Romance , sex and coercion : insights into undergraduate relationships

Background Understanding youth sexuality involves more than describing their sexual behaviour. Aims To describe the influence of gender roles in intimate relationships among undergraduates and to describe the attitudes of female undergraduates on sexual relationships. Methods Information was obtained from unmarried female undergraduates (n=283) in the faculties of Arts, Science and Law in a Sri Lankan university through qualitative inquiries and selfadministered questionnaires. Results In the sample studied, 52% were engaged in romantic relationships. On inquiring whether they knew of instances where girls were forced to commence a romantic relationship, 36% responded positively while 73% knew of instances where girls were forced to continue relationships. A fear of being physically harassed by males and a fear of social unacceptability if the relationship was discontinued were the most cited reasons for being coerced into commencing or contituing a relationship. Sexual relationships within romantic relationships were known to 81% of students. Verbal abuse in romantic relationships was known to 57% of students while 23% were aware of physical violence in such relationships. Furthermore, 64% reported knowing females who unwillingly agreed to sexual relationships due to the fear of losing the relationship and 21% knew of instances where violence was used by male partners to coerce females in to sexual activities. On exploring attitudes it was shown that females did not accept the use of violence by males within romantic or sexual relationships. Female undergraduates did not accept premarital sex and were unsure of the responsibilities of males in this practice. Conclusions Male dominance within relationships resulting in coercion seems to be common in undergraduate relationships though such behaviour was unacceptable to females. Continuation of such behaviour might endanger the establishment of healthy sexual attitudes and practices in both genders.


Introduction
Sexuality is defined as how people experience the erotic and express themselves as sexual beings (1).Sexual health is the integration of the somatic, emotional, intellectual and social aspects of sexual being, in ways that are positively enriching and enhancing personality and communication.Three basic elements of sexual health include firstly, the capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic, secondly, the freedom from fear, shame, guilt, false beliefs and other psychological factors inhibiting sexual responses and impairing sexual relationships and thirdly freedom from organic disorder, disease and deficiencies that interfere with sexual and reproductive function (2).In more operationalised terms, sexual health represent 'healthy sexuality' which incorporates a sense of volition in sexual relations and control over one's body (3).
There is evidence that youth are more "sexually liberated" all over the world due to certain global influences.Economic development and expansion of education promotes autonomy and a decline in parental authority over youth.Increasing availability of both electronic and print media which portrays 'irresponsible' sexual behavioural patterns among youth can be assumed to give rise to a cultural transformation that makes sexual activity more appealing and acceptable.Access to such media promotes messages of liberation and deviation from traditional ways of life among youth.These messages encourage sexual freedom without emphasising the importance of responsibility in such behaviour.
The International Conference on Population and Development in 1994 highlighted the importance of promoting responsible and healthy reproductive and sexual practices, voluntary abstinence and the provision of services and appropriate counselling specifically suitable for youth (4).
Persons between 10-24 years are defined as young people while youth are defined as those between 15-24 years of age (2).During this age period, young people become independent, mature psychologically and develop their own identities.Many aspire to escape from an environment controlled by parents to another that allows more freedom and the company of peers.The physical and psychological dynamism associated with this age makes them vulnerable to irresponsible behaviour.This period includes the entry into the reproductive phase of the life cycle.Important steps in the reproduction related transitional process such as puberty, initiation to sexuality, engaging in romantic relationships, marriage and child bearing are also critical life events.The timing, as well as sequence and context in which these events take place have immediate and long term repercussions on an individual's sexual and reproductive health.It has been shown that behaviour patterns young people acquire during this period are carried through their lifetime (5).Undesirable sexuality related behaviour may have a life long influence on the young person and also the marital partner.
Studies conducted in South East Asian countries have shown that premarital sex is common among youth and mostly occur between partners of romantic relationships (6,7).It has also been noted that sexual relations that occur within romantic relationships are not always consensual.Force and coercion by males are common.Furthermore, in Asian cultures, short term and long term negative consequences of premarital sexual behaviour, both physical and emotional, have been found to be more in women.Gender inequality and the imbalance of power have been cited as playing a crucial part in coercive and abusive sexual behaviour within romantic relationships between males and females (7).Attitudes of young people on gender roles are cited as a powerful mediator of their expressions of sexuality and to be an underlying determinant of sexual behaviour (8).Therefore, describing attitudes on gender roles would help in understanding sexuality issues among youth.
Research on youth sexuality in Sri Lanka has mainly focused on knowledge of reproductive health issues and sexual behaviour.Few studies have inquired into the attitudes related to acceptance of premarital sex.Studies that have inquired into details of romantic relationships are scarce.None of these studies had inquired into force or coercion associated with romantic relationships or sexual relationships.
A study in 1999 among 1738 secondary school students in Sri Lanka documented that knowledge on the concept of virginity and attitudes towards virginity indicated mixed results (9).
Another study in 1998 found that there was considerable disagreement in the attitudes of males and females regarding the appropriateness of premarital sex.This study was conducted among 303 youths from an urban low income community in Sri Lanka and 312 students from a leading university in Sri Lanka.Less than 10% of the sample reported penetrative sex.Approximately one third of the sample (36%) agreed that a "man should have sexual experiences before marriage" (10).
An attitudinal survey conducted by the Family Planning Association of Sri Lanka in 1996, among a group of 2524 unmarried persons aged 16-29 years, assessed whether they approved of pre-marital sex.Nearly 10% of the sample approved of premarital sex even if the couple was not engaged in a romantic relationship.Approximately one third (37%) of males and 9% of females approved of pre marital sex if the couple were engaged in a romantic relationship (11).
A national study on adolescent sexual and reproductive health was conducted in 2008 among 4004 young persons aged between 10-24 years from nine selected districts in Sri Lanka.Among adolescents in the 10-14 year age group, 4.3% stated that they were currently in a romantic relationship.This rose to 20.5% in the 15-17 age group and 42.9% in the 18-24 age group.This survey did not focus on exploring influence of gender roles on romantic relationships.Attitudes on females remaining a virgin until marriage were inquired into.More than half (53%) of unmarried males and about two-thirds (65%) of unmarried females in the 18-24 year old age group, wanted the female to remain a virgin until marriage.The authors concluded that the concept of remaining a virgin until marriage remains very strong in Sri Lanka and more females than males believed that they should be virgins until marriage (12).
The present study aims to describe the influence of gender roles on romantic relationships among undergraduates and the attitudes of female undergraduates with regard to sexual relationships.This would also redress to some extent the dearth of evidence regarding the influence of gender roles on interactions among partners in romantic relationships in Sri Lanka.

Methods
The study was conducted among unmarried female undergraduates of the faculties of Arts, Science and Law in a leading university in Sri Lanka.
Initially, a qualitative survey using focus group discussions (FGD) was conducted in each faculty with the participation of six to eight female students in each group.The objective of these FGDs was to obtain an insight into issues related to romantic relationships among undergraduates and to describe the range of attitudes of students on premarital sexual relationships.The focus groups were moderated by a trained senior female medical student.The qualitative survey was followed by a quantitative survey.The study included 283 female students, calculated to be approximately 10% of female students registered in the three faculties at the time of the study.The study attempted to include equal numbers from each faculty and junior and senior students.The study instrument used was a structured pre-tested self administered questionnaire, which was prepared in all three languages.Personal experiences of romantic relationships and sexual relationships, knowledge of occurrence of coercion/ violence related to romantic relationships and sexual relationships and related issues among peer undergraduates were inquired into, using the self administered questionnaire.The FGDs provided information on attitudes of undergraduates on different aspects of premarital sex and coercion/ violence within romantic relationships.Based on this information attitudinal statements were carefully designed and were included in the self administered questionnaire in the quantitative survey.These were presented in a five point Likert scale which measured the agreement to the statements with an option of being neutral.In the analysis, responses were converted to a score with a range of one to five (1: strong agreement to the statement and 5: strong disagreement to the statement); the results are presented as mean scores.Questionnaires were administered in a class room setting with permission of the staff.Informed verbal consent was obtained from the students and the selected female students were seated in a room apart from each other to ensure confidentiality.The academic and non-academic staff was not present in the vicinity.An explanation of the purpose of the study and details relating to maintaining confidentiality was provided by a medical undergraduate.
Ethical clearance for the study was obtained from the Ethical Review Committee of Faculty of Medicine, University of Colombo.

Results
A little more than half of the total sample (161, 56.9%) was 'junior' students.Junior students constituted a significant majority (69.6%) of the sample from the Faculty of Arts (Table 1).
A vast majority of students, 83.7%, (237) were Sinhalese while 10.2% (29) and 6.1% (17) of students were Tamil and Moor respectively.The mean age of the respondents was 22.34 (SD +1.98) years.The modal age was 21 years.The age pattern was similar across faculties.A proportion of 69.7% of students (197) from the Faculty of Arts, 32.3% (91) from the Faculty of Science and 12.9 % (37) from the Faculty of Law reported that their home town is either a rural area or a village.
On inquiring into current romantic relationships, 52.3% (148) responded positively.Of the students who were engaged in romantic relationships, a majority (108, 72.9%) had a boyfriend who was also an undergraduate studying in the same university.
During focus group discussions (FGDs) that were conducted among both junior and senior students, it was revealed that students had 'concerns' regarding romantic relationships among undergraduates.Many agreed that initiation and continuation of romantic relationships among undergraduates are not always 'natural' or 'voluntary' as it should happen but is at times 'forced' upon female students.They expressed their concerns about students being under such coercion.
In the self administered questionnaire we inquired from the respondents whether they were aware of instances in which romantic relationships were initiated against the will of the female and 36% (102) responded positively.The common reasons for initiating the romantic relationship against their will were fear of being harassed (167, 59%) and the influences of peers forcing them to agree to the relationship (103, 36.3%).
Having to continue romantic relationships against their will was also inquired into and 55.5% (157) of respondents stated that they were aware of instances where female students were forced to continue romantic relationships against their will.The probable reasons given were the fear of being physically Regarding inquiries into coercion/ violence related to sexual relationships, 64% reported knowing females who unwillingly agreed to sexual relationships due to fear of losing the relationship.A total of 59 (21%) reported that they knew of instances where abusive behaviour was used by male partner to compel their partners into sexual activities.Of them, 34 (57.3%)knew of instances of verbal abuse while 14 (23.7%) reported that they knew of instances of physical violence forcing female partners into sexual relationships.
On exploring attitudes in FGDs, it was found that females did not accept the use of violence by males within romantic or sexual relationships.The questionnaire also inquired into attitudes related to this and the average scores for responses based on the Likert scale is presented in Table 3.Female students of all faculties strongly rejected the use of violence by males within romantic or sexual relationships, for any reason with average scores of over 4.

Discussion
In a population of 1.7 million (11%) of Sri Lankan of young persons (19-24 age group), approximately 50,000 are following undergraduate courses in state universities in a given year (13).This study was conducted among a sample of female undergraduates in a leading university in Sri Lanka.
The attitudes of Sri Lankan undergraduates on gender roles, sexuality or sexual practices have not been studied extensively.Females were selected for the study as the available literature indicated that female partners face more negative influences of gender related double standards and imbalances of power within romantic relationships.This results in females becoming victims of coercive and abusive sexual behaviour.Young females from many parts of the country representing all the ethnic, religious and social groups of Sri Lanka follow degree courses in the university where the study was conducted.They would in the near future hold positions such as educators, administrators and policy makers in the country.Studying their attitudes on gender roles, sexuality and sexual practices and initiating action to improve them would have a greater effect on society.Programmes to develop positive attitudes on gender roles and sexuality and thereby promote healthy sexual practices among undergraduates are feasible through the existing system of tertiary education.
This study utilised a triangulation of qualitative and quantitative data collection techniques to collect information, which was necessary considering the sensitive nature of the subject surveyed.In addition to the students' own experiences regarding force/ coercion within romantic relationships and premarital sexual practices, their awareness on peer experiences of these events were also inquired into.A similar strategy of direct and indirect questioning was used in the national survey on adolescent sexual and reproductive health (13).
The proportion of female undergraduates who were engaged in romantic relationships was higher than the proportions of youth of all age groups engaged in romantic relationships as found in the national survey (13).The study results, describing their own experience and the awareness of peer experiences, indicated that considerable proportions of physical violence and verbal abuse in relation to initiation of romantic relationships and maintaining of such relationships occurred among undergraduate couples.Occurrence of physical violence and verbal abuse within romantic relationships was similar across faculties and among junior and senior undergraduates.A great majority (72.9%) of the partners of the females who were committing these abusive acts were males studying in the same university.The initiation of romantic relationships and engaging in sexual activity are considered as critical sexuality related events in the lives of young adults.The reported unfavourable contexts in which these events occur for the female undergraduates suggest that they are prone to immediate and long term repercussions related to their sexual and reproductive health.Furthermore, as indicated in the literature, the undesirable violent behaviour of their male undergraduate partners is likely to be carried through their lifetime (5).
The attitude of female undergraduates was clearly biased towards the non-acceptance of premarital sex.This is in keeping with findings of the previous studies (11).
However, in the present study, the non-acceptance of premarital sex was found to be less strong when there is consensus among partners, delayed marriage and nonpenetrative sex.Though only 21.2% admitted to engaging in sexual activities, a very high proportion, 81.2% reported awareness regarding sexual activities within romantic relationships.Though these figures are not directly comparative it is indicative that a high proportion of unmarried undergraduate couples engage in sexual activities.
The fact that a high proportion (64%) reported that they knew of peers who agreed to sexual relationships unwillingly explains the discrepancy between the results on attitudes rejecting pre-marital sex and the occurrence of sexual activities among partners of romantic relationships.The use of force/ coercion by means of physical violence and verbal abuse by male partners to persuade females into sexual activities was found to be considerably high in the study group.
The attitudes of female undergraduates indicate that they very strongly rejected the use of violence by males within romantic or sexual relationships, under any circumstances.Having to agree to premarital sexual activity unwillingly or due to physical or verbal abuse indicates that some female undergraduates are in an extremely vulnerable position.
In conclusion, the study found an undesirable male dominance within romantic relationships and within sexual relationships among undergraduates which clearly points to an unhealthy orientation to sexuality in both female and male partners.Gender-related double standards and imbalances of power appear to play a crucial role in coercive and abusive sexual behaviour within romantic relationships.The undesirable short term repercussions on sexual and reproductive health among female undergraduates as a result of this behaviour were evident.
Programmes to promote male responsibility and mutual respect in romantic relationships are suggested for university undergraduates.Female undergraduates should be empowered through life skill enhancement programmes to cope better with situations of coercion.

Table 1 -
Distribution of students by Faculty and seniority

Table 2 -
Mean score (SD) on attitudes of female students of the three Faculties on premarital sexual practices

Table 3 -
Mean score (SD) on attitudes of female students of the three Faculties on use of coercion or violence by males within romantic or sexual relationships Nalika Gunawardena, Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Manuj Weerasinghe, Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka Lalini Rajapaksa, Consultant Community Physician Pabasi Wijesekara, Medical Officer, Ministry of Health, Sri Lanka P.W.P. Chathurangana,Medical Officer, Ministry of Health, Sri Lanka Corresponding author Nalika Gunawardena, Department of Community Medicine, Faculty of Medicine, Colombo 08, Sri Lanka E mail: nalikaguna@hotmail.com