM, Gombak campus, Kuala Lumpur, Malaysia. All were Malaysians. A random sampling was used to select participants. The principle component analysis (PCA) was conducted where the number of sample depends on the items of the questionnaire. Since the number of the item is 40, the minimum sample size is 40 x 5 = 200 participants. In this study, the participants were 255 which were more than the minimum requirement (Hair et al., 2006). Data Collection To distribute the questionnaires, researchers sought help from three students which researchers have known. The questionnaire has an attached covering letter that assures the confidentially of data collected and describes the major components of questionnaires to be completed. Students were given one week to complete the questionnaires and had to return them to the assigned persons within the time allocated. The usable returned response rate was 72.9 % (n=255) out of 350 students. The data collected was operated on January 2008. Validity and Reliability To establish the face and construct validity of the instrument, the opinions of two experts in education were sought on the design and items used for the various dimension. The instrument was pilot tested on 30 students that was not on the list of the selected students. Based on the pilot test, 50 items from Nik Suryani et al. (2007) was tested and a few items were omitted in order to refine the instrument further. Finally, 40 items were confirmed with a reliability of Alpha Cronbach = .72. Instrumentation The survey instrument was adopted from a core questionnaire developed by Nik Suryani et al. (2007). The questionnaire comprised 40 questions divided into two sections: social and demographic variables and students views and knowledge on a wide range of topics on sex and attitudes towards sex. It sought to find out students perceptions on: (1) school and tertiary curriculum (5 items; no.1-5); (2) Islamic values on sexuality (6 items; no.6-11); (3) electronic and printed media (4 items; no.12-15): (4) sexual novel (4 items; no.16-19): (5) their prior knowledge of sexual and reproductive health 5.1 protected sex (6items; no.20-25): 5.2 sexual act (9 items; no.26-34): 5.3 circumcisions (9 items; no.35-40). The response to each item is in the form of a five-point Likert scale of â€Å"strongly disagree, â€Å"disagree†, â€Å"undecided†, â€Å"agree†, and â€Å"strongly agree†. The demographic characteristic of the first section of the questionnaire contains questions with regard to the respondents background information (gender, age, country of origin, former school and location, faculty, year of study, CGPA, and marital status). Data analysis For the demographic data, frequency and percentage were employed. To answer the research question on factors influencing students perceptions of sexual and reproductive health, principle component analysis was utilized. An explanatory factor analysis was conducted to construct-validate the factor influencing students perception. To find out the number of factors the following rules were used: (1) the Kaisers rule of 1.0 as the minimum eigenvalues, (2) the scree test and (3) the interpretability of the solutions. The degree of intercorrelation among items justified the application of the factor analysis as well as the Batletts test of sphericity recorded a Chi square value. Results Table 1 shows out of 255 students, 152 (59.6%) were females and 101 (39.6%) were males. A majority of the students (91.4%) were between 20 and 25 years of age, the remaining being distributed between the age group of younger than 20 (7.4%) and older than 25 (1.2%). Approximately, 239 (93.7%) of the respondents were Malaysians while 16 (6.3%) were international students. Most of students (37.2%) graduated from urban day school, followed by religious school (27.1%), boarding school (16.5%), rural day school (9.0%), private school (5.9%), and others (1.9%). The respondents were represented from different faculty with nearly half (42.4%) being law students (AIKOL). The other half was distributed between Human Sciences (24.3%), KENMS (11.8%), ENGINEERING (7.1%), KAED (5.5%), INSTED (3.9%), KICT (2.7%), and IRK (2.4%) respectively. Majority of students were second year student (32.5%), the remaining being almost distributed between the final year (29.8%), the first year (21.2%), and the third year (16.5%). In general, almost more than half of the students (49.4%) had CGPA more than 3.0, while the rest (28.7%) had less than 3.0. Almost 95.7% students were single which 131 (53.7%) were not attached to someone and 110 (45.1%) were having attached to someone, only 11 (4.3%) students were married. Table 1 Respondents Demographic Background Variables N Percent 1. Gender: Male 101 39.6 Female 152 59.6 Missing Value 2 0.8 2.Age 19 7.4 20-25 233 91.4 >25 3 1.2 3.Country of Origin Malaysian (local student) 239 93.7 Non-Malaysian (international student) 16 6.3 4. Former School and Location Urban Day School 95 37.2 Rural Day School 23 9.0 Boarding School 42 16.5 Religious School 69 27.1 Private School 15 5.9 Others 6 2.4 Missing values 5 1.9 5. Faculty Information and Communication Technology (KICT) 7 2.7 Engineering 18 7.1 Laws (AIKOL) 108 42.4 Human Sciences (HS) 62 24.3 Islamic Revealed Knowledge (IRK) 6 2.3 Institute of Education (INSTEAD) 10 3.9 Economics and Management Sciences (KENMS) 30 11.8 Architecture and Environmental Design ( KAED) 14 5.5 6. Year of study 1st year 54 21.2 2nd year 83 32.5 3rd year 42 16.5 4th year 76 29.8 5. CGPA 1 0.4 2.00-2.49 11 4.4 2.50-2.99 61 23.9 3.00-3.49 102 40 >3.50 24 9.4 Missing Value 56 21.9 6. Marital status Single 244 95.7 Single and have attached to someone 110 45.1 Single and have not attached to someone 131 53.7 Missing Value 3 1.2 Married 11 4.3 n = 255 Perceptions toward Sexual and Reproductive Health Table 2 summarizes the results of the descriptive analysis of the students perceptions on sexual and reproductive health. The data showed that the mean scores ranged between 1.83 (items PRO23) and 4.57 (items REL10); the standard deviations ranged from .66 (items SEX34) to 1.18 (items PRO23). The mean scores were located within the expected range (none of the items are included a mean score of zero, at 95 % level of confidence, with a reliability of Alpha Cronbach = .72). The data showed that the dispersion of the scores for each item sufficiently discriminated the students perceptions. In addition, the degree of bivariate correlation among most of the 40 items matric variables ranged from low to high. However six of them (items EDU1, EDU2, PRO24, SEX28, SEX31, and CIR39) were found to link weakly and negatively with the rest of the items. Table 2 Mean (Standard Deviation) and Item-Total Correlations of Students Perceptions on Sexual and Reproductive Health Items Code M SD r 1. The content of information on sexual related matters taught at school is sufficient. EDU1 2.95 1.157 .081 2. Courses like Family Management and Parenting at undergraduate level should openly discuss sexual and reproductive health matters. EDU2 4.11 .876 .023 3. Sexual education should be taught as subject of its own at secondary schools. EDU3 3.28 1.176 .227 4. Sexual education should be taught as a separate subject at the tertiary level. EDU4 3.60 1.043 .195 5. Sexual education should be taught in pre-marital courses. EDU5 4.38 .686 .176 6. Quran provides me with information on sexuality in a decent manner. REL6 4.38 .789 .239 7. My religious knowledge provides basis for me to develop the conscience not to engage in premarital sex REL7 4.52 .728 .192 8. Religion helps me suppress my sexual desire. REL8 4.26 .847 .237 9. Fasting is one of the best ways to keep my sexual desire under control. REL9 4.31 .910 .327 10. Watching pornography is forbidden in Islam. REL10 4.57 .767 .303 11. The only way to eliminate illicit sex is by implementing the Syariah Law. REL11 4.19 .922 .389 12. Electronic media portrays negative perception of sexuality. MED12 3.70 1.079 .339 13. Printed media portrays negative perception of sexuality. MED13 3.65 1.075 .372 14. Electronic media leads young people to embark on pre-marital sexual relationship. MED14 4.10 .927 .357 15. Printed media leads young people to embark on pre-marital sexual relationship. MED15 3.94 .987 .412 16. Reading sexy novels leads people to having pre-marital sex. NOV16 3.42 1.036 .354 17. Novels are most descriptive about sexual intercourses than other sources. NOV17 2.98 1.072 .350 18. Novels with sexual descriptions increase my desire to masturbate. NOV18 2.69 1.107 .324 19. Novels with sexual descriptions increase my sexual fantasies. NOV19 2.95 1.093 .268 20. There is fertility problem if pregnancy does not occur in the first year of marriage. PRO20 2.52 .972 .218 21. Unprotected sexual intercourse will guarantee pregnancy. PRO21 3.32 1.175 .339 22. Protected intercourse guarantee pregnancy wont occur. PRO22 2.70 1.085 .235 23. Kissing and touching can lead to pregnancy. PRO23 1.83 1.177 .153 24. The use of contraceptives or protected sex ensures safety from sexually related diseases. PRO24 3.41 .996 .069 25. Islam forbids the use of contraceptives. PRO25 2.87 1.010 .169 26. Preservation of virginity is most important for both men and women before getting married. SEX26 4.53 .781 .125 27. Sex is painful for first timers. SEX27 3.44 .933 .100 28. Sex is painful for women. SEX28 3.22 .886 .069 29. Sex is pleasurable to both men and women. SEX29 4.04 .853 .162 30. Only matured people enjoy sexual relationship. SEX30 2.88 1.088 .100 31. Sexual relationship is for young people only. SEX31 1.91 .909 -.057 32. Good Communication between spouses ensures satisfying sexual relationship. SEX32 4.32 .839 .100 33. Knowledge about sex is a pre requisite for enjoying sex. SEX33 4.05 .876 .246 34. Understanding between each others needs help improve sexual satisfaction. SEX34 4.39 .660 .168 35. Circumcision is mainly for health reasons. CIR35 3.93 1.090 .192 36. Circumcision is for cultural reasons. CIR36 2.43 1.033 .189 37. Circumcision for women reduces sexual satisfaction. CIR37 2.89 .935 .116 38. Circumcision for women represses their sexual desires. CIR38 2.96 .856 .235 39. Circumcision for men reduces sexual satisfaction. CIR39 2.59 .977 .076 40. Circumcision for men represses their sexual desires. CIR40 2.92 .969 .105 The Underlying Dimensions of Students Perceptions To identify the factors that influence undergraduate Muslim students response toward sexual and reproductive health, the data collected from the sample of 255 respondents were subjected to principal component analysis. Nevertheless, the present analysis used only the responses on the 34 of the 40 items (Table 3). Based on the results of item analysis as described in the preceding section, 6 of the items (items EDU1, EDU2, PRO24, SEX28, SEX31, and CIR39) were excluded because they were behaving poorly in the item-total correlation. Table 3 summarizes the correlations among the 34 items supported the use of principal component analysis. Specifically, the Bartlett Sphericity Test yielded statistically significant intercorrelation c2 (561) = 2525.854, p = .001 with an overall MSA of .65, which exceeded the value of .60. Thus, the data matrix has sufficient correlation to justify the use of the exploratory factor analysis. The principal component analysis yielded a seven -factor dimension structure, accounting for 60.69% of the variance. This indicates that four underlying dimensions explain more than 60% of the variance among the 34 variables. The eigenvalues, ranging from 1.616 to 3.0622 (which is greater than 1 as required), satisfied the standards of important factors as prescribed by Hair, Jr. et al. (2006). Table 3 Correlation Matrix and Descriptive Statistic EDU3 EDU4 EDU5 REL6 REL7 REL8 REL9 REL10 REL11 MED12 MED13 MED14 MED15 NOV16 NOV17 NOV18 NOV19 PRO20 PRO21 PRO22 PRO23 PRO25 SEX26 SEX27 SEX29 SEX30 SEX32 SEX33 SEX34 CIR35 CIR36 CIR37 CIR38 CIR40 EDU3 .548 EDU4 -.284 .557 EDU5 -.134 -.128 .747 REL6 .051 -.046 -.085 .769 REL7 -.021 .017 -.107 -.385 .735 REL8 .061 -.006 .027 -.125 -.233 .724 REL9 -.052 .028 -.011 -.130 -.104 -.210 .771 REL10 .015 -.084 -.110 -.084 -.023 -.234 -.002 .742 REL11 .007 .040 -.099 .027 -.140 .031 -.194 -.153 .782 MED12 .062 .071 .045 -.034 .068 .107 -.062 -.183 -.005 .669 MED13 -.162 -.074 .029 -.025 -.014 -.082 .046 .100 -.202 -.784 .666 MED14 .046 .052 -.088 .045 -.021 .080 .110 -.118 .071 .005 -.172 .664 MED15 -.032 -.025 .017 .003 .001 -.124 -.044 .120 -.113 -.074 .052 -.763 .688 NOV16 .162 -.022 .047 -.145 .047 .001 -.010 -.069 -.191 .020 .072 -.138 -.034 .757 NOV17 -.020 -.056 .094 .046 .028 .017 -.174 .000 .125 .028 -.029 .045 -.141 -.328 .713 NOV18 -.034 .113 -.078 -.017 -.081 .124 -.030 -.024 .209 -.019 -.076 .141 -.089 -.188 -.191 .591 NOV19 .085 -.105 -.101 .183 -.018 -.168 .126 .040 -.053 -.004 -.012 -.011 .013 -.001 -.047 -.663 .588 PRO20 -.106 .172 .097 -.095 .194 -.099 .024 -.007 -.015 -.018 -.118 -.040 .033 -.075 .118 .036 -.051 .630 PRO21 .032 -.077 -.059 .056 -.056 .056 -.098 .072 -.002 .006 -.031 .051 -.044 -.124 .065 -.090 .049 -.093 .610 PRO22 -.055 -.041 .006 -.023 -.001 .022 -.140 .004 -.097 -.053 .109 .067 -.031 .108 -.111 -.081 .059 -.147 -.290 .485 PRO23 -.120 .028 .054 -.017 .112 -.070 .003 .149 -.198 -.060 .040 -.141 .111 .042 -.050 -.087 .012 .010 -.045 -.196 .619 PRO25 .088 -.126 .092 -.052 .056 .126 -.134 -.206 .005 .114 -.030 -.028 -.017 -.015 .002 .025 -.096 -.120 -.169 .099 -.126 .490 SEX26 .004 -.041 .071 -.092 -.141 .034 -.010 -.063 -.056 -.031 .023 -.049 .067 .080 -.175 .047 .036 -.006 -.204 .086 .101 .057 .671 SEX27 .079 .083 -.093 .080 -.078 -.056 .098 .135 -.107 .051 -.024 -.100 .015 .098 .074 -.135 .085 .026 .196 -.244 .092 -.128 -.197 .319 SEX29 -.085 -.058 -.089 -.088 .013 -.091 .011 -.055 .033 -.086 .153 .029 -.007 .048 -.105 .135 -.199 -.211 -.196 .120 .069 .111 .114 -.195 .572 SEX30 -.023 .064 -.009 -.090 .118 .029 -.161 -.055 .048 -.006 .000 -.110 .075 -.117 -.027 .114 -.097 -.009 .011 -.001 .036 .092 .101 -.143 .147 .536 SEX32 -.243 .095 .094 -.039 .066 -.068 -.006 .074 -.018 -.148 .127 -.028 .018 .047 -.001 -.043 -.004 .231 -.038 .114 .041 -.106 -.040 -.103 -.054 .089 .640 SEX33 -.023 .060 .014 .163 -.195 .084 -.110 -.149 .058 .090 -.043 .062 -.055 -.124 -.088 .088 -.092 -.192 .057 .133 -.119 .097 -.036 -.040 .056 -.046 -.193 .570 SEX34 .127 -.132 -.039 -.139 .173 -.044 .020 .067 -.049 .105 -.085 -.076 .025 .064 .193 -.167 .075 .158 .006 -.155 .072 .032 -.058 .123 -.256 -.054 -.333 -.463 .555 CIR35 -.103 .093 .052 -.006 .018 .025 -.115 -.101 -.075 -.026 .058 -.053 .056 .011 -.026 -.020 -.012 .065 -.052 .054 .038 -.065 -.104 -.074 .019 .018 .053 .128 -.237 .600 CIR36 .003 -.139 .060 -.085 .159 -.147 .181 .069 -.084 .015 .045 -.014 .021 .025 -.197 -.173 .174 -.052 -.137 .084 .010 -.068 .108 -.114 .020 -.026 .032 -.170 .133 -.113 .613 CIR37 -.145 .013 .021 .044 -.011 .168 -.081 .037 .072 -.034 .015 -.086 .068 -.157 .067 .104 -.121 .003 .126