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

Plain English SummaryExisting 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. BackgroundExisting 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.MethodsThe 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.ResultsFindings 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.ConclusionThe 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.

Automated summary

Existing studies have shown that negotiation of safer sex affects contraceptive use, and it is expected that women who can negotiate safer sex will use contraception. However, not all contraceptive users have the ability to negotiate safer sex, and there is no evidence that all non-users are unable to negotiate safer sex with partners. This study aims to assess the prevalence of women's ability to negotiate safer sex and examine the determinants of this ability among contraceptive users and non-users. The findings suggest that the ability to negotiate safer sex differs between these two groups, and new strategies promoting reproductive autonomy are needed for contraceptive users.