Sex Composition of Children and Spousal Sexual Violence in Sub-Saharan Africa.

Objective In societies with a cultural preference for sons over daughters, women who do not bear sons may be at increased risk for spousal violence. This study examined whether women with daughters only are at an elevated risk for spousal sexual violence compared to women with sons only in Sub-Saharan Africa. The study tested the hypothesis that the association between sex composition of children and spousal sexual violence would be observed only in large families. Methods Data were from the most recent (as at February, 2016) Demographic and Health Surveys conducted in 22 Sub-Saharan African countries for 37,915 women. Odds ratios comparing experience of spousal sexual violence of women with sons only to those with daughters only were estimated, separately for women with three or fewer children and those with four or more children, controlling for age, age at first cohabitation, age at first birth, educational attainment, urban residence, and household wealth. Results Having daughters only was associated with a greater likelihood of spousal sexual violence among women with many children (adjusted odds ratio [AOR] = 1.53; 95% CI 1.02-2.30) but not among those with few children (AOR = 0.92; 95% CI 0.82-1.04). Conclusions for Practice A higher risk of sexual violence for women without sons suggests that son preference may have implications on women's health and wellbeing. Efforts to further understand and address increased risk of sexual violence for women without sons should consider son preference and intra-couple conflict concerning fertility intentions.