Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

Abstract

Background Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/“stealthing”, reproductive coercion, ability to refuse sex, and contraceptive confidence). Methods Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15–24 recruited via respondent-driven sampling in Abidjan, Côte d’Ivoire (n = 555; 2018–19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use. Findings Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing. Interpretation AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.

A Scoping Review of Nonconsensual Condom Removal (“Stealthing”) Research

“…Correlates of NCCR victimization were reported in nine (33.3%) of the 27 articles and correlates of NCCR perpetration were reported in one article (3.7%; see Table 3). Findings showed that individuals who identified as racial or sexual minorities (Boadle et al, 2021; Bonar et al, 2021) or were in nonexclusive, noncommitted relationships (Boadle et al, 2021; Lévesque et al, 2021) or transactional relationships (Decker et al, 2021) were at higher risk for NCCR victimization. Moreover, psychological challenges such as decreased confidence (Boadle et al, 2021), guilt and worry (Lévesque & Rousseau, 2021), and fear and depression (Latimer et al, 2018; Tarzia et al, 2020)—as well as sexual abuse (Czechowski et al, 2019), STIs, and unintended pregnancies (Czechowski et al, 2019; Nikolajski et al, 2015)—were noted correlates of NCCR victimization.…”

“…Some reported experiencing STIs and unintended pregnancy from NCCR. Decker et al (2021) Lifetime stealthing was significantly more common among women with a history of transactional sex outside the relationship. Latimer et al (2018) Women who had been stealthed were more likely to be a current sex worker.…”

“…0.0% of men had a partner intentionally damage a condom. Decker et al (2021) 15.6% of women in Nairobi, 41.9% of women in Adidjan, and 26.7% of women in Lagos had experienced stealthing in their lifetime. Grace et al (2022) 38.2% of the women who experienced RC had a partner remove the condom during sex when they did not want to.…”

Prevalence and characteristics of covert contraceptive use in the Performance Monitoring for Action multi-country study

“…Conversely, women in more casual relationships may believe family planning to be in the realm of female decision-making rather than one to be made jointly [3] . Or it may be that women in both polygynous and casual relationships have less bargaining power within the relationship compared to women in monogamous relationships, and are therefore less able to communicate and collaborate around decisions on contraceptive use [18] .…”

Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women’s contraceptive use in Burkina Faso, Côte d’Ivoire and Kenya

“…However, including pregnant women in the sample would also lead to a systematic attenuation of the results between RC and contraceptive use given that these women are not in need of contraception. Women in dating partnerships were also excluded from the present analysis due to embedded survey skip logic, though evidence among urban adolescents and young women indicates high prevalence of RC29; further research and oversampling is needed to understand reproductive health needs for this high risk subpopulation. Social desirability biases and privacy concerns could further contribute to under-reporting of experiences of violence, despite extensive training and privacy protocols aligned with best practices 22 23…”