Married Adolescent Women’s Sexual and Reproductive Health Needs (Ghiasi et al., 2022)

• Populations: Children and adolescents
• Age ranges: 10-19
• Countries: Iran

Items

Subscales:

• need to improve MAW’s sexual quality of life (13 items);
• need to promote MAW’s SRH self-care (8 items);
• need to improve MAW’s SRH self-efficacy (6 items)
• need to increase MAW’s SRH knowledge (18 items);
• need to increase husband’s involvement in MAW’s SRH (9 items);
• need to improve the performance of health care providers (6 items);
• need to strengthen the family support to MAW (8 items);
• need to improve family involvement in SRH education of MAW (3 items);
• need to provide specific premarital counselling to MAW (3 items)

Items by Subscale:

need to improve MAW’s sexual quality of life (13 items)

• My husband prepared me both mentally and emotionally for the first time sex.
• In our sexual relationship, my husband does not do anything that bothers me or if I ask him, he won’t repeat it again.
• My husband pays attention to my sexual needs.
• My husband spends enough time on foreplay before intercourse.
• I enjoy having sex with my husband.
• My husband kisses or hugs me after sex.
• I can openly express my love and feelings for my husband during sex.
• My husband forces me to have sex with him when I don’t want to.
• I have no interest to have sex.
• Because of the fear of the consequences of saying no to my husband, despite not having desire, I am forced to have sex with him.
• I can initiate sex with my husband.
• I talk openly to my husband about my sexual needs and expectations.
• I don’t criticise my husband’s sexual behaviour when he is tired, angry, upset or sexually aroused.
  
  

need to promote MAW’s SRH self-care (8 items);

• As soon as I know I am pregnant, make first prenatal appointment with a doctor or midwife.
• I eat a varied diet during pregnancy based on a range of foods from the five food groups (fruits, vegetables, grains, protein foods and dairy).
• For appropriate weight gain during pregnancy, I follow the healthcare providers’ advice.
• If I suspect that I have a vaginal infection, see a doctor as soon as possible.
• If I have a sexual problem, I will try to solve it.
• I take vitamin and mineral supplements (especially iron, folic acid and calcium) during pregnancy and up to 3 months after delivery.
• If I have a vaginal infection, I will complete the entire course of treatment.
• During pregnancy, I brush and floss my teeth regularly, even if nausea and vomiting or bleeding gums occur.

need to improve MAW’s SRH self-efficacy (6 items)

• I can persuade my husband to pay attention to my ideas about timing and number of births.
• I can persuade my husband to involve in family planning.
• If I decide to use a method of contraception, I am able to get it.
• During pregnancy if I feel that I can no longer control my anger when I argue with my husband, I will postpone the discussion to another time.
• When I encounter a stressful situation during pregnancy (such as facing financial difficulties, arguing with husband, Concern about foetal health), I can manage it.
• I feel comfortable talking about my sexual and reproductive health concerns with healthcare professionals.

need to increase MAW’s SRH knowledge (18 items);

• A woman is most likely to become pregnant in the middle of her menstrual cycle (usually about 14 days before the start of the next period).
• Pregnancy can happen if semen is spilled outside the vagina (such as in intercrural sex, or anal sex).
• The correct way to take the oral contraceptive (COC) tablet is to take one every day (regardless of whether you have sex or not) for 21 days, then stop for seven days.
• The condom should be unrolled onto an erect (hard) penis before any penetration occurs.
• Birth control pills do not cause infertility.
• The mini-pill is a good choice for breast-feeding mothers because it does not reduce the milk supply.
• Preconception care should begin at least 3 months before a woman becomes pregnant.
• Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies.
• Because I’m a teenager, I should pay more attention to my diet during pregnancy than other pregnant women.
• Fever and chills, severe headache, vision problems; such as blurring or seeing flashing lights, and severe nausea-vomiting are some warning signs of possible pregnancy complications.
• Periodontal infection such as tooth decay and gum disease is linked to an increased risk of premature birth and low birth weight.
• In a normal and healthy pregnancy, orgasm doesn’t increase the risk of miscarriage or preterm labour.
• Having sex during pregnancy is generally safe and won’t hurt the foetus.
• Genital herpes and genital warts are both transmitted through sexual contact.
• Apart from HIV/AIDS, there are many other diseases that can be transmitted throughs sexual contact.
• Condoms are most effective at protecting against sexually transmitted diseases like HIV/AIDS
• Genital ulcers are usually caused by sexually transmitted diseases.
• HIV/AIDS cannot be transmitted through kissing, hugging, sharing toilets, towels or dishes.

need to increase husband’s involvement in MAW’s SRH (9 items);

• My husband and I decide together which form of birth control to use.
• My husband pays attention to his sexual hygiene.
• My husband cooperates with me during treatment of genital infection (e.g. he stops having sexual intercourse, or uses a condom from the beginning of sex, and takes medication if necessary).
• My husband is emotionally abusive towards me while I am pregnant.
• My husband is physically abusive towards me while I am pregnant.
• My husband accompanies me to prenatal care (including appointments, screening tests and ultrasound scans) and the delivery process.
• My husband and I decide together how many children to have, and when to have them.
• My husband understands my mood swings during pregnancy.
• My husband helps me with household chores during pregnancy.

need to improve the performance of health care providers (6 items);

• I am satisfied with the way the health care providers communicate with me.
• I have received information about nutrition during pregnancy, sex during pregnancy, oral health care during pregnancy, childbirth preparation classes, how to take iron supplement, benefits of taking iron and multivitamins during pregnancy from health care providers.
• Because I became pregnant as a teenager, I receive special attention from health care providers during, and after pregnancy.
• Healthcare providers provide me all the information I need (pregnancy nutrition, sex in pregnancy, pregnancy risk symptoms, how to use contraception … ) without having to wait for a question from me.
• Health care providers provide me the required health information in a simple and understandable language.
• Because I became pregnant before the age of 19 years, health care providers blame me. 

need to strengthen the family support to MAW (8 items);

• My family tries to keep me calm and stress free during pregnancy.
• My husband’s family tries to keep me calm and stress free during pregnancy
• My family will financially support me for costs associated with pregnancy (e.g. for purchasing foods, routine antenatal tests, ultrasound screening or frequent hospitalisations), if needed.
• My husband’s family will financially support me for costs associated with pregnancy (e.g. for purchasing foods, routine antenatal tests, ultrasound screening or frequent hospitalisations), if needed.
• I will receive help from my family to take care of my child, if needed.
• I will receive help from my husband’s family to take care of my child, if needed.
• During pregnancy and postpartum, I receive attention and emotional support from my family.
• During pregnancy and postpartum, I receive attention and emotional support from my husband’s family.

need to improve family involvement in SRH education of MAW (3 items);

• I received sexual and reproductive health information from my family before I got married.
• I received sexual and reproductive health information from my family during the engagement period.
• I feel comfortable talking about sexual and reproductive health issues with my mother.
• In the pre-marriage counselling program, sexual and reproductive health issues should be taught in several sessions.

need to provide specific premarital counselling to MAW (3 items)

• In pre-marriage counselling classes, sexual and reproductive health content is taught insufficiently.
• It is necessary to hold a special pre-marriage counselling training class for teenagers.
• If in the pre-marriage counselling classes, in addition to group education, the conditions for couple education were provided, the possibility of understanding of the subject taught would be increased

Scoring

“To convert raw scores into standard scores, the following conversion formula was used:

linear transformed formula
 = [(actual raw score - lowest possible row score) / possible row score range)] x 100

Where ’actual raw score’ is the values achieved through summation, ‘lowest possible raw score’ is the lowest possible value that could occur through summation and ‘possible raw score range’ is the difference between the maximum possible raw score and the lowest possible raw score.

For example, in the five-point Likert scale, each item had scores of 1–5, so to calculate the percentage score of sub-scale 1, the maximum score is 65 and the minimum score is 13 because it has 13 items and to calculate the percentage score of subscale 2, the maximum score is 40 and the minimum score is 8 because it has eight items. But, after considering the weight of items, each subscale of questionnaire is scored on a scale of 0–100, with higher scores indicating fewer unmet need. The total score of the questionnaire is computed using
calculating the average of the total modified scores of the questionnaire. Higher scores in the entire questionnaire represent fewer unmet need for SRH.”

(Ghiasi et al., 2022)

Citations

Ghiasi, A., Keramat, A., Zayeri, F., Farjamfar, M., Vakilian, K., & Bagheri, L. (2022). Design and psychometric properties of a questionnaire for assessing sexual and reproductive health needs of married adolescent women: An exploratory sequential mixed methods study. Journal of Obstetrics and Gynaecology, 42(7), 3172-3180. https://doi.org/10.1080/01443615.2022.2109132

Team comments

This measure is noted by the authors as highly contextualized to Iranian culture, saying “Further modifications and psychometric testing of this new instrument should be performed before using it in other cultural contexts.”  (Ghiasi et al., 2022)  Further, the authors note many negative health outcomes associated with adolescent and childhood marriage and the “widespread efforts to end child marriage,” and it may not represent support for that practice.  (Ghiasi et al., 2022)