Knowledge, Attitudes and Practices of Russians on Reproductive Health and Family Planning

This 65-page report details the results of formative research carried out by the Center for Communication Programs (CCP) of John Hopkins University's Bloomberg School of Public Health to guide the development of materials for Healthy Russia 2020's "Hear Each Other!" campaign. The research involved 16 focus groups conducted in 2 Russian cities (Irkutsk and Orenburg), with 8 groups in each city; participants were men and women between the ages of 18 and 35 who were identified as having a sexual partner of the opposite gender. This research was designed to:

• explore the knowledge, attitudes and practice of couples from different socio- demographic groups regarding contraceptive use
• investigate gender roles in reproductive health decision making and contraceptive use
• explore the sources of information couples in different social groups use when making decisions about family planning and contraceptive use.

The report provides a detailed look at the various factors impacting one population's reproductive and sexual health (RSH) and contraceptive decision-making. The research reported here is qualitative, and includes quotations from specific focus group participants reflecting on such communication-centred issues as the emotional risks of poor communication: how stress and conflict impact reproductive and sexual health, for example. Moderators asked questions (listed in the Appendix of the report) delving into the reasons behind many of the respondents' feelings about particular issues; for example, "Some respondents felt that an extensive information campaign on sexually transmitted infections issues would cause them to pay more attention to their reproductive health. At the same time, however, most of the respondents felt that because they already possess sufficient information on reproductive health issues information campaigns are necessary only to influence young people." Here are some additional research findings:

Understanding and maintaining RSH:

• The research participants had a good general understanding of the concepts of RSH, though, implicitly (and in line with cultural norms), they tend to see these related more to female health than to male health.
• Participants were well aware of the importance of maintaining their RSH - particularly in preventing pregnancy and disease. In practice, however, respondents do not always take the necessary steps; health is not highly valued and plays a subordinate role to other values.
• Women not only pay more attention to their own health, but are widely perceived to be responsible for the health of their entire family. They are more likely to have routine, preventative medical examinations, while men go to the doctor only when there is a specific reason, usually when there is a risk of a sexually transmitted infection (STI).
• The majority of participants said they discuss family planning and RSH issues with their partners, but this isn't necessarily reflected in their behaviour.
• When women were alone in groups they were much more likely to focus on their role in the couple when it comes to RSH. But men and couples in focus groups were likely to say that couples jointly share responsibility for their RSH.
• The desire to have healthy children is one of the major incentives most females and males in focus groups have for paying attention to their RSH. Planning a pregnancy can make both a woman and her partner reconsider their behaviour, have a medical examination, and give up bad habits.
• Participants stated unanimously that if another person expresses concern about their RSH they are more willing to contribute to maintaining and strengthening their own RSH. Women are particularly influenced by male initiative, but men seldom express concern over their partner's RSH. Men also reported that a woman's appeal that men take better care of their health usually goes unanswered.
• Many factors impact RSH: factors people can actively control (random sexual contacts, unhealthy behavior, contraceptive choices, time pressures, an irresponsible attitude to prevention, and some financial decisions, etc.) and those they are more passively subject to (environmental hazards, access to health care, etc.)

Risk and risk reduction:

• Respondents had a good understanding of the risks that can impact their RSH: unplanned pregnancy, abortion, and STIs. When people ignore these risks it can be attributed to a lack of responsibility, not a lack of information. People often make decisions spontaneously about sexual relationships that have consequences for long-term RSH, while ignoring possible known risks.
• Women feel most vulnerable to the risks associated with possible infidelity on the part of their partners; both the psychological consequences of infidelity (deception, loss of trust between partners) and the medical consequences (STIs). Men believe that the most serious RSH risks are STIs and unplanned pregnancy, particularly pregnancy that is the result of a random contact.
• Men and women have negative feelings about abortion - even when they have had abortions: They do not approve of abortion but often see it as a necessary and acceptable solution to an unplanned pregnancy.
• Participants showed a high level of knowledge regarding STIs.

Contraceptives:

• The vast majority of participants know many contraceptive methods, as well as their advantages and disadvantages. They are well aware of the importance of contraception in preventing pregnancy and providing protection from STIs. They unanimously approve of using contraception and think they should be well publicised to ensure that people receive information on contraceptives from an early age.
• They were satisfied that many contraceptive choices are currently available and felt it is possible to select a contraceptive that is appropriate for their needs.
• The use of contraception to prevent STIs is an indication of the degree of trust between partners. For example, it is widely thought that if you have one permanent partner, there is no need to protect against STIs. Males, in particular, think that marriage almost completely eliminates the risk of contracting STIs from their spouses. In contrast, females fear they may contract STIs from their partner.
• Participants said that people should be able to choose the contraceptive that is best for them. Couples say they are willing to engage in joint decision-making regarding the choice of contraceptives. In reality, however, women in permanent relationships have less control over this decision than men. When men are in a permanent relationship they often prefer to stop using condoms and rely instead on female-controlled methods like oral or intrauterine contraceptives.

Sources of information:

• Though men and women differ on which sources of information they trust and which are the most important, all of the respondents listed: relatives, friends, and acquaintances; doctors; the mass media (including the internet); and special medical publications (newspapers, brochures, booklets, posters, etc.) as important sources of RSH information. Among the findings: "Although the respondents said that actively use the mass media as a source of reproductive health information, they acknowledged that they do not trust the information they get from the mass media. Respondents felt that they can trust only those media outlets that are known to have good reputations, have existed for a long time, are 'conservative', and have been 'verified'."
• The respondents were equally divided on how information should be presented by gender. Half believed that RSH information should be designed differently for males and females, while the other half felt that males and females should be presented with the same information.
• There was no consensus, based on age or gender, on ideal sources of family planning and RSH information. For instance, respondents have ambivalent attitudes to doctors and information coming from doctors. This suggests that many sources of information are needed to reach people of different ages and gender, and that any RSH campaign should use all available information channels.
• All of the respondents said it is critical to raise children to be responsible or their own RSH and that parents should teach their children about contraceptives and how to avoid unplanned pregnancy and STIs. However, most of the male participants and some of the females felt that it is not appropriate for both parents to take part in the sexual upbringing of their children, perpetuating gender stereotypes that make certain RSH topics taboo between males and females.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.