Multi-level predictors of sexual autonomy among married women in Nigeria.

backgroundExtant 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.

methodsThis 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.

resultsFindings 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).

conclusionWomen'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.