Women’s ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria
Tóm tắt
Existing studies established that safer sex negotiation influences contraceptive use, and women who are able to negotiate safer sex were expected to be contraceptive users. However, it is not certain that all contraceptive users have the ability to negotiate safer sex. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners. The study assesses the prevalence of women’s ability to negotiate safer sex and examines the determinants of women’s ability to negotiate safer sex among contraceptive users and non-users. The comparative cross-sectional research design was adopted. Data were extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a sample of 2,765 contraceptive users and 20,304 non-users. The outcome variable was women’s ability to negotiate safer sex with partners. The explanatory variables examined are eight socio-demographic characteristics (age, child marriage, education, parity, media exposure, religion, work status, and experience of female genital mutilation), six relational characteristics (healthcare autonomy, financial autonomy, household wealth quintile, partners’ education, ownership of assets, and type of marriage). Attitude to wife-beating, male controlling behavior, place of residence, and geo-political zone of residence were included as control variables. Multivariable regression models were estimated. Findings showed that 6.2% of women who were not able to negotiate safer sex were contraceptive users, while 15.9% of women who were able to negotiate safer sex were contraceptive users. Among non-users, the significant determinants were child marriage, education, parity, mass media exposure, religion, work status, healthcare autonomy, financial autonomy, household wealth, partner education, type of marriage, geo-political zone, attitude to wife-beating, and male controlling behavior. Regarding contraceptive users, the significant determinants were parity, religion, the experience of female genital mutilation, financial autonomy, partner education, type of marriage, and the geo-political zone of residence. The ability to negotiate safer sex differs among contraceptive users and non-users. Also, the determinants of the ability to negotiate safer sex differ among contraceptive users and non-users. While existing strategies may continue to focus on women not using contraceptives, new strategies promoting reproductive autonomy are required among contraceptive users. Existing studies established that safer sex negotiation influences contraceptive use, and women who are able to negotiate safer sex were expected to be contraceptive users. However, it is not certain that all contraceptive users have the ability to negotiate safer sex. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners. The objectives of the study were to assess the prevalence of women’s ability to negotiate safer sex and to examine the determinants of women’s ability to negotiate safer sex among contraceptive users and non-users. The comparative cross-sectional research design was adopted. Data were extracted from the most recent Nigeria Demographic and Health Survey. Samples of contraceptive users and non-users were analyzed in the study. The outcome variable was women’s ability to negotiate safer sex with partners. The explanatory variables examined are eight socio-demographic characteristics (age, child marriage, education, parity, media exposure, religion, work status, and experience of female genital mutilation), six relational characteristics (healthcare autonomy, financial autonomy, household wealth quintile, partners’ education, ownership of assets, and type of marriage). Attitude to wife-beating, male controlling behavior, place of residence, and geo-political zone of residence were included as control variables. Findings showed a higher ability to negotiate safer sex among contraceptive users. There were differences in the determinants of safer sex negotiation among contraceptive users and non-users. The study concluded that the ability to negotiate safer sex and its determinants differs among contraceptive users and non-users. It was suggested that while existing strategies may continue to focus on women not using contraceptives, new strategies promoting reproductive autonomy are required among contraceptive users.
Tài liệu tham khảo
Aboagye RG, Ahinkorah BO, Seidu A-A, Adu C, Hagan JE, Amu H, et al. Mass media exposure and safer sex negotiation among women in sexual unions in sub-saharan Africa: analysis of demographic and health survey data. Behav Sci. 2021;11:63. https://doi.org/10.3390/bs11050063.
Seidu A-Z, Aboagye RG, Okyere T, Agbemavi W, Akpeke M, Budu E, et al. Women’s autonomy in household decision-making and safer sex negotiation in sub-saharan Africa: an analysis of data from 27 demographic and health surveys. SSM - Popul Health. 2021;14:100773. https://doi.org/10.1016/j.ssmph.2021.100773.
Sano Y, Sedziafa AP, Vercillo S, Antabe R, Luginaah I. Women’s household decision- making autonomy and safer sex negotiation in Nigeria: an analysis of the Nigeria demographic and health survey. AIDS Care. 2018;30(2):240–5. https://doi.org/10.1080/09540121.2017.1363363.
Feyisetan B, Oyediran KO. Can married or cohabiting women negotiate protective sex? Findings from demographic and health surveys of two west african countries. J Biosoc Sci. 2020;52(6):785–808. https://doi.org/10.1017/S0021932019000798.
Solanke BL, Awoleye AF, Ikotun FF, Ogunjuyigbe PO. Timing of first marriage and women’s ability to negotiate safer sex in Nigeria. Sex Relatsh Ther. 2021. https://doi.org/10.1080/14681994.2021.1900559.
Sunmola AM, Mayungbo OA, Fayehun OA, Opayemi RS, Morakinyo LA. Is women’s tendency to negotiate safer sex another opportunity for intimate partner violence in Nigeria? J Interpers Violence. 2021;36(7–8):3624–45. https://doi.org/10.1177/0886260518779071.
Amoyaw JA, Kuuire VZ, Boateng GO, Asare-Bediako Y, Ung M. Conundrum of sexual decision making in marital relationships: Safer-sex knowledge, behavior, and attitudes of married women in Zambia. J Sex Res. 2015;52(8):868–77. https://doi.org/10.1080/00224499.2014.996280.
Ruby Grant and Meredith Nash. Navigating unintelligibility: Queer Australian young women’s negotiations of safe sex and risk. J Health Psychol. 2018;23(2):306–19. https://doi.org/10.1177/13591053177416.
Bras H, Smits J. Contexts of reproduction: gender dynamics and unintended birth in sub- Saharan Africa. J Marriage Fam. 2021. https://doi.org/10.1111/jomf.12807.
Orisaremi TC. Gender, sexual health seeking behavior, and HIV/AIDS among Tarok Women in North-Central Nigeria. Health Care Women Int. 2016;37(6):687–704. https://doi.org/10.1080/07399332.2014.971953.
Princewill CW, Wangmo T, Jegede AS, Riecher-Rossler A, Elger BS. Bride price payment and women’s autonomy: findings from qualitative interviews from Nigeria. Women Health. 2019;59(7):775–88. https://doi.org/10.1080/03630242.2018.1549645.
Sunmola AM, Sambo MN, Mayungbo OA, Morakinyo LA. Moderating effect of husband’s controlling attitudes on the relation between women’s household decision-making autonomy and intimate partner violence experience in Nigeria. J Interpers Violence. 2021;36(21–22):NP12125–54. https://doi.org/10.1177/0886260519888534.
Ajayi CE, Chantler K, Radford L. The role of cultural beliefs, norms, and practices in nigerian women’s experiences of sexual abuse and violence. Violence Against Women. 2021;28(2):465–86. https://doi.org/10.1177/10778012211000134.
Rizvi N, Khan KS, Shaikh BT. Gender: shaping personality, lives and health of women in Pakistan. BMC Womens Health. 2014;14(53). https://doi.org/10.1186/1472-6874-14-53.
Stern E, Heise L, McLean L. The doing and undoing of male household decision-making and economic authority in Rwanda and its implications for gender transformative programming. Cult Health Sex. 2018;20(9):976–91. https://doi.org/10.1080/13691058.2017.1404642.
Khumalo S, Taylor M, Makusha T, Mabaso M. Intersectionality of cultural norms and sexual behaviours: a qualitative study of young black male students at a university in KwaZulu-Natal, South Africa. Reprod Health. 2020;17(188). https://doi.org/10.1186/s12978-020-01041-3.
Achen S, Rwabukwali CB, Atekyereza P. Socio-cultural perceptions of sexuality influencing the sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda. Social Sci Humanit Open. 2021;4:100191. https://doi.org/10.1016/j.ssaho.2021.100191.
Rominski SD, Gupta M, Aborigo R, Adongo P, Engman C, Hodgson A, Moyer C. Female autonomy and reported abortion-seeking in Ghana, West Africa. Int J Gynaecol Obstet. 2014;126(3):217–22. https://doi.org/10.1016/j.ijgo.2014.03.031.
Osuafor GN, Mturi AJ. Attitude towards sexual control among women in conjugal union in the era of the HIV/AIDS epidemic in Mahikeng, South Africa. Afr Popul Stud. 2014;28(1):538–50.
Potter JE, Stevenson AJ, Coleman-Minahan K, Hopkins K, White K, Baum SE, Grossman D. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception. 2019;100(1):1–4. https://doi.org/10.1016/j.contraception.2019.02.005.
Spindola T, Costa Santana RS, Antunes RF, Machado YY, de Moraes PC. Prevention of sexually transmitted infections in the sexual scripts of young people: differences according to gender. Ciencia & Saude Coletiva. 2021;26(7):2683–92. https://doi.org/10.1590/1413-81232021267.08282021.
Adu C, Frimpong JB, Mohammed A, Tetteh JK, Budu E, Ahinkorah BO, Seidu A-Z. Safer sex negotiation and parity among women in sub-saharan Africa. J Biosoc Sci. 2022;1–13. https://doi.org/10.1017/S0021932021000651.
McLean KE, Thulin EJ. “If the woman doesn’t prevent, you will become pregnant”: exploring male involvement in contraceptive use preceding unplanned pregnancy in Sierra Leone. Stud Fam Plan. 2022;53(1):153–71.
Adebayo SB, Olukolade RI, Idogho O, Anyanti J, Ankomah A. Marital status and HIV prevalence in Nigeria: implications for effective prevention programmes for women. Adv Infect Dis. 2013;3:210–8. https://doi.org/10.4236/aid.2013.33031.
Fagbamigbe AF, Adebayo SB, Idemudia E. Marital status and HIV prevalence among women in Nigeria: ingredients for evidence-based programming. Int J Infect Dis. 2016;48:57–63. https://doi.org/10.1016/j.ijid.2016.05.002.
Urry K, Chur-Hansen A. Who decides when people can have sex? Australian mental health clinicians’ perceptions of sexuality and autonomy. J Health Psychol. 2020;25(13–14):2188–99. https://doi.org/10.1177/1359105318790026.
Memiah P, Opanga Y, Bond T, Cook C, Mwangi M, Fried J, et al. Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis. PLoS ONE. 2019;14(2):e0212413. https://doi.org/10.1371/journal.pone.0212413.
Patrikar SR, Basannar DR, Sharma MS. Women empowerment and use of contraception. Med J Armed Forces India. 2014;70:253–6. https://doi.org/10.1016/j.mjafi.2013.12.014.
Asaolu IO, Okafor CT, Ehiri JC, Dreifuss HM, Ehiri JE. Association between measures of women’s empowerment and use of modern contraceptives: an analysis of Nigeria’s demographic and health surveys. Front Public Health. 2017;4:293. https://doi.org/10.3389/fpubh.2016.00293.
Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reprod Health. 2018;15(214). https://doi.org/10.1186/s12978-018-0658-5.
Sougou NM, Bassoum O, Faye A, Leye MMM. Women’s autonomy in health decision- making and its effect on access to family planning services in Senegal in 2017: a propensity score analysis. BMC Public Health. 2020;20:872. https://doi.org/10.1186/s12889-020-09003-x.
Putra IGNE, Dendup T, Januraga PP. The roles of women empowerment on attitude for safer sex negotiation among indonesian married women. Women Health. 2021;61(1):95–108. https://doi.org/10.1080/03630242.2020.1831685.
Muluneh MD, Francis L, Ayele M, Abebe S, Makonnen M, Stulz V. The effect of women’s empowerment in the utilisation of family planning in western Ethiopia: a structural equation modelling approach. Int J Environ Res Public Health. 2021;18(6550). https://doi.org/10.3390/ijerph18126550.
Some SYM, Pu C, Huang S-L. Empowerment and use of modern contraceptive methods among married women in Burkina Faso: a multilevel analysis. BMC Public Health. 2021;21(1498). https://doi.org/10.1186/s12889-021-11541-x.
Woolfork MN, Fox A, Swartzendruber A, Rathbun S, Lee J, Mutanga JN, et al. Empowerment and HIV risk behaviors in couples: modeling the theory of gender and power in an african context. Women’s Health Reports. 2020;1(1):89–101. https://doi.org/10.1089/whr.2019.0020.
Baiden F, Mensah GP, Akoto NO, Delvaux T, Appiah PC. Covert contraceptive use among women attending a reproductive health clinic in a municipality in Ghana. BMC Women’s Health. 2016;16(31). https://doi.org/10.1186/s12905-016-0310-x.
Kibira SPS, Karp C, Wood SN, Desta S, Galadanci H, Makumbi FE, et al. Covert use of contraception in three sub-saharan african countries: a qualitative exploration of motivations and challenges. BMC Public Health. 2020;20(865). https://doi.org/10.1186/s12889-020-08977-y.
Vishwakarma M, Shekhar C. Covert use of reversible contraceptive methods and its association with husband’s egalitarian gender attitude in India. BMC Public Health. 2022;22(460). https://doi.org/10.1186/s12889-022-12882-x.
Moreira LR, Ewerling F, Barros AJD, Silveira MF. Reasons for non-use of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys. Reprod Health. 2019;16(148). https://doi.org/10.1186/s12978-019-0805-7.
Mukherjee S, Mahapatra B, Saggurti N. Why women do not use contraceptives: exploring the role of male out-migration. PLoS ONE. 2021;16(3):e0249177. https://doi.org/10.1371/journal.pone.0249177.
National Population Commission. National Policy on Population for Sustainable Development. Abuja: NPC; 2021.
StatCorp, Stata. Release 14. Statistical Software. College Station: StataCorp LP; 2015.
National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Abuja and Rockville: NPC and ICF; 2019.
Budu E, Ahinkorah BO, Seidu A-A, Hagan JE Jr, Agbemavi W, Frimpong JB, et al. Child marriage and sexual autonomy among women in sub-saharan Africa: evidence from 31 demographic and health surveys. Int J Environ Res Public Health. 2021;18(3754). https://doi.org/10.3390/ijerph18073754.
Adu C, Frimpong JB, Mohammed A, Tetteh JK, Budu E, Ahinkorah BO, et al. Safer sex negotiation and parity among women in sub-saharan Africa. J Biosoc Sci. 2022. https://doi.org/10.1017/S0021932021000651.
Chai X, Sano Y, Kansanga M, Baada J, Antabe R. Married women’s negotiation for safer sexual intercourse in Kenya: does experience of female genital mutilation matter? Sex Reprod Health. 2017;14:79–84. https://doi.org/10.1016/j.srhc.2017.09.003.
Hannoun A, Usta IM, Awwad J, Moukalled D, Yahya F, Jurdi A, et al. Effect of parity on maternal and neonatal outcomes in twin gestations. Acta Obstet Gynecol Scand. 2012;91:117–21. https://doi.org/10.1111/j.1600-0412.2011.01192.x.
Idoko P, Nkeng G, Anyawu M. Reasons for current pregnancy amongst grand multiparous gambian women - a cross sectional survey. BMC Preg Child. 2016;16(217). https://doi.org/10.1186/s12884-016-1016-7.
Solanke BL. Maternal socio-demographic factors associated with low parity and grand multiparity in Nigeria. Women Health. 2019;59(7):730–47. https://doi.org/10.1080/03630242.2018.1553815.
Ung M, Boateng GO, Armah FA, Amoyaw JA, Luginaah I, Kuuire V. Negotiation for safer sex among married women in Cambodia: the role of women’s autonomy. J Biosoc Sci. 2014;46(1):90–106. https://doi.org/10.1017/S0021932013000151.
Dodoo N, Atiglo DY, Biney AAE, Alhassan N, Peterson MB, Dodoo FN. Does financial autonomy imply reproductive and sexual autonomy? Evidence from urban poor women in Accra, Ghana. Afr Stud. 2019;78(4):477–95. https://doi.org/10.1080/00020184.2019.1584485.
Mtenga SM, Geubbels E, Tanner M, Merten S, Pfeiffer C. ‘It is not expected for married couples’: a qualitative study on challenges to safer sex communication among polygamous and monogamous partners in southeastern Tanzania. Glob Health Action. 2016;9(1):32326. https://doi.org/10.3402/gha.v9.32326.
Eteng MJ. Socio-Cultural issues in gender and healthcare utilization in South East Nigeria. UNIZIK J Gend Res. 2022;1:174–94.
Imo CK, Odimegwu CO, De WetBillings N. Women’s attitudes towards negotiating safe sexual practices in Nigeria: do family structure and decision-making autonomy play a role? BMC Women’s Health. 2022;22:16. https://doi.org/10.1186/s12905-022-01602-7.
Al-Qahtani AM, Ibrahim HA, Elgzar WI, El Sayed HA, Essa RM, Abdelghaffar TA. The role of self-esteem and self-efficacy in women empowerment in the Kingdom of Saudi Arabia: a cross-sectional study. Afr J Reprod Health. 2021;25:69–78. https://doi.org/10.29063/ajrh2021/v25i/s.7. [s1].