Chapter 3

AWARENESS, KNOWLEDGE AND PERSONAL BELIEFS ABOUT SEXUALITY AND

SEXUAL HEALTH ISSUES

3.1.           Pubertal changes

Survey data

This survey found that public in general has basic knowledge about pubertal changes in girls. Thus, more than 88% of adults and 70% of young people gave correct replies, concerning approximate age at starting the first menses (menarche). But about 11% of adults over 24 years of age and 30% of young people had wrong beliefs or were not aware about this issue (Figure 3.1).

Figure 3.1. Awareness about pubertal changes in girls and boys among young people and adults over 24 years of age

(Survey data, n=1800)

In fact, there was a lack of public awareness about pubertal changes in adolescent boys, in particularly about wet dreams (nocturnal semen emission). About 51% of young people and 43% of those over 24 years of age had incorrect beliefs or were not aware that adolescent boys may have wet dreams long before beginning their sexual life (Figure 3.1).

Case studies data

The case studies demonstrate that majority of young people, which have been provided with training courses on sexuality, and sexual and reproductive health at least 6 months before the interview (Group ”A”), as well as most of those young people, which received information on related issues from previously trained peer educators (Group ”B”) were aware and had basic knowledge about pubertal changes among girls and boys. In fact, significant proportion of youngsters, who never had an access to accurate information on related issues (Group "C”) had wrong ideas or were not aware about these issues (Figure 3.2).

Figure 3.2. Awareness of young people about pubertal changes in girls and boys, by access to sex education

(Case studies data, n=150)

We provide below extract from the interview with an adolescent boy, who never had an access to reliable information on pubertal changes in boys and worried about his wet dreams (Group "C"):

Respondent of male gender, 14 years of age, student of public school:

“ I have heard that boys have some kind of discharge from sexual organs, when they are infected through sexual relationship. I have never had sexual intercourse, but sometimes in the mornings, after waking up, I notice some kind of strange discharge on my pants. I am afraid that have got some infection through toilet seat… But will never ask my mum about this… I know that there is a need for investigation, but I don’t have money… Could you, please, advise me what to do?”

3.2.   Sexuality

Survey data

This study provided also unique information on awareness, knowledge, and personal beliefs of young people 13-24 years of age about human sexuality and sexual relationships. The first question on sexuality in the questionnaire for children was given in the following manner:

“Do you know that the word SEX has different meanings and people understand it differently? Thus, for example, the word SEX in English means also male or female gender of human being. In your opinion, what other meanings does  the word SEX include?”

In total, 117 (13%) young people, the majority out of which were females (97 girls – 83%), mentioned that they didn’t have an idea what the word “sex” meant. Most of these respondents (59%) were adolescents below 18 years of age. There were also 109 (12%) young people, who refused to reply. However, 674 out of 900 (75%) respondents, including 293 (43%) males and 381(57%) females, replied to this question (Table 3.1.).

The first most frequent reply, given by the great majority of respondents (89%) was  “sex is sexual intercourse between females and males, unity of their bodies”. The second most frequent reply, given by 39% of respondents was “sex is - falling in love, sexual desire, expression of feelings and satisfaction of sexual needs through kissing, masturbation, intercourse or other kind of intimate relationships”. The third most frequent reply, given by 34% of respondents was “sex is the great pleasure, physical and spiritual harmony between two persons”. In total 113 (17%) young people defined sex, as “sexual relationship for producing offspring and creation of family”. There were also other curious replies, such as “sex is my job”, and "sex is business of prostitutes”, “sex is usual actions of men outside the marriage”; “sex is responsibility for pleasure of partner”, “sex is amoral behavior of street people”, etc.

The great majority of 850 (94%) young people knew that in order to have children people have to be engaged in sexual relationships. However, 48 (5%) respondents, including 25 (52%) teenagers 13-14 years of age, mentioned that they didn’t have an idea about this, and 2 (0.2%) didn’t want to reply. In total 795 (88%) young people were aware that most people have sexual relationships not only for producing offspring, but also because of sexual desire and getting pleasure from intercourse. But 99 (11%) respondents didn’t hear about this issue.

Table 3.1. Personal beliefs among young females and males about sexuality*

(Survey data, n=900) 

*Note:  More than one explanation is possible

Case studies data

It was interesting to observe through in-depth interview with 150 participants of the case studies that all of them (100%), regardless of age, gender, place of living and access to sex education were aware and knew that people have sexual relationships not only for having children, but also for pleasure and satisfaction of sexual desire. The case studies provided valuable information on impact of sex education on personal beliefs of young people about human sexuality and sexual relationships. Below an extract from the interview with an adolescent boy is given, who participated at training courses on sexuality, and sexual and reproductive health 2 years ago (Group “A”):

Respondent of male gender, 15 years of age, student of public school:

“First I heard the word SEX when I was 10 years old. My mother told me that I should never repeat this word, since street people use it. However, I didn’t stop to think about this and asked explanations from my elder brother, who was 16. He laughed at me and said that it is “too early” for me to ask such questions.

I remembered that my parents also often used wording “too early” and turned off the TV, when I was looking something related to naked women or kissing. I supposed that the word SEX was related to watching such movies...

Than I decided to ask my 11 years old friend about this . He explained to me that SEX is insertion of penis of man into genital organ of woman … I asked him: why do they do it? He said: after this woman becomes pregnant and in her belly a child starts to grow. They do it in order to have children... I was scared and ran away from him.

Later on, I asked my mother: ''Tell me the truth, how was I actually borne?'' She answered in the usual manner: it is “too early“ for you to understand… After this I hated my mother and decided never to ask her about anything …

The next day I didn’t go to school and stayed at home alone. I found a videocassette “Love Story” and watched it alone… I understood what they were doing and decided to make love with my girlfriend as soon, as possible…

After the lessons I suggested to accompany her home. When we reached her house, I said to her that I was in love with her, kissed her and immediately ran away. It was my first attempt to make love and I was happy…I couldn’t do anything more.

When I became 13 years old, I decided to try “real sex” with a prostitute, but didn’t know how to find one. By chance, I participated at the training course on sexuality and related issues, which opened my eyes. We discussed in the large group values of life, love, sexual relationships, secrets of pregnancy and childbearing. Everything was natural and it became clear to me… No, I will never try it with somebody else but my real lover… I will wait for her…”          

3.3.   Pregnancy

Survey data

Most of the survey respondents, including young people (78%) and adults over 24 years of age (90%) were aware that teenage girls are able to become pregnant, however, 22% of young people had no or wrong ideas about this issue Moreover, the majority of young people (70%) were not aware or had lack of knowledge about the fertile days of the menstrual cycle  (Figure 3.3).

Case studies data

It was pleasant to observe that the great majority of young people, which have been provided with training courses on sexuality, and sexual and reproductive health (Group "A"), as well as most of those young people, which received related information from previously trained peer educators (Group "B") were aware and had basic knowledge about conception. In fact, significant proportion of those young people, who never had an access to accurate information on sexuality, and sexual and reproductive health (Group "C") had wrong ideas or were not aware about these issues (Figure 3.4.).

Figure 3.3. Awareness and knowledge among young people about conception

(Survey data, n=900) 

Statement: “13 years old girl may conceive”

We provide below an extract from the interview with 22 years old girl, which participated at training courses on sexuality, and sexual and reproductive health 4 years ago and currently volunteers her time as a peer-educator (Group "A"):

Respondent of female gender, 22 years of age, university student:

“ A girl usually begins her period between the ages of nine and eighteen. At that time eggs in her ovaries start to ripen. In the middle of the menstrual cycle the ripened egg breaks out of its follicle and rises to the surface of the ovary. This process is called “ovulation”. To get pregnant, a girl, whose ovaries already produce eggs, has to have had sexual intercourse or intimate relationship with a boy ended with ejaculation near the opening of her vagina. Therefore, girl can get pregnant even if she is very young, even less than 13 years of age… However, teenage mothers and their babies face a higher risk of pregnancy and childbirth complications than older mothers do, because teenage bodies are still developing…”

Figure 3.4. Awareness and knowledge among young people about conception, by access to sex education

(Case studies data, n=150)

Statement: “13 years old girl may conceive”

3.4.   Fertility regulation

Survey data

There is 100% awareness among adults over 24 years of age about abortion, however, 12% of young people don’t know what is abortion. There is lack of information on some specific methods of contraception, especially among young people (Table 3.2). Thus, for example, hormonal pills as method of contraception were reported only by 12% of young people, and IUDs – by 4% of them. The most frequently reported by young people known methods of contraception (Table 3.2) were condom (88%), withdrawal method (25%), and breast-feeding (19%). For adults over 24 years of age the most frequently reported methods were: condom (93%), withdrawal method (72%), and intrauterine device (67%).

Table 3.2. Awareness of young people and adults over 24 years of age about methods of fertility regulation*

(Survey data)

*Note:  More than one reply is possible

Only 346 (38%) adults over 24 years of age considered hormonal contraceptive pills as reliable method of fertility regulation. Positive opinion about reliability of the withdrawal method was given by 348 (39%) respondents.    

Case studies data

All young people (100%), involved in the Group “A” (have been provided by training course on sexuality, and sexual and reproductive health), as well as 43 (86%) respondents from the Group “B” (received related information from previously trained peer educators) and 39 (78%) – from the Group "C" (didn’t have an access to the accurate information on sexuality, and sexual and reproductive health) were aware of abortion. The extract from interview with previously trained adolescent girl from the group “A” is provided below:

Respondent of female gender, 16 years of age, student of the college:

 “ Yes, I have heard about abortion, I am scared of it and know how to avoid it. In our society girls should remain virgins before marriage and get pregnant as soon as possible after it. So, I am going to follow this tradition and will postpone sexual relationships before my marriage. That means that I will never terminate my first pregnancy… Unfortunately, there are so many unexpected situations and it is not easy to live according to a certain plan.

Once I imagined myself pregnant after the rape… What kind of decision shall I make? Shall I continue the pregnancy and have a baby? Or may choose to end the pregnancy by having abortion? Then I asked myself:

-         Can I raise a child? - the answer was “no”.

-         Can I have a baby and leave him for adoption? – again “no”.

-         Can I have an abortion? – “I am not sure about this”.

In one thing I am sure for 100%: the decision should be mine and I have to live with its consequences…”        

The condom was the first most frequently reported by young people method of contraception (Table 3.3), regardless the age of respondents, place of their living, and access to sex education (group "A"- 98%, ”B”- 86%,”C”- 78%). The second most frequently reported by young people method of contraception was the withdrawal method (group ”A”- 46%, ”B”- 44%,”C”- 40%). 

Table 3.3. Awareness of young people about methods of contraception, by access to sex education*

(Case studies data, n=150)