Safer sex negotiation and parity among women in sub-Saharan Africa

Abstract

Women’s ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15–49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75–0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women’s ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.

Women’s ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria

“…Four, the determinants of women's ability to negotiate safer sex differ among contraceptive users and non-users. In line with existing studies, it was found among nonusers that child marriage [44], mass media [1], healthcare autonomy [50], financial autonomy [51], parity [45], household wealth, and partners' education [4] are important determinants of safer sex negotiation. However, most of these determinants were not found significant among contraceptive users.…”

“…The threshold of women's autonomy is the ability to negotiate safer sex with partners. Such negotiation in many developing countries where patriarchy remained dominant is likely to lead to a positive change in existing gender norms within marital or sexual relationships, which may translate into improving women's capacity to protect themselves from sexually transmitted infections [22,25], unintended pregnancies [23], and other adverse health outcomes [26,27]. In this paper, we assessed the prevalence of women's ability to negotiate safer sex by contraceptive status, and also examined the determinants of women's ability to negotiate safer sex among contraceptive users and non-users.…”

“…One, eight socio-demographic characteristics associated with safer sex negotiation in previous studies were selected. These are age [3], child marriage [44], education [32], parity [45], media exposure [1], religion [4], work status [2], and experience of female genital mutilation [46]. Age was grouped into three categories 15-24, 25-34, and 35 years or older.…”

“…Two, it indicates the extent to which a woman is able to protect herself from sexually transmitted infections, unintended pregnancies, and the accompanying health and childbearing challenges. Many studies have documented how women's lack of power to negotiate safer sex elevates their risks of sexually transmitted infections including HIV/AIDS, as well as unintended pregnancies, and abortion [18][19][20][21][22]. A recent study in Sierra Leone [23] observed that the rate of unintended pregnancies will continue to increase if women do not take the initiative to protect themselves.…”

Association between women’s empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries

“…However, it is essential to recognise that the impact of religion on contraceptive use is influenced by a complex interplay of socioeconomic and cultural factors 28 42. Factors such as education and gender equality not only affect women’s access to and utilisation of modern contraceptives but also their ability to properly use traditional contraceptives, which require knowledge of the ovulatory cycle and negotiation within intimate relationships 12–14 43 44…”