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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 102-109

Characteristics of and risk factors associated with self-reported sexual repression among internal migrants in China: A large-scale cross-sectional study


1 Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Medial School, Fudan University, Shanghai 200032, China
2 Division of Epidemiology and Biostatistics, University of Illinois, Chicago, IL, USA
3 Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China

Date of Submission20-Sep-2018
Date of Web Publication9-Jul-2019

Correspondence Address:
Dr. Jun-Qing Wu
NHC Key Lab of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research (Shanghai Institute of Planned Parenthood Research), 779 Laohumin Road, Shanghai 200032
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2096-2924.262395

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  Abstract 


Objective: This large-scale cross-sectional study aims to identify the characteristics of and risk factors associated with sexual repression among internal migrants in China.
Methods: Between August 2013 and August 2015, a total of 8,669 internal migrants from four major cities in China (Beijing, Shanghai, Chengdu, and Chongqing) voluntarily participated in our study. They were interviewed, and the data on their demographic information, occupation, and sexual activities were collected. The Chi-square test and multiple logistic regressions were conducted to identify significant associations. A stepwise method was adopted for the selection of variables.
Results: There were 3,597 (41.49%) males and 5,072 (58.51%) females in total. A higher percentage of males reported that they felt sexual repression compared to females (14.43% vs. 9.21%). After adjusting for other covariates, the consequence was showed that male migrants working for more than 5 days were more likely to report sexual repression (odds ratio [OR] = 1.40, P < 0.05). Living in a collective dormitory with others was also a risk factor for male migrants. The longer males spent with their partners, the less sexual repression occurred (OR= 0.94, P < 0.05). Similarly, agricultural household registration status and working for more than 5 days increased the risk for sexual repression among female migrants (OR= 1.41 and OR = 1.46, respectively, P < 0.05). Frequent and constructive communication also protected females against sexual repression (P < 0.05). Well-educated females experienced relatively less sexual repression when compared to their counterparts with less education (P < 0.05).
Conclusions: Sexual repression was significantly associated with a few demographic, occupational, and sexual risk factors. Meaningful differences have been identified between male and female migrants. More effective intervention programs such as safeguard measures and welfare policies should be designed and implemented for a majority of female migrants and for those with agricultural household registration status.

Keywords: China; Migrant; Risk Factors; Self-Reported Sexual Repression


How to cite this article:
Zhao R, Li YR, Gao Y, Zhang JG, Li YY, Zhou Y, Wu JQ. Characteristics of and risk factors associated with self-reported sexual repression among internal migrants in China: A large-scale cross-sectional study. Reprod Dev Med 2019;3:102-9

How to cite this URL:
Zhao R, Li YR, Gao Y, Zhang JG, Li YY, Zhou Y, Wu JQ. Characteristics of and risk factors associated with self-reported sexual repression among internal migrants in China: A large-scale cross-sectional study. Reprod Dev Med [serial online] 2019 [cited 2019 Oct 17];3:102-9. Available from: http://www.repdevmed.org/text.asp?2019/3/2/102/262395




  Introduction Top


Although the number of influential studies on sexual issues has increased in many countries,[1],[2],[3],[4] sex is still a taboo topic in China. The majority of Chinese citizens tend to pay more attention to reproductive diseases, but underestimate basic sexual needs. Therefore, there is a significant gap between the current health status and the expected productive health. According to the WHO,[5] “reproductive health implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.” To the best of our knowledge, some studies have focused on sexual problems in China,[6],[7] but there is little to no mention of sexual repression among internal migrant workers.

Sexual repression among internal migrants should be studied and addressed appropriately because it can have negative consequences for both the person and society. As a special vulnerable subpopulation, internal migrants in China refer primarily to migrants without local household registration status based on the Chinese Hukou system. The primary cause of migration was the surplus rural labor force. In the past 2 decades, rural people have poured into large cities to seek job opportunities, while their families have been left behind in their hometowns, including their children and spouses. Most migrants take up low-wage jobs, such as in the construction, industrial, and coal mining industries.[8],[9],[10] Because of substantial stress from personal life and work, these migrants are more likely to suffer from sexual repression. Moreover, male migrants might seek unhealthy ways to release their sexual stress, such as through sexual assault or harassment. Besides violence and other forms of crime, unmet sexual needs could lead to marital breakdown and physical and mental illness. In contrast, a healthy and satisfying sex life has a positive impact on many areas of life,[11],[12],[13] such as marriage, mental health, and overall quality of life. A happy sexual relationship strengthens the relationship with partners and promotes both trust and empathy. Nevertheless, to the best of our knowledge, there have been no large sample surveys, but rather only a few qualitative or sociological studies, concerning the problem of sexual repression among migrants in China.[14],[15]

Before deriving any possible solution to the existing problem, the risk factors associated with sexual repression among migrants should be identified. Therefore, a large-scale cross-sectional study was designed to identify the demographic, occupational, and sexual risk factors associated with sexual repression among internal migrants in China. In future, appropriate intervention strategies can be designed and implemented to improve the productive health of migrants on the basis of our findings.


  Methods Top


Participants and sampling

Between August 2013 and August 2015, a total of 8,669 migrants from four highly migrant-populated cities in China (Beijing, Shanghai, Chengdu, and Chongqing) participated in our study after giving their informed consent. The city-wise number of participants was 2,099 from Beijing, 2,414 from Shanghai, 2,124 from Chengdu, and 2,032 from Chongqing. The eligibility criteria for participants were as follows: (1) age 18–49 years; (2) not a permanent resident in the targeted city; (3) been residing in the current city for at least half a year; and (4) voluntary participation in the survey.

A multistage cluster sampling method was used to select the participants. As shown in [Figure 1], two districts were selected within each city. Four sites were selected from each district. The sites consisted of workplaces where the migrants were concentrated. For blue-collar workers, the main sites include factories, construction areas, the service sector (such as the restaurant and hotel), and entertainment places (such as the singing and dancing halls, KTV establishments, and other places of entertainment and operating games). For white-collar workers, the main sites include foreign, Taiwanese, or Hong Kong enterprises. Thus, a total of eight sites were chosen in each city. With both permission from employers and informed consent from participants, all migrants in the selected sites were interviewed [Figure 1].
Figure 1: Multistage cluster sampling method.

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Investigation

Self-administered questionnaires were adopted to assess sexual repression and other factors. The questionnaires were structured in accordance with the study design, literature review, purpose of the study, and the presurvey data, which were suitable for a floating population. After obtaining their informed consent, the migrant workers were asked to fill out the structured questionnaires by themselves since some questions asked about private matters. The investigators were responsible for clarifying doubts and answering any questions that the participants had. All investigators were rigorously trained before administering the survey, in order to ensure they understood the context of the questionnaire, had interviewing skills and knowledge of interviewing techniques, and could assist the participants in completing the questionnaires. The respondents' personal information was kept confidential in our study.

Measures

Demographic characteristics

This study collected data on the following demographic characteristics: gender (dichotomous, male/female), age (years, four categories: <25, 25–34, 35–44, and 45 years or older), educational background (five categories: primary school graduate or below, junior middle school graduate, high school graduate, 3-year college education, and bachelor's degree or above), Hukou (dichotomous, agricultural/nonagricultural, and household registration status in China), number of years living in the present residence (years, continuous), duration of stay in the residence per year (months, continuous), and types of housing in the present residence (five categories: collective dormitory with others, separate room in a dormitory, room with family, rented room, and others).

Occupation characteristics

The study also collected data on several occupation factors: occupation type (three categories: unemployed, blue-collar worker, and white-collar worker), weekly working days (three categories: 0 day, 1–5 days, and >5 days), and monthly income (CNY) (four categories: <1,000, 1,000–2,999, 3,000–4,999, 5,000–6,999, 7,000 and higher).

Characteristics of sexual activities

Several characteristics of sexual activities were also included in the study. In our study, sexual repression refers to emotional depression caused by a lack of satisfaction of sexual desire[16],[17] as well as other sexual issues. In this study, sexual repression was identified by asking “Have you ever felt sexual repression (where, sometimes, you have sexual needs, but cannot be satisfied, and this in turn makes you feel depressed and/or anxious) since the time you left your hometown?” Participants had to respond with either a “Yes” or a “No.” The frequency of sexual intercourse was determined by asking “How many times have you had sexual intercourse with a male/female in the past 30 days (times, continuous)?” Other factors examined included sexual relationships (three categories: married and regular sex partner, unmarried but regular sex partner, and casual sex), age at first sexual experience (years, continuous), age at first marriage (years, continuous), duration of living with sex partner per year (months, continuous), and frequency of sexual communication (three categories: seldom, sometimes, and often).

Statistical analysis

Descriptive statistics included frequencies, means, standard deviation, and percentages. The Chi-square test was used to analyze the distribution of sexual repression by demographic, occupation, and sexual activities factors. All factors significant at P < 0.10 in the Chi-square test were included in the multiple logistic regression analysis as independent variables. Sexual repression (yes/no) was used as the dependent variable. Odds ratios (OR s) were used as indicators of the strength of association. P < 0.05 was considered statistically significant. Given the obvious difference between males and females in terms of sexual psychology, subgroup analysis was conducted for each gender in the primary results.

The quantitative data obtained from the questionnaire were checked and coded by professional personnel. The database was established using EpiData3.2 software (The EpiData Association, Odense, Denmark). The SAS 9.4 (v. 9.4 SAS Institute, Cary, NC, USA) program was used for statistical analysis.


  Results Top


Demographic characteristics of the participants

Of the 8,669 participants, 41.49% were male while 58.51% were female. Nearly three-quarters (71.94%) of the participants were aged 25–44 years, and a majority (40.02%) of the participants had finished junior middle school. Nearly two-thirds (68.10%) held agriculture accounts under the Hukou system. The average years of living in the present residence was 8.04 years, and the average months of living in the present residence per year was 10.91 months. Approximately a quarter (21.70%) of the total participants lived in a collective dormitory with others, while 28.62% of the respondents had their own rooms in a dormitory, and 27.18% of the respondents lived with their families. The remaining 17.78% lived in a rented room [Table 1].
Table 1: Demographics characteristics of the study participants

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Occupation characteristics of participants

Most participants (69.72%) were blue-collar workers (defined as workers who are mainly engaged in manual labor). Most of the participants (64.93%) reported that they were working for more than 5 days a week. More than two-fifths (44.77%) of the participants reported that their income had been < 3,000 (CNY) per capita monthly in the previous year [Table 2].
Table 2: Occupation characteristics of the study participants

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Characteristics of sexual activities of participants

While most of the participants (83.22%) were married and had regular sex partners, 11.40% were unmarried but had regular sex partners, and 5.39% had casual sex. The average age at first sexual experience and the average age at the time of first marriage were 21.72 and 23.76, respectively. Nearly one-fifth (19.59%) of the participants rarely communicated with their partners about sexual issues [Table 3].
Table 3: Characteristics of the sexual activities of the study participants

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Factors associated with sexual repression: for males and females

In our study, 519 male and 467 female migrants reported that they were sexually repressed, accounting for 14.43% and 9.21%, respectively. There was statistical significance.

In the univariate analyses of males, there were four demographic factors associated with sexual repression: Hukou (household registration), number of years living in their present residence, the duration of stay in their residence per year, and the type of city housing in their present residence. In addition, one occupation factor was associated with sexual repression: weekly working days. Two sexual activities factors were also associated with sexual repression: age at the time of first marriage and months of living with sex partner per year (in the past 2 years). In the case of female migrants, in addition to three demographic factors, which were consistent with male migrants (Hukou, number of years living in their present residence, and the duration of stay in their residence per year), age and education level were also associated with sexual repression. The distribution of all occupation factors was not exactly the same. Meanwhile, age at the time of first marriage, months of living with sex partner per year (in the past 2 years), frequency of sexual activities, and sexual communication were associated with sexual repression [Table 4].
Table 4: Univariate analyses of factors associated with sexual repression, separately for male and female migrants

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All factors significant at P < 0.10 in the univariate analysis were included in the multiple stepwise logistic regression analysis (SLE = 0.05 and SLS = 0.10). After controlling for potential confounding variables, these results indicated that sexual repression among male migrants was associated with type of housing in the present residence, number of working days in a week, and number of months of living with sex partner per year (in the past 2 years). Participants who lived in a collective dormitory with others were more likely to feel sexual repression than those who lived in other types of residence. Compared with those who worked between 1 and 5 days a week, participants who worked 0 days or worked for more than 5 days were more likely to report sexual repression (OR = 1.36 and OR = 1.40, respectively). The number of months of living with the sex partner per year was a protective factor against sexual repression (OR = 0.94). The longer the time that the participants spent with their partner each year, the less that sexual repression occurred. For female migrants, five factors were selected into the model, including education level, Hukou, number of working days in a week, frequency of sexual communication, and duration of living with the sex partner per year. Participants who had agricultural accounts were more likely (OR = 1.41) to feel sexual repression than those who held nonagriculture accounts. Compared to those who worked 1–5 days a week, female migrant respondents who worked 0 days were less likely to report sexual repression. However, those who worked for more than 5 days a week were more likely to report sexual repression (OR = 0.51 and OR = 1.46, respectively). Participants with 3 years of college education had less sexual repression than those who graduated from primary school or below (OR = 0.57). The frequency of sexual communication demonstrated a strong protective correlation with sexual repression. The higher the frequency of sexual communication between female participants and their partners, the lower the number of reported cases of sexual repression (OR = 0.71 and OR = 0.54, respectively). Months of living with sex partner per year was also a protective factor against sexual repression among females (OR = 0.97) [Table 5].
Table 5: Multiple stepwise logistic regression analysis of factors associated with sexual repression, separately for male and female migrants

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  Discussion Top


This study had two important purposes: to find out which characteristics of demographic, occupation, and sexual activities affected self-reported sexual repression and to investigate whether there are differences between male and female migrants in China when it comes to sexual repression. To the best of our knowledge, this is the first study in China to carry out a large sample survey to document self-reported sexual repression and assess the factors that possibly influence sexual repression among male and female migrants.

In our investigation, we found a high proportion of self-reported sexual repression, which may represent an underreporting of sexual repression because of the sensitive nature of the issue and the strong social and cultural taboos related to this area in China. There were significant differences in the proportion between male (14.43%) and female (9.21%) migrants. This may be related to the fact that males are more likely to talk about sex and related issues than females[18] and because males generally initiate sex more often and desire a higher frequency of sex than do females.[19] At childbearing age, females always pay more attention to the next generation and neglect their sexual needs.[20],[21] In traditional Chinese society, sexual needs of females have not only been suppressed for a long time but have also been considered immoral. Thus, females tend to cover up their sexual problems. Moreover, because of the influence of the standard of living and education levels, female migrants are bound by traditional ideas more strongly.[22]

This study found that there were more impact factors on self-reported sexual repression among female migrants than among male migrants. In the univariate analysis of male migrants, there were only 6 factors associated with sexual repression, while in the case of female migrants, there were 12. After controlling for potential confounding variables, the results indicated that weekly working days were associated with sexual repression in both genders. For both male and female migrants, work stress was found to be an important factor affecting their sexual repression. However, there were some differences between male and female migrants. For male migrants who worked 1–5 days a week, the degree of sexual repression was lower than that for unemployed male migrants, while females are not. The degree of sexual repression of working women was higher than that of nonworking women, no matter how many days they worked. The main reason for this could be the traditional gender inequality that prevails in China, where males are expected to bear more responsibility to support their families. Unemployment and lack of income exert greater influence on male migrants than on female migrants. Many female migrants choose to take care of their children and families at home after childbearing. Unemployment has a lower impact on female migrants. However, when working female migrants face both the pressure of work and life, they are more likely to feel sexual repression. Thus, it is a possible explanation for why unemployed female migrants have the lowest rates of sexual repression. Of course, for both male and female migrants, excessive workload is an important factor that causes sexual repression.

Both the univariate analysis and the multiple stepwise logistic regression analysis results showed that household registration status and education level were important factors associated with sexual repression among female migrants. However, neither factor affected sexual repression in male migrants. Agricultural status seemed to be a risk factor for sexual repression, and this may be due to China's urban–rural dual structure, which isolates rural citizens from urban citizens,[23] thus making it difficult for rural–urban migrants to have access to social services in cities. The social security of urban Hukou is relatively sound, and the ability to bear social pressure is higher, whereas the converse is true of rural Hukou.[24],[25] Female migrants with agricultural status faced greater inequality in the collective resource allocation in rural areas. There is gender-based exclusion,[26] including in areas such as land rights, wage rates, and access to education. These inequalities may be among the reasons why female migrants with agricultural Hukou are more vulnerable to sexual repression. The proportion of sexual repression among female migrants with higher education level is relatively lower than that among female migrants who are undereducated. Female migrants with 3 years of college education have the lowest rate of sexual repression (3.86%). We analyzed why this result was found among female migrants but not among male migrants. One of the possible reasons for this could be that female migrants with high education levels are more likely to integrate into the city[27] and are more adaptive. Gender-specific effects were also found in other studies.[28] A study that conducted an investigation on sexual satisfaction showed that high education and high socioeconomic levels were associated with sexual satisfaction in females but not in males.[29],[30] The impact of the type of housing on the sexual repression of migrants also reflects gender-based differences. In the multiple stepwise logistic regression analysis, living in a collective dormitory with others was found to be a risk factor for sexual repression only for male migrants and not for female migrants. This may be because migrants living in a collective dormitory are less likely to find opportunities to meet their sexual needs. Meanwhile, as mentioned earlier and in other studies, male migrants desire a higher frequency of sex than do female migrants.

In our study, the duration of living with the sex partner per year (months in the past 2 years) was a strong protective factor for sexual repression, which was observed both in male and female migrants. This finding is important because it enhances our understanding that a stable sexual relationship has a more important protective effect on sexual repression. Another interesting finding is that the frequency of sexual communication was a strong protective factor for sexual repression only in females but not in males. Our finding is in line with previous studies,[31],[32] which have concluded that better sexual communication was related to higher sexual satisfaction among females. On the one hand, sexual communication is an important factor for females to feel intimate. Males care more about their physical feelings.[16] On the other hand, the degree of sexual affinity affects female sexual satisfaction.[33] Some studies have suggested that female sexual satisfaction improved because of programs on communication skills for couples.[34],[35] Therefore, for both male and female migrants, it is necessary to solve the problem through the transition from personal to family mobility, while it is equally significant for female migrants to satisfy their emotional needs.

One limitation of this study is that the data were obtained from migrant individuals. If couples had been surveyed, they might have offered more information, as a result of which more interesting findings could have been revealed. In summary, sexual repression has a significant impact on the physical and mental health of migrants, and it is related to many risk behaviors. Therefore, dedicated intervention programs, safeguard measures, and welfare policies should be targeted at migrants, especially at those with agricultural household registration status. Moreover, it seems that alleviating sexual repression could be achieved in four ways: (a) by breaking the urban–rural and gender inequalities through policies; (b) by reducing work pressure through the perfection of the social security system; (c) by increasing emotional communication skills through education and training programs, especially for female migrants; and (d) by changing the flow pattern from personal to family mobility, which is significant for both male and female migrants.

In conclusion, to the best of our knowledge, this study is the first in China to carry out a large sample survey to document self-reported sexual repression among migrants. Sexual repression was associated with quite a few risk factors related to the characteristics of demographic information, occupation, and sexual activities. Meaningful differences have been identified between male and female migrants, with more impact factors among female migrants. Sexual repression is also related to many risk behaviors. Therefore, more effective intervention programs such as safeguard measures and welfare policies should be designed and implemented for the benefit of migrants with agricultural household registration status and for a majority of female migrants.

Acknowledgments

We thank the National Science and Technology R&D Programme for their initial funding and support. We thank all the study participants and research staff in four cities for their support.

Financial support and sponsorship

This study was funded by the National Science and Technology R&D Programme, as a part of the 12th Five_Year Plan of China (No. 2012BAI32B08).

Conflicts of interest

There are no conflicts of interest.



 
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