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Try out PMC Labs and tell us what you think. Learn More. E-mail: bl. The aim of this study was to elicit definitions of the concept of reproductive health among women in three communities around Beirut, Lebanon, as part of the reproductive health component of a larger Urban Health Study. The communities were characterised by poverty, rural-urban mobility and heterogeneous refugee and migrant populations. A random sample of 1, women of reproductive age completed a questionnaire, of whom a sub-sample of women were randomly selected.
The women's understanding of good reproductive health included three major themes, which were expressed differently in the three communities.
Their understanding included good physical and mental health, and underscored the need for activities promoting health. Their ability to reproduce and raise children, practise family planning and birth spacing, and go through pregnancy and motherhood safely were central to their reproductive duties and their social status. Finally, they saw reproductive health within the context of economic status, good marital relations and strength to cope with their lives. These findings point to the need to situate interventions in the life course of women, their health and that of their husbands and families; the importance of reproduction not only from a health services point of view, but also as regards women's roles and responsibilities within marriage and their families; and taking of the harsh socio-economic conditions in their communities.
A Reproductive Health Matters. All rights reserved. THE past decade has witnessed the emergence of an increased interest in women's reproductive health and development-related programmes to improve reproductive health across the globe. This conference solidified a new, comprehensive understanding of reproductive health, largely owing to the efforts of participating policymakers, researchers, health service providers, scholars, feminists and health advocates from developed and developing countries. Although substantial discourse on reproductive health and attempts at defining the term preceded ICPD, the new approach represented a radical departure from population rhetoric.
Indeed, it has been widely suggested that ICPD produced a paradigm shift, a transformation from a macro-level focus to a micro-level concern, with individuals' rights in relation to sexuality and reproduction gaining ascendance over the demographic arguments for population policy. Among other major accomplishments of the new concept of reproductive health was the inclusion of the needs of a wider age range of women, emphasising a life-cycle approach rather than the childbearing years only, 67 and the incorporation of ly neglected groups, notably men and adolescents.
Numerous scholars and health advocates, particularly in the developing world, have argued that the globally-used concept of reproductive health is not always applicable across cultures. This is a concept which is absent from the ICPD definition, yet it is construed as central to women in the Arab region as part of their perception of reproductive health. The success of reproductive health programmes is thought to rely largely on involving women in the process of prioritising health issues in order for services to be relevant to their lives and culturally acceptable.
Our research asked women living in three impoverished communities located on the outskirts of Beirut, Lebanon, for their own definitions of the concept of reproductive health. This study was a preliminary attempt at exploring poor women's understanding of reproductive health, based on the assumption that women attach meaning to the concept within specific socioeconomic and cultural contexts.
Our aim was to contribute to the incorporation of women's views into useful definitions of reproductive health in order to make community-level strategies used to improve reproductive health more relevant to women in those communities. The study surveyed three population groups within the household: adolescents boys and girlsever-married women, and older people men and women. Specifically, it explored the social, economic and environmental conditions influencing various dimensions of health for these three groups, with a focus on poverty, social capital, the gendered division of labour, work of women, displacement and migration.
Three communities - Hay Sellom, the Bourj El Barajneh camp and Nabaa - located close to each other on the outskirts of Beirut, the capital of Lebanon, were selected based on the following criteria: densely populated, impoverished, characterised by rural-urban mobility, including war-displaced populations, lacking basic infrastructure, and having a heterogeneous population.
It is a very poor area, densely populated by mostly Shiite migrants, mainly displaced from southern Lebanon and the Bekaa district of eastern Lebanon due to war and poor economic conditions. Private health services are available in the area, in addition to the public health services, including reproductive health services, mainly maternal and child health and family planning, offered by a limited of local, family-oriented NGOs and the community development centre of the Ministry of Social Affairs.
However, the Hezbollah Health Committee remains the main provider of various types of health services. The Bourj El Barajneh refugee camp, located to the south of central Beirut, is one of the largest Palestinian refugee camps, established in to house Palestinian refugees mainly from the Galilee in what is now northern Israel. The socioeconomic conditions in the camp are generally poor, with a high population density, inadequate basic infrastructure and cramped living conditions. Considered as foreigners, the camp dwellers are legally prohibited from working in more than 60 professions and trades.
They also have very limited or no access to the government's public health and social services or educational facilities. UNRWA centres also provide Housewives wants real sex Lebanon South health services, mainly family planning and maternal and child health. Nabaa is part of the eastern outskirts of the capital, which grew as a result of migration from south Lebanon and the Bekaa area.
Home to a highly mobile migrant population, it is characterised by poor infrastructure, overcrowding and sub-standard living conditions. As part of the urbanisation process, displacement into Nabaa started before the civil war, as rural Shiite and Christian migrants sought employment in and around the city. In the post-war period, the community has witnessed an influx of foreign labourers Asian, Syrian and Egyptian as the Lebanese labour market is absorbing low-paid labour. Many local NGOs provide social and health services, including maternal and child health and family planning, in the area.
The Ministry of Social Affairs has a communitybased development centre in Nabaa, which provides health and social services. However, due to limited funds and the diversity of health problems in the community, these services cannot cover all needs. The Urban Health Study was conducted in two phases and included four large structured questionnaires in colloquial Arabic.
Three thousand households were sampled using a two-stage cluster random sampling, out of which 2, The household questionnaire solicited information about every member in the household, covering demographics, education, income, migration, labour and division of household work, largely obtained from the wife of the household head.
In Phase II October to Januaryindividuals were interviewed in all the sampled households. The reproductive health questionnaire was administered to all ever-married women aged The adolescent health questionnaire was administered to all unmarried boys and girls aged The older people's health questionnaire was administered to all men and women aged 60 and above. Both the latter two questionnaires included questions for the girls and women on reproductive health. The reproductive health component included about open and closed-ended questions, covering general perceptions of health, current health and reproductive Housewives wants real sex Lebanon South problems, pregnancy history, childbirth, infertility, family formation, contraceptive use, menopause and use of reproductive health services.
The open-ended questions aimed to gain insight into women's perceptions, beliefs and practices regarding their own health, reproductive health and related issues. The data were collected in face-to-face interviews by female fieldworkers, recruited mainly from the three communities, to gain acceptance in the communities and households, to benefit in the de phase from their local knowledge, and to provide skills and employment for people from the communities.
All fieldworkers hadfinished at least high school and had some experience in field surveys. They underwent training prior to both study phases, to develop their interviewing skills, hold in-depth discussions on the study aims and instruments and carry out pilot testing in the communities.
Pilot testing of the reproductive health questionnaire aimed also to ensure the use of proper language comprehensible to women. Informed consent was sought from all respondents. Of the 2, eligible women, a total of 1, completed the questionnaire Non-response was mainly due to people moving outside the communities. This paper is based on one open-ended question, soliciting women's understanding of reproductive health.
The format of the question was pilot tested with 40 women living in communities similar to the ones under study, using different versions of the question to ensure that women's answers were about the concept itself. A sub-sample of of the 1, women who completed the reproductive health questionnaire, stratified by community, were randomly selected to explore the data.
Their mean age was 37 rangeand the vast majority The three communities were similar for all these variables, except that women from Nabaa had a higher mean age. The sub-sample was very similar to the total sample of women who completed the reproductive health questionnaire as regards sociodemographic variables.
Probing by the interviewers was limited, in line with our exploratory purpose and setting the ground for further in-depth qualitative research. Our sample was small for convenience and feasibility reasons, but even though the answers cannot be generalised they do give a good sense of the women's understandings in these communities. The data were analysed in Arabic using thematic analysis. Women's responses Housewives wants real sex Lebanon South mostly of several short statements, limiting the possibility of investigating underlying meanings.
Final themes were analysed and translated into Housewives wants real sex Lebanon South. Most women considered health as their point of departure in explaining their understanding of good reproductive health, including good health more broadly, good mental and psychological health and activities that promote health. In Hey Sellom, it was further described as the absence of pain, complaints and harmful exposures, as well as having the strength to work. Good health was linked by 24 women to a specific understanding of women's role in society. Reproduction was why good health was of the utmost necessity.
It was the means of fulfilling their primary role within the domestic sphere as wives and mothers. Women considered the health of their families as another important aspect of good health, even though the question specifically asked them about themselves.
This implies that women's perceptions went beyond their own individual health to include that of their families, which constitutes a connective view of the self. Four women one from Hey Sellom and three from Nabaa considered good health to be a gift from God.
Activity that promotes health was another theme that emerged, mostly from women from Nabaa. This is about women's responsibility and the fact that health is not merely granted but must be attained through their own efforts. These women focused mostly on physical health, and the need for preventive measures, such as going regularly to physicians and followingtheir recommendations, having a yearly Pap smear, avoiding communicable diseases and cold weather, having a good diet, eating nutritious food and exercising. They should be energetic, rest and not exhaust themselves.
They should not be overweight, smoke or drink. The importance of health promotion was again related to the fulfillment of household duties and ensuring the overall well-being of the family. Seven women from the three communities mentioned the importance of psychological health, described as better management of their lives, not dwelling on problems, coping and not getting angry, having internal strength and being patient and avoiding stressful events.
Reproduction was the second most frequent point of departure to explain the concept of reproductive health. It consisted mainly of the ability to bear and raise children, planning and spacing births and safe pregnancy and motherhood. A prevalent perception among women in most Arab societies is that childless women face a difficult old age, as children function in lieu of social security. Many childless women are threatened by divorce and consequent destitution, especially in the context of poverty. Motherhood or procreation represented an important aspect of the expressed meaning of reproductive health for women in these three communities, especially in Hey Sellom.
The women considered motherhood as the fulfillment of the fundamental role of women to bear children, and more specifically healthy children. Having the capacity to bear children is considered both essential and desirable, because children are the basis for happiness in marital life. The ability to get pregnant without medical intervention was crucial for two women in Hey Sellom; delayed pregnancy means being disgraced in the eyes of the community.
Reproduction was seen as a duty women need to fulfill in order to secure good reproductive health. Choice, in terms of bearing children and women's role, was not articulated as important.
This is not to suggest that choices and rights are not relevant to the women, but choices were made in relation to the consequences for their future, especially old age security, and their status within their communities.
As such, their choices were dictated by the duty of women to have a lot of children. This finding is in line with what has been reported in the literature. Winkvist and Akhtar 19 report that having children is central to women's identities, and the only route to authentic womanhood.
Harris and Smyth 20 found that women gain social status through their reproductive functions, so that their reproductive health has considerable repercussions on their overall existence.
Four women from the Bourj El Barajneh camp added women's ability to raise their children properly as complementary to their understanding of good reproductive health. This was deemed important because properly raised children become good citizens who are able to better serve their society and the generations that follow. Another woman from the camp emphasised the ificance of having her own dwelling, separate from her extended family, in order to enjoy autonomy in child-rearing. Family planning was another theme that emerged, mainly in statements by women from the Bourj El Barajneh camp.
Women identified limiting the of births, as well as spacing pregnancies, as important elements of good reproductive health. The ificance of family planning was related to the effect of many births on women's bodies and their current and future health status, which might become a burden on their children.
Family planning was also seen as important because women have to take into consideration the current economic and political situation, both unfavourable for excessive births. This theme also emerged largely in the Bourj El Barajneh camp. Women considered having healthy bodies, bodies free from disease cardiovascular disease, diabetes, gynaecological or hereditary problemsas necessary in order to be able to pass safely through the years of childbearing.
A woman also needs to be active to ensure her general and psychological health to avoid problems during pregnancy, such as avoiding stress and hard work. Some women stressed the importance of antenatal care and compliance with the physician's recommendations.
Getting pregnant at an appropriate age, not later than 35, was identified as an important factor to ensure safe pregnancy and delivery. Breastfeeding and having social support in performing household work were identified as important for post-partum health. Women situated reproductive health within the broader social, Housewives wants real sex Lebanon South and familial context of their lives, and as inseparable from them.
Overcoming economic problems, as well as having a good home and a socially favourable environment, were thus integral elements of the meaning of reproductive health for them. Rather than directly stating what reproductive health means for them, women, particularly in the Bourj El Barajneh camp, identified lack of economic hardship as a prerequisite for having good reproductive health.
Economic problems prevented them from meeting their needs and wants, including getting medical care during childbirth, and carrying out their responsibilities as mothers in taking care of the needs of their children clothing, food, nappies, medical care and education. Good marital relations resonated more for women in Hay Sellom than other communities as a requirement for good reproductive health. Women reported that good marital relations mean that the husband treats his wife well, ensuring her comfort and happiness.
Five women from Hey Sellom and two women from Bourj El Barajneh camp associated reproductive health with a woman's ability to enjoy her womanhood. They related reproductive health to women making decisions, possessing a strongpersonality in order to live, manage their personal and family life and cope with difficulties.
Thus, a woman with good Housewives wants real sex Lebanon South health thinks and acts properly and is useful to society as well. Information like this is a prerequisite for implementing successful intervention projects. Without a thorough understanding of women's perceptions of reproductive health in specific contexts, we run the risk of incorrectly homogenising and universalising women and their needs, which would weaken the effectiveness of reproductive health programmes.
The women's understanding of reproductive health in this study points to the need to situate interventions to improve reproductive health in the life course of women and their health more broadly, in the importance of reproduction not only from a health point of view as regards essential services such as maternity services and family planning, but also as regards their own health and roles and responsibilities within their marriages and families, and in the harsh socioeconomic conditions in which they and their families and communities are living.Housewives wants real sex Lebanon South
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