Socio cultural factors. The entire participant of focus group agreed that there was a culture that encourages males as decision maker on all family matters. This habit also exacerbated by poor discussion in the family on all family issues. On the other hand there is a culture that encourages many number of children and that provides great social value for large family size. Even one participant said “lijoch ye’egzaber xxxxx nachew”.This culture inhibits spouses to practice family planning methods. One discussant said that Other cultural barrier that was explained by study participant was perception of community children as an asset socially and economically gain from having a large number of children, fear and low desire by men to practice family planning method, fear among females to disclose the benefit of family planning, gender-based power imbalance in the issue of sexual and reproductive health, low Habit in spousal discussion, and family planning rumors in the community such as contraception causes sterility. But the discussant perceived that this should be changed.
Socio cultural factors. There is increasing evidence to suggest that social factors play a role in the development of ED. According to the Tripartite Influence Model of body image and eating disturbance (Xxxxx, Van den Xxxx, & Xxxxxxxx, 2004), social-cultural factors such as peers, parents and media, influence body image and eating difficulties. The model suggests that social-cultural factors influence body image and eating difficulties through internalisation of the thin-ideal and appearance comparison processes. Pressure to be thin has also been recognised as socio-cultural risk factor (Xxxxx, 2002). Meal times play a key role in interpersonal behaviour, unfavourable social comparisons fuel weight and shape concerns and the drive for thinness (Fairburn et al., 1998; Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004; Stice, Ng, & Xxxx, 2010; Xxxxx, 2002). Critical comments made by others, about weight and/or shape, have been linked with the development of BN (Fairburn et al., 1997; Xxxxxxxx et al., 2001). Also criticism, teasing and bullying which focus on food, weight and shape are associated with the risk for ED (Xxxx & Xxxxx, 2007). The neurodevelopmental model of AN (Connan, Campbell, Katzman, Lightman, & Treasure, 2003) focuses on the relationship between negative interpersonal experiences during adolescence and disordered eating. The model proposes that the adolescent period increases vulnerability to chronic stress which accompanies hypothalamic-pituitary-adrenal (HPA) axis dysregulation. It is suggested that stressful experiences, like negative interpersonal experiences, impair HPA axis response by elevating activity of the corticotrophin releasing hormone (CRH). As a result an imbalance between the anabolic and catabolic pathways of the hypothalamus could lead to a loss of appetite and weight. Negative interpersonal experiences could be linked with the development of ED. Genetic, epigenetic and social influences have been implicated in the development of ED.
