Reproductive health is a serious concern not only for adults but also for male and female adolescent...

1. Adolescent male reproductive health: awareness and
behavior among peri-urban and rural boys in West Bengal,
India.
Reproductive health is a serious concern not only for adults but also for male and female
adolescents. The present study looks at the similarities and differences in reproductive health
awareness and behavior among adolescent males living in peri-urban and rural areas of the State of
West Bengal, India. Questionnaire data was collected from 111 school-age adolescent boys (55 peri-urban
and 56 rural) between the ages of 15 and 18. Results show that the level of awareness about
some aspects of reproductive health seems greater among peri-urban boys than their rural
counterparts. However, in terms of reproductive health behaviors both groups appear similar.
Keywords: adolescent males, reproductive health, reproductive behaviors, West Bengal, India, peri-urban,
rural
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The World Health Organization (WHO) refers to "adolescence" the period between 10-19 years.
According to the Program for Appropriate Technology for Health (PATH) (2004), the world's
adolescent population has exceeded the 1 billion mark, 85% of which live in developing countries
(United Nations [UN], 1999; WHO, 1999); while some 700 million adolescents live in Asia (UN,
2000). In India, for example, adolescents make up about 22% of the population (IIPS & Macro, 2000;
UN, 2001); while projections estimate that 15-19 year olds will make up 22.4% of the total national
population by 2006 (Central Statistical Organisation [CSO], 1998).
Adolescence is a period of marked development regarding reproductive biology, and yet adolescents
often lack knowledge of reproductive health issues. Adolescents' lack of knowledge concerning
reproduction can be attributed to social and cultural barriers and their hesitancy to access family
planning and reproductive health services compared to adults (Kilbourne-Brook, 1998). Consquently,
adolescents may be at an increased risk of sexually transmitted diseases (STDs) including HIV,
unintended pregnancy, and other consequences that can affect their futures as well as the future of
their communities. Thus the reproductive and sexual health needs of adolescents are different from
those of adults and are still poorly understood in most of the world. It is also true that the
reproductive health needs and sexual behavior of adolescents vary with sex, marital status, class,
region and cultural context (WHO, 2003; Pacahuri & Santhya, 2002).
Adolescent Males
At the meeting of International Council for Population Development (ICPD) held in Cairo in 1994
(UN, 1995a) and at the Fourth UN Conference on Women held in Beijing in 1995 (UN, 1995b), the
importance of attending to the reproductive health of adolescent males along with that of females
was recognized. Participants at both conferences concluded the reproductive health behaviors of
adolescent males are not only directly related to the reproductive health of adolescent females, but
also to their own health as future adults (WHO, 2000a). Across cultures, beginning in childhood,
males and females are socialized by separate sets of practices, symbols, representations, norms, and
social values that influence their expressions of masculinity and femininity, respectively (Bruce,

2. Lloyd, & Leonard, 1995; Lamas, 1996; Ortner & Whitehead, 1996; Scott, 1996; Verma, 1997). In
general, men are socialized to be dominant, aggressive, to cultivate toughness, and to take risks
(O'Neil, Good, & Holmes, 1995). These qualities may have harmful consequences for both young
men and their sexual partners, as these qualities may lead to young men to engage in high-risk
sexual behaviors (Brown, Jejeebhoy, Shah, & Yount, 2001; Pleck, 1993). Moreover, males are
socialized to be independent, self-reliant, to show little emotion, and to not seek assistance for
health problems. Young men frequently ignore their reproductive health problems and rely mostly
on self-treatments (WHO, 2000b). Adolescent males form one of the largest groups with unmet
needs for reproductive health information and services. These unmet needs vary among different
socioeconomic strata of the given society and also between rural and urban areas (Pachauri &
Santhya, 2002; Porter & Koo, 2000).
Knowledge of Reproductive Health
Studies conducted on adolescent males in some Asian countries, including India, suggest that young
men have many misconceptions about puberty and reproductive health. Among these
misconceptions we find many have little knowledge about STDs, little or no communication with
parents about sexual issues, and few informational resources about reproductive health. Research
finds that many young men get information about sexuality and reproductive health from media and
friends (Adjahoto, Hodonou, De souza, & Tete, 2000; Ali, Bhatti, & Ushijima, 2004; Hoy, 2001;
Masilamani, 2003; Patil, Chaturvedi, & Malkar, 2002). However, some have found that adolescent
males are willing to use more suitable sources to learn more about their reproductive health (Ali,
Bhatti, & Ushijima; Kapamadzija, Bjelica, & Segedi, 2000; Zheng, 1997). A study in India, for
example, showed that although the level of knowledge and awareness about puberty, menstruation,
physical changes during puberty, knowledge about the male sex organs, reproduction,
contraception, pregnancy, childbearing, reproductive tract infections (RTIs), and HIV were low
among young adolescents (10-14 years of age), older adolescents (15-19 years of age) had a better
knowledge of these issues (e.g., about 80% of older adolescents knew about STDs, including HIV)
(Gupta, 1988). A baseline study conducted by the Centre for Population Studies and CINI (2003)
found that over 90% of the young adults of the peri-urban areas around Kolkata (also known as
Calcutta) were aware of HIV/AIDS, about 50% had knowledge about the transmission of the virus,
and a large portion was aware of at least one of the reversible methods of birth control. The NACO
National Behavioral Surveillance Survey reported that about 30% of the boys (15-19 years old) know
how the HIV virus is transmitted, with slight variations between urban and rural boys (NACO &
UNICEF, 2002).
Sexual Activity during Adolescence
In South East Asia, sexual activity during adolescence is associated with either early marriage or
premarital sexual relations. Early marriage is a social norm of this region, which leads to early
sexual activity and an increase of teenage pregnancy. In India, according to the Child Marriage
Restraint Act of 1929 (amended in 1978), the statutory age limit for marriage is 21 for males and 18
for females. However, a large number of females marry before they reach the legal age, compared to
a smaller number of the males. The national average for the age of marriage for women is 16.4
years, though this average varies from region to region (IIPS, 2000; Santhya & Jejeebhoy, 2003).
Recently, however, statistics in the region have shown a trend toward later marriage for both males
and females resulting in greater incidence of premarital sexual relations (Dixon-Mueller, 1993; Rai,
2001; Sharma, 2000; Singh & Samara, 1996; Uddin, 1999).
Globally, young people attain puberty at an earlier age and marry later. As a result, an individual
remains sexually mature for a longer period of time prior to marriage (James-Trarore, Magnany,

3. Murray, Senderowitz, Speizer, & Stewart, 2001). This is one of the major reasons for the increase of
premarital sexual relations among adolescents (Boyd, 2000). Studies suggest the following
percentages of adolescent males who have sex prior to marriage, by region: 24 to 75% in Asia, 44 to
66% in Latin America, 45 to 73% in sub-Saharan Africa, and 80% in some developed countries
(Brown, Jejeebhoy, Shah, & Yount, 2001 ; Darroche, Singh, & Frost, 2001). Social and economic
changes have eliminated many of the traditional restraints on premarital sexual activity and have
exposed many adolescents, especially adolescent females, to the risks associated with unplanned
pregnancy and abortion. In India, induced abortion became legal for married and unmarried women
with the Medical Termination of Pregnancy (MTP) Act of 1971. Adolescents, especially unmarried
females, who are unaware of the existence of abortion services and the right to avail the services,
tend to seek the help of untrained and unqualified service providers, and thereby increase the risks
to their reproductive health and well-being (Chhabara & Nuna, 1993; Dixon-Mueller, 1993; Ganatra
& Hirve, 2002; Gupta, 2003; Jejeebhoy, 2000a). A number of Indian studies suggest that many
adolescent males, especially in urban areas, engage in unprotected sexual intercourse, which makes
them vulnerable to STDs (Abraham, 2001; Awasthi & Pande, 1998; Centre for Population Studies &
CINI, 2003; Jejeebhoy, 2000b; Mawar et al., 1998; Mutatkar & Apte, 2001; Patil, Chaturvedi, &
Malkar, 2002; Sriur, 2000; Verma, 1997). Reproductive tract infections (RTIs) and sexually
transmitted diseases (STDs) are common in India. Some adolescent males, perhaps because of their
sexual activity with sex workers, have higher (12-25%) reported cases of STDs than do adolescent
females (Ramasubban, 1995). An Indian study reveals that some reproductive health morbidities for
men are nearly identical to the rates found among women (Bang, Bang, Baitule, & Phirke, 1997).
Another study conducted in rural West Bengal on men between 15-60 years of age suggests that the
most common reproductive health complaint is urinary problems such as a burning sensation during
urination and/or frequent difficulty at the time of urination (Dunn, Das, & Das, 2004).
Masturbation and pornography are two other common sexual behaviors used by adolescent males
for sexual expression. Studies of Indian adolescent males find that around 20% masturbate (Gupta &
Jain, 1998; Mehra, Savithri, & Cutinho, 2003; Patil, Chaturvedi, & Malkar, 2002; Sachdev, 1998;
Sharma & Sharma, 1997), while some studies report that adolescent boys regard excessive
masturbation and nocturnal emission as having ill effects (Awasthi, Nichter, & Pande, 2000; Patil,
Chaturvedi, & Malkar, 2002).
Why Study Adolescent Males in Peri-urban and Rural Areas?
India is a country where an overwhelming majority of its people, including adolescents, lives in peri-urban
and rural areas. In Indian society, especially in peri-urban and rural areas, reproductive and
sexual health matters remain a hidden agenda and people feel uncomfortable discussing these issues
openly. In order to develop better sexual and reproductive health, both government and non-government
organizations (NGOs) have to be mindful of the needs of the large number of
adolescents in peri-urban and rural areas.
It is commonly thought the people living in peri-urban areas (geographic areas circling or joining
large metropolitan cities) have better socioeconomic conditions than their rural counterparts in
terms of educational level, occupational types, exposure to the modernity of life, and communication
systems. Consequently, awareness of health in general and reproductive health in particular should
be better among peri-urban populations than rural populations.
The present study is an attempt to explore adolescent males' knowledge, awareness, and behavior
regarding reproductive health in both peri-urban and rural settings.
Methods

4. Location of the Study
The study focused on adolescent boys attending school and residing in peri-urban and rural areas in
the State of West Bengal, India. This state has the country's second highest literacy rate and has
large-scale socioeconomic diversity. The State of West Bengal is situated in eastern India with the
city of Kolkata as its capital. Kolkata is situated on the eastern bank of the river Ganga. Across the
river Ganga, on its western bank is with its peri-urban environment, which is quite different from the
city of Kolkata. For our study's purpose then, Howrah is representative of peri-urban locality
(outskirts of a larger urban area). Initially, the researchers approached two schools from this area.
However, one of the school's authorities later declined to participate because the students' annual
examination was about to commence. Thus, only one school located in the peri-urban area
participated in the study.
Likewise, two schools were initially contacted to represent the study's rural (R) portion. Both schools
are situated in Demur, a place situated in the district of Howrah. However, the authorities from one
of the schools also declined to participate, as they believed the research topic was too sensitive for
their student body. Consequently, another school from the Burdwan district (adjacent to the district
of Howrah) was selected. Both the schools selected to represent rural school are located
approximately 60 kms. outside Kolkata. The criteria for selecting these schools (both peri-urban and
rural) was based on a set of shared features, same language for instruction (i.e., Bengali), their
similar tuition fees, male-only student body, and their similar curriculum (i.e., up to the 12th
standard.
Subjects
The participants were 111 adolescent males between 15-18 years studying in three schools (55 peri-urban
and 56 rural). The median age for both groups was 16.0 years.
Method of Data Collection
Before collecting the data, the nature and importance of the study were explained to the respective
school authorities and the students. Data on social demography and reproductive health awareness,
knowledge, and behavior were collected with the help of a well-tested structured
questionnaire/schedule. After agreeing to participate, the first author (BMD) interviewed each of the
subjects independently in a separate location inside the school premises. Prior to the actual
interview the researcher discussed topics like sports, literature, and movies to put the participants
at ease and build rapport. Each interview lasted approximately 40-50 minutes. Data was collected
during the school hours, i.e., between 10 a.m. and 5 p.m.
Classification of Data
Participants' age and educational levels as well as their parents' occupations and household income
were collected. Data on knowledge and awareness of reproductive health included responses to
questions regarding: HIV/AIDS and its modes of transmission, STDs, condoms, sexual intercourse
and safe sex practices; the development of secondary sexual characteristics at the time of puberty in
males and females, the male reproductive system and its function, perceptions about the cause of
pregnancy and the process of conception; acquaintance with the types of contraceptives, abortion in
general and the legality of induced abortion in India (both for married and unmarried women),
statutory age of marriage for males and females in India, views about inclusion of sex education in
the school curriculum, and sources from which information on reproductive health has been
gathered. Data on reproductive behavior included ways of fulfilling sexual urges, experience of

5. ejaculation and masturbation, frequency of masturbation in the last week (preceding the date of the
interview), types of feelings after masturbation, perceptions about the effect of masturbation on
health, experience of nocturnal emissions, and sexual intercourse.
Duration of the Study
The study's data collection took place between February and August 2005.
Results
Socioeconomic Conditions
The parents' socioeconomic levels were measured in terms of their educational level and
occupational types. A majority of both the fathers (76.36%) and mothers (58.18%) in the peri-urban
areas had obtained an educational level above the secondary level (10th standard) compared to only
57.14% of the fathers and 37.5% of the mothers of the rural areas.
Most of the peri-urban boys' fathers are engaged in business (47.27%), followed by service
industries (45.45%). A majority of the rural boys' fathers are engaged in business (32.14%), followed
by farming (26.78%), and service industries (25%). Most of the mothers of the peri-urban and rural
boys are full-time housewives.
The monthly household income of 47.27% of the peri-urban subjects was Rs. 5000 (USD $100) and
above, compared to 23.21% of their rural counterparts at that income level.
Reproductive Health
Awareness of sexually transmitted diseases. With the exception of five of the rural adolescent males,
most boys from both groups understood the different modes of transmission of HIV/AIDS, such as
sexual intercourse (PU 100% and R 92.15%), sharing of infected needles (PU 85.45% and R 60.78%),
and infected blood transfusion (PU 78.18% and R 64.7%). However, the peri-urban boys appeared
slightly more knowledgeable about the different modes of HIV/AIDS transmission. A small portion
from both the groups (PU 16.36% and R 11.76%) believed that HIV/AIDS could be transmitted
through water, mosquito bites, superficial human body contacts, and human excreta. None of the
boys from these two latter groups appeared to have any knowledge about other STDs (e.g.,
gonorrhea and syphilis).
Discussing sex-related issues with friends was common among both groups of boys. Some of the
topics and the percentages reporting discussing such topics were: HIV/AIDS (PU 85.45%, R 57.14%),
sexual relations (PU 94.54% and R 67.85%), use of condoms (PU 90.9% and R 69.64%), sexual
intercourse (PU 89.09% and R 62.5%), and safe sex practices (PU 12.72% and R 3.57%).
Knowledge of the development of secondary sexual characteristics at the time of adolescence. A
large portion of the boys reported the appearance of pubic hair (PU 100.0% and R 96.42%), axillary
hair (PU 98.18% and R 83.92%), facial hair (PU 96.36% and R 71.42%), body hair (PU 85.45% and R
46.42%), change of voice (PU 94.54% and R 98.21%) and change in the size of the penis (PU 98.18%
and R 92.85%) as the major secondary sexual characteristics that develop among males at the time
of adolescence. The adolescent males of both groups reported development of breasts (PU 100% and
R 87.45%), axillary and pubic hairs (PU 96.36% and R 48.21%) and attainment of menarche (PU
67.27% and R 30.35%) as the major secondary sexual characteristics that develop in females at the
time of adolescence. However, it appears that in general, the peri-urban boys are more aware about

6. the development of secondary sexual characteristics than their rural counterparts.
Knowledge of reproductive biology. To test the boys' knowledge of reproduction, they were asked
seven questions and their answers were recorded (Table 1 contains the seven questions, the
"correct" answers, and the numbers and percentages of "correct" and "incorrect" answers given by
both groups.
Looking at Table 1, we see that most of the boys from both locations didn't give the "correct" answer
for Item 1 as most didn't know the answer or reported only the "penis" as the male sex organ. It
seems that the rural boys are more unaware than their peri-urban counterparts about the male sex
organ, but the difference is not statistically significant. On the other hand, a majority of the
adolescents of both groups were able to state the functions of penis (Item 2) correctly. The peri-urban
boys seemed to be more aware than their rural counterparts, but the difference was not
statistically significant. For item 3, less than 50% of the peri-urban boys and less than 20% of the
rural boys had the correct idea about the place of formation of semen, and in this case the difference
was statistically significant. The odds ratio suggests that the peri-urban boys are 4.04 times more
likely to have the knowledge about the place of formation of semen than the rural boys. More than
50% of the peri-urban boys, compared to more than 25% of their rural counterparts, knew that
sperm is one of the components of semen (item 4); the difference is statistically significant. The odds
ratio suggests that the adolescent males of peri-urban areas are 1.41 times more likely to have the
knowledge that sperm is one of the components of semen than the rural males. It appeared from
item 5 that more than 65% of the peri-urban boys had the correct knowledge about the function of
sperm, compared to 28.57% of the adolescents of the rural area, and again, the difference is
statistically significant. The odds ratio suggests that the adolescent males of the peri-urban area are
5.13 times more likely to have correct knowledge about the function of sperm than the rural males.
For item 6, it was found that all the adolescent males of the peri-urban area and an overwhelming
majority of the rural boys had the "correct idea" about the cause of pregnancy (item 6) and the
difference is statistically significant. However, few of the adolescents in either group possessed the
"correct idea" about the process of conception (Item 7).
Knowledge about family planning methods. The adolescent males of both the groups were asked to
name the common family planning methods generally adopted by the people in this region. In
general, the adolescents of both the groups (barring 4 of the rural boys) were aware of the practice
of different reversible and irreversible methods of family planning such as the use of condoms (PU
94.54%, R 78.84%), administration of oral pills (PU 85.45% and R 55.76%), practice of withdrawal
(PU 41.81% and R 41.07%), vasectomy (PU 16.36% and R 3.84%) and tubectomy (PU 20.0% and R
26.92%). A majority of both the groups were found to be aware of at least two of these family
planning methods (PU 89.09% and R 65.38%); a smaller portion were aware of at least one method
(PU 10.9% and R 34.61%), and the difference is statistically significant ([chi square] = 8.63, df = 1 ,
p < 0.01).
Knowledge about the legal provision of abortion and age of marriage. The following are the right
answers to items 2, 3 and 4 (a & b) mentioned in table 2. Subjects who were able to answer any of
the items correctly were considered to have an awareness for that item and those who could not
answer these items correctly or totally unaware of have been considered to have no awareness.
Items 2 and 3: Subjects who reported that induced abortion (1) in general and (2) in cases of
unmarried females are legal in this country were considered to have the right knowledge,
independent for each of the items.
Items 4(a) and (b): Subjects who answered that the statutory age at marriage in India for (a) males is

7. 21 years and that for (b) females is 18 years were considered to have the right knowledge,
independent for each of the items.
It appears from table 2 that about 50% of the adolescent males of the peri-urban area had
knowledge of abortion (item 1) compared to around 10% of the rural males, and the difference is
statistically significant. The odds ratio suggests that the peri-urban boys are 7.26 times aware about
abortion than their rural counterparts. Though abortion has been legalized in this country since
1971, less than 20% of the peri-urban boys and none from the rural area are aware of its legality in
the case of married women (item 2), and the difference is statistically significant. The knowledge
about the legality of abortion in the case of unmarried women (item 3) seems to be negligible in the
case of peri-urban boys and nonexistent in the rural area. From this table it appears that half of the
adolescent males of peri-urban areas are aware of the statutory age of marriage for males (item 4a)
against one third of their rural counterparts, and the difference is statistically significant. The odds
ratio also suggests that the peri-urban boys are 2.78 times more aware about the statutory age of
marriage for males than their rural counterparts. However, an overwhelming majority of the
individuals of both the groups knew the statutory age of marriage for females (item 4b) in this
country.
Sources of information about reproductive health matters. An overwhelming majority of the
adolescent males of both the groups have at least two sources (PU 70.91% and R 87.5%) from which
they get information about the reproductive health matters, followed by a smaller percentage who
reported having at least three sources (PU 29.09% and R 25.5%). Friends were the major source
from which the adolescents of both the groups acquired this information (PU 100% and R 91.07%)
followed by books (PU 72.72% and R 69.64%) and media (PU 25.45% and R 17.85%).
Adolescent males of both groups (PU 96.36% and R 92.85%) expressed their view that a course
related to reproductive health should be included in the school curriculum, and 30% of them
preferred inclusion of this course from the 9th standard.
Reproductive Behavior
Ways to Fulfill the Sexual Urge
All the adolescent males of both the groups (except 4 of the rural area) reported having sexual
urges, and the majority of them fulfill this through masturbation (PU 87.27% and R 78.57%) and/or
looking at pornographic materials (PU 72.72% and R 51.78%). The median age of masturbation and
ejaculation (both for the first time) for the individuals of both groups was found to be 14.0 years.
Table 3 shows that a majority of the adolescent males of both groups have experienced masturbation
(PU 87.27% and R 78.57%) and most of them have masturbated three times or more in the one week
period preceding the date of survey. Mostly, the stimulations for masturbation for these individuals
are pornographic materials (PU 50% and R 45.45%) and fantasizing some sexual incident or some
romantic ideas (PU 68.75% and R 72.72%). In general, the individuals of both the groups expressed
that after masturbation they had a feeling of satisfaction (PU 91.66% and R 56.81%) and/or a feeling
that it would harm the body and soul (PU 62.5% and R 84.09%). An overwhelming majority of them
(PU 62.5% and R 81.81%) felt worried when they masturbated excessively, and the difference is
statistically significant. The odds ratio suggests that the peri-urban boys are less worried about
excessive masturbation than the rural ones by 0.37 times. Most of the individuals of both groups
believe that the act of excessive masturbation makes a person weak. Nocturnal emission had been
experienced by less than half of the boys of both the groups (PU 47.27% and R 39.28%). All the boys
of both the groups, irrespective of their experience of nocturnal emission, perceived the event as a

8. sexual problem. A few of the adolescent males (PU 20% and R 7.14%) had experienced unprotected
sexual intercourse. Among the rural boys who had experienced sexual intercourse, all had
experienced vaginal intercourse with girls of their peer group. Among the peri-urban boys who had
experienced sexual intercourse, a majority of them experienced vaginal (10) and a few anal (1) with
the same sex. The peri-urban males reported that their sexual partners were girls and boys (in case
of anal) of their peer group (8), or sisters-in-law (2).
Discussion
The present study was conducted on school-age adolescent males from two different socioeconomic
settings: peri-urban and rural areas of the State of West Bengal, India. The present study sought to
determine the knowledge, attitudes, and behavior among these adolescents regarding their
reproductive health as well as determining similarities and differences between them.
The findings reveal that the adolescent males of both the groups show a similar trend on issues such
as: HIV/AIDS and its modes of transmission; the male sex organs and function of the penis; the
development of secondary sexual characteristics in males at the time of puberty; the process by
which a woman can conceive; the legality of abortion for unmarried women in India; the statutory
age of marriage for females in India; the sources from which information on reproductive health
awareness have been acquired; relations with whom sex related issues are discussed; and support
for the inclusion of sex education in school curriculum. On the other hand, the peri-urban boys seem
to be more aware than their rural counterparts regarding issues such as: the tendency to discuss
different types of sex-related matters; perceptions about the development of some of the secondary
sexual characteristics in females at the time of puberty; knowledge about the place of production of
semen; composition of semen and function of sperm; correct idea about the cause of pregnancy;
knowledge about the various types of contraceptive devices; knowledge about abortion and its
legality in India; and statutory age at marriage for males in India. In reproductive behavior, a similar
trend was observed between the adolescent males of both the groups on matters related to
satisfying sexual urges by the act of masturbation, the median age of masturbation and ejaculation,
frequency of masturbation (during previous one week period) and stimulation for masturbation.
However, the peri-urban and rural boys differ in their attitudes regarding the fulfillment of sexual
urges by looking at pornographic materials, their perceptions about the ill effect of masturbation on
health, and the experience of sexual intercourse.
Thus, it appears from the above discussion that both similarities and differences exist in the
reproductive health awareness between the peri-urban and rural boys, but in reproductive behavior,
both the groups are largely similar, barring a few.
In general, the present findings reflect that adolescent males have a poor level of knowledge
regarding reproductive health and limited communication on these issues with family members,
which corroborates the findings from some earlier studies conducted in India and some other Asian
countries (Adjahoto, Hodonou, De souza, & Tete, 2000; Ali, Bhatti & Ushijima, 2004; Hoy, 2001;
Masilamani, 2003; Patil, Chaturvedi, & Malkar, 2002;). Since the topic of reproductive and sexual
health is considered taboo among the adolescents in most societies in the developing world, and as
there is hardly any proper source from where they can acquire appropriate knowledge on these
issues, most of the young people remain ignorant. However, a high level of awareness about
HIV/AIDS and its mode of transmission, as found in both the present study and in some earlier
studies (Centre for Population Studies & CINI, 2003; Gupta, 1988) indicates the success of the effort
taken by the governmental and nongovernmental organizations in India to make the general
population aware of this dreadful disease. A report prepared on the young men of peri-urban areas
of Kolkata (West Bengal) shows that the knowledge about the reversible methods of family planning

9. (especially use of condoms and oral contraceptives) is very high (Centre for Population Studies &
CINI, 2003); the present research on the adolescent boys of this region gives a similar picture.
However, both http://uptightnotary9628.webgarden.com/sections/blog/small-business-posts-in these
findings from West Bengal contradict another study conducted by the IIPS (1995), which shows that
an overwhelming majority of the adolescents in India are more aware of sterilization, compared to
any other methods of family planning.
The development of better reproductive health awareness among adolescents will remain incomplete
if information about basic reproductive biology is not imparted to them. Many adolescents in south
Asia are poorly or incorrectly informed about sexual issues, reproductive biology and health. A low
level of school attendance, lack of sex education and the presence of attitudes that prohibit
discussion of sexual issues all confound to exacerbate ignorance in these matters (Bott & Jejeebhoy
2003; McCauley & Salter 1995). A study conducted by Gupta (1988), along with the present study,
demonstrates a lack of knowledge among adolescent regarding reproductive biology.
Premarital sexual activities during the adolescent period increase the risk of unwanted pregnancy
among teenage girls. Generally in Indian society, pregnancy as a result of premarital sex is a matter
of shame, and these pregnancies mostly end up with induced abortions. As many are unaware of the
fact that abortion is legal in this country, some 80% of the abortions are performed illegally in
private institutions and by untrained persons in unhygienic conditions, putting a woman's life at risk
(Chhabra & Nuna, 1993; Ganatra & Hirve, 2002). In the present study it was found that a large
section of adolescent males who are likely to be the sexual partners of their female counterparts are
unaware about the legality of abortion.
Enhancing access to reproductive health information and services targeted to adolescents is a big
challenge. The present study, as well as other studies conducted in other Asian countries, reveal that
adolescents acquire reproductive health related information predominantly from their peer groups
and/or independently by going through books (Adjahoto, Hodonou, De souza, & Tete, 2000; Ali,
Bhatti & Ushijima, 2004; Hoy, 2001). One of the suggested main channels to reach adolescents is
through the schools. As summarized in a study from the U.S.A, adolescent males who had dropped
out of school received significantly less reproductive health education than those who stayed in
school (Lindberg, Ku, & Sonenstein, 2000). In this part of the developing world, inclusion of
reproductive health information in the school curriculum still remains a delicate issue, but
adolescents in the present study have expressed their keen desire in its favor.
In India, though pornography is legally banned, these materials are widely available in various forms
such as, films, magazines, writings, photographs and internet sites. A large section of adolescents in
India, including the ones of the present study (especially the peri-urban boys), have access to these
pornographic materials and use these materials to pacify their sexual urges (Sachdev, 1998; Sharma
& Sharma, 1996). Masturbation is another common sexual behavior of the adolescent males. In
India, data on masturbation is limited and it appears that adolescents of the present study group
masturbate 4 times more often than boys of earlier studies (Gupta & Jain, 1998; Mehra, Savithri, &
Cutinho, 2003; Patil, Chaturvedi & Malkar, 2002; Sachdev, 1998; Sharma & Sharma, 1997). There is
a common notion among the people of this country that excessive masturbation may harm body and
soul and make a person weak. In addition, the occurrence of nocturnal emission/wet dreams (swapna
dosh) is perceived as a sexual problem. An overwhelming majority of the adolescents in the present
study, as well as some other studies on Indian adolescents, corroborate the same finding (Awasthi,
Nichter, & Pande, 2000; Patil, Chaturvedi, & Malkar, 2002). In India, there are a large number of
private clinics that advertise in public places in the form of bills/posters to offer non-western medical
treatment for nocturnal emission/wet dreams and for other reproductive health problems (gupta rog,
which means secret disease). However, detailed data about these clinics, the nature of treatments

10. they offer, the age group of the clients who visit these clinics, and the type of problems mostly
attended to, are not available.
From studies conducted in the 1990s it appears that about 20-35% of the young men in India have
experienced sex before marriage, with a very little difference between rural and urban males (Pelto,
2000). Premarital sexual experiences may be both penetrative (sexual intercourse of any type) as
well as non-penetrative (e.g., kissing, hugging, touching sexual organs) in nature. In general the
non-penetrative types of sexual activities are practiced more than the penetrative type among
unmarried adolescents (Abraham, 2001; Abraham & Kumar, 1999; Centre for Population Studies &
CINI, 2003). Moreover, penetrative sexual intercourse is generally perceived as profane in Indian
society. In the present study only penetrative sexual experiences or intercourse were considered
because these activities have direct consequences to STDs and RTI. In India, it has been observed
that information regarding adolescent males and premarital sexual intercourse varies with the
technique applied in collecting the data. Data collected by self-administered questionnaire gives a
higher rate of report compared to data collected by face-to-face interview (Jejeebhoy, 2000b). The
present study on adolescent males was conducted with the latter technique and has been compared
with the findings from other studies conducted by the same technique. The result shows that in the
present study a higher number of peri-urban adolescents (20%) have experienced sexual intercourse
compared to another study conducted on the young people of peri-urban area of Kolkata (12.9%), on
the urban adolescents of Gujarat (9%) and on the urban slums of Mumbai (9%). Moreover, the
present findings show a reverse trend in the difference between rural and urban subjects regarding
the frequency of premarital sexual intercourse when compared with the study from Gujarat (Sharma
& Sharma, 1997). It is interesting to note that none of the adolescents of the present study used
condoms at the time of sexual intercourse and did report having sex with commercial sex workers as
similarly reported by other research from India (Centre for Population Studies & CINI, 2003;
Sharma and Sharma, 1997; Patil, Chaturvedi & Malkar, 2002).
Thus, it appears that except for a few traits, the trend of reproductive health matters of adolescent
males in West Bengal largely corroborates the pan-Indian situation.
To the best of the authors' knowledge, the present research is a maiden attempt to explore the
adolescent male reproductive health situation in the eastern part of India. As the study is based on a
small sample size, with the subjects selected from only three schools, the authors do not claim the
findings to be conclusive. However, the trend that emerges from this exploration gives a lead for
conducting future research on this topic in this region and also enhances the existing database from
India in particular and Asia in general. A more detailed investigation with a larger sample size
including the adolescent males of the urban sector, and with an understanding of the process of
socialization of these adolescent males, will reveal a better picture of the reproductive health
situation.
After a prolonged debate the Government of West Bengal (the state where the present study has
been conducted) recently introduced a program that will address the reproductive health issues of
adolescents who are at school in the 6th, 7th, and 8th standard. Under this program, secondary
school teachers will have to go for training which will provide them with information on how to
provide reproductive health information to the students in an effective way. The entire program will
be treated as a compulsory extra curricular activity. Further, the Department of Secondary
Education of the State of West Bengal has brought out a handbook named Jeebon Shaily (both in
English and Bengali languages), which provides information on reproductive health. The initiative
taken by the government is appreciable though it is at too nascent a stage to warrant any comment.
However, it seems that the school-goers will benefit from this program. But what about the large
section of boys who is not at school?

11. The authors of the present study suggest that along with the growing awareness of reproductive
health, equal effort should be given to develop knowledge of reproductive biology, to increase the
general awareness of certain legal provisions related to reproductive health, and to remove certain
misconceptions about reproductive behavior among the males of this age group. But how this can be
done is beyond the purview of the present research.
The authors are indebted to the school authorities and the students for their cooperation in data
collection. We are grateful to Dr. Susmita Mukhopadhyay and Mr. Shailendra Mishra of BAU, Indian
Statistical Institute. Kolkata for providing academic help in connection with this work. Partial
financial support received from DSA Phase III (UGC) is thankfully acknowledged.
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Table 1
Knowledge about Reproductive Health Matters
Peri-urban Rural
1. What is (are) the male sex organ(s)? (Correct answer: Penis and
testes.)
Answered correctly 7 4
(12.72) (7.14)

16. Answered incorrectly or no answer 48 52
(87.27) (92.85)
2. What is (are) the function(s) of the penis? (Correct answer:
Passing of urine and ejection of semen.)
Answered correctly 44 39
(80.0) (69.64)
Answered incorrectly or no answer 11 17
(20.0) (30.35)
3. Where is semen formed? (Correct answer: Testis.)
Answered correctly 24 9
(43.63) (16.07)
Answered incorrectly or no answer 31 47
(56.36) (83.92)
4. Where is major composition of semen? (Correct answer: Sperm.)
Answered correctly 33 15
(60.0) (26.78)
Answered incorrectly or no answer 22 41
(40.0) (73.21)
5. What is the function of sperm? (Correct answer: Fertilize a woman's
egg or ova.)
Answered correctly 37 16
(67.27) (28.57)
Answered incorrectly or no answer 18 40
(32.72) (71.42)
6. What is a major way to cause pregnancy? (Correct answer:
Sexual intercourse.)

17. Answered correctly 55 49
(100.0) (87.5)
Answered incorrectly or no answer -- 7
(12.5)
7. Does intercourse always lead to conception? (Correct answer:
Sexual intercourse does not always lead to conception.)
Answered correctly 12 16
(21.81) (28.57)
Answered incorrectly or no answer 43 40
(78.18) (71.42)
[Chi.sup.2] Odds Ratio(CI 95%)
1. What is (are) the male sex organ(s)? (Correct answer: Penis and
testes.)
Answered correctly 0.97 1.89
(0.52-6.81)
Answered incorrectly or no answer
2. What is (are) the function(s) of the penis? (Correct answer:
Passing of urine and ejection of semen.)
Answered correctly 1.58 1.74
(0.72-4.14)
Answered incorrectly or no answer
3. Where is semen formed? (Correct answer: Testis.)
Answered correctly 10.09 ** 4.04 *
(1.64-9.77)
Answered incorrectly or no answer
4. Where is major composition of semen? (Correct answer: Sperm.)

18. Answered correctly 12.47 ** 1.41 *
(1.85-9.02)
Answered incorrectly or no answer
5. What is the function of sperm? (Correct answer: Fertilize a woman's
egg or ova.)
Answered correctly 5.13 * 16.66 **
(2.29-11.45)
Answered incorrectly or no answer
6. What is a major way to cause pregnancy? (Correct answer:
Sexual intercourse.)
Answered correctly 5.37 * --
Answered incorrectly or no answer
7. Does intercourse always lead to conception? (Correct answer:
Sexual intercourse does not always lead to conception.)
Answered correctly 0.67 0.69
(0.29-1.63)
Answered incorrectly or no answer
*Significant p < 0.05, ** Significant p <0.01, *** Significant p < 0.001
Figures in the parenthesis indicates percentages.
Table 2
Knowledge about Some Legal Provision Related to Abortion and Age of
Marriage
Peri-urban Rural [Chi.sup.2] Odds Ratio
1. Knowledge about abortion (CI 95%)
Present 28 7 18.96 *** 7.26
(50.9) (12.5) (1.04-2.92)

19. Absent 27 49
(49.09) (87.5)
2. Knowledge that induced abortion is legal in case of married women
Present 10 0 9.08 ** --
(18.18) --
Absent 45 56
(81.81) (100.0)
3. Knowledge that induced abortion is legal in case of unmarried women
Present 2 0 0.52 --
(3.63) --
Absent 53 56
(96.36) (100.0)
4 (a). Knowledge about the statutory age at marriage for males
Present 29 16 6.72 ** 2.78 *
(52.72) (28.57) (1.27-6.04)
Absent 26 40
(47.27) (71.42)
4 (b). Knowledge about the statutory age at marriage for females
Present 44 37 2.73 2.05
(80.0) (66.07) (0.86-4.81)
Absent 11 19
(20.0) (33.92)
* Significant p < 0.05, ** Significant p < 0.01,
*** Significant p < 0.001
Figures in the parenthesis indicates percentages
Table 3 Sexual Behavior

20. Peri-urban Rural [Chi.sup.2] Odds Ratio
(CI 95%)
1. Experience of masturbation
Yes 48 44 1.48 1.87
(87.27) (78.57) (0.67-5.10)
No 7 12
(12.72) (21.42)
2. Frequency of masturbation in the last one week period
Never (#) 14 19 0.95
(25.45) (33.92)
Once only 11 9
(20.00) (16.07)
Twice only 11 11
(20.0) (19.64)
Thrice and above 19 17
(34.5) (30.36)
3. Perception about the effect of masturbation on health
(a) Worried about excessive masturbation
Yes 30 36 4.2 * 0.37*
(62.5) (81.81) (0.14-0.97)
No 18 8
(37.5) (18.18)
(b) Belief that masturbation makes a person weak
Yes 41 48 2.18 0.48
(74.54) (85.71) (0.18-1.28)
No 14 8

21. (25.45) (14.28)
4. Experience of nocturnal emission
Yes 26 22 0.72 1.38
(47.27) (39.28) (0.65-2.91)
No 29 34
(52.72) (60.71)
5. Ever experienced sexual intercourse
Yes 11 4 2.9 3.25
(20.0) (7.14) (0.98-10.59)
No 44 52
(80.0) (92.85)
* Significant p < 0.05
(#) includes PU 7 and R 12 number of boys who have not yet
experienced masturbation
Figures in the parenthesis indicates percentages
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