APPROPRIATE METHODOLOGIES FOR STUDYING SEXUAL BEHAVIOUR IN INDIA DP....
APPROPRIATE METHODOLOGIES FOR STUDYING SEXUAL
BEHAVIOUR IN INDIA
DP. BASU
This paper describes a study carried out to develop appropriate methodologies for studying sexual
lifestyles and habits of urban Indians. The paper points out the need for large scale quantitative studies
to map sexual behaviour and contends that no systematic study has been carried out to develop
methodologies which will be appropriate for Indian conditions. From the study undertaken, it concludes
that, given an indepth understanding of the sociocultural issues, it is possible to undertake such an
exercise with reasonable levels of acceptability and validity.
Mr. DP. Basu is Director, Social Research, Mode, Calcutta, India.
Introduction
More than four decades ago Alfred Kinsey (Kinsey et al., 1948) had commented
that "Human sexual behaviour represents one of the least explored segments of
biology, psychology and sociology". His words remain largely valid even today, at
least in India. The realisation of the seriousness of the threat posed by AIDS, to the
economic, social and demographic structure of the human race has, however,
provided some impetus towards the subject in the recent times.
But, despite the apparent increase in the saliency of the subject, there is little reliable
data on the sexual habits of the general population, based on a large scale study,
even in the developed countries (Wellings et al., 1990).
The reasons for this situation seem to be three-fold: First is the issue of the need
for such a data base. It has been argued by some anthropologists that such
information does not provide the depth of understanding that is available from
studies using qualitative and ethnographic techniques. On the other hand, the width
of the statistically-valid quantified results provided by a large scale cross-sectional
study is a vital input for strategic and policy planners. Not only are estimates required
for planning support services and community involvement projects but they are also
needed to plan the communication and health education strategy which starts from
an analysis of gaps in knowledge, attitudes and practices. In fact, the two types of
studies are really complimentary to each other in providing the width as well as depth
in selected areas.
Second is the ethical issue of invasion into peoples' privacy. Modern survey
techniques, however, do provide the privacy and confidentiality desired by the
respondents. In fact, the study design can, and often do, provide for it specifically.
The third reason, and the most important one, concerns the acceptability of such
research among the general population and the validity of the findings.
The concern for acceptability and validity of the findings is not unfounded. Sexual
behaviour is considered to be an intensely personal issue, more so in India.
Therefore it is entirely expected that such issues will be raised.

574 D.P. Basu
Unfortunately no organised study has been undertaken to understand the nature of
the points of resistance that a researcher has to face for collecting data related to
sexual habits. Similarly, there may be undiscovered motivational pegs which may
be utilised to help the research process. Analysis of such resistances and motiva-
tions in the proper sociocultural and historical context is an important step in evolving
methodological solutions. Therefore, without such a study it is perhaps unwise to
come to the conclusion that such studies cannot be conducted with any degree of
validity. Moreover organised attempts should be made to experiment with informa-
tion collection methodologies also, in the framework of an operations research.
In India, quite a few studies have been carried out on the subject, but mostly small
ones, primarily covering special target groups, such as: physicians and health
personnel (Thirumalaikolundu Subramanian et al., 1992); medical officers (Divekar
and Banerjee, 1992); students (Chitale et al., 1992: 15-19); truck drivers (Singh et
al., 1992); and physicians (Chitale et al., 1992: 61-62). Moreover, most of these
studies concentrated on measuring awareness and knowledge of AIDS, HIV infec-
tion and related issues and do not adequately cover such sensitive areas as sexual
habits and practices.
It is, however, incorrect to state that no attempt has been made to study the sexual
habits through large scale surveys. Mention must be made of such studies as those
done by Sex Education Counselling Research Therapy Training, a division of Family
Planning Association of India (FPAI, 1990), Family Planning Foundation (FPF and
ORG, 1992) and the survey conducted amongst students in colleges in Madras
(Reddy et al., 1983). In addition, studies have been undertaken and carried out by
a few magazines like Debonair in 1991, Savvy in 1992 and Femina in 1993. These
studies, however, have mostly relied on the responses of those motivated enough,
for reasons not scientifically analysed, to complete and return the questionnaires.
In all cases, the proportion that responded was either quite small or uncontrolled
thus raising questions on the validity and representativeness of the sample and,
consequently of the results. Moreover, none of the studies undertook any basic
research on methodological issues in response to the concern for acceptability and
validity for such studies.
This study was conceived to fulfill these gaps and it attempts to evaluate the efficacy
of alternate data collection methodologies.
Research Design and Methodology
The starting premise for this study is that there is no sacrosanct blueprint method-
ology for studying sexual behaviour. It must depend on what we wish to know, why
we wish to know and from whom we want to get the information (Standing, 1992).
Therefore, no presumption was made as to the relative efficacy of the different
methodologies. This lead to the adoption of a research programme.
The first stage of the programme involved an in-depth analysis based on qualitative
research techniques. The primary objective at this stage was to generate a list of
possible methodologies for carrying out such a study. This was achieved through
the diagnostic route of analysing the cultural, social and historical context of sexual

Methodologies for Studying Sexual Behaviour 575
attitudes and behaviour, thus identifying the root causes of the resistances and the
possible motivators for informed and willing participation in the study.
The technique of focus group discussions was used in this phase.
In the second stage the methodologies generated were short-listed through a
quantitative study amongst the general population. Two methodologies were then
selected for actual field testing.
In the third and final stage of the research programme, an operations research was
carried out. This involved field testing of selected methodologies among middle class
urban Indians in Delhi, Calcutta and Madras using scientific survey research
technology.
Focus Group Discussions
The focus group discussions (FGDs) were carried out amongst men and women in
the middle social class. In all, eight FGDs were conducted — four in Calcutta and
four in Bombay. Married males, married females, unmarried males and unmarried
females were covered in separate groups. The FGDs were conducted by members
of the research team themselves.
As stated earlier, the focus of the qualitative stage was identifying appropriate
methodologies of data collection, given the nature of the topic. In this context,
detailed discussions were carried out to identify the specific resistances and
motivations which must be considered for the success of the project. The appropri-
ateness of the questions in terms of both content and form, and the language of the
interview, were other issues that were included. Projective techniques were exten-
sively used to elicit responses to sensitive issues.
The group discussions provided the two basic requirements for any study of sexual
behaviour — appropriate cultural knowledge to supply meaning and social knowl-
edge to supply context (Standing, 1992). This was vital as, in our view, the adoption
of a methodology would be intrinsically linked to the social background of the
population.
The qualitative phase produced a host of rich information for the study. That the
subject of sexual behaviour is an intensely personal matter, was reconfirmed to start
with. It was clear that societal pressures largely determined individual behaviour and
value systems. But it was found that the intensity varied with the social class. The
Victorian closed-mind attitude to sex seems to affect the educated middle class the
most. The less educated and poor as well as the liberated and westernised upper
class suffer less from the social taboos associated with the subject. The lower social
class still retain the pre-British open attitude to the subject of sex — at least to some
extent. On the other hand, the upper-upper social stratum seems to have got into
the Western 'liberalised' mould.
The middle class and, especially the women from this class, suffer from a sense of
guilt and therefore may be expected to understate their sexual behaviour. One must
also add that in this class sexual freedom in the western model is absent and

576 D.P. Basu
therefore the fear of disclosure becomes a strong deterrent for discussing the issue
freely and frankly.
On the other hand, lack of sexual opportunity induces a 'deprivation syndrome'
which, many a time, leads to sexual fantasy and over-statement of sexual experi-
ence. (The extent of this syndrome may be gauged by the fact that some participants
in the group discussion admitted that they felt excited even reading the draft
questionnaire which was given to them to indicate the kind of information that would
be eventually collected.)
The group discussion findings also indicated that, despite the initial strong barrier
of discussing such a topic, there was no lack of spontaneity once the ice was broken.
This indicates that, despite the social taboo, the relevance of the subject, especially
in the context of AIDS, is well appreciated. Therefore the research programme must
explain the context of the study to overcome the barrier and provide legitimacy and
credibility. In fact, once it was mentioned in the groups that the project was to aid
research on AIDS and it was supported by well-known national and international
organisations, the level of cooperation increased dramatically. This also indicated
that the credibility of the researchers is a vital issue. Pre-data collection counselling
or detailed briefing would also be a vital input. If the briefing includes visuals, projects
a sense of seriousness and a sense of institutional operation rather than an
individual one, then the cooperation level is likely to increase. It can be further
heightened through a mass media communication programme supporting the
research, thus adding to its credibility.
Confidentiality of the information collected is another issue which must be given
more serious considerations. It should not only be promised but also demonstrated.
Elaborate and visible efforts are required to overcome 'the fear-of-disclosure syn-
drome'. Any methodology which is suspected of not providing fool-proof confidenti-
ality is likely to be rejected actively or passively. Therefore such practices as
collecting names and addresses or even numbering the questionnaires for field
control purposes have to be avoided. (This consequently means a different field
work control system, since back-checking will not be possible.) This requirement of
confidentiality negates such methodologies as telephone survey since respondents
can never be sure that telephone numbers will not be linked up to the responses
provided by them. In many western countries the telephone method is used
extensively for conducting marketing and political surveys. For example, the analy-
sis of sexual behaviour in France (ASCF) relied on this method (ASCF, 1992).
Unfortunately this does not seem to be true for India.
The issue of confidentiality even extends to the family members. The ideal situation
seems to be that the entire exercise is kept secret from them also. This seems to
be due not only to the fear-of-disclosure syndrome but also to the embarrassment
factor associated with anything to do with sex. Therefore, it is important that
information is collected in total secrecy and the chances of other family members,
including spouses, intervening before the exercise is complete is minimised. This
aspect negates methodologies involving questionnaires which are left behind, sent
by post or the diary method. Questionnaires published in magazines face the
problem of embarrassment especially among women. In any case magazine

Methodologies for Studying Sexual Behaviour 577
surveys cannot provide the design robustness of a scientifically planned random
survey.
Another aspect that requires attention is the requirement of privacy during actual
filling up of the questionnaire. This is most applicable to questions relating to habits
and practices rather than knowledge and attitudes. This is not a problem of
acceptability of the methodology per se but an issue which might affect the
correctness of the responses and therefore the validity of the findings. This attitude
negates face to face interviews as also group discussions as methods of collecting
behaviour data. (FGDs, however, are excellent preparators.)
The participants of the group discussions also recommended that questions not
directly related to the research issue be avoided. This is necessary so that the
respondents do not see the exercise as an invasion into their privacy unnecessarily.
In fact, this linkage should be apparent and, if possible, explained.
The issue of translation of the questionnaire in the vernacular raised an inconclusive
debate in the group discussions. It was generally felt that it would be a difficult task
because words associated with sex habits were not usually used in the vernacular.
And when used, words based on Sanskrit are more prevalent which are not always
understood by the general population. A section of the participants, however, felt
that careful translation coupled with explanatory notes, to provide clarity, might solve
the problem. In the current pilot study this issue was avoided by not translating the
questionnaires and administering them in English. This was possible since the study
was confined to the urban middle class who were conversant with English. For a
large-scale study covering the total population, this issue needs to be resolved.
The qualitative study also underscored the need for clarity in words and language.
Unambiguous, non-scientific, commonly-used words, which are not perceived to be
offensive, have to be used.
The tone of the questionnaire has to be non judgemental and serious.
As far as the data collectors are concerned, the findings of the FGDs indicate the
need for careful selection. Male interviewers were recommended for men and
females for women. This appearance should project maturity and induce confidence
for the respondents to overcome the social barriers.
The participants also suggested that projective techniques might be used wherever
possible. It is obvious that this technique cannot be used for practice-related
questions. However, such questions seem to soften the respondent if they precede
intimate behavioural questions on sex habits.
The qualitative research also generated ideas with respect to usual research issues
like recall problem and reference periods. Since these do not pertain specifically to
the topic, these are not discussed.
The conclusion that can be drawn from the above discussion is that, with a well-
thought-out research programme, it is possible to break down the social barriers
and get cooperation from the respondents.

578 D.P. Basu
Methodology of Selection Study
In the next stage, the methodologies of information collection generated in the
qualitative stage were put to consumer test through a quantitative exercise. The test
was a simple one involving asking a cross-section of middle class urban respond-
ents, randomly selected, to rank the methodologies in order of their suitability to elicit
correct information from the general population. ("In your opinion which method is
most suitable for getting frank and correct answers to questions such as these [the
questionnaire was shown] from respondents of your sex, age and social class?")
Suitable probing was carried out, along with detailed explanation of the different
methodologies, to obtain well-thought-out responses.
One hundred such respondents were included in this study — fifty each from Delhi
and Calcutta. The results of the survey are given in Table 1.
Table 1
PREFERENCE OF DATA COLLECTION METHODOLOGY
As can be seen from the table, twelve methodologies were tested. The first three
involved in-house interviews. In each case, pre-interview briefing explaining the
research was proposed in keeping with the group discussion findings. The next three
methodologies involved bringing the respondents to a central location (in-hall) after
a suitable random recruitment exercise, briefing them in a group, possibly with visual
aids and then carrying out the interviewing and self completion exercise individually
with adequate privacy.
Within the magazine-published questionnaire group there were three variations:
questionnaires published in film magazines; those published in special magazines

Methodologies for Studying Sexual Behaviour 579
meant for a particular target group, with or without sexual overtones, like Business
India, Debonair, and such others; and other magazines of the literary type.
Results clearly validate the general findings of the qualitative research — need for
immediate filling up of the questionnaire, self completion of the exercise and role of
group briefing in breaking the ice.
The Operations Research
The next stage of the study involved field testing of selected methodologies to
assess their acceptability and validity. Two methodologies were selected — the less
expensive in-home interview, preceded by a briefing and immediate self completion;
and the more expensive in-hall interview also preceded by a briefing and immediate
self completion.
The questionnaire used for the two methodologies were the same. It was a short
questionnaire covering most, but not all, of the issues relevant to AIDS programme.
For example, the time-frame for behavioural questions was "ever practiced" only;
not different time-frame cohorts. The qualitative study indicated that the length of
the questionnaire, as long as it was within reasonable limits, did not affect the quality
of responses. Therefore, this should not be a factor affecting the experiment.
The questions asked included those related to demographic profile, knowledge and
practice related to STD, premarital sex, extramarital sex, homosexuality and contact
with sex workers. Personal practice related questions were always preceded by
attitudinal questions. Great care was taken in the choice of investigators. The male
respondents were interviewed by only male investigators and female respondents
by female investigators. Investigators were briefed in detail, especially on the
aspects of the interview technique, tone of presentation and the general attitude
towards the respondent.
Each respondent was handed over a letter written by the author of this paper
explaining in detail the research background and the importance of the study. The
letter gave exact details of the proposed use of the findings and assurance of
confidentiality.
The in-home interviews were preceded by a detailed briefing of the respondents by
the investigators, covering the aspects of secrecy, confidentiality, and so on. Each
investigator carried a closed bag with a slit on top (like a ballot box) where the
respondents were asked to drop the questionnaire after they had completed them
in privacy (in a secluded place) and sealed them in an envelope. A similar procedure
was adopted for the in-hall study except that the briefing was done in a group
followed by a discussion session. This acted as an excellent method for unfreezing
the respondents.
The survey was carried out in Calcutta, Madras (conservative locations) and Delhi
(relatively more progressive).
The total contact samples are given in Table 2.

580 D.P. Basu
Table 2
SAMPLE SIZES — OPERATIONS RESEARCH
The respondents were selected from the middle class (monthly household income
Rs. 2,500 - Rs. 3,500) in the age group of 21 to 45 years. They were contacted
using the random route technique in locations selected in an unbiased fashion.
Validity of the Findings
A reasonable level of sampling rigour was exercised in the study so that the effect
of sampling error on the validity of the findings could be minimised. Moreover, rigid
field control systems ensured elimination of non-sampling error.
Validation of studies of sexual behaviour presents considerable difficulties. Apart
from problems of recall bias and interviewer approach, it is impossible to determine
whether subjects tell the truth (Johnson et al., 1989). For the purpose of this pilot
study, three aspects were considered to comment on the validity of the findings. The
first involved internal consistency of the data. The second was distribution of
responses between males and females, and the married and the unmarried, to
check the trends against a prior knowledge. The third aspect considered was
estimates of a few key behavioural parameters based on feedbacks received from
a group of opinion leaders. The comments on validity that follow are based on these
considerations.
The Results: Operations Research
The operations research quantitative survey was undertaken with two objectives.
First, the two short-listed methodologies were sought to be compared to arrive at
the better option. Secondly, the study aimed at evaluating the validity of the findings
from this exercise.
The parameters considered for comparing the two methodologies were the relative
acceptance rates and the quality of information generated by them. The information
comparison was restricted to the "softer" areas of knowledge, attitudes and not-so-
unacceptable practices. This is so as the taboo areas like homosexuality, contact
with sex workers, etc. had low levels of positive responses, thus making the
comparison statistically difficult.
Before the information generated by the two methodologies are compared, it is
necessary to analyse the demographic profiles of the respondents covered by the
two methodologies to see whether they are adequately matched.

Methodologies for Studying Sexual Behaviour 581
Table 3
DEMOGRAPHICS PROFILE: COMPARISONS
It can be seen from the above that the two samples are relatively well matched.
Therefore, the results arrived at from these two methodologies should not be
influenced by the differences in the demographic characteristics of the two samples.
Table 4 presents the acceptance rate, separately, for the two methodologies
adopted. The acceptance rate at around 57 per cent is not radically different from
that observed in most consumer and political research in India, though this is lower
than the rate experienced in the ASCF survey in France (ASCF, 1992). In absolute
terms it is quite encouraging in view of the strong social taboo against open
discussion on a subject like sexual habits.
Table 4
ACCEPTANCE RATE

582 D.P. Basu
The results also indicate that the in-hall acceptance rate was not significantly
different from that for the in-home methodology. However, it must be noted that
refusals in the case of in-hall methodology was more due to the inconvenience factor
of coming to a central location. For in-home, refusals were more after exposure to
the questionnaire. This is understandable as the quality of briefing in a central
location were distinctly superior. As may be expected, the rejections after introduc-
tion resulting from the topic of research was more or less similar.
The results also indicate that the rejections due to inconsistency (for example,
mismatch between attitudes and behaviour) and incompleteness (defined as those
not filling up two or more behavioural questions) were quite low. In other words,
once accepted, respondents seemed to fulfill their commitment.
In short, it may be concluded that survey methodologies do not seem to have the
inherent problem of acceptability. Moreover, there is further scope in improving the
acceptability levels by adopting better procedures of briefing, backed up by credi-
bility-generating-communication support. It may also be concluded that the inherent
potential of the in-hall methodology to achieve a higher acceptance rate is better
than that for in-home because the inconvenience factor is more controllable and
therefore can possibly be reduced.
As mentioned earlier, the comparison of the two methodologies was also carried
out on a few softer issues. These are aided or prompted knowledge of sexually
transmitted diseases (STD); belief regarding the practice of reading adult books or
watching adult films amongst people of the same social class as the respondent;
belief regarding the level of masturbation practice and whether respondents had
ever practiced it; belief regarding premarital sex, homosexuality and multi-partner
sex; experience of premarital sex and practice of extramarital sex.
Table 5 presents the level of knowledge of STD from which it is apparent that, though
the knowledge levels of the in-hall respondents seem to be higher, the difference is
really marginal.
Table 5
KNOWLEDGE OF STDs
It may be mentioned here that awareness of the terminology 'HIV is far less than
that for AIDS — a point that should be considered by the communicators.
Similarly, there is hardly any difference between the two methodologies in the results
with respect to belief of the practice of watching/reading adult films/books.

Methodologies for Studying Sexual Behaviour 583
Table 6
BELIEF REGARDING ADULT BOOK/FILM READING/WATCHING PRACTICE
However, significant differences are observed between the responses resulting from
the two methodologies concerning beliefs with respect to masturbation and its
practice (Table 7). The difference is really between the responses of the male
groups. It is felt that this is due to the fact that the in-hall methodology was able to
break the barrier of discomfort and shyness somewhat better.
Table 7
BELIEF REGARDING AND PRACTICE OF MASTURBATION
Table 7 also seems to indicate a degree of internal consistency in the data. The
belief among most men (in-home 78 percent, in-hall 89 percent) seems to match
the declared level of practices (in-home 74 per cent, in-hall 82 per cent) and the
same is true for the female respondents.
As far as beliefs and experience of premarital sex are concerned (Tables 8 and
9), there is a significant difference between the responses of the male groups
covered in the two methodologies. We must remember that premarital sex is one
of the prime areas influenced by the 'deprivity syndrome' and, therefore, is prone
to exaggeration.
However, it is possible that the difference is due to a misinterpretation of the question
itself whereby the in-home respondents may have included sexual contacts other
than actual intercourse in premarital sex. But the lack of difference in the results for
the female respondents seem to contradict this hypothesis.
There is, however, little difference in the distribution of type of partners in premarital
sex between the two study methods.

584 DP. Basu
Table 8
BELIEF REGARDING PREMARITAL SEX
In Table 11 the extramarital sex experience has been presented which indicates a
similar trend.
And similar is the situation for the beliefs concerning homosexual and multi-partner
practices.
The above analyses show that though there is no significant difference between the
methodologies for the softer areas, the in-hali methodology seems to produce more
confidence amongst the respondents and reduces the tendency of overstatement
in the taboo areas.

Methodologies for Studying Sexual Behaviour 585
The data generated from the in-hall study was therefore further analysed to
understand and estimate the validity of the results.
Table 11
EXPERIENCE OF EXTRAMARITAL SEX
Table 12
BELIEF REGARDING HOMOSEXUALITY
Table 13
BELIEF REGARDING MULTI-PARTNER SEXUAL PRACTICE
The In-hall Study
Contact with sex workers, personal experience of STD and experience of homo-
sexuality are the three most socially disapproved practices. Overstatement resulting
from 'deprivity syndrome' is most unlikely to influence these results. And, therefore,
these areas were chosen to estimate the extent to which survey research method-
ology is able to extract the truth out of the normally reluctant respondents.
The above tables indicate that the extent of disclosure is not insignificant. Despite
lack of relevant comparative information on the subject, a group of opinion leaders
consulted by us felt that the results were not inconsistent with a prior estimate of the
current situation in the social class (middle) covered by us.
The validity of the findings was further assessed by analysing the age distribution
by which first premarital sex experience occurred.

586 D.P. Basu
Table 14
CONTACT WITH SEX WORKER: EVER: MALE
The above table demonstrates the consistency of the data. As may be expected, it
also shows existence of a downward trend with respect to the age of first experience
of sex.

Methodologies for Studying Sexual Behaviour 587
Study Limitations
This study was conducted with limited resources and therefore suffers from the
problems associated with small sample sizes. Moreover, it was restricted to the
urban middle class and therefore the results are not strictly projectable to the entire
population. The interviews for the quantitative study were carried out in the English
language to avoid the problems associated with translation in the vernacular. Finally,
some of the questions asked suffered from lack of clarity which was the result of an
attempt to avoid using embarrassing words repetitively. Therefore, there is a lot of
scope to improve the methodology adopted.
As is apparent, the methodologies tested in this study are suitable only for the literate
population because of the self-completion aspect. The only method to collect
sensitive behavioural data from the illiterate target groups appears to be the credible
source route. For example, doctors considered highly reliable may be able to collect
reliable information from a community. This method merits actual field testing.
*
Conclusion
Despite the drawbacks of the study it seems to have achieved three objectives: The
first is the issue of applicability of large survey research methodology to the topic of
sexual habits. It seems beyond doubt that it is possible to carry out such a study
albeit with suitable modifications. Secondly, the study has been able to bring out
many of the resistance points and motivational factors which can be worthwhile
inputs for designing a large-scale study. Lastly, and most importantly, the study
proves that it is possible to achieve a reasonably high acceptance rate and that the
concern for validity of the results is unfounded.
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