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					1                                                                       Abou Shabana K




    Women's Perception and Practices Regarding Their Rights in Reproductive Health

               Abou Shabana K, El-Shiek M, El-Nazer* M and Samir N
            Faculty of Nursing and Obstetrics* and Gynecology Department,
                                 Ain Shams University.


ABSTRACT
Setting: This study was conducted at the outpatient clinic of Ain Shams University
Maternity Hospital from 1-12-1999 to 1-12-2000.
Objective: To evaluate women’s perception and practices about their reproductive health
rights.
Hypothesis:-The majority of women have negative perception concerning their RRs . There
is a difference in the concept and utilization of RRs between women in urban and rural
areas . Women’s education affects their concept and utilization of their rights .
Design: Descriptive cross-sectional study.
Sampling: One thousand women were randomly selected from all women attending the
outpatient clinic.
Method: A structured interview questionnaire was used. It included 50 questions covering
2 parts, the first part assesses demographic data, while the second part was concerned
with women's perception and practices regarding their reproductive health rights. On
average, 5-8 women were interviewed every day.
Results: The majority of women had positive perception about their rights in reproductive
health, while 30% had negative perception related to prohibition of all forms of
discrimination against women as female genital mutilation (FGM). A significant
association was found between their perceived sexual rights and their demographic
characteristics. A significant relationship was detected between women educational level
and their awareness and practices regarding early detection of cancer as reproductive
rights. However, no significant relation was noticed between women’s educational level
and their concept of adolescent health education as a reproductive right.
Recommendations: Encouragement of men's role in active participation as equal partners
in reproductive health to empower women toward their reproductive rights. The non-
governmental organizations should improve public awareness regarding this issue. To
integrate the concept of women's rights in reproductive health into the maternal and
neonatal nursing curriculum at AIN shams faculty of nursing .
2                                                                            Abou Shabana K

INTRODUCTION
        In Egypt, a national study was on maternal mortality reported that 84 women die
per 100,000 live births each year (National Study on Maternal Mortality, 2000). Females
are source of the nation and a basic unit of the society. Hence, the reproductive health of
the women should be supported, protected, and considered a crucial part of the general
health (Beijing, 1995). Reproductive health (RH) is a state of complete physical and social
well being and not merely the absence of disease or disability in all matters relating to the
reproductive system and to its function and processes. RH, therefore, implies that people
are able to have a satisfying and safe sexual life, also have the capability to reproduce and
the freedom to decide when and how often to do so (ICPD, 1994; WHO, 1995).
Reproductive rights is defined as an integral and indivisible part of universal human rights
including the basic right of all couples and individual to decide freely and responsibly the
number and spacing of their children, and to have information, education and means to do
so, the right to attain the highest standard of sexual and reproductive health, the right to
make decisions concerning reproduction, free of discrimination, coercion, and violence
(Cook and Plata, 1994 and WHO, 1997). The reproductive rights RRs are the cornerstone
of the development. through the teaching of the Holy Quraan and sayings of the Prophet,
peace and blessings be upon him (PBUH). Islam is interested in women‟s life as RRs from
the moment they are born. It forbade the pre-Islamic practices of burying young girls alive
ensuring their right to live. God says in Quran “you should not kill your children for fear of
poverty“ (Sura 6:15). In addition Islam guarantees the right of life for the fetus forbidding
abortion and the killing of the fetus (WHO, 1997). Within the framework of Islamic
teachings, RRs imply that married couples are able to have a responsible, satisfying and
safe sexual life (Ragab, 1995). Islam also encourages sexual foreplay before intercourse,
moreover married couples are encouraged to wait for each other until they both have
satisfied their desire (Alkhayate, 1997). Allah says also in Quran: „no mother should
expose her own child to harm, nor should any father expose his child to harm (Sura 2:233).
Moreover, female genital mutilation was not recommended in Beijing (1995), as the
international community has identified the need of urgent action including violence, sexual
abuse, rape of women and children, HIV/AIDS, teenage pregnancy, harmful practices as
FGM, population overgrowth and poverty mortality and morbidity, beside exclusion of
women from educational, economical, and social opportunities (Cook and Plata, 1994). In
Egypt, the National Council for Women (NCW) was set up by the presidential decree No.
90 for the year 2000. The NCW aims at the promotion and empowerment of women in the
Egyptian society to play an active role in the social and economic growth, also will
organize awareness raising program about women‟s RRs. In Egypt, it is banned to employ
women in hard labor that would affect their health (Article No. 153). The working mother,
who spends 6 months in employment, has the right to take 50 days leave with full salary.
This right can be obtained 3 times in the course of her employment. Also it is prohibited to
employ the women before 40 days from delivery (Article No. 154). The working woman
has the right to have the breakup periods during work time to feed her baby without any
decrease in the salary. The Egyptian women and the female child agreements are enlisted
in the world agreements and national legislation. Women have the right to get benefit from
the medical insurance system according to the law of social insurance No. 79 for 1975.
This includes treatment and medical care, hospitalization, investigation and the necessary
3                                                                          Abou Shabana K

care for mothers during and after labor. Islam has accorded women a status, which they
never enjoyed at any time in human history; a status which is clearly established Islam.
The Egyptian marriage document states that the married couple should be free from illness
that requires separating them. The Egyptian personal affairs law determines the condition
of competency for marriage such as age, (16 years for female and 18 years for male in
addition the women consent on marriage and attending the marriage document herself or
assigning someone for her (EMD, 2000). The understanding of women perception may
illuminate our understanding of their health seeking behavioral, and is considered a mirror
to their practice toward their RRs (Younis et al., 1993). It was also concluded that women
perception toward their RRs depend on many factors as cognitive, culture, emotional,
social and political factors. Nurse play an important role by improving women perception
toward RRs, and enhancing their decision making in the area of sexuality and
reproduction, since RH has become a basic need and important factor to decrease maternal
mortality and morbidity (Freedman, 1993).

Operational definition: Perception is defined as the process of acquiring information
about the environment through the senses, and interpreting the sensory input in a
meaningful way (Khattab, 1996).

Justification of the study: The long neglect of women‟s RRs are now beginning to
receive attention as a result of tragically high rate of maternal mortality and morbidity in
developing countries, (El-adawy and Ragab, 1997) the Egyptian women has been
struggling for along time to gain their RRs as a citizen as well as a human (NCW, 2000).
Research plays an important role to increase the attention regarding to the issue of women
reproductive rights. Therefore this study was conducted to investigate women perception
and utilization of their RRs.

Aim of the study: To assess women‟s perception and practices regarding their RRs

Research Hypothesis: The majority of women have negative perception concerning
their RRs. There is a difference in the concept and utilization of RRs between women in
urban and rural area. Women‟s education affects their concept and utilization of their RRs.

Research Questions:
Q1) Are there differences between women in rural and urban areas as regard RR?
Q2) Will education of women affect their concept and utilization of their RR?

METHODOLOGY:
Setting: The study was conducted in the out patient clinic at Ain shams university
maternity hospital. It was involved Obstetric and gynecological clinics. It has covered the
period from 1-12 –1999 to 1-12 2000.The reason for choosing this setting is the high rate
of clients attending this clinics (10.000 women/year).
4                                                                            Abou Shabana K

Design: Descriptive cross-sectional study.
Sampling: One thousand women were selected randomly from all women attending the out
patient clinics of Ain-shams university maternity hospital, in the aforementioned clinics.

Sampling criteria: Women the in reproductive age, with different educational levels
and occupations were included in the sample.

Tools: A structured interviewing questionnaire was constructed based on the review of
the pertinent literature. It has been used to collect the necessary data from the sample. It
was composed of three parts and covered 50 questions.
The first part covered the general characteristics of the sample these have included
demographic data such as age, educational levels, occupation, religion and residence. The
second part was concerned with the women‟s concept and practices regarding their (RAS),
which included questions about the following RRs: to marry and found a family, the right
of sexual health and family planning services, prevention and treatment of sexual
transmitted diseases and cancer, infertility treatment, safe abortion, prohibition of all form
of discrimination against women‟s as FGM, adolescent needs for nutrition and education
and health care during perinatal period. The questionnaire included open-ended and close-
ended and multiple choice questions, to which the women responded by marking their
correct or incorrect answers regarding their knowledge about their RRs. While evaluation
of questions related to women's perception was considered as follows: “agree” as a positive
perception, “disagree" as a positive perception while "don‟t know" as an indifferent
perception. Assessment of women‟s practices concerning their RR were conducting using
'yes‟ for practice, and “no” for not practicing.

Data collection: the study setting was visited from 9:00 am to 1:30 pm, 3 times per week.
Each interview was completed within 20-25 minutes. The sample was chosen by the
sequence of their names from the clinic registration book and were selected randomly,
where the first ten women admitted to the clinic were interviewed daily. First, the aim of
the study was explained to the women and their consent to participate in the study was
obtained.

Pilot study: This was conducted on 100 women to test the content validity of the used
tool. This group of women was excluded from the study sample. According to the data
obtained from the pilot study, modification of the questionnaire was done, as the number of
question were decreased from 60 to 50 questions, a few words and questions were
simplified and the time was reduced from 30 minutes to 20 minutes.

Limitation of the study: During data collection 50 women refused to be interviewed
because they left their children at home.

RESULTS
The findings of the present study revealed that 32% of women aged from 25-30 years,
while those aged >30 years were 51%, and 17% of women aged 20-24 years. Moreover the
majority of women were from urban area, compared to few 9% from rural area. Illiterate
5                                                                            Abou Shabana K

women constituted 18%, those with primary education constituted 14%, while 30% had
secondary school education, in addition to one third who had university education. It was
observed from Table (1) that the majority of women had positive perception toward the
following RRs: Marry and found a family; Use of family planning; Prevention and
treatment of sexual diseases and cancer; treatment of infertility; Health care during
perinatal period and the right of adolescents to education and nutrition. One third had a
negative perception toward prohibition of all forms of discrimination against females as
FGM, in addition to 81% women who had positive perception toward sexual health as a
RR, while few had indifferent and negative perception toward their RRs. Table (2) reflects
the relation between women‟s concept concerning the right to marry and their demographic
characteristics. It was noticed that 45% illiterate women had incorrect concept regarding
their right to choose a husband compared to 21% with primary education and 24% with
secondary school education, but this percent dropped to 10% among university educated
women. The majority of women in urban area compared to few from rural area had the
correct concept regarding their right to choose a husband, while the suitable age for
marriage was 16 years as reported by 28.6% illiterate women, 32.5% with secondary
school and 18% of women with university education, in addition to 85% from urban area
compared to 15% women from rural area, while few illiterate women compared to 60.6%
university educated women chose the age of 25 years as a suitable time to get married. The
right of the woman to choose a husband by herself was reported by 10.8% of illiterate
women and 40.4% of university educated women, meanwhile the majority of females in
urban areas compared to few in rural areas chose their husband by themselves. The
difference observed was statistically significant (p<0.01). Table (3) shows that 76% of
women who aged 30 to<35 years had correct concept concerning the right to discuss sexual
heath, while this percent turned to be less than 61.9% in the 20-<25 years age group.
Concerning the right to choose the time of practicing sex, 79.3% women aged 30-<35y had
correct concept, in addition to 88.7% of women in the age group of 25-<30 years. The
same table reflects a significant difference (p<0.001) between the relation of women
concept about sexuality in urban and rural areas. As far as the education is concerned, there
was a statistically significant difference (p<0.001) regarding this issues and women‟s
educational levels. At the university level, 85.2% of females had a correct concept of the
right to discuss sexual life. This percent dropped to 54.4% at the primary level, compared
to 55% illiterate females. It was noticed that 88.9% at the university level while 71.7% of
illiterate women had a correct concept concerning their right to choose the timing to
practice sex. Table (4) shows that 76.6% of women utilized family planning services.
However, no statistically significant difference was observed between women's concept of
family planning as a RR and their utilization of this services. Table (5) reflects the relation
between women‟s awareness and practices regarding screening techniques and educational
levels, at university level 41.3% of women were aware about STDs and visited doctor for
treatment, while 38% were aware but did not visited doctor, while those women with no
history of STDs were doubled among university educated than illiterate females. Few
illiterate women compared to more than one third university educated female were aware
and perform cervical smear, while half of the university educated women were aware of
cervical smear but did not practice, in addition to 32% of illiterate women are not aware of
it. Regarding self breast examination, less than half of university educated women had
awareness and practice compared to few illiterate females. A statistically significant
6                                                                             Abou Shabana K

association was detected between women concept about FGM and their educational levels
(p<0.001) is presented in Table (6). In addition to 44.3% university educated women
compared to 10.0% illiterate female their grandmothers were the decision makers for
practicing FGM to them. Moreover, 21% illiterate women, 17% with primary education
and 25.5% with secondary school education compared to 35.7% university educated
female mentioned that the decision for FGM was taken by the wife and husband. Among
the sample studied, 92.2% of women were circumcised and 14.4% self reported sexual
problems as a complication for FGM. There was a statistically significant association
between women‟s place of residence and their practices of FGM (p<0.001). However,
63.3% of urban women intended not to practice FGM in the future, compared to 40%
women from rural communities. When reasons to eliminate FGM were assessed, 50.9%
women cited for heath protection, 6.6% stated that it was against the law, while 42.2%
approved to eliminate this process because it reduces sexual desire. On the other hand the
main reason to practice FGM as reported by 66% women because it was considered as a
tradition and habits, while 13% approved it for religion reason.

Table (7) shows a statistically significant association between women‟s concept and
practice toward their rights for health care during perinatal period and their educational
levels (P<0.001), only 17.6% illiterate women compared to 37% university educated
women had correct concept of antenatal care, on the other hand less than half among
university educated women had regular antenatal visit compared to 16 % illiterate women,
while 30.6% female with secondary education, and 26 % illiterate women never practice
antenatal care. The same table revealed that all the university educated women compared
to 17% illiterate female had correct concept regarding health care during delivery, and a
very similar figures were observed in relation to women acceptance of hospital deliveries.

Table (8) shows a statistically significant relation (p<0.001) was found between education
and women concept of healthy food, but no statistically significant association could be
detected between women‟s concept about adolescent education as a reproductive right and
their educational levels.
Table (1): Number and Percentage Distribution of Women's Perception Regarding their Reproductive
Rights (n=1000)
Women’s Rights to:                                 Positive Indifferent         Negative
                                                  No      %  No     %          No     %
Marry and found a family                          942 94.2    8    0.8          50   5.0
Sexual health                                     810 81.0 90      9.0         100 10.0
Use of family planning methods                    900 90.0 64      6.4          36   3.6
Prevention and treatment of STD and cancer        900 90.0 18      1.8          82   8.2
Treatment of infertility                          980 98.0 20      2.0           0   0.0
Safe abortion                                     800 80.0 92      9.2         108 10.8
Prohibition of all forms of discrimination        630 63.0 70      7.0         300 30.0
against women as FGM
Adolescents needs about nutrition/education 978 97.8 22     2.2     0   0.0
Health care during perinatal period         974 97.4 26     2.6     0   0.0
 Table (2): Relation Between Women’ Concepts and Practice Related to Marry and
Found a Family and their Demographic Characteristics
    7                                                                                            Abou Shabana K

                 Right to                          Education                                Residence
                              Illiterate      Primary    Secondary     University      Urban          Rural
                               n=184           n=136       n=302        n=378          n=910          n=90
                              No      %      No     %    No    %       No     %       No     %    No       %
Choose Husband:
Correct                       158    85.9 124       91.2   288   95.4 372    98.4    872      95.8   70       77.8
Incorrect                      26    14.1 12        8.8     14   4.6    6    1.6      38      4.2    20       22.2
           Statistical test          2 = 38.67                   P < 0.01             2 = 49.2          P< 0.01
Suitable age for
marriage
             16-y             118    64.1 86        63.2   134   44.4 74     19.6    350 38.5        62       68.9
             21-y              60    32.6 44        32.4   154   51.0 264    69.8    494 54.3        28       31.1
             25+y              6     3.3    6       4.4    14    4.6   40    10.6     66    7.3       0       0.0
Statistical test                      2= 144.5                   P < 0.01             2 = 33.3          P< 0.01
Who chose husband:
Parents                       78     42.4 50        36.8    72   23.8 76     20.1    228      25.1   48       53.3
Relatives/Friends             62     33.7 30        22.1    88   29.1 138    36.5    306      33.6   12       13.3
Herself                       44     23.9 56        41.2   142   47.0 164    43.4    376      41.3   30       33.3
           Statistical test          2= 51.955                   P < 0.01             2 = 35.6          P< 0.01



    Table (3): Relation between Women‟ Concepts about their Right to Sexual Health and
    Demographic Characteristics

                 Demographic              Right to Discuss                Right to Choose              Total
                Characteristics              Sexual life                   Timing of act
                                      Correct          Incorrect       Correct       Incorrect
                                       n=680             n=320         n=814          n=186           n=1000
                                     No      %       No        %      No     %      No      %           No
    Age (years):
              20-                   104     61.9     64      38.1    126      75.0   42       25.0        168
              25-                   214     67.3     104     32.7    282      88.7   36       11.3        318
              30-                   214     76.4     66      23.6    222      79.3   58       20.7        280
              35-                   148     63.2     86      36.8    184      78.6   50       21.4        234
    Statistical test                  2 = 14.5         P < 0.01       2 = 17.7          P< 0.01
    Residence
              Urban                 628      69.1    282     30.9    752      82.6   158 17.4             910
              Rural                  52      57.8    38      42.2     62      68.9    28    31.1           90
    Statistical test                    2 = 4.7        P < 0.05       2 = 10.2        P< 0.01
    Education
              Illiterate            102      55.4    82      44.6    132      71.7   52       28.3        184
              Primary                74      54.4    62      45.6    114      83.8   22       16.2        136
              Secondary             182      60.3    120     39.7    232      76.8   70       23.2        302
              University            322      85.2    56      14.8    336      88.9   42       11.1        378
    Statistical test                   2 = 84.5        P < 0.01       2 = 30.1          P< 0.01
    8                                                                                  Abou Shabana K

    Table (4): Relation between Women‟ Concepts about their Right in Family Planning and
    Utilization of Services.
    Women‟ concept in relation to:                    Services                Total
                                                 Used        Not used
                                               n=762           n=238         n=1000
                                             No       %     No       %         No
    Use family planning methods:
                  Correct                   738 96.9 226 95.0                  964
                  Incorrect                  24      3.1     12      5.0        36
    Statistical test                           = 1.87
                                                2
                                                              P = 0.17
    Access to family planning service:
                  Don‟t know                 66      8.7    98      41.2       164
                  Easy                      634 83.2 130 54.6                  764
                  Not easy                   62      8.1    10       4.2        72
    Statistical test                          = 140.2
                                              2
                                                              P < 0.01

    Table (5): Relation between Women‟ Awareness and Practice Regarding Screening of
    STD and malignancy According to Educational Level.
Awareness and practice             Illiterate        Primary     Secondary        University    Total
regarding:
                                    n=184             n=136         n=302            n=378      n=1000
                                  No.     %        No.      %    No.      %       No.      %      No.
STDs         Yes/visited doctor   44    15.9        38    13.8    80    29.0      114    41.3     276
             Yes/didn‟t visit     72    25.7        34    12.1    68    24.3      106    37.9     280
             No history           68    15.3        64    14.4   154    347       158    35.6     444
         Statistical test                   2 = 19.8                      P < 0.01
Cervical     Yes/did it           12      12.8      10    10.6    40    42.6       32    34.0     94
smear
             Yes / didn‟t do      42      12.2      38    11.0    90    26.2     174     50.6    344
             Not aware            130     23.1      88    15.7   172    30.6     172     30.6    562
         Statistical test                   2 = 49.18                    P < 0.01
Breast       Yes/did it           12       5.3      18     8.0   84     37.2     112     49.6    226
self-
exam
             Yes / didn‟t do       22      9.8      28    12.5    62    27.7     112     50.0    224
             Not aware            150     27.3      90    16.4   156    28.4     154     28.0    550
         Statistical test                   2 = 97.88                    P < 0.01
     9                                                                                                Abou Shabana K

     Table (6): Relation between Women‟ Concept and Decision-Making Regarding Female
     Genital Mutilation and their Educational level.
 Women‟ Concept                     Illiterate           Primary           Secondary         University       Total
 About:
                                   n=184                  n=136              n=302            N=378           n=1000
                                 No.    %               No.    %           No.    %          No.   %            No.
 Female circumcision
   Correct                       148       80.4    104          76.5       194     64.2    218       57.7      664
   Incorrect                      36       19.6     32          23.5       108     35.8    160       43.3      336
   Statistical test                           = 79.8
                                              2
                                                                                    P < 0.01
 Who takes the decision
 for circumcision?
 Husband                         40        21.7      26         14.1        54     29.3     64       34.8      184
 Wife                            88        18.3      44         9.2        166     34.6    182       37.9      480
 Grand mother                    14        10.0      32         22.9        32     22.9     62       44.3      140
 Husband and wife                42        21.4      34         17.3        50     25.5     70       35.7      196
   Statistical test                           2 = 34.5                             P < 0.01


     Table 7: Relation and Practice of their Rights for Health Care During Perinatal Period
     According to their Education Level.

Women‟s concept about:                  Illiterate        Primary           Secondary          University        Total
                                        N=184             n=136             n=302              n=378             n=1000
                                        No       %        No    %           No     %           No      %         No
Ante-natal care practice
           Always regularly              76       41.3     34      25.0      136      45.0      228   60.3           474
           Irregular follow-up           32       17.4     30      22.1       78      25.8      98    25.9           238
           Never                         76       41.3     72      52.9       88      29.1      52    13.8           288
           Statistical test                         2= 101.3                                  P<0.01
Health care during delivery
           Yes                          166      90.2     136      100.0    294      97.4      387    100.0      974
           No                           18       9.8      0        0.0      8        2.6       0      0.0        26
           Statistical test                          2= 51.2                                  P<0.01
Health care during
           Yes                          160      87.0     122      89.7     288      95.4      358    94.7       928
           No                           24       13.0     14       10.3     14       4.6       20     5.3        72
           Statistical test                           = 16.4
                                                      2
                                                                                               P<0.01




     Table (8): Relation between Women‟s concept of the Right of Adolescence for Health
     Food and Education According to their Education Level.
Women‟s concept about:                  Illiterate        Primary           Secondary          University        Total
                                        n=184             n=136             n=302              n=378             n=1000
                                        No       %        No    %           No     %           No      %         No
Influence of food on Reproductive
health
           Correct                      184      100.0    134      98.5     294      97.4      372     98.4      984
     10                                                                            Abou Shabana
     K
          Incorrect              0     0          2    1.5     8     2.6    6      1.6     16
          Statistical                      2=   5.1                        P<0.16
Adolescence education as a
Reproductive right
          Correct                182   98.9     136    100.0   300   99.3   378    100.0   996
          Incorrect              2     1.1      0      0.0     2     0.7    0      0       4
          Statistical                      2= 4.76                         P=0.19




     DISCUSSION
              Long neglecting to women‟s RRs has serious impact on female health as increased
     maternal mortality and morbidity. Moreover, women's RRs constitute an issue that
     concerns every woman, man and every generation. Therefore, the awareness of women
     about their RRs should be promoted and improved through access to accurate information
     (WHO, 1998). This study was carried out in order to test the hypothesis that the majority of
     women has negative perception about their RRs, also there is difference in the concept and
     utilization between women urban and rural areas in addition to women‟s education affect
     their concept and utilization of their RRs. It was surprising to find the majority of women
     in the present study had a positive perception concerning their RRs, although few
     respondents had indifferent and negative perception regarding sexual health and safe
     abortion as a RRs. This disagrees with that of El-Zanaty (1999), who found that the
     meaning of safe abortion was still not clear to the majority of Egyptian women because it
     is forbidden by our religions and wrong to be done. A very important finding of the present
     study was the significant relation between women‟s demographic characteristics and their
     rights to marry and choose a husband. It was noticed that the increase in women‟s
     educational levels was positively correlated to the decision to choose their husband. This
     was pointed out by Qayed (1998), who found a significant relation between women‟s
     educational levels and their rights to choose a husband. In Islam men and women are
     advised to choose their marriage partners on sound basis, the Prophet says “Make a wise
     selection of your sperm" (Alkhayate, 1997). It was also observed in the present study that
     the majority of women in urban areas had the right to choose their husband by themselves,
     but in rural area the parent had the right to choose their daughter‟s husband. This agrees
     with the study of El-Zanaty (1999), who reported that the majority of women in urban
     areas have the right to choose their husbands, but in rural areas the parents took the
     marriage decision for their daughters. The present study revealed a statistically significant
     association between women‟s demographic characteristics and their concept of female
     right to sexual health, it was observed that most of university educated women had correct
     concept regarding this issue compared to more than half of the illiterate female. This
     finding disagrees with those of Sadik (1998), who reported that discussing sexual life is
     often difficult in our country, and the majority of women were ashamed to discuss any
     topics related to this issues. It was found in the present study that more than two third from
     urban area compared to about half from rural area reported that they had the right to
     discuss their sexual issues, whereas to practice sexuality in suitable timing was considered
     as a RR by the most of the educated women compared to more than one third of the
     illiterate women. Islam which is the religion of the majority, is a fundamental part of
     culture that helps the lives of individuals. All forms of sexuality are openly discussed in
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Quraan and in the Hadith, such husband wife relation, intercourse, menstruation,
homosexuality, and sex. Islam's positive and relaxed attitude regarding sexuality will
enable us to approach education in this field through religious teaching It was known that
both men and women consulted the prophet on sexual matters, since it was essential for
them to be sure that they are following the precepts laid down (Khattab, 1996). Several
saying of the Prophet Mohamed Hadith indicate clearly that Islam acknowledges the right
of both men and women for sexual fulfillment. The Prophet says „Let no one of you fall
like a camel over his wife'. In Islam, sexuality is legitimized only within the marriage
framework. Islamic teaching can provide the context within which education about
sexuality can be approached in our culture. Regarding women‟s RRs in family planning, it
was noticed in the present study that most had correct concept and it was easy for them to
get this services. This may be due to the mass media that has a positive effect on women
awareness regarding family planning. Major part of the sample in the present study had
incorrect concept about treatment of STDs. Women in rural Egypt are silent endure
reproductive morbidity without complaining of its symptoms, they give a low priority to
their own health in comparison to those of their husband and children (Khattab, 1996).
This is probably due to economic factors or lack of information (Oueda, 1999). In the
current study, there was a statistically significant relation between awareness and practices
of screening techniques and women educational levels. Regarding women‟s RR of
prohibition of all forms of discrimination against, such as FGM, the result of the present
study pointed out that the majority of the sample had been circumcised. However, more
than two third of women in urban areas refused to circumcise their daughters in the future,
in addition to 63% among the sample had a positive perception about the prevention of
FGM, about one-fifth of the women approved it for the protection of girls from sin, and
lesser percentage due to religion. This agrees with Khattab (1996), who reported that the
main reasons for FGM were Islamic sunna, tradition, and social habits. The present study
concluded that the university educated women their grand mother was the decision-maker
for FGM in the family among 44% female, while the wife and the husband shared the
decision-maker for performing FGM in more than one third of the sample. In the current
study, there was a statistically significant relationship between women‟s educational level
and their concept about the right of adolescent nutrition and education. This may be due to
lack of information about adolescent health and educational needs. God says in the Quraan
“Eat of the good, which we have provided for you“ (Sura 2:173) (Alkhyate, 1997), also
God commands us not to have overeat or be wasteful. The current study pointed out that
less than half of the university educated women compared to few illiterate female had a
correct concept about their right to practices regular antenatal care, in addition to 38%
delivered at hospital. This may be due the fact that illiterate women trust in Days and feel
more secure and comfort with them. Informing women about religious doctrine (in Fikh
El-Islam), regarding reproductive health informing female of their rights and not only their
duties in sexuality within marriage may empower them to seek help, and to stand up for
their rights to respectful protection of their reproductive rights (Khattab, 1996). So,
improving women status and enhancing their decision making in the area of sexuality and
reproductive health is essential for the long term success of population programs. This will
occur by elimination of all forms of discrimination against women to enable them to
exercise their right for sexual and reproductive health and to promote their equal
representation at all levels of political and public life (ICPD, 1994). Further research
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should be encouraged to investigate men perception concerning women's RRs. Encourage
of men role for active participation as equal partners in reproductive health to empower
women toward their RRs.

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