Group Couples' Intervention to Improve Sexual Health Among Married Women in a Low-Income Community in Mumbai, India

A narrative review on sexual wellbeing and dysfunctions: Research in the past 15 years

Background

Psychosexual health is an important aspect of mental and physical wellbeing. Though Indian culture has a rich history of sexuality, over the years, our population has been reticent in talking about the same. With the advent of technology and new legislations protecting the rights of LGBTQIA population, awareness is also on the rise.

Methods

This review focuses on research published by Indian authors over the past 15 years, with search of databases like PubMed, Scopus, Google Scholar, and Litmaps to include original articles and case reports.

Results

Most studies focus on male sexual dysfunctions. Some emerging research showed promise in female sexual dysfunctions, the elderly, and the LGBTQIA population. The majority of research in sexual health continues to concentrate on dysfunctions, primarily prevalence, associations, or risk factors. Several studies investigated various medical/psychiatric comorbidities associated with sexual dysfunctions. A few studies have explored management strategies as well.

Conclusion

This review highlights the need for a more holistic approach to management to sexual health issues. It further underscores the importance of grassroots-level initiatives working on improving the training of all medical practitioners and postgraduate students, increasing the availability of services for sexual disorders, promoting sexual health research in areas with gaps, and raising awareness in the general population.

Individual empowerment and community norm effects of engaging young husbands in reproductive health in rural India: findings from a pilot study

BACKGROUND

Despite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men's perspective of the pilot of a gender transformative intervention for newly married couples in India.

METHODS

A pilot study was conducted of TARANG, a 4 month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June 2023-January 2024.

RESULTS

Men had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community.

CONCLUSIONS

Men in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement. TRIAL REGISTRATION CLINICALTRIALS.GOV : 03/13/24.NCT06320964.

Individual empowerment and community norm effects of engaging young husbands in reproductive health in rural India: findings from a pilot study

Background

Despite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men's perspective of the pilot of a gender transformative intervention for newly married couples in India.

Methods

A pilot study was conducted of TARANG, a 4-month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June-January, 2023.

Results

Men had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community.

Conclusions

Men in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement.

Trial registration

clinicaltrials.gov (NCT06320964), 03/13/24.

The effectiveness of "Women's Postpartum Sexual Health Program (WPSHP)" on Iranian women's postpartum sexual health: A randomized clinical trial

In this study, we examined the effectiveness of Women's Postpartum Sexual Health Program (WPSHP) on Iranian women's sexual health in the postpartum period. A single-blinded randomized clinical trial was conducted in 2016 on 80 postnatal women in Iran. We used the Female Sexual Function Index, Sexual Quality of Life - Female questionnaire and Female Sexual Distress Scale. The intervention group received counseling based on WPSHP. After 28 weeks, the mean score of the Female Sexual Function Index and Female Sexual Quality of Life significantly increased in the WPSH group (p < 0.001, p < 0.001), while the mean score of the Female Sexual Distress significantly decreased in the WPSH group (p < 0.001). We concluded that Women's Postpartum Sexual Health Program could promote postnatal women's sexual function and female sexual quality of life and reduces female sexual distress in women suffering from sexual problems in the postpartum period.

Sexual intimacy and marital relationships in a low-income urban community in India

Data from a six-year study of married women's sexual health in a low-income community in Mumbai indicated that almost half the sample of 1125 women reported that they had a negative view of sex with their husbands. Qualitative interviews and quantitative survey data identified several factors that contributed to this diminished interest including: a lack of foreplay, forced sex, the difficulty of achieving privacy in crowded dwellings, poor marital relationships and communication, a lack of facilities for post-sex ablution and a strong desire to avoid conception. Women's coping strategies to avoid husband's demands for sex included refusal based on poor health, the presence of family members in the home and non-verbal communication. Factors that contributed to a satisfactory or pleasurable sexual relationship included greater relational equity, willingness on the part of the husband to not have sex if it is not wanted, a more 'loving' (pyaar karna) approach, women able to initiate sex and greater communication about sexual and non-sexual issues. This paper examines the ecological, cultural, couple and individual dynamics of intimacy and sexual satisfaction as a basis for the development of effective interventions for risk reduction among married women.