Physician's Perceptions of Women's Reproductive Health

Abstract:
This article aims to study the content of the teaching materials used by the medical students and possible effects on the development of their perception towards women’s health, using contraception as an illustration. This paper focuses on the contraception chapter, which deals with the health of women, involving the husband and addresses the social issues related to family planning. Contraception is mainly addressed in the didactic part of the curriculum, hence the main source of information about contraception would be the teaching materials used by the student. The in-depth analysis reveals that the counseling, social, gender and ethical issues are poorly addressed. This article calls for giving more weight to the above mentioned issues in the curriculum so that these future doctors would have a sound cognitive, emotional and attitudinal perceptions towards women’s reproductive health.

Introduction:
The perceptions of medical professionals towards women’s health are formed largely from the theory and teaching of biomedicine, which they obtain in the universities and while training as physicians. Medical educators during the past decade have been concerned with whether doctors are being trained and educated to respond to women’s changing health needs. This article is concerned with the analysis of the content of the reading materials used by the students and its possible effects on the development of their perception. The article focuses on contraception, as family planning and birth control need discussion of more than just mechanics of method but they are part of reproductive life with emotional and sexual issues. Also this chapter deals with health women, where participation of the woman and her husband is essential and the choice of the client is a crucial part in prescribing the method of birth control.

Objective:
To investigate the role played by the textbooks and the references used by the students at Al Azhar Medical School in shaping their perceptions towards women’s reproductive health.

Methodology:
This pilot study focused on one medical school (Al Azhar University Medical School for Men), and on the fifth year class only. Al Azhar has been chosen for three reasons. First, because we had access to the school since 4 members of our team are medical teaching staff at the school. Secondly because, as a male only school, it naturally controls for gender. Thirdly it is a small highly regarded school of medicine, which could also act as a possible site for future intervention.

We chose fifth year students because it is the last year of formal education and clinical training for the majority of them. It is a critical year, particularly for those who do not continue to do post-graduate work. We focused on education in Gynecology and Obstetrics because it is the most relevant part of medical education to our work based on complete list of study aids and other text used by students. Team members undertook analysis of these texts to discover the constructions of gender, health and disease that are both explicit and implicit in these publications. Our interest was to appreciate the "messages" conveyed to medical students about reproductive health and reproductive rights for women and for men. Contraception was used as an illustration.

Results:
The analysis of the contents of the teaching materials as regard counseling revealed that:

Counseling does not exist or is referred to in all the notes used by the students. The message conveyed to the students is that they should dominate the conversations and also that they are the appropriate ones to make decisions for individual clients about which contraceptive method to use, noting to learn that clients are more often satisfied if they are informed and actively discussing their health care.

Social Dimensions:
The issues of concern to women include hazards such as disturbances of menstrual cycles, depression, weight gain and loss of libido, often referred as side effects. They are of vital importance to women and are critical determinates of whether or not they continue using specific methods. Taking the pills "only as needed" implying a misunderstanding of the method and resulting in high pregnancy rate, and social consequences of unwanted pregnancy. In Muslim cultures, where a woman’s everyday activities range from praying, marital relations are severely circumscribed during menstruation and breakthrough bleeding, which with many methods of contraception are not addressed as a social problem, deserved to be explained to women.

Gender Dimensions:
Male contraceptive methods (the condom, for example). Although it protects from S.T.D.s and it requires no medical intervention, the main focus in all the texts is on male dissatisfaction. This suggests that family planning services, focusing exclusively on women, do not acknowledge men’s often critical roles and responsibilities in birth control.

Ethics:
The client’s right to make a voluntary unpressured decision concerning her choice of a birth control method is not mentioned in any of the notes reviewed. The text on injectables, I.U.D., and subdermal implants does not have any referrence to consumer’s consent, although the informed consent in family planning is crucial as it is usually initiated at the request of a healthy woman and in the absence of traditional medical indication for treatment.

Discussion:
The study of physicians’ perceptions of women’s health is an essential component for the understanding and improvements of health and health care for women. We have found that the approach of the curriculum to the issues of contraception focuses almost exclusively on the women and does not acknowledge men’s critical roles and responsibilities in women’s use of contraception. Some men refuse to use or facilitate women’s use of contraception. Some partners continually re-infect their wives with sexually transmitted diseases because of non-use of condoms. A gap between what medical education prepares doctors to do and what society needs is obviously seen in these notes, as all of the texts reviewed are not addressing the social implications of contraception. Text books provide little or no concern to the issue of counseling, and on the contrary, the notes ones to make decisions for individual clients about which contraceptive method to use.