Background Safer sex negotiation refers to the means through which partners in sexual relationships agree to have intercourse that protects both partners from adverse sexual health outcomes. Evidence is sparse on the socio-cultural barriers to safer sex negotiation, especially in Northwest Nigeria where almost every aspect of women’s lives is influenced by religious and cultural norms. Understanding the socio-cultural barriers requires having knowledge of the perspectives of community stakeholders such as religious leaders, and community leaders. Thus, from the perspectives of community stakeholders, this study explored the perception and socio-cultural barriers to safer sex negotiation of married women in Northwest Nigeria. Method A qualitative research design was adopted. Participants were purposively selected across six states, namely, Kano, Katsina, Jigawa, Kebbi, Kaduna, and Zamfara. Data were collected through Key Informant Interview (KII). A total of 24 KIIs were conducted using the in-depth interview guide developed for the study. The selection of the participants was stratified between rural and urban areas. The interviews were tape-recorded, transcribed, and translated from the Hausa language into the English language. Verbal and written informed consent were obtained from participants prior to the interviews. Data were analyzed using inductive thematic content analysis. Results Safer sex negotiation was well-understood by community stakeholders. Men dominate women in sexual relationships through the suppression of women’s agency to negotiate safer sex. Married women endured domination by males in sexual relationships to sustain conjugal harmony. The practice of complying with traditional, cultural, and religious norms in marital relationships deters women from negotiating safer sex. Other socio-cultural causes of the inability to negotiate safer sex are child marriage, poverty, poor education, and polygyny. Conclusion Community stakeholders have a clear understanding of safer sex negotiation in Northwest Nigeria but this has not translated into a widespread practice of safer sex negotiation by married women due to diverse socio-cultural barriers. Strategies that will empower women not only to gain more access to relevant sexual and reproductive health information and services but also to encourage women’s assertiveness in family reproductive health decisions are imperative in Northwest Nigeria.
Background Extant studies have established diverse individual-level and relational-level predictors of sexual autonomy among women in different countries. However, information remains scanty about the predictors beyond the individual and relational levels particularly at the community level. This study examined the multi-level predictors of sexual autonomy in Nigeria. This was done to shed more light on the progression toward attaining women-controlled safe sex in Nigeria. Methods This study adopted a cross-sectional design that utilised the 2018 Nigeria Demographic and Health Survey (NDHS) data. The study analysed responses from 8,558 women. The outcome variable was sexual autonomy, while the explanatory variables were individual-level (maternal age group, maternal education, nature of first marriage, parity, work status, religion, and media exposure), relational-level (spousal violence, type of marriage, spousal living arrangement, household wealth quintile, alcoholic consumption, family decision-making, and degree of marital control), and community-level characteristics (community residency type, geographic region, community literacy, female financial inclusion in community, female ownership of assets in community, and community rejection of wife-beating). Statistical analyses were performed using Stata version 14. The multilevel regression analysis was applied. Statistical significance was set at p < 0.05. Results Findings showed that parity, nature of first marriage, maternal education, media exposure, work status, and religion were significant individual-level predictors, while spousal violence, degree of marital control, type of marriage, family decision-making, and household wealth quintile were significant relational-level predictors of sexual autonomy. Results further showed that community-level characteristics also significantly predicted sexual autonomy. The likelihood of sexual autonomy was lower among rural women (aOR = 0.433; 95% CI 0.358–0.524), while the odds of sexual autonomy were higher among Southern women (aOR = 3.169; 95% CI 2.594–3.871), women who live in high literate communities (aOR = 3.446; 95% CI 3.047–3.897), women who reside in communities with high female financial inclusion (aOR = 3.821; 95% CI 3.002–4.864), and among women who live in communities with high female ownership of assets (aOR = 1.907; 95% CI 1.562–2.327). Conclusion Women’s sexual autonomy was predicted by factors operating beyond the individual and relational levels. Existing sexual health promotion strategies targeting individual and relational factors in the country should be modified to adequately incorporate community-level characteristics. This will enhance the prospect of women-controlled safe sex in Nigeria.
Background Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with a high rate of unintended pregnancies leading to unsafe abortions, maternal morbidity and mortality. In Nigeria, little is known about modern contraceptive discontinuation using the calendar data. Methods A cross-sectional research design from the 2018 Nigeria Demographic and Health Surveys (NDHS) women’s dataset was used to examine the prevalence and associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria. A weighted sample size of 3,353 currently sexually active married or in union women who have ever used a modern contraceptive 5 years before the survey and with complete reproductive histories and are not sterilised or declared infecund was analysed. Data were analysed and displayed using frequency tables and charts, chi-square test, and binary logistic regression model at 5% level of significance. Results The prevalence of modern contraceptive discontinuation was 35.8% (1199) with 45.8% (549) of the women discontinuing using modern contraceptives while at risk of pregnancy. The most modern method discontinued was Injectables (25.2%) while the commonest reason for modern method discontinuation was because they wanted to become pregnant (36.1%). Associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria were: marital duration (aOR = 3.0; 95%CI: 1.5–6.2), visitation to a health facility in the last 12 months before the survey (aOR = 0.6; 95%CI: 0.4–0.8), education (aOR = 2.0; 95%CI: 1.2–3.4) and region of residence (aOR = 2.7; 95%CI: 1.6–4.7). Conclusion Modern contraceptive discontinuation among the study respondents was high. Region of residence, health facility visitation and marital duration were significantly associated with modern contraceptive discontinuation. The study suggests that health care providers should address the discontinuation of contraception through counselling, particularly among women who reside in the region of high prevalence of contraceptive discontinuation, short-term users as well as strengthen the use of contraception among those who are still at risk of becoming pregnant. Governments and stakeholders should also partner with private sectors to make health care accessible to women by bring health facilities closer to them to improve facility visitation.
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