Internet use, exposure to digital family planning messages, and sexual agency among partnered women in Northern Nigeria: implications for digital family planning intervention.

Digital health interventions are gaining ground in conflict-affected countries, but studies on their reproductive health benefits for women are scanty. Focusing on conflict-affected northern Nigeria, this study examined the relationships between Internet use, exposure to digital family planning messages via text messages or social media, and sexual agency - measured as the ability to refuse sex and ask a male partner to use a condom - among partnered women including the rural-urban differentials. Partnered women's data (n= 18,205) from the 2018 Nigeria Demographic and Health Survey were analysed using descriptive and multinomial logistic regression analyses. 44.6% of women are able to refuse sex, and 31.4% to ask a male partner to use a condom. Internet use was positively associated with women's ability to refuse sex in the northern region and urban areas, and across the region to ask a male partner to use a condom. It was also positively associated with women's uncertainty about asking a male partner to use a condom. Exposure to digital family planning messages was positively associated with women's ability to ask a male partner to use a condom across the region, in both urban and rural areas. However, exposure to digital family planning messages was negatively associated with women's uncertainty in urban areas about their ability to refuse sex. Implications of these findings for digital family planning interventions are discussed.

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

BACKGROUND: Existing 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. METHODS: The 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. RESULTS: Findings 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. CONCLUSION: The 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.

Existing 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.

Do health service contacts with community health workers influence the intention to use modern contraceptives among non-users in rural communities? Findings from a cross-sectional study in Nigeria.

BACKGROUND: Studies in many developing countries have shown that community health workers (CHWs) are valuable for boosting contraceptive knowledge and usage. However, in spite of the evidence, studies in Nigeria have rarely examined whether in the absence of skilled health personnel such as doctors and nurses in rural and remote communities, the health service contacts of non-users with CHWs drive the intention to use modern contraceptives. This study, therefore, examines the extent to which health service contacts with CHWs are associated with the intention to use modern contraceptives among non-users in rural communities of Nigeria. METHODS: This study adopted a descriptive cross-sectional design. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). The study analyzed a weighted sample of 12,140 rural women. The outcome variable was the intention to use modern contraceptives. The main explanatory variable was health service contacts with CHWs. Statistical analyses were performed at three levels with the aid of Stata version 14. Three multivariable regression models were estimated using an adjusted Odds Ratio (aOR) with a 95% confidence interval. Statistical significance was set at p < 0.05. RESULTS: Findings showed that more than a quarter (29.0%) of women intends to use modern contraceptives. Less than one-fifth (15.9%) of the women had health service contacts with CHWs. In Model 1, women who had health service contacts with CHWs were more likely to intend to use modern contraceptives (aOR =1.430, 95% CI: 1.212-1.687). Likewise, in Model 2, women who had health service contacts with CHWs had a higher likelihood of intending to use modern contraceptives (aOR = 1.358, 95% CI: 1.153-1.599). In Model 3, the odds of intention to use modern contraceptives were higher among women who had health service contacts with CHWs (aOR =1.454, 95% CI: 1.240-1.706). CONCLUSION: In rural areas of Nigeria, health service contacts with CHWs are significantly associated with the intention to use modern contraceptives. Family planning programmers should leverage the patronage of CHWs for the purpose of family planning demand generation in rural areas.

Exploring the perception and socio-cultural barriers to safer sex negotiation among married women in Northwest Nigeria.

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.

Rural-urban differentials in the relationship between household wealth index and maternal anaemia status in Nigeria.

Anaemia - a condition of low haemoglobin level in the blood is prevalent among women in Nigeria despite years of interventions. Wealth status have implications for this prevalence but there is a dearth of research examining this relationship and residential dimensions in it. The social determinant of health framework was employed to understand the rural-urban dimension of this relationship. Chi-square test and multivariate logit regression models were used to analyse data from the 2018 Nigeria Demographic and Health Survey (n=13,575). We found that anaemia status is higher among rural women (66%). The odds of being anaemic is higher with decreasing wealth status irrespective of place of residence but the odds are higher for poor women in urban areas compared to poor women in rural areas after adjusting for covariates. Maternal health interventions should be more innovative in their design of programs by being sensitive of residential dimension.