Women’s Attitudes Towards Negotiating Safe Sexual Practices in Nigeria: Do Family Structure and Decision-making Autonomy Play a Role?

Abstract BackgroundThe risk of contracting sexually transmitted infections (STIs) is related to women’s sexual attitudes, beliefs, and power dynamics within marriages in developing countries. Despite the interventions towards improving women’s sexual health and well-being, the risk of transmission of STIs which disproportionately affect women continues to be widespread in most sub-Saharan African countries including Nigeria. The dearth of social research on the influence of family structure and decision-making autonomy on women’s attitudes towards negotiating safe sexual practices necessitated this study in Nigeria. MethodsThe study involved analyses of data from nationally representative and weighted sample size of 28,219 ever-married or cohabiting women aged 15-49 years from the 2018 Nigeria Demographic and Health Survey. Descriptive and analytical analyses were carried out, including frequency tables, Pearson’s chi-square test, and multivariate binary logistic regression model.ResultsThe overall prevalence of having strong attitudes towards negotiating safe sexual practices were 76.7% and 69.6% for a wife justified in asking the husband to use a condom if he has an STI and refusing to have sex with the husband if he had sex with other women, respectively. The analyses further showed that polygamous unions negatively influenced urban and rural women’s attitudes towards negotiating safe sexual practices with partners, for instance, the belief that a wife is justified asking the husband to use a condom if he has STI (aOR: 0.71; CI: 0.61-0.83 and aOR: 0.74; CI: 0.67-0.81, respectively). Similarly, urban and rural women whose husbands/partners made independent decisions on their healthcare were less likely to belief that a wife is justified in asking the husband to use a condom if he has STI (aOR: 0.60; CI: 0.47-0.76 and aOR: 0.80; CI: 0.67-0.97, respectively). Plausibly, women’s decision-making autonomy on issues relating to their earnings and healthcare might have constrained them to compromise their sexual relationships with partners. ConclusionThe outcomes of this study have some policy implications for both maternal and child health. Hence, the need to intensify programmes aimed at improving women’s sexual health and rights towards achieving sustainable development goals of preventing deaths of newborns, ending STIs and creating gender in Nigeria.