Women's sexual health in Saudi Arabia: A focused ethnographic study

Study aim:
This study was conducted to describe how women and health care professionals perceive sexual health and services that are currently provided in Saudi Arabia.

Background:
At present, the worldwide health authority, in the form of the World Health Organisation (WHO) has drawn great attention to the importance of improving women‘s sexual health globally. It is increasingly concerned about women‘s sexual health and permanently works to shed light on the innovative approaches that are needed to raise women‘s awareness of risky behaviour, and to help them access the advice and treatment they need to avoid negative health outcomes that would impact on their future lives. Research into women‘s sexual health in Saudi Arabia will help in identifying possible causes of poor sexual health care that could be used as preventive tools in that, or similar cultures. In addition, it helps to meet women‘s physiological, emotional and educational needs, which is essential to support good sexual health.

Methods and data:
The researcher adopted an exploratory, qualitative method to conduct the study with an ethnographic design. It was undertaken in two governmental hospitals in Jeddah city, namely King Abdulaziz University Hospital and Maternity and Children Hospital. The duration of data collection was two months in each hospital. Women, doctors, nurses, and clinic managers all were participated in the study. Observational notes, document analysis and in-depth interviews were used for data collection. Detailed field notes were recorded of observations in the setting, clinical consultations and the participant‘s behaviours and interactions. 40 Interviews were conducted (21 with female patients and 19 with Health care professionals) and 74 consultations were observed. The data analysis was conducted using the framework identified by Holloway and Todres (2006, p. 219), for use in ethnographic research.

Findings:
Female participants reported experiencing more difficulties in talking about sexual matters generally, and specifically those that related to sexual intercourse. They also delayed seeking sexual health care as a result of the influence of Saudi social norms around women‘s sexuality. Plus, appointment issues, long waiting times, low quality of care provided and being dependent upon husbands for transportation were also barriers to accessing sexual health care or advice. Health care professionals tended to avoid initiating discussions about sexual matters in their clinical practices, to respect the cultural norms and avoid offending the patient. Many other barriers to talking about sexual topics in the clinic were also reported by the health care professionals in the current study. Sexual health care and services in Saudi Arabia are limited, lack integration to sexual health education and centre on reproductive health through the provision of obstetrics and gynecology care and contraception.

Discussion:
Using the Theory of Reasoned action as a theoretical framework to discuss the findings of the study this chapter sets out how the social norm pressures that are embedded in Saudi culture particularly those related to women and sex significantly influence both health care professionals and women‘s attitudes and behaviour towards sexual health care. The effect of Islamic guidance on Saudi culture and in participants‘ lives was very strong and clear. Adopting the concept of holistic sexual health explicitly in Saudi Arabia would be difficult and problematic. Missing the opportunity to talk about sexual issues in general, and in consultations in particular, put women at the possible risk of poor sexual health.

Conclusion:
Multifaceted interventions and programs are necessary to improve the quality of services that provide women sexual health care in Saudi Arabia. Efforts to influence social norms, empower women, enhance health care professionals‘ roles and functions and more research into women‘s sexual health is required.