Defining and enacting “responsible sexual behavior” in rural Iowa

Abstract

Abstract Objective: Individual level or personal “responsibility” is often implicitly or explicitly used to improve sexual health outcomes. Rural women face unique contextual barriers that increase their risk for poorer sexual health. Therefore, the objective of this study was to understand how rural Iowa women define responsible sexual behavior (RSB) and to identify what contextual variables influence these women’s ability to enact their definitions. Study Design, Setting, and Participants: This qualitative descriptive study used a semi-structured interview guide to conduct telephone interviews with rural women living in non-core Iowa counties who have had (or planned to have) sex with men. Data were analyzed using within and across case analysis to produce defining and enacting themes of responsible sexual behavior. Results: Ten women from eight Iowa counties completed telephone interviews. For rural women in this sample, RSB was defined as understanding the consequences of sex and taking action to manage risks by using contraception or abstinence, “knowing” your partner, and seeking knowledge and resources. The rural context influenced how participants acquired information and created barriers to enacting responsible sexual behavior. Conclusion: Rural women’s definition of responsible sexual behavior did not align with rural values about sexuality. As a result, women often relied on informal information and resources. Emphasizing community-level interventions that act on contextual influences over individual approaches may further assist rural women in enacting responsible sexual behavior.