Australia is the third largest provider of education to international students in the world (Australian Education International, 2012). This has ranked it the fourth largest sector in respect to the subject (Connelly & Olsen, 2013). About 379,000 international students reside and study in Australia (Australian Trade Commission, 2013). Many international students present to health professionals with sexual and reproductive health issues e.g. unplanned pregnancies, sexually transmitted infections, and sexual assault (Kalsi, Do, &Gu, 2007). This research led to the interview of professionals about their perspectives on the risk factors and experiences of international students. Other than the professionals, interviews were also conducted to international and domestic students to determine their perceptions about sexual health issues.
Population sampled
Two groups of participants were sampled for the local needs assessment. The group included various categories, and in the first category there were the sexual health professionals and the international student health insurance providers. Apart from the mentioned, the second categories were students at the international and domestic level majorly from one university known as Deakin University.
The documents that dealt with ethical clearance for the purpose of interviewing those who were participating were obtained from Deakin University. Students were asked a number of interviewing questions as a strategy that is used for asking concerns.
Data gathered
Participants in the first category outlined the factors that are associated with risk to the life of the international students. The subject provided for recommendations that can be used in preventative measures and as strategies that supports learning. International and domestic students were asked about their background, whatever they were studying, and where they get information on sexual health. Additionally, their knowledge on unsafe sex activities, unplanned pregnancies and STIs, sources of prevention and intervention were probed.
Findings
Eleven international (4 males, 7 females- 5 China, 3 India, 1 Vietnam, 1 Singapore, 1 Denmark) and 16 domestic (9 females, 7 males) were recruited into the study. The issues that have been raised inform of concerns are discussed in the subsequent paragraph.
Perspectives on the risk factors
Professionals identified pre-arrival risk factors for sex health problems. First, they mentioned that international students lack knowledge on sexual health, reproduction and contraception. Secondly, they cited lack of sex education from families, schools and other organisations as a risk factor. Thirdly, there was a concern on the use of contraception as some saw it as a risk factor. Lastly, cultural values like talking about sex, responsibility for protection, and the use of terminations as a form of contraception also acted as risk factor. This shows that the government is not playing an adequate role of offering the necessary support to the international students. They mentioned that new found freedom and the urge to experiment sex was risk factor. The risk factors that were identified included alcohol which majority of the students engage in courtesy of peer pressure, drug abuse and unprotected sex. It was also vivid that lack of basic life skills was a major cause of health problems that are related to sex. Some students found it embarrassing to seek support if issues related to sexual health arose.
Experiences of students
People of different professions commented on the student’s challenges that they encounter on the day to day life. They stated that students were ashamed and disgraced due to falling pregnant out of wedlock. This makes such students to keep quiet about their conditions cannot decide whether to tamper with or to live with the pregnancy. Learners end up being depressed and feel isolated. Students worried that the government could discover their pregnancy.
Pre-university sexual health information sources
Interviews were conducted to determine where participants got sexual health information prior to joining university. Australian and international students got information in high school. However, international students got little detail in high schools than Australian students. The age at which Australian students started school was lower (age 12.13) than the age at which international students from china started schooling (age 18) or older. Both international and Australian students admitted that they got sexual health information from friends and magazines. They also mentioned that some little information was obtained from family and internet. Australian mentioned that they also got information from community organizations. They also mentioned that the sources of information and details given changed with age/maturity (Dolly to Cleo; high school classes to university classes which are more in detailed).
Both international and Australian students got sexual health information from O week and brochures. International students accessed information through information desk and brief group session.
Whether they heard about unplanned pregnancies with university students
Students were asked about the second hand information from friends or acquaintances on unplanned pregnancies. Both international and Australian mentioned that they heard from their friends in high school, including back in home country for international students. the two group got information their friends in the university. On whether the pregnancies continued or not, both international and Australian students reported that only the ones who had partner support and stayed together continued with pregnancy. Pregnancies were terminated in cases of one night stand. Both students reported that because the pregnant ladies loved their partners and had baby they married. Students were asked whether they had experienced unplanned pregnancies. An international student from northern Europe admitted that she had a baby and gave to the boyfriend. Interestingly, one international student from India who was tested for pregnancy proved negative.
Students were asked on whether they have heard about casual sex and protected sex with university students. International and Australian students went to social joints to drink with casual acquaintances. Alcohol contributed to unsafe sex. One male china student even confessed to having sex sometimes after drinking. Australian and international students mentioned that they do not like condoms and that they do not prepare to have sex.
Who do students turn to for support when having an unplanned pregnancy?
Only international students responded to this question. Students approach and talk to close friends for support. Students go to other groups and services.
International and Australian students gave different responses to prevention and support barriers. According to international students, sexual health was never discussed with parents and family members. They do not know where to find services or how they operate in Australia, within and outside of Deakin University. Students do not know what services are available at Deakin University. Students fear being seen by people they know at the medical centre on campus when pregnant some students cannot afford the charges at the clinics. Students could not get services due to language barrier. Differences in social values around pregnancy outside wedlock were barriers to accessing help. Cultural values hinder talk about sexuality. Lastly, international students pointed to lack of many friends at the university as barrier. The Australian students gave fewer reasons for not seeking prevention or support. They know where to find free or cheap services. The shame or embarrassment of having STI or unplanned pregnancy was a barrier to them. They also mentioned that the information learnt in high school was more on biology and not relationship. Mature age students were not exposed to information during O week hence they were not well informed. Lack of friends in the university was a challenge.
Discussion
The professional mentioned that international students that international students lack knowledge on sexual health, reproduction and contraception. Secondly, families, schools, organizations do not provide sex education. Thirdly, there is negative attitude against the use of contraception. Lastly, cultural values like talking about sex, responsibility for protection, and the use of terminations as a form of contraception also was mentioned. These findings agree with a research linking unplanned pregnancy and abortion to limited sexual health literacy and immigration experiences (Poljski, 2011). The lack of knowledge on sex health also concurred with findings of study which showed that University of Sydney – students born in Asia had poorer HIV/STI knowledge than Australian-born students (Song, Richters, Crawford, & Kippax, 2005).
Research from Adelaide revealed that international students had insufficient knowledge about reproductive health and tended to increase their sexual relationships when they arrived in Australia (Burchard, Laurence, & Stocks, 2011).
The data described above reveal several similarities and differences in the acquisition of sex health information. Prior to joining university both international and Australian students get information from friends magazines and internet. Australian students get more information on sex health from high school. Australian students also get additional information from community organizations. Finding agrees with report by Burchard, Laurence, & Stocks (2011) which revealed that international students had insufficient knowledge about reproductive health and their sexual relationships increased upon arrival in Australia.
As far as acquiring information in the university both international and Australian students mentioned same sources. International students got information from extra sources. This is also in accord to a study from Adelaide which showed that international students increase their sexual relationships when they upon landing in Australia (Burchard, Laurence, & Stocks, 2011).
International and Australian students admitted to having heard of unplanned pregnancy from friends in high school and university. Most students lack first-hand information on unplanned pregnancies. This finding is not consistent with previous reports which have shown that international students in Australia increasingly present to health professionals with sexual and reproductive health issues including unplanned pregnancies, sexually transmitted infections (STIs), abortions and sexual assault (Burchard, N, & Laurence, 2009; Kalsi, Do, &Gu, 2007).
International and Australian students go out with casual acquaintances to drink. One male china student even confessed to having sex sometimes after drinking. Australian and international students neither use condoms nor prepare for sex. This finding is consistent with reports which showed that international students increased their sexual relationships when they arrived in Australia (Burchard, Laurence, & Stocks, 2011). It was also similar to findings by Rosenthal, Russell, & Thomson (2008) which showed that less than half of sexually active international students (49.6% of females and 49.6% of males) always used a condom with their partners. Similar findings were also captured by a research in other countries which demonstrated that university student have unplanned pregnancies and frequent unsafe sex (American College Health Association, 2012).
International students mentioned that apart from turning to friends for support, they also go to other groups and services. This is in accord with a recent report which showed international students increasingly presenting to health professionals with sexual and reproductive health issues (Kalsi, Do, &Gu, 2007).
International students could not easily access support and prevention. Australian students know where to get support. This is in agreement with a study which showed University of Sydney – students born in Asia had consistently poorer HIV/STI knowledge scores than Australian-born students (Song, Richters, Crawford, & Kippax, 2005).
Contraceptives were not affordable to international students. This agrees with a report which showed that international health insurance does not offer subsidized contraception (Kalsi, Do, &Gu, 2007).
To prevent sex health problems the following strategies should be adopted by the university and health providers:
The assessment had some limitations. First, sampling of participants was not random. Proper sampling procedure was not used to recruit participants. Samples didn’t represent the population (Daniel, 2005). Secondly, a small sample size was used. This limited the statistical power of the survey (Fisher, Laing, and Stoeckel, 1983). The study therefore didn’t capture a lot of information. Questionnaires were designed poorly. Only open ended questions were in the questionnaire. Quantifying the information given by the participants was therefore a challenge. Lastly, we are not provided with sample size of professional. It is therefore not clear whether this a true picture on the ground.
We thank BUPA foundation for the funding towards this project. We thank students who volunteered information in the study. We also thank health professionals and insurance providers for participating in the study.
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