Sexual and reproductive health-related questions and concerns of newly married couples: A qualitative content analysis.

Background and Aims: Approximately half of Iranian marring couples have poor sexual knowledge and attitudes. This article delves into the main concerns and queries regarding sexual and reproductive health among Iranian newly married couples. Methods: We conducted a content analysis of the sexual and reproductive health questions and concerns that were anonymously submitted by newly married couples to the researcher via social media in 2021-2022. Results: A total of 141 questions and concerns that were related to sexual and reproductive health were considered for content analysis. Findings illustrated two main categories: (1) the need to create a reproductive life plan, and (2) the need for sexual knowledge and counseling. The first category consisted of three subcategories: "Poor contraceptive knowledge," "Need for support in case of a missed period or unplanned pregnancy," and "Need for preconception care." The second category included three subcategories: "Concern regarding virginity," "Sexual problems on the honeymoon," and "Sexual problems in newlyweds." Conclusion: Iranian newly married couples need long-term specialized services addressing their reproductive life planning and sexual knowledge needs. Integrating reproductive life planning and comprehensive sex education into the primary care services for newly married couples can help to reduce delayed childbearing, unintended pregnancy, unsafe and illegal abortion, and subsequent infertility.

Exploring the Consequences of Early Marriage: A Conventional Content Analysis.

Early marriage is one of the most important social issues for young women and can have many consequences. The present study aimed to explore the consequences of early marriage among Kurdish women in western Iran who were married under the age of 18. This qualitative study was conducted with the approach of conventional content analysis. The data were collected through semi-structured interviews with 30 women selected by purposeful sampling. Data analysis was performed using Graneheim and Lundman's method. A total of 389 codes, 12 subcategories, 4 sub-categories, and 2 main categories were extracted from the data analysis. Negative consequences of early marriage include: 1-physical and psychological problems (high-risk pregnancy and childbirth, physical illnesses, depression, and emotional distress); 2-family problems (dissatisfaction with married life, experience of having lots of responsibility, lack of independence in family life); 3-social problems (risky social behaviors, lack of access to social and health services, social isolation, lack of access to a job, and educational opportunities); and 4-positive consequences, including receiving intra-family support, improving living conditions, and opportunities for progress and empowerment. It is possible to reduce problems and challenges after early marriage by increasing the awareness and knowledge of young women about contraceptives and providing appropriate social and health facilities, and services during pregnancy. Providing the necessary training and psychological counseling for them and their husbands on how to deal with personal problems and marital life will be effective to a great extent.

Significance of Knowledge in Children on Self-Protection of Sexual Abuse: A Systematic Review.

Background: Sexual child abuse is a form of anti-social behavior with the children that cause potential harm to the health, development and dignity of the child. Knowledge of children about these issues can help to protect themselves against sexual abuse. This study aimed to review systematically available documents about the importance of knowledge on self-protection of sexual abuse in children. Methods: In this systematic review, "sexual abuse", "self-protection" and "knowledge" were searched in Scopus, Google Scholar, Ovid, PubMed, and Science Direct as the search words, and after considering the inclusion criteria and excluding irrelevant articles, the relevant articles were included for data extraction. In the included studies, children were educated about sexual abuse, and questionnaires were designed to compare the impact of education and the level of knowledge in children before and after education. Results: Overall, 19 articles with overall 6582 children were found that were published from 1987-2020. The main awareness of children was from parents, educators and then the media. Age of the child, education level of family, good relationship between family members, adequate education by school teachers in the form of educational programs and even media play an important role in increasing knowledge of children about sexual abuse. Education to children, on average, led to 77.43% more awareness and as a results self-protection against sexual abuse and rape. Conclusion: Insufficient education or lack of knowledge about sexual abuse is a critical issue in children. Therefore, it is necessary to design educational programs to increase their knowledge about sexual abuse and strategies for self-protection in this age group.

Development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality: an explanatory sequential mixed method study protocol.

BACKGROUND: The modern Iran is a blend of tradition and modernity, but its dominant culture is still traditional and takes pride in female virginity. On the other hand, the influential factors such as modernity, education, social networks, global communication, influence from advanced Western societies, have obviously led to the emergence of a freer sexual attitude associated with less significance of virginity. Since the traditional, cultural and religious significance of virginity among Iranian girls can shape their sexual behaviors, therefore, the aim of the present study is development of strategies to promote healthy sexuality based on Iranian girls perspective about the role of virginity in the construction of their sexuality. METHODS/DESIGN: This is a two-stage study; an explanatory sequential mixed-methods follow-up design will be employed in the first stage, which consists of two quantitative and qualitative phases. The first phase is the cross-sectional survey that will be conducted on 700 single girls born in the 1970s, 1980s and 1990s. The sample will be selected using the cluster sampling method in the health centers of Tabriz-Iran. The determined sample size will be divided among the selected health centers based on the quota criterion, and eligible households will be selected randomly from the said centers using the SIB website (sib.tbzmed.ac.ir). To collect the required data in the quantitative phase, we will use a researcher-made questionnaire to evaluate the girls' views about virginity and its influential factors, designed based on the theory of "social construction of sexuality". After quantitative data collection and analysis, the findings inform qualitative data collection and analysis. The qualitative phase of the study will be conducted on girls living in Tabriz using in-depth and semi-structured individual interviews and purposive sampling method to collect the required qualitative data. The collected data will be analyzed using the conventional content analysis approach. The findings of two phase will be integrated for further explanation and interpretation to be used in the second stage. In the second phase of this study, a nominal group meeting will be held with the participation of reproductive and sexual health experts. The strategies extracted from the results of the first phase and review the texts in this meeting will be provided to experts and after receiving the opinions and ideas of the relevant group of experts and prioritizing them, appropriate strategies to improve and promote the healthy sexuality of Iranian girls will be presented. DISCUSSION: This study is one of the few studies conducted in the field of sexual health and culture in Iran, that using a "mixed-methods" approach to determine and explain the role of virginity in the construction of the sexuality from the Iranian girls perspective. We hope that this study can present evidence-based documents from the latest physical, psychological and social developments in young Iranian girls' sexuality and that the presented healthy sexuality promotion strategies, which will be based on Iranian socio-cultural developments, can provide the basic information required for policy-making and planning for young girls' sexual health. It is also hoped that the findings of this study will be useful in culture-based sexuality education and support for reproductive and sexual health care for the young Iranian generation.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study.

BACKGROUND: Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby's health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears. METHODS: In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research. RESULTS: After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality. CONCLUSION: Pregnancy in adult age is better than adolescent age. The women's fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

A qualitative examination of men's participation in contraceptive use and its barriers in Tehran.

From 1989 to 2014, Iran was known as a country with a successful family planning programme, and has experienced a sharp decline in fertility over recent decades. This led to the introduction of pronatalist policies in 2014 and the restriction of family planning services. The aim of this study was to explore men's views on their access to contraceptive information and services and the socio-cultural barriers to such access in Tehran. The qualitative study was conducted in 2014 using in-depth interviews with 60 married men of varying ages and socioeconomic status from across Tehran. The data were analysed with a basic interpretive approach using MAXQDA10. Although the majority of the men acknowledged the importance of family planning and contraceptive use, they reported that their access to contraceptive information and services was limited. Discussion of sexual matters and contraception among men was identified as being somewhat embarrassing. Three main issues were identified: (1) men's poor awareness of contraceptive use; (2) men's poor access to high-quality health care services; and (3) cultural taboos and gender norms as barriers to contraception use by men. Socio-cultural and gender norms were found to significantly affect the men's contraceptive use. The study results support the growing call for gender-transformative approaches to family planning and reproductive health service delivery in Iran, to involve men and facilitate their greater participation.

A multicenter randomized controlled trial protocol to evaluate the effectiveness of an educational intervention on fertility knowledge, intention and behavior among Iranian new couples.

BACKGROUND: Recent evidence shows that men and women have inadequate fertility knowledge which may negatively affect their childbearing decisions in future. Given the fact that decision making for fertility needs accurate information, targeted educational interventions especially through media are needed to improve knowledge regarding the best age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Aim of the study is to evaluate whether a fertility educational program can be effective in increasing fertility knowledge, childbearing intention and the planned pregnancy rate among couples referring to premarital counselling centers. METHODS: This study is a parallel randomised clinical trial with pre-test/post-test design. We will recruit 1240 marrying couples referring for compulsory premarital counselling in public health centers through stratified sampling in five metropolitan cities of Iran. The intervention group will receive both the typical premarital counselling training and a fertility knowledge package containing verbal and virtual educational package at five time episodes (one verbal session and four virtual sessions) within 4 weeks. The primary outcomes are fertility knowledge, childbearing intention and the first planned pregnancy rate (positive pregnancy test) and the secondary outcomes include contraception method use, miscarriage and unplanned pregnancy. Participants will respond to a self-administered demographic/reproductive characteristics questionnaire, the Cardiff Fertility Knowledge Scale (CFKS) and the childbearing intention questionnaire. Data will be collected through online questionnaires at baseline and 3, 12 and 18 months after the intervention. Data will be analyzed using Chi-square or Fisher-exact test for categorical variables, Independent sample t-test for normally distributed quantitative variables and Mann-Whitney U test for non-normally distributed quantitative variables. To compare the outcomes between the two groups over the time, repeated measures ANOVA will be used. We hypothesize that the positive impact of increasing the fertility knowledge is the reduced involuntarily childlessness. DISCUSSION: The findings are proposed to inform government policies and public education strategies aiming at supporting childbearing among young couples who postpone their first pregnancy while they might not have any important social and economic obstacles. TRIAL REGISTRATION: This study was approved by Iranian Registry of Clinical Trials (IRCT), Number: IRCT20201005048925N1 , Date of registration: 2020-10-12.

The Effect of Theory-Based HIV/AIDS Educational Program on Preventive Behaviors Among Female Adolescents in Tehran: A Randomized Controlled Trial.

BACKGROUND: Adolescents are increasingly at risks of HIV infection through high-risk sexual behaviors. This paper aimed to assess the effectiveness of a HIV/AIDS educational intervention among female adolescents in Tehran. METHODS: A randomized controlled trial was conducted among high school girls aged 12-16 years studying in Tehran in 2016-17. The sample was selected using multistage random cluster sampling. Four schools per district were randomly selected using probability-proportional to size. Adolescents were randomly assigned to the experimental (n=289) and the control (n=289) groups. The theory of planned behavior (TPB) was the basis of both the intervention and the evaluation phase. Both experimental and control groups completed a questionnaire designed for HIV related behaviors for female adolescents (HBQFA) at baseline and after six months follow up. A theory-based educational program was implemented for the experimental group. RESULTS: The mean age of participants was 14.1 years (SD=0.96). In the experimental group, significant improvements were shown in adolescents' HIV knowledge (31.9%, 95% CI: 28.8-35.0), attitudes towards HIV (16.6%, 95% CI=14.4-18.8), subjective norm (16.8%, 95% CI=12.9-20.6) and perceived behavioral control (19.1%, 95% CI=16.2-22.1), perceived parental support (17%, 95% CI=13.8-20.2), behavioral intention to prevent HIV (19%, 95% CI=16.3-21.6), and HIV preventive behavior (17.3%, 95% CI=13.9-20.6) (p<0.001). CONCLUSION: Theory-based educational intervention on HIV/AIDS prevention can significantly protect adolescents from misconceptions, wrong attitudes and risky behaviors and unsupportive social environment that expose them to greater HIV risk. Health policy -makers are advised to consider effective training programs related to HIV/AIDS prevention behaviors in the school system.

Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran.

This study explored the factors that educated young Iranian women consider when they decide whether to have premarital sex. Using a purposive sampling method, 30 in-depth interviews were conducted with female college students in both government and private universities in Tehran in 2005-2006. The respondents included unmarried women who had experienced sexual relations, unmarried women who had abstained, and married women. Young women's considerations for premarital sex included (1) marriage meaning and motivations; (2) compliance with family values and expectations; (3) perceived gender and social norms of premarital sex; (4) importance of religiosity; and (5) sexual knowledge and self-efficacy. Marriage meaning and motivation seem to be the central pillar in the complex decision to engage in or refrain from premarital sex among female college students. These considerations have theoretical implications for understanding premarital relationships and sex in a conservative setting. Finally, some shifts are occurring in the meaning of marriage and sexual mores among educated young women in Iran; these changes are discussed.

HIV/STI RISK-TAKING SEXUAL BEHAVIOURS AND RISK PERCEPTION AMONG MALE UNIVERSITY STUDENTS IN TEHRAN: IMPLICATIONS FOR HIV PREVENTION AMONG YOUTH.

Recent evidence indicates a rising trend in premarital sexual activity among young people in Iran. However, little is known about the extent to which young people's sexual behaviours expose them to HIV and STI risks. This study aimed to assess HIV/STI-related sexual risk-taking behaviours (correlates and determinants) and HIV/STI risk perception among male university students in Tehran. A representative sample of male university students (N=1322) studying in government and private Tehran universities completed an anonymous questionnaire survey in 2013-14. Respondents were selected using two-stage stratified cluster sampling. About 35% of respondents had ever had premarital sex (n=462). The majority (about 85%) of the sexually experienced students reported having multiple sexual partners in their lifetime. More than half (54%) reported inconsistent condom use over the previous month. Despite this exposure to HIV/STI risk, the respondents had a very low level of HIV/STI risk perception. Only 6.5% were highly concerned about contracting HIV over the previous year, and an even lower percentage (3.4%) were concerned about contracting STIs in the near future. Early sexual debut (<18 years), studying in a private university, ever watching pornography and work experience were found to be significant predictors of having multiple sexual partners. Younger age at sexual debut, having one lifetime sexual partner and poor HIV knowledge were significant predictors of inconsistent condom use over the preceding month. HIV prevention programmes among Iranian youth need to focus on the postponement of first sex and enhancement of HIV/STI knowledge in the light of increasing access of young people to pornography.

Development and Psychometric Properties of Menstrual Health Seeking Behaviors Questionnaire (MHSBQ-42) in Female Adolescents.

BACKGROUND: Lack of accurate menstrual knowledge, attitude, and practices leave female adolescents ignorant of the necessary health behaviors during menstruation. This study aimed to develop a menstrual health-seeking behavior questionnaire based on the theory of planned behavior to evaluate its psychometric properties in female adolescents in Tehran. METHODS: This study was conducted on 578 female adolescents aged 12-15 years in Tehran. The first draft of the menstrual health-seeking behavior questionnaire containing 52 items was developed based on the theory of planned behavior (TPB). The content and face validity of the questionnaire was assessed by a panel of experts. Construct validity was also assessed using exploratory factor analysis (KMO=0.73) with varimax rotation. Cranach's alpha and test-retest were used to examine the reliability of the questionnaire. All statistical analysis was performed using SPSS 23.0 and AMOS 23.0. RESULTS: The content and face validity of the 42 items were finally confirmed. Content validity index was greater than 0.73 for all six TPB constructs. Explanatory factor analysis yielded an acceptable fit for the six-factor model (RMSE=0.053, 95% CI 0.042-0.064). These factors jointly explained 65% of the variance in the outcome variables. Cranach's alpha coefficients ranged from 0.79 to 0.91, demonstrating an excellent internal consistency and high reliability of the questionnaire. Test-retest reliability was also satisfactory for all items (ICC=0.86-0.94). CONCLUSION: The results illustrate that the menstrual health-seeking behavior questionnaire is psychometrically adequate and highly reliable. This theoretically grounded questionnaire can be well applied in future interventions for female adolescents to assess their menstrual health-related knowledge, attitude, and practices.

The Effect of a Theory of Planned Behavior-based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial.

BACKGROUND: We aimed to assess the effect of a theory of planned behavior (TPB)-based educational intervention on attitude, norms, parental control, behavioral control, and intention in high school girls in Tehran, Iran. STUDY DESIGN: Randomized controlled trial. METHODS: This study was conducted among 578 high school girls, 12 to 16 yr, in Tehran, Iran in 2016. The subjects were randomly assigned to the experimental (n=289) and control (n=289) groups using multistage random cluster sampling. TPB is the basis for both education and evaluation; therefore, the TPB-based questionnaire was used before and after the intervention. The intervention included three months education and six months follow up. The obtained data were analyzed using SPSS version 16 through statistical tests and analysis of covariance. RESULTS: Significant improvement in attitude (difference=16.8; 95% CI: 15.3, 18.3), subjective norms (16.4; 95% CI=14.83 to 18.11), perceived behavioral control (18.0; 95% CI: 16.6, 19.4), perceived parental control (17%; 95% CI: 15.1, 18.9), behavioral intention (18.4%; 95 CI: 14.8, 18.3), and behavior (18.5; 95% CI:16.8, 20.2) was observed in experimental group compared to control group (P<0.001). CONCLUSIONS: Theory-based educational intervention in sexual and reproductive health can effectively reduce the high-risk behaviors related to sexual and reproductive health in adolescent girls. Health and education policy-makers are advised to review the current education programs and replace them with new influential education programs related to sexual and reproductive health in the school system.

Intention for Cesarean Section Versus Vaginal Delivery Among Pregnant Women in Isfahan: Correlates and Determinants.

BACKGROUND: Iran has the second highest rate of cesarean section in the world. the corresponding rate in the third metropolitan city of Iran, Isfahan, is even higher. This paper aimed to assess correlates and determinants of intention for cesarean section versus normal vaginal delivery (NVD) among pregnant women in Isfahan. METHODS: A study was conducted among 400 pregnant women aged 18-38 years, with gestational age of 24-40 weeks who attended labor clinics of nine hospitals in Isfahan during June and July 2014. Probability proportional to size was used to estimate the number of cases required to be selected for each hospital. T-test, chi-square and logistic regression analysis were employed to analyze the data. RESULTS: Mean age of women was 26.6±4.4 years. Multivariate analysis identified selected factors as determinants of intention for CS. These were "the role of physician" (OR=1.33, p<0.001), "subjective norms" (OR=1.19, p<0.01) and "body Image" (OR= 1.46, p<0.001) upon control of education, income and intended fertility (number of children intended). Moreover, path analysis showed that "attitude towards cesarean section" and "individualism" influence CS decision through subjective norm. CONCLUSION: Choosing cesarean section voluntarily is a multifaceted decision which is shaped by various factors; hence, comprehensive interventions are suggested to discourage voluntary cesarean section. These interventions need to encompass changes in physicians' role, social norms, body image and correcting misperceptions among women towards CS and NVD during prenatal courses.

Paradoxical attitudes toward premarital dating and sexual encounters in Tehran, Iran: a cross-sectional study.

BACKGROUND: The purpose of this study is to assess attitudes toward premarital dating and sexual encounters in individuals aged 15-49 years in Tehran. METHODS: Utilizing the attitudes section of an original cross-sectional study (n = 755) aimed at assessing sexual health needs of adults, this paper examined personal attitudes towards premarital dating, non-sexual relationships and sexual encounters in both male and female adults aged between 15-49 years. Multi-stage cluster random sampling and a validated/reliable questionnaire were used. Descriptive, bivariate and multivariate analyses were conducted using statistical software. RESULTS: The results indicated that the majority of the participants were supportive of dating. Almost three-fourths of the males were more positively inclined towards non-sexual, yet tactile, affectionate interactions between unmarried males and females as opposed to only half of the females (70 % vs. 50.5 %). Also, males held significantly more liberal attitudes than females in their acceptance of premarital sex. On preserving virginity prior to marriage, 43 % of the males felt that it was important for a female to be a virgin, whereas only 26 % felt it was important for males to remain a virgin. Interestingly, more females (61 %) supported the importance of a female's virginity compared with the importance of males' virginity (48 %). This study showed that, being a male, of a younger age, single, and being less religious or being secular were important determinants of a liberal sexual attitude. CONCLUSION: These results might reflect a socio-cultural transition in the sexual attitudes of different age groups of participants - a phenomenon that will need empirical studies to unpack in the Iranian socio-cultural context.

Factors Influencing Fast-Food Consumption Among Adolescents in Tehran: A Qualitative Study.

BACKGROUND: The consumption of different types of fast food is increasingly growing in all parts of the world, both in developed and developing countries. Because of the changes and transitions in the lifestyle and dietary habits of people, an increasing number of people from different age groups, particularly adolescents and young adults, are inclined toward consuming fast food. OBJECTIVES: The objective of this study was to investigate the factors influencing fast-food consumption among adolescents in Tehran, Iran. PATIENTS AND METHODS: The present qualitative study was conducted in 2012 - 2013 in Tehran, the capital of Iran. To achieve the objective of this study, 42 adolescents were enrolled in this study through a purposive sampling method, and the required data was collected via individual semi-structured in-depth interviews. Data collection and analysis were carried out simultaneously, and the collected data was analyzed via a thematic content analysis and using MAXQDA 10 software. RESULTS: In this study after coding the transcribed interviews, the findings were categorized into three main themes as follows: personal views, social factors, and family factors. Each theme included several categories and subcategories, and the coded sentences and phrases were placed under each category and subcategory. CONCLUSIONS: The results of this study showed that the number of factors promoting fast-food consumption appeared to be more than the inhibiting factors and that the diverse factors at the individual and social level influenced fast-food consumption among adolescents.

Sexual and Reproductive Health Knowledge Among Men and Women Aged 15 to 49 Years in Metropolitan Tehran.

Sexual and reproductive health (SRH) knowledge is an important predictor of an individual's sexual behavior; however, little is known regarding this issue among Iranians. This study assessed sexual and reproductive health knowledge among men and women aged 15 to 49 years in Tehran. A total of 755 men and women aged 15 to 49 years were recruited using multistage, random cluster sampling in June 2014. An illustrative anonymous questionnaire endorsed by the World Health Organization (WHO) was used to collect the data. Bivariate and multivariate analyses were performed. The results showed that men and women were moderately knowledgeable about sexual and reproductive health (mean score of SRH knowledge = 39, range: 26 to 52); however, myths and misperceptions prevailed in different aspects of SRH. For example, only 45% of women and 38.7% of men accurately knew that a person infected with human immunodeficiency virus (HIV) can look healthy. Friends were identified as the primary or secondary source of knowledge about puberty and sex-related issues. A multivariate analysis showed that being female (coefficient = 0.139, p < 0.001) and being married (coefficient = 0.180, p < 0.001) were significant predictors of better SRH knowledge, while being young (age group 15 to 24) was a significant determinant of poor SRH knowledge (coefficient = -0.161, p < 0.001) when other influencing factors were controlled. Culturally appropriate and age-specific comprehensive education is recommended, particularly for men, the unmarried, and the younger generation in Iran.

Perceived norms of premarital heterosexual relationships and sexuality among female college students in Tehran.

This paper describes perceptions of the societal acceptability and acceptability among peers of different types of premarital heterosexual relationships in Iran. Sources of variation in subjective norms are assessed. Results derive from a survey conducted in 2005 of a representative sample of 1743 female college students from four multidisciplinary universities in Tehran using two-stage random cluster sampling. An anonymous pilot-tested questionnaire was used. Respondents displayed remarkable heterogeneity and ambiguity concerning the social acceptability of premarital heterosexual friendship, dating and physical contact, but expressed greater certainty about the unacceptability of premarital sex. The majority (77.5%) reported that premarital sex was socially prohibited, while about one third (33.1%) were unsure about the social acceptability of having a boyfriend and dating before marriage. Peer norms were perceived to be more liberal but, nevertheless, very few peers were thought to be in favour of premarital intercourse. Older students, those with educated fathers and those studying in a mixed-sex university perceived norms to be more liberal than their counterparts. Access to satellite television, a major source of exposure to new information and values about sexuality, was a major predictor of liberal peer norms. It appears that a significant proportion of young people in Tehran have broken with tradition with regard to premarital social interaction and romantic friendships, but the majority still conforms to traditional cultural and religious values regarding abstinence before marriage.

Iranian primigravid women's awareness of the risks associated with delayed childbearing.

OBJECTIVES: To explore older (35 years +) primigravid women's knowledge of the risks of delayed childbearing and to identify the characteristics of those with limited knowledge. METHODS: A cross-sectional survey involving 675 primigravid women in Tehran, Iran, using a cluster random sampling method at the first prenatal visit. A validated questionnaire assessed the women's awareness of delayed-childbearing risks. RESULTS: Women variously identified conception difficulties, gestational diabetes, hypertension, multiple birth, caesarean section, preterm delivery, stillbirth, Down's syndrome, congenital abnormality, and low birth weight, as associated with delayed childbearing. Awareness of infant risks ranged between 10 and 72%. Awareness of maternal risks were independently related to the women's educational levels (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.12-3.38), planned pregnancy (OR: 1.87; 95% CI: 1.25-2.78) and maternal age ≥ 40 (OR: 1.24; 95% CI: 1.14-2.53). Women aware of infant risks were significantly likely to be aged ≥ 40 (OR: 1.87; 95% CI: 0.01-5.12), have post-graduate education (OR: 2; 95% CI: 1.90-4.42), and have a planned pregnancy (OR: 1.99; 95% CI: 1.03-5.12). CONCLUSION: Women are largely unaware of the potential complications of delayed childbirth. Understanding the risks is important for reproductive healthcare providers and policy makers in providing appropriate information to enable women to make informed decisions on the timing of conception.