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Volume 12, Issue 2 (2024)
Health Educ Health Promot 2024, 12(2): 347-356 |
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Received: 2024/05/26 | Accepted: 2024/08/11 | Published: 2024/08/30
Received: 2024/05/26 | Accepted: 2024/08/11 | Published: 2024/08/30
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Promoting Sexual and Reproductive Health among Married Women of Reproductive Age in Sanandaj City, Iran. Health Educ Health Promot 2024; 12 (2) :347-356
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URL: http://hehp.modares.ac.ir/article-4-75308-en.html
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Introduction
Improvement of women's health is a comprehensive approach that significantly impacts a country's long-term development strategies and economic progress [1]. Reproductive and sexual health is crucial for women's overall well-being. It ensures healthy sexual lives, reproductive capabilities, and informed decisions. Improving SRH (Sexual and Reproductive Health) supports sustainable development goals, particularly in achieving gender equality and enhancing health and well-being for all [2, 3].
Globally, reproductive and sexual health issues among women represent a substantial proportion of health-related challenges. Enhancing these aspects of health not only empowers women to gain greater control over their well-being but also addresses underlying factors that influence health outcomes [4, 5]. Promoting sexual health involves empowering individuals to manage and enhance their sexual well-being [6]. This can help prevent sexually transmitted diseases, avoid unintended pregnancies, and improve sexual performance [7]. Furthermore, sexual and reproductive health promotion extends beyond clinical aspects to include a wide range of choices, behaviors, and social impacts [8]. It seems that there are multiple individual and interpersonal factors that can influence the adoption of behaviors promoting reproductive and sexual health [9, 10]. In Abedi et al.'s study, a significant relationship was observed between various dimensions of a health-promoting lifestyle, such as responsibility, interpersonal relationships, and stress management, and all aspects of sexual functioning in women of reproductive age [11]. Family responsibilities, environmental pressures, financial pressures, family and social support networks, and inadequate communication are among the barriers that can affect the promotion of sexual and reproductive health [12].
In a study conducted in Iran, women took measures to improve their reproductive health by making informed decisions, engaging in self-care behaviors, having satisfactory sexual relationships through discussing their needs and desires, and striving to resolve sexual issues. Effective communication between couples and joint decision-making were also identified as actions that prevent unwanted pregnancies and enhance women's reproductive health [13]. In another study, the use of condoms, traditional medicine, antibiotics, and disinfecting and cleaning oneself after sexual intercourse were among the preventive behaviors identified for maintaining reproductive and sexual health and preventing sexually transmitted infections [14]. In the study by Cipres et al., it was observed that women used various strategies to reduce the risk of sexually transmitted infections, including condom use, asking partners about STIs (Sexually Transmitted Infections), frequent STI screening, and inquiring about their partners' other sexual partners. It also appears that another factor influencing the incidence of sexually transmitted infections in women is related to power inequities in sexual partnerships [15]. Married women face multiple roles and responsibilities, and the nature of their marital relationship can greatly influence their reproductive and sexual health [16]. Numerous studies have been conducted on health-promoting lifestyles among women of reproductive age in Iran and around the world. However, there has not been a study specifically examining health-promoting reproductive and sexual behaviors in the particular group of married women of reproductive age.
Differences in healthy behaviors across cultures highlight the significant impact of cultural and religious contexts on women's reproductive and sexual health. Context is critical for understanding health behavior, and its importance is emphasized for planning behavior change interventions and policies [17]. Each society's unique value system influences these behaviors, underscoring the need for qualitative studies to understand women's perspectives. Such studies are crucial for developing tailored health services and interventions. The absence of qualitative research on married women of reproductive age in Iran, despite their vital role in family and community health, motivated this study to explore their experiences regarding health-promoting sexual and reproductive behaviors.
Participants and Methods
The current research was conducted between December 2019 and March 2022 in Sanandaj, the capital of Kurdistan province in western Iran.
The qualitative study utilized a conventional content analysis approach to gain deeper insights into the experiences of married women regarding promotion behaviors related to sexual and reproductive health. Sampling took place at two health centers with high visitor numbers, located in distinct regions characterized by various social and economic levels. The research population comprised women attending urban healthcare centers in Sanandaj. Sampling was purposeful, aiming for maximum diversity in age, education levels of both women and their spouses, family income status, occupations of both women and their spouses, number of children, and place of residence. Sampling continued until data saturation was achieved. The inclusion criteria encompassed women aged 15-49 years, Iranian nationality, ability to communicate effectively with the researcher, not being pregnant, and willingness to participate in the study.
The study's exit conditions encompass any distinct physical or psychological ailment that hinders the participant's involvement in the research including pregnancy. The interviews were conducted solely by the first author, who possesses extensive expertise in qualitative research. A total of 23 interviews were conducted, and to ensure comprehensive coverage, three additional participants were interviewed once data saturation was reached. Additionally, to enrich the insights gleaned from participant interviews, discussions were held with 6 specialists. The participants were interviewed at specific locations and times as arranged. Due to the widespread occurrence of COVID-19, interviews took place in various settings such as parks, open areas, and occasionally at the participants' homes. Key informant interviews were conducted using online methods. Information was collected through semi-structured and comprehensive interviews with women. Field notes were taken, and audio recording was conducted with participants' consent. Additionally, insights were derived from participants' nonverbal cues. Occasionally, participants requested to temporarily pause the recording during the interview to share information more comfortably. In such cases, the interviews were paused, and the details were transcribed. These transcribed sections were promptly reviewed and edited. At the start of the interview, a series of broad and open-ended inquiries were employed. The interview started with a general and open question.
Search engine queries were used as needed to ask detailed questions, including seeking further elaboration, clarification, specific details, examples, and consideration of additional factors related to discussed behaviors. Participants were also encouraged to share any additional insights they wished to offer and invited to address any questions not asked. Permission for future interviews was obtained. Participants freely expressed viewpoints through unbiased inquiries, with opportunities to share experiences. Interviews lasted 40 to 90 minutes, allowing broad perspectives to emerge.
Data analysis
This study utilized content analysis following the steps proposed by Graneheim & Lundman [18]. After each interview, the researcher listened to the recordings multiple times for comprehension, transcribed the data manually, and then typed them. Analysis was conducted using MAXQDA10 software (version 10). Initial categorization occurred concurrently with interviews, with units of meaning condensed into codes, organized based on commonalities and distinctions, resulting in subcategories. These subcategories were grouped into categories, and fundamental themes were identified.
To ensure data accuracy and robustness, Guba & Lincoln's fourfold criteria were applied, focusing on dependability, transferability, credibility, and confirmability [19]. To boost data credibility, the first author used three methods over a year: Extensive data work, cross-checking notes with participants for alignment, and verifying codes and categories with the research team. A mixed data collection approach was employed, including interviews, observations, and written materials.
When participants couldn't review texts due to literacy or time constraints, segments needing clarification were revisited through various means. Texts were reviewed and modified if necessary. Sample diversity was ensured to enhance data credibility. Reliability was ensured by recording interviews in audio and handwritten forms, with a 2-week gap for comparison. Identical questions were asked to all participants, validated by two qualitative researchers.
Confirmability was maintained through review by two faculty members, extending to data analysis procedures. For transferability, the research methodology provided comprehensive descriptions of the study population and contextual details.
The datasets generated and/or analyzed during the current study are not publicly available due to privacy protection of the participants but are available from the corresponding author on reasonable request.
Findings
The age of the women ranged from 18 to 45 years. Women had varying levels of education, ranging from being illiterate to holding a master's degree (Tables 1 & 2).
Table 1. Demographic characteristics of participants
![src=./files/hehp/images/HTML_Publish/75308/1.png]()
Table 2. Demographic characteristics of specialists
![src=./files/hehp/images/HTML_Publish/75308/2.png]()
After analyzing the qualitative data, 2650 semantic unit were identified. Through the process of combining overlapping phrases and eliminating similar and duplicate codes, a final set of 76 codes, 23 subcategories, 6 categories and 3 themes were detected which all could be categorized under the umbrella of personal empowerment (Table 3).
Table 3. Promoting behavior of sexual and reproductive health in married woman
![src=./files/hehp/images/HTML_Publish/75308/3-1.png]()
![src=./files/hehp/images/HTML_Publish/75308/3-2.png]()
![src=./files/hehp/images/HTML_Publish/75308/3-3.png]()
Personal empowerment
This theme was classified in 3 main categories, namely Self-regulation, developing communication skills and the healthy sex life extracted from 7 subcategories.
Self-regulation
Self-regulation encompasses women's focus on self-care and management, empowering them with greater control over their lives for enhanced reproductive and sexual health.
Self-care: Self-care involves routines to maintain physical and mental health, including physical, psychological, social, and spiritual aspects.
Certain women enhanced self-satisfaction and tranquility by maintaining proper nutrition, exercising, getting adequate sleep, grooming well, and practicing good hygiene. Additionally, many people alleviated stress, cleared their minds, and managed anger through soothing music and dance, nature, hobbies, crying, warm showers, positive affirmations, and deep breathing exercises.
This quote reflects it:
“When I sleep well, I engage in my daily walks and follow my special diet, which is no sugar. It makes me a more positive thinker, happier, and kinder. I also have more energy in my relationship with my spouse”. (participant 11, 37 years old, married for 15 years)
Some participants found serenity and resilience through gratitude, nature, and faith. Others achieved joy and tranquility by avoiding pessimistic people, following motivational content, avoiding self-blame for their spouse's unchangeable actions, and spending quality time with loved ones.
The following quote reflects this:
“Every day, I engage in prayer, expressing gratitude to God for all aspects of my life, and I humbly request His blessing of patience, which brings me a profound sense of peace”. (participant 8, 28 years old, married for 9 years)
Self-management: The self-management category suggests that by actively promoting resilience, self-awareness, and acquiring financial independence skills, women can strengthen their marital relationships and make informed decisions together.
Some women emphasized resilience in reducing tension with their husbands through hope, patience, solution-seeking, and resistance to difficult conditions for marital harmony. They also discovered that self-awareness, including setting life goals, understanding strengths and weaknesses, embracing personal principles, and believing in abilities, boosts self-confidence. Additionally, they viewed involvement in family financial planning and skill development for financial independence as vital for making joint decisions and maintaining individual autonomy effectively.
The following quotes reflects this:
“At times during my marriage, I felt confined and burdened by significant stress from my partner's painful behaviors and my responsibilities toward our children and family. Leaving wasn't an option; I had to find a viable resolution, work hard, and believe that things would improve”. (participant 22, 45 years old, married for 28 years)
“In the past, my rights were entirely under my husband's authority. However, I have now taken control of my finances and gained the freedom to decide how to use my money. This change has led to a heightened sense of self-reliance and ease”. (participant 1, 43 years old, married for 23 years)
Developing communication skills
This main theme includes behaviors aimed at improving relationships with your spouse and those around you, which can enhance decision-making and effectively improve women's sexual health.
Effective communication with spouse: Effective communication between spouses involves conversations with spouse, trust, empathy, flexibility, and intimacy.
Spousal communication involves clear, purposeful conversations, avoiding past hurts, seeking forgiveness, respecting opinions, being open to perspectives, expressing appreciation, actively listening, avoiding arguments, managing emotions, and ensuring a suitable environment with enough time and space for discussions. This quote reflects it:
“I refrain from discussing important matters with my husband during moments when he's tired or when the children are awake because I anticipate that it will inevitably lead to disagreements and conflicts”. (participant 14, 41 years old, married for 26 years)
Trust is built on honesty, confidentiality, avoiding hidden agendas, demonstrating loyalty, and not exploiting trust. These actions alleviate tension, strengthen bonds, and help couples navigate life effectively. A participant's statement exemplifying this concept goes like this:
“I have complete control over my husband's finances due to his unwavering trust in me and confidence that I will handle this responsibility responsibly and without misuse”. (participant 11, 37 years old, married for 15 years)
Demonstrating empathy involves actively listening, validating feelings, understanding emotions, adapting expectations, and sympathizing with your partner during tough times.
“I understand my spouse well. When they come home exhausted and irritable, it's tough, but after eating and sipping tea, they become more tender and compassionate. (participant 18, 26 years old, married for 5 years)
Improving relationships and reducing tension involves a flexible approach: Not overreacting, letting go, avoiding stubbornness, acknowledging differences, and accepting unchangeable behaviors. A sample quote from participants is provided below:
“My partner says I have a binary perspective, seeing things as either completely right or wrong, causing frustration and arguments. I'm working on being more adaptable and open-minded”. (participant 16, 31 years old, married for 9 years)
Participants believe that spending quality time, openly showing love, sharing interests, and physical affection contribute to a nurturing relationship, enhancing closeness, affection, and the bond with one's spouse.
The following statements indicate it:
“Despite struggling to express emotions, I consistently seek moments of tenderness by asking my spouse for a kiss, driven by a strong urge for closeness”. (participant 17, 18 years old, married for 3 years)
Creating a supportive network: Building a robust support system can help reduce tensions, manage daily life problems, control spousal violence, and significantly improve women's sexual health. This involves enhancing communication with family members and seeking help during crucial moments.
Fostering respect, engaging in family activities, setting boundaries, respecting privacy, resisting external interference, staying flexible, and seeking support during difficult times effectively reduce marital stress and prevent spousal violence. One participant stated:
“I've always made it a priority to build a strong bond with my spouse's family by showing them the utmost respect. This effort has fostered their affection for me, which has greatly strengthened my connection with my spouse as well”. (participant 20, 28 years old, married for 4 years)
Some individuals believe that confiding in trustworthy people, informing family members about spousal violence, and seeking help from reliable sources are effective strategies to protect themselves from their spouse's anger and prevent related negative consequences.
“Years ago, my spouse injured me with a knife, but I kept it secret. When he struck me again, causing bruises, I confided in my family. Together, we sought help from a legal clinic and initiated a case against him. As a result, he stopped all violent behavior”. (participant 9, 38 years old, married for 15 years)
Healthy sex life
Behaviors and actions that people take in dealing with their spouses and also individually to improve their sexual performance, prevent unwanted pregnancy and sexually transmitted diseases.
Enhancing sexual performance: Enhancing sexual performance category include flirting before and during sex, creating a conducive environment, understanding the spouse's sexual desires, and maintaining a positive attitude towards sex while being aware of the dynamics of couples' first sexual encounters.
Participants engage in pre-sex banter, caressing, romantic ges
Improvement of women's health is a comprehensive approach that significantly impacts a country's long-term development strategies and economic progress [1]. Reproductive and sexual health is crucial for women's overall well-being. It ensures healthy sexual lives, reproductive capabilities, and informed decisions. Improving SRH (Sexual and Reproductive Health) supports sustainable development goals, particularly in achieving gender equality and enhancing health and well-being for all [2, 3].
Globally, reproductive and sexual health issues among women represent a substantial proportion of health-related challenges. Enhancing these aspects of health not only empowers women to gain greater control over their well-being but also addresses underlying factors that influence health outcomes [4, 5]. Promoting sexual health involves empowering individuals to manage and enhance their sexual well-being [6]. This can help prevent sexually transmitted diseases, avoid unintended pregnancies, and improve sexual performance [7]. Furthermore, sexual and reproductive health promotion extends beyond clinical aspects to include a wide range of choices, behaviors, and social impacts [8]. It seems that there are multiple individual and interpersonal factors that can influence the adoption of behaviors promoting reproductive and sexual health [9, 10]. In Abedi et al.'s study, a significant relationship was observed between various dimensions of a health-promoting lifestyle, such as responsibility, interpersonal relationships, and stress management, and all aspects of sexual functioning in women of reproductive age [11]. Family responsibilities, environmental pressures, financial pressures, family and social support networks, and inadequate communication are among the barriers that can affect the promotion of sexual and reproductive health [12].
In a study conducted in Iran, women took measures to improve their reproductive health by making informed decisions, engaging in self-care behaviors, having satisfactory sexual relationships through discussing their needs and desires, and striving to resolve sexual issues. Effective communication between couples and joint decision-making were also identified as actions that prevent unwanted pregnancies and enhance women's reproductive health [13]. In another study, the use of condoms, traditional medicine, antibiotics, and disinfecting and cleaning oneself after sexual intercourse were among the preventive behaviors identified for maintaining reproductive and sexual health and preventing sexually transmitted infections [14]. In the study by Cipres et al., it was observed that women used various strategies to reduce the risk of sexually transmitted infections, including condom use, asking partners about STIs (Sexually Transmitted Infections), frequent STI screening, and inquiring about their partners' other sexual partners. It also appears that another factor influencing the incidence of sexually transmitted infections in women is related to power inequities in sexual partnerships [15]. Married women face multiple roles and responsibilities, and the nature of their marital relationship can greatly influence their reproductive and sexual health [16]. Numerous studies have been conducted on health-promoting lifestyles among women of reproductive age in Iran and around the world. However, there has not been a study specifically examining health-promoting reproductive and sexual behaviors in the particular group of married women of reproductive age.
Differences in healthy behaviors across cultures highlight the significant impact of cultural and religious contexts on women's reproductive and sexual health. Context is critical for understanding health behavior, and its importance is emphasized for planning behavior change interventions and policies [17]. Each society's unique value system influences these behaviors, underscoring the need for qualitative studies to understand women's perspectives. Such studies are crucial for developing tailored health services and interventions. The absence of qualitative research on married women of reproductive age in Iran, despite their vital role in family and community health, motivated this study to explore their experiences regarding health-promoting sexual and reproductive behaviors.
Participants and Methods
The current research was conducted between December 2019 and March 2022 in Sanandaj, the capital of Kurdistan province in western Iran.
The qualitative study utilized a conventional content analysis approach to gain deeper insights into the experiences of married women regarding promotion behaviors related to sexual and reproductive health. Sampling took place at two health centers with high visitor numbers, located in distinct regions characterized by various social and economic levels. The research population comprised women attending urban healthcare centers in Sanandaj. Sampling was purposeful, aiming for maximum diversity in age, education levels of both women and their spouses, family income status, occupations of both women and their spouses, number of children, and place of residence. Sampling continued until data saturation was achieved. The inclusion criteria encompassed women aged 15-49 years, Iranian nationality, ability to communicate effectively with the researcher, not being pregnant, and willingness to participate in the study.
The study's exit conditions encompass any distinct physical or psychological ailment that hinders the participant's involvement in the research including pregnancy. The interviews were conducted solely by the first author, who possesses extensive expertise in qualitative research. A total of 23 interviews were conducted, and to ensure comprehensive coverage, three additional participants were interviewed once data saturation was reached. Additionally, to enrich the insights gleaned from participant interviews, discussions were held with 6 specialists. The participants were interviewed at specific locations and times as arranged. Due to the widespread occurrence of COVID-19, interviews took place in various settings such as parks, open areas, and occasionally at the participants' homes. Key informant interviews were conducted using online methods. Information was collected through semi-structured and comprehensive interviews with women. Field notes were taken, and audio recording was conducted with participants' consent. Additionally, insights were derived from participants' nonverbal cues. Occasionally, participants requested to temporarily pause the recording during the interview to share information more comfortably. In such cases, the interviews were paused, and the details were transcribed. These transcribed sections were promptly reviewed and edited. At the start of the interview, a series of broad and open-ended inquiries were employed. The interview started with a general and open question.
Search engine queries were used as needed to ask detailed questions, including seeking further elaboration, clarification, specific details, examples, and consideration of additional factors related to discussed behaviors. Participants were also encouraged to share any additional insights they wished to offer and invited to address any questions not asked. Permission for future interviews was obtained. Participants freely expressed viewpoints through unbiased inquiries, with opportunities to share experiences. Interviews lasted 40 to 90 minutes, allowing broad perspectives to emerge.
Data analysis
This study utilized content analysis following the steps proposed by Graneheim & Lundman [18]. After each interview, the researcher listened to the recordings multiple times for comprehension, transcribed the data manually, and then typed them. Analysis was conducted using MAXQDA10 software (version 10). Initial categorization occurred concurrently with interviews, with units of meaning condensed into codes, organized based on commonalities and distinctions, resulting in subcategories. These subcategories were grouped into categories, and fundamental themes were identified.
To ensure data accuracy and robustness, Guba & Lincoln's fourfold criteria were applied, focusing on dependability, transferability, credibility, and confirmability [19]. To boost data credibility, the first author used three methods over a year: Extensive data work, cross-checking notes with participants for alignment, and verifying codes and categories with the research team. A mixed data collection approach was employed, including interviews, observations, and written materials.
When participants couldn't review texts due to literacy or time constraints, segments needing clarification were revisited through various means. Texts were reviewed and modified if necessary. Sample diversity was ensured to enhance data credibility. Reliability was ensured by recording interviews in audio and handwritten forms, with a 2-week gap for comparison. Identical questions were asked to all participants, validated by two qualitative researchers.
Confirmability was maintained through review by two faculty members, extending to data analysis procedures. For transferability, the research methodology provided comprehensive descriptions of the study population and contextual details.
The datasets generated and/or analyzed during the current study are not publicly available due to privacy protection of the participants but are available from the corresponding author on reasonable request.
Findings
The age of the women ranged from 18 to 45 years. Women had varying levels of education, ranging from being illiterate to holding a master's degree (Tables 1 & 2).
Table 1. Demographic characteristics of participants
Table 2. Demographic characteristics of specialists
After analyzing the qualitative data, 2650 semantic unit were identified. Through the process of combining overlapping phrases and eliminating similar and duplicate codes, a final set of 76 codes, 23 subcategories, 6 categories and 3 themes were detected which all could be categorized under the umbrella of personal empowerment (Table 3).
Table 3. Promoting behavior of sexual and reproductive health in married woman
Personal empowerment
This theme was classified in 3 main categories, namely Self-regulation, developing communication skills and the healthy sex life extracted from 7 subcategories.
Self-regulation
Self-regulation encompasses women's focus on self-care and management, empowering them with greater control over their lives for enhanced reproductive and sexual health.
Self-care: Self-care involves routines to maintain physical and mental health, including physical, psychological, social, and spiritual aspects.
Certain women enhanced self-satisfaction and tranquility by maintaining proper nutrition, exercising, getting adequate sleep, grooming well, and practicing good hygiene. Additionally, many people alleviated stress, cleared their minds, and managed anger through soothing music and dance, nature, hobbies, crying, warm showers, positive affirmations, and deep breathing exercises.
This quote reflects it:
“When I sleep well, I engage in my daily walks and follow my special diet, which is no sugar. It makes me a more positive thinker, happier, and kinder. I also have more energy in my relationship with my spouse”. (participant 11, 37 years old, married for 15 years)
Some participants found serenity and resilience through gratitude, nature, and faith. Others achieved joy and tranquility by avoiding pessimistic people, following motivational content, avoiding self-blame for their spouse's unchangeable actions, and spending quality time with loved ones.
The following quote reflects this:
“Every day, I engage in prayer, expressing gratitude to God for all aspects of my life, and I humbly request His blessing of patience, which brings me a profound sense of peace”. (participant 8, 28 years old, married for 9 years)
Self-management: The self-management category suggests that by actively promoting resilience, self-awareness, and acquiring financial independence skills, women can strengthen their marital relationships and make informed decisions together.
Some women emphasized resilience in reducing tension with their husbands through hope, patience, solution-seeking, and resistance to difficult conditions for marital harmony. They also discovered that self-awareness, including setting life goals, understanding strengths and weaknesses, embracing personal principles, and believing in abilities, boosts self-confidence. Additionally, they viewed involvement in family financial planning and skill development for financial independence as vital for making joint decisions and maintaining individual autonomy effectively.
The following quotes reflects this:
“At times during my marriage, I felt confined and burdened by significant stress from my partner's painful behaviors and my responsibilities toward our children and family. Leaving wasn't an option; I had to find a viable resolution, work hard, and believe that things would improve”. (participant 22, 45 years old, married for 28 years)
“In the past, my rights were entirely under my husband's authority. However, I have now taken control of my finances and gained the freedom to decide how to use my money. This change has led to a heightened sense of self-reliance and ease”. (participant 1, 43 years old, married for 23 years)
Developing communication skills
This main theme includes behaviors aimed at improving relationships with your spouse and those around you, which can enhance decision-making and effectively improve women's sexual health.
Effective communication with spouse: Effective communication between spouses involves conversations with spouse, trust, empathy, flexibility, and intimacy.
Spousal communication involves clear, purposeful conversations, avoiding past hurts, seeking forgiveness, respecting opinions, being open to perspectives, expressing appreciation, actively listening, avoiding arguments, managing emotions, and ensuring a suitable environment with enough time and space for discussions. This quote reflects it:
“I refrain from discussing important matters with my husband during moments when he's tired or when the children are awake because I anticipate that it will inevitably lead to disagreements and conflicts”. (participant 14, 41 years old, married for 26 years)
Trust is built on honesty, confidentiality, avoiding hidden agendas, demonstrating loyalty, and not exploiting trust. These actions alleviate tension, strengthen bonds, and help couples navigate life effectively. A participant's statement exemplifying this concept goes like this:
“I have complete control over my husband's finances due to his unwavering trust in me and confidence that I will handle this responsibility responsibly and without misuse”. (participant 11, 37 years old, married for 15 years)
Demonstrating empathy involves actively listening, validating feelings, understanding emotions, adapting expectations, and sympathizing with your partner during tough times.
“I understand my spouse well. When they come home exhausted and irritable, it's tough, but after eating and sipping tea, they become more tender and compassionate. (participant 18, 26 years old, married for 5 years)
Improving relationships and reducing tension involves a flexible approach: Not overreacting, letting go, avoiding stubbornness, acknowledging differences, and accepting unchangeable behaviors. A sample quote from participants is provided below:
“My partner says I have a binary perspective, seeing things as either completely right or wrong, causing frustration and arguments. I'm working on being more adaptable and open-minded”. (participant 16, 31 years old, married for 9 years)
Participants believe that spending quality time, openly showing love, sharing interests, and physical affection contribute to a nurturing relationship, enhancing closeness, affection, and the bond with one's spouse.
The following statements indicate it:
“Despite struggling to express emotions, I consistently seek moments of tenderness by asking my spouse for a kiss, driven by a strong urge for closeness”. (participant 17, 18 years old, married for 3 years)
Creating a supportive network: Building a robust support system can help reduce tensions, manage daily life problems, control spousal violence, and significantly improve women's sexual health. This involves enhancing communication with family members and seeking help during crucial moments.
Fostering respect, engaging in family activities, setting boundaries, respecting privacy, resisting external interference, staying flexible, and seeking support during difficult times effectively reduce marital stress and prevent spousal violence. One participant stated:
“I've always made it a priority to build a strong bond with my spouse's family by showing them the utmost respect. This effort has fostered their affection for me, which has greatly strengthened my connection with my spouse as well”. (participant 20, 28 years old, married for 4 years)
Some individuals believe that confiding in trustworthy people, informing family members about spousal violence, and seeking help from reliable sources are effective strategies to protect themselves from their spouse's anger and prevent related negative consequences.
“Years ago, my spouse injured me with a knife, but I kept it secret. When he struck me again, causing bruises, I confided in my family. Together, we sought help from a legal clinic and initiated a case against him. As a result, he stopped all violent behavior”. (participant 9, 38 years old, married for 15 years)
Healthy sex life
Behaviors and actions that people take in dealing with their spouses and also individually to improve their sexual performance, prevent unwanted pregnancy and sexually transmitted diseases.
Enhancing sexual performance: Enhancing sexual performance category include flirting before and during sex, creating a conducive environment, understanding the spouse's sexual desires, and maintaining a positive attitude towards sex while being aware of the dynamics of couples' first sexual encounters.
Participants engage in pre-sex banter, caressing, romantic ges