Part 1. CHAPTER I.

PART 1

CHAPTER I

SEXUAL AND REPRODUCTIVE HEALTH OF ARMENIAN MEN

MATERIAL AND METHODS

The Part I of this report represents results of the questionnaire-based survey that was carried out in a national representative sample of 1400 men, ever married or in consensual union, between 15 and 44 years of age throughout Armenia. It was carried out in all 11 regions (“marzes”) of the country, including the capital Yerevan. General design and methodology of the survey described above in Introduction to this report.

1.1.1. Definitions Used and Fertility Categories

For determination of the status of a man’s fertility we developed a diagnostic algorithm that was based on the risk of resultant pregnancy. Any heterosexual couple who had regular unprotected sexual intercourse was considered exposed to the risk of pregnancy, if neither partner was sterilized, nor had any other surgery that would prevent pregnancy. For analytical purposes we used the following fertility categories: 1) fertile, 2) presumably fertile, 3) primarily infertile, 4) primarily sub-fertile, 5) secondarily infertile, and 6) secondarily sub-fertile.

Infertility was defined as inability to conceive after two years of exposure to the risk of pregnancy. If the spouse or partner of the respondent had never been pregnant after two or more years of exposure to the risk of pregnancy, the couple was classified as “Primarily infertile”. Couples, whose length of exposure to the risk of pregnancy was greater than 12 months, but less than 24 months, were classified as “Primarily sub-fertile”. If the risk of exposure was less than 12 months, couples were assigned to the “Unknown” category of fertility.

If the spouse or partner had previously been pregnant, but had been exposed to the risk of pregnancy without conceiving in the past two years, the couple was defined as “Secondarily infertile”. But if the risk of pregnancy was of one to two years’ duration, the couple classified as “Secondarily sub-fertile”.

If the spouse or partner of the respondent was pregnant at the time of interview, had been pregnant within the preceding two years, or was breast-feeding a child, the couple was classified as “Fertile”. Those couples using contraception since a pregnancy, more than two years prior, were defined as “Presumably fertile”.

1.1.2. The Questionnaire Content

The questionnaire was developed by the AFHA researchers and was tested in the pilot survey of about 50 men of reproductive age. It includes two main components: 1) the household questionnaire and 2) the individual questionnaire. The household questionnaire consisted from the following sections: identification, visit records, household characteristics, and table for random selection of eligible men. The individual questionnaires covered a wide range of topics related to family health and welfare. A summary of topics and issues in the questionnaires are given below:

N	TOPICS	ISSUES
*Household Characteristics*
1	Identification	Cluster and questionnaire numbers, address, telephone
2	Visit records and the outcome	Date and time of the visit, outcome
3	Household characteristics	Number of families, number of persons, number of eligible men, age and marital status of all eligible men
4	Table for random selection of eligible man	Linear number of men, last digit of the questionnaire number
*Individual Questionnaire*
1	General information	Age of partners, citizenship, education, religious belief, frequency of the religious service attention
2	Sexual behaviour and marriage pattern	Age at first intercourse, number of marriages or consensual unions, age at the first marriage, marital status, duration of the marriage, number of sexual partners, frequency of sexual intercourse, date of the last intercourse; date of the spouses, date and reasons of death/divorce/separation, if appropriate
3	Fertility, reproductive outcome, children’s survival, future intention to have children	Date of the last conception, if ever happened; the outcomes of pregnancies, number of living children; age and reason of children’s death, congenital birth defects, ideal and desired number of children, current intention to have children
4	Abortion practice	Total number of abortions, information about the first and last abortions: age of men, gestational age of fetus, main reasons, contraceptive use prior to abortion, decision making, place, providers, attitude, post-abortion family planning, history of self-induced abortion, complications and consequences
5	Family planning	Contraceptive methods ever and currently used; reasons for not using
6	Awareness, knowledge, and personal beliefs about the family planning methods, STDs/AIDS	Awareness about fertile days, knowledge about contraceptive methods and where it is possible to get them, opinions about their safety, reliability, ease of use and where it is possible to get them, sources of information, attitude to abortion right; knowledge about Syphilis, gonorrhea, chlamydial infection, HIV/AIDS
7	Access to the mass media	Access to TV, radio and printed media, opinions about the best mean of public information
8	Impaired sexual function and reproductive health	Self-confidence about own fertility, history of the sexual dysfunction, reasons
9	Access to medical services	Attendance for sexual health and infertility care, reasons for not applying, affordability of care
10	History of the STDs and the symptoms, associated with the urogenital infection	History of infection of the lower and upper uro-genital tract, symptoms of the STDs
11	History of other diseases and disorders of the urogenital system	History of the varicocele, cryptorchidism
12	Harmful habits and long-term use of the pharmaceutical drugs	Smoking, alcohol consumption, drug abuse, long-term use of the pharmaceutical drugs
13	Social and economic profile	Family income, employment, average monthly expenses, supports from other sources, living and housing conditions, energy and water supply, basic household amenities

1.1.3. The Interview Status by the Regions

The survey sample consisted mainly of inhabitants of towns and cities (72%) since more than two thirds of the Armenian population lives in designated urban areas. About 34% of the men were from the capital city of Yerevan .The requested sample of 1400 eligible respondents was identified after a total number of 2202 attempts were made to obtain informed consent to participate (Table 1.1.2.). Eight hundred and two men (36.4%), out of those approached, refused to participate in the survey. Refusal rates differed by regions and the highest was in Tavush marz (41.1%). Besides the high refusal rates, interviewers had difficulties in finding men at home during the daytime.