The psychosocial experiences of girls with visual impairment about the ideal spouse and marriage

Introduction

According to Lancet Global Health statistics, by 2020, 1 billion persons have moderate or severe distance vision impairment or blindness due to unaddressed refractive error (Bourne et al, 2021). According to statistics, by 2020, between 600,000 and 700,000 people in Iran have been identified with visual impairment (VI), and 115,000,000 of them were completely blind (Aghaee-Chaghooshi et al., 2021). Blind people, as sensory disabled people, face limitations in having an independent life, psychological and social problems, poor involvement in social activities, and even the problems of not adapting to the urban space and public transportation (Aslan et al., 2012). Blindness and VI are problems and challenges that make affected people face many psychological and social problems (Bhagchandani, 2014). Every society is formed based on diversity in language, gender, religion, age, and disability, and having a family and children is a human right for all people regardless of these diversities. Each society is founded on the family system (Satvat et al., 2019). Marriage can meet the need for love and affection. Marriage is a psychological and physical need for humans, and loving and being loved is a human need that can be satisfied with another person. There is a stereotype that people with disabilities are sexually disabled, unattractive, and lack sexual desire. In some cases, they are not considered a full woman or “fully human beings” (Goyal, 2017; MacInnes, 2011).

This common thinking does not exist only in ordinary people, but health professionals are also affected by these false beliefs about sexual ability and sexual functions in blind, and VI men and women. For example, Peta (2017) revealed that health and care providers refuse to advice on sexual health and contraceptive methods for women with disabilities, assuming that they are not involved in this relationship or do not need this information (Peta, 2017). In another study in Iran, the researchers analyzed the challenges of the marriage of physically disabled people and concluded that there is a strong social stigma about their marriage and even the public is not willing to accept their psychological, emotional, and sexual needs for marriage. There is a dominant assumption that why these people should get married when they cannot even take care of themselves. Other obstacles to the marriage of physical–motor disabled people in Iran were unemployment, dual attitudes and feelings toward marriage, and lack of government economic support (Satvat et al., 2019).

People with VI are directly and indirectly exposed to various discriminations in their daily lives. A major part of discrimination is rooted in social misconceptions, and even many people in various societies not only do not consider marriage to be a psychological and physical need for these people, but also consider it a kind of burden for society (Warner & Adams, 2016).

Bekoe (2018) examined the obstacles to the marriage of people with disabilities in Ghana and concluded that these obstacles are more severe when it comes to sensory disabled, that is, blind and VI people. The results showed that the major obstacles to the marriage of blind and VI people include: (1) severe public rejection, (2) interaction problems with family members and surrounding people, and (3) motor and physical problems, for example, in using public transportation system and even the ability to move independently without physical restrictions in cities or villages. The results also indicated these problems are worsening several times when a blind or VI person lives in developing and poor countries (Bekoe, 2018).

Although blind people face many challenges and obstacles in their daily life, finding a good partner and having a high-quality and satisfying married life solves many of their emotional and psychological problems (Schulz, 2008; Trelfa, 2004). In their meta-analysis study, Robles et al., (2014) concluded that the quality of life of a couple has a direct and significant relationship with the physical health of the couple. Couples who experience high marital quality in their relationships experience longer life spans and higher psychological health compared to unhappy couples (Robles et al., 2014).

Despite the prevenient public belief, a disabled person has the same mental and sexual needs as other non-disabled people and even sometimes they feel the need to love and to be loved more than non-disabled people (Satvat et al., 2019). Public beliefs governing societies and conventional policies in countries are one of the main obstacles to the marriage of disabled people (Li & Singleton, 2016).

In general, marriage and mate choice are of the basic social and psychological problems of girls with blindness and VI. Considering the special cultural sensitivities of the Iranian society toward the marriage of girls and the negative views about celibacy, marriage has become a challenge for this group of girls. Blind and VI people face major problems in getting married and forming a life, including unemployment, high cost of living, negative beliefs, or biased public views. Even health care experts have negative attitudes toward the marriage of these people (Peta, 2017). Accordingly, it is essential to explore mate choice problems and marriage issues among Iranian girls with blindness and VI. An important thing to note is the small number of qualitative studies in this field in Iran and other countries. Thus, this qualitative phenomenological study aims to provide an in-depth analysis of the psychosocial experiences of VI and blind girls about mate choice and marriage criteria.

Method

This qualitative study was conducted using a descriptive phenomenological research design. In this type of study, the researcher explores the lived experiences of people and seeks to discover the meaning of the phenomena from their point of view (Valle & King, 1978). People narrate their actions or experience and feelings to the researcher, and the researcher then interprets their statements. This research method can provide researchers with information about the participants’ experiences and views. Accordingly, this phenomenological study aimed to analyze the psychosocial experiences of blind and VI girls about the ideal husband and marriage. The research population included girls with blindness and VI who were members of the White Cane Society of Tehran in 2021. In phenomenological studies, sampling should continue until the data collected about the phenomenon in question are saturated, that is, when no significant information is obtained with further sampling (17). The participants in this study were selected through purposive sampling, and data collection continued until the data were saturated by interviewing 20 girls. To check the degree of blindness and VI, the International Classification of Diseases 11, Fricke et al. (2018) classifies vision impairment into two groups, distance and near presenting vision impairment.

The selection criteria for the participants in the study were: (1) having at least a high school diploma for the interview and the ability to understand the content of the interviews, (2) having disability records in the welfare department and being a member of the Tehran White Cane Society, (3) the girls who were planning to get married, and (4) the girls of marriageable age (20–35 years). The exclusion criteria were: (1) single participants who had married previously and (2) those who had other physical and mental disabilities in addition to visual disabilities.

To eliminate the researcher’s bias in her personal views and inference in detecting the saturation of the data, not only sampling continued until the data were saturated, but also the data collected from the participants were reviewed by three professors of mental rehabilitation, ophthalmology, and nursing and data collection continued until the adequacy of the data was confirmed by the three experts.

The data were collected through semi-structured interviews to explore the experiences of VI and blind girls and their views about marriage and mate choice criteria. Before conducting the interviews, it was ensured that the participants were involved and had experiences with the subject, and intended to get married. Examples of the questions asked in the interviews were: What experiences and views do you have about mate choice? What personal experiences do your family and people around you have about the criteria for choosing your future partner?

Before starting the interview, the researcher introduced herself and the research topic. Each interview lasted from 45 to 70 min, totaling 1240 min. The interviews were conducted from 10 April to 20 October 2021. The location of the interviews was the White Cane Society in Tehran. First, the participants’ demographic information, including age, education, employment, the field of study, parents’ kinship, type of disability, medical class, cause of disability, and place of residence were recorded. All interviews were conducted in person. Then, the participants responded to the main interview questions. At the end of each interview, the content of the interview was transcribed for subsequent coding and analysis.

The collected data were analyzed using Colaizzi’s seven-step method (Shosha, 2012). In the first step, at the end of each interview and taking field notes, the researcher listened to the participants’ recorded statements several times and transcribed their statements word by word on paper. Then, the transcripts were reviewed several times to understand the participants’ feelings and experiences. In the second step, the significant statements related to the phenomenon in question were identified and underlined. In the third step, the themes related to each statement that reflected the participants’ ideas and experiences were extracted and classified. The extracted themes were then compared with the corresponding statements to ensure their relevance. In the fourth step, the researcher carefully reviewed the themes and classified them into related categories based on their similarities. The related categories were merged into thematic clusters. In the fifth step, the emerged thematic clusters were merged into more general categories. In the sixth step, a thorough description of the phenomenon in question was provided. Finally, in the seventh step, the findings were reviewed and confirmed by asking the participants to express their opinions about the findings of the study.

To check the rigor of the study, the credibility and trustworthiness criteria proposed by Guba and Lincoln (1994) were used. This was done through long engagement with the research setting, triangulating the findings with the previous studies in the literature on obstacles to the marriage of people with sensory disabilities and the experiences of blind and VI girls, engaging the participants and returning to them frequently in interpreting the data and reviewing the findings (member checking), and describing the research procedures clearly to help readers understand the findings. The findings were also reviewed by the two professors (peer checking) in the qualitative research. To comply with the ethical principles for voluntary participation and withdrawal, conducting the interviews, and recording the participants’ voices, informed consent was obtained from them. The participants were also reassured of the confidentiality of their names, phone numbers, and addresses. After the interview, the recorded voices of the participants will be stored in a secure place for 5 years, after which they will be destroyed. The protocol for this study was confirmed by the Research Council of Khatam University.

Results

Table 1 shows the participants’ demographic characteristics.

OPEN IN VIEWER

Table 1.

The participants’ demographic data.

Code	Age	Education	Field of study	Parental marriage	Occupation	Type of VI	Visual classification	Cause of VI	Living conditions
1	34	Master’s	Counseling	Cousin	Operator	Retinal tear	B1	Trauma during pregnancy	Independent
2	37	Master’s	Criminology	Cousin	Legal expert	RP	B2	Genetic factors	Living with parents
3	35	Bachelor’s	English literature	Cousin	Translator	RP	B2	Genetic factors	Living with parents
4	36	Master’s	Physical education	Cousin	Sport trainer	Optic atrophy	B3	Congenital	Living with parents
5	39	Bachelor’s	Islamic jurisprudence	Cousin	Unemployed	Retina tear	B3	Car crash	Living with parents
6	36	Bachelor’s	Social work	Cousin	Operator	Cataracts	B2	Genetic factors	Independent
7	25	Master’s	Music and Iranian musicianship	Non-cousin	Music teacher	Retina tear	B1	Congenital	Living with parents
8	29	PhD	Sociology	Cousin	Librarian	RP	B1	Genetic factors	Living with parents
9	36	Master’s	Counseling	Cousin	Counselor	Retina tear	B3	Congenital	Living with parents
10	25	Associate’s	Management	Cousin	Salesperson	Nerve palsy	B3	Brain tumor	Living with parents
11	25	High school diploma	Accounting	Cousin	Unemployed	Nerve palsy	B3	Brain tumor	Living with parents
12	37	Master’s	Management	Cousin	Secretary	Retina tear	B3	Falling from height	Living with parents
13	39	Master’s	History	Cousin	Researcher	RP	B1	Genetic factors	Living with parents
14	30	Master’s	Law	Cousin	Legal consultant and professor	Optic atrophy	B3	Congenital	Living with parents
15	29	Bachelor’s	Social sciences–research	Non-cousin	Order register	LCA	B1	Genetic factors	Living with parents
16	27	Master’s	Counseling	Cousin	Counselor	Optic atrophy	B1	Congenital	Living with parents
17	35	Bachelor’s	General psychology	Cousin	Order register	RP	B2	Genetic factors	Independent
18	30	Master’s	Management of educational sciences	Cousin	Unemployed	RP	B2	Genetic factors	Living with parents
19	26	Bachelor’s	Advocacy	Cousin	Legal consultant	Glaucoma	B2	Congenital	Living with parents
20	30	Bachelor’s	Sociology	Cousin	Sound engineer and editor	RP	B1	Genetic factors	Independent

VI: visual impairment; RP: retinitis pigmentosa; LCA: Leber congenital amaurosis.

As can be seen in Table 1, 18 participants out of 20 participants, their parents had a consanguineous marriage. This marriage is encouraged for religious reasons in Iran and other Muslim countries in the Middle East. For this reason, most of the disabilities of people in Iran are also due to genetic reasons (Saadat et al., 2004; Table 2).

Theme 1: experiencing love and freedom

Independence in decision-making

Independence means the ability to think and act without relying on others. For example, a participant stated,

I think by getting married, I will be able to become independent and make progress. I will also have a bit fewer limitation. For example, my parents constantly ask me where I am going, and what I am doing. I cannot take every course or I can’t hang out with anyone. When I get married, I will be relieved from my parents’ strict behavior and somehow, I will experience freedom and independence. (Participant 11)

OPEN IN VIEWER

Table 2.

The subthemes and main themes extracted from the interviews with the participants.

Primary subthemes	Main themes
Independence in decision-making Satisfying psychological, emotional, and sexual needs Experiencing the feeling of motherhood Attaining the position approved by the family	Experiencing love and freedom
The suitable age of the partner The severity of the disability Having religious faith and beliefs Having a receptive family Mutual understanding and respect	Criteria for choosing an ideal partner
Fear of talking about vision problems Inability to do household chores The rejection and judgment from the husband’s family Rejection by the partner Giving birth to a disabled child	Fear and worry about marital life in the future
The inability of blind people to marry The perception that blind people do not need to marry	Stigma and strict public judgments

Meeting psychological, emotional, and sexual needs

People marry to survive their generation and meet their mental, emotional, and sexual needs. One of the participants pointed out,

I want to marry to reach mental, spiritual, and psychological peace through love. I don’t think about anything else in marriage because, in my opinion, there is nothing more pleasant than that two people love each other so much that they enrich and free each other from everything in this world and they support each other and live peacefully together. In my opinion, marriage has no higher purpose than that two people support and rely on each other and bring peace to each other. The biggest goal in marital life is to achieve peace and of course, marriage is also an emotional and sexual need that must be satisfied. (Participant 2)

Experiencing the sense of motherhood

For many women, one of the most beautiful experiences in life is the feeling of motherhood, as was frequently highlighted by the participants. For example, a participant stated,

When you are young and up to 25 years old, you have a lot of energy and you are busy with work, studies, etc. so that you don’t think about finding a good partner. I didn’t think about marriage then and I believed that I still had enough time. But not anymore. When you see that everyone is getting married, you will not be satisfied, no matter you have a good job and something is missing with you because everything must be done at its right time. You suddenly end up being alone and longing for having children but you have not married yet. I love children and want to have 5–6 children. Sometimes I think how hard it is to come into this world as a woman without experiencing the feeling of motherhood for a moment. It’s very sad. (Participant 4)

Attaining the position approved by the family

In some cases, people marry to gain approval from the family. For example, a participant said,

Many times, marriage gives a person a sense of approval. When you see your brothers or sisters married and how much more respected by other family members or parents, you also want to get married as if to prove yourself that you can get married too. (Participant 13)

Discussion

The findings of the present study showed that the marriage of blind girls is associated with fear and hope. This means that VI and blind girls face many challenges in Iranian society in terms of the criteria for selecting a partner and starting martial life. However, they want to marry to experience love and freedom. Some Iranian families are sensitive to girls’ freedoms, and sometimes girls have to marry just to gain freedom and get rid of the pressures and the strict family atmosphere. At the same time, these girls referred to the sense of motherhood and emotional needs as other factors in their desire to get married. Similarly, Shpigelman and Vorobioff (2021) showed that romantic relationships in adults with vision disorders lead to self-acceptance and psychological well-being. Although, individual, cultural, religious, and gender-related factors can be influential in the formation and continuation of a romantic relationship (Shpigelman & Vorobioff, 2021). The participants in the present study considered some criteria for marriage, including the suitable age of the partner, the severity of the disability, having religious faith and belief, a receptive family, and mutual understanding and respect. In line with these findings, Kapperman and Kelly (2019) examined the criteria for mate choice according to gender. They found that girls with vision problems choose their husbands based on higher education, social status, and financial resources. Higher body size and strength are also important (Kapperman & Kelly, 2019). The present study also showed that the spouse’s family and having a good family were also important criteria due to cultural differences. Moreover, blind and VI girls tend their husbands to be at a suitable age that is, not too old or too young. Some participants emphasized the beautiful and expressive voice of their ideal partner as one of their criteria for marriage. Accordingly, the researchers showed that auditory ability is an important mate selection criterion for both men and women with blindness disorders (Scheller et al., 2021; Sorokowska et al., 2018). Another study showed that emotional maturity is an important criterion for marriage for VI youth (Pinquart & Pfeiffer, 2012). Moreover, Fekler et al. showed that people with VI did not have much difference in ideal romantic partners with sighted people. However, VI was a problem in finding a mate and offered proposals (Fekler et al., 2020).

Although studies have provided some evidence for the ideal partner criteria for VI girls, the concerns and psychosocial problems experienced by these girls about having a marital life have been less addressed or not addressed at all. The participants in the present study stated that they had many fears about their marital life in the future. For instance, they feared that their vision or their disability worsens, they could perform housework and conjugal duties, and eventually, their husbands get tired of them and leave them.

The perception that people with VI do not need to marry and have sexual relations is one of the basic problems to address the importance of psychological and social needs of this group of people for marriage. Even there are some social and cultural obstacles to education on sexuality and sexual health. People with VI face many challenges to sexual health education like health issues, communication problems, and people’s acceptance of the inhibition of their sexuality (Jablan & Sjeničić, 2021).

The participants in this study stated having an emotional and sexual relationship is essential for the continuation of marital life. However, the importance of teaching sexual organ physiology, sexual health education, creating educational content and the necessity of people’s participation in sex education should be highlighted in rehabilitation and treatment programs (Aghaee-Chaghooshi et al., 2021; Kapperman & Kelly, 2013; Wild et al., 2014).

Previous studies have revealed that the marriage of disabled people is very different depending on the type of disability and even the gender of disabled people. For example, Bekoe (2018) examined the challenges of disabled people’s marriage and showed that blind and VI people are subject to more social judgment and rejection for marriage, and there are more problems faced by blind women. Furthermore, Anderson (2018) considers the role of social relationships and interactions to be very important for marriage in people with disabilities. The findings also indicated that disabled people generally experience higher social isolation, low self-esteem, and more depression than non-disabled people. Therefore, they have fewer social activities and less chance of getting married (Anderson, 2018). Likewise, other studies have shown that the level of life expectancy and hope for the future in blind girls are much lower than their sighted counterparts (Monah, 2018).

In addition to the physical and psychological challenges that VI and blind girls face on the path to choosing an ideal spouse and marriage, social rejection and the belief that blind and VI girls do not need to marry are other problems on their way to marriage. This problem is worsening in developing and poor countries. For example, Monah (2018) investigated the public opposition to the marriage of disabled people in Kenya and concluded that families, relatives, and even the public systematically do not accept the presence of people with visible disabilities in the community, and this opposition is more server for women and girls. Similarly, the studies conducted in Western countries do not consider cultural restrictions the only obstacles to the marriage of these people, but also the type of national and community policies, which reduce the chance of interaction and finding a partner for these people (Caputo & Simon, 2013).

Limitations

The present study was conducted with some limitations, including the difficulty of conducting interviews due to the participants’ physical conditions and restrictions in their transportation and movement. Moreover, the participants were selected only from blind and VI girls in the Tehran White Cane Society. These participants did not represent blind or VI girls ready for marriage in the cities and villages and illiterate or low-educated people in Iran.

Conclusion and implication

The findings of the present study highlighted two basic issues: The first issue was related to the perspective of VI and blind girls regarding their psychological and personal challenges and concerns about marriage and their marital life, which may be rooted in their low social activities and poor self-esteem and self-concept. The second challenge was the family and public rejection and the perception that blind and VI girls do not need to marry. However, the findings of this study highlighted that emotional, psychological, and sexual needs are not related to the appearance or the visual power of people. Besides, since marriage and mate choice are considered human needs in all cultures regardless of their differences, non-governmental organizations (NGOs) and organizations supporting the blind should provide an opportunity for these people to get acquainted with other people by holding various social events. Moreover, educating and raising the awareness of the public, mental health professionals, and health care workers about the psychological and sexual needs of blind and VI is essential. Future studies can also focus on the perceptions and beliefs of the families of girls with IV about marriage and address the role of gender differences in women’s and men’s experiences.