Decision-making on sexual and reproductive health issues among women in heterosexual relationship in Mahikeng, South africa

Thesis (PhD (Population Studies) North-West University, Mafikeng Campus, 2014 Problem statement: Sexual and reproductive decision-making has emerged as an important health indicator as husbands dominate in family reproductive health issues and continue to be the greatest source of sexually transmitted infections including HIV to their wives. While there is evidence of male dominance in sexual and reproductive health decision, the role of socio-demographic factors on women's control over their sexuality is not well understood. Using the theory of gender and power, it was conceptualized that socio-cultural and socio-economic factors influence women's control over their sexuality. Objectives: The aim of this study was to investigate the extent to which women in marital and cohabiting unions have control over their sexuality and implications on reproductive health. Method: To achieve this purpose sexual and reproductive health decision-making survey of 568 respondents and 33 in-depth interviews was conducted among married and cohabiting women in Mahikeng, South Africa in 2012. Data were collected on respondents' socio-demographic characteristics and reproductive health matters under which the relationship exits. Quantitative data were analyzed using descriptive and logistic regression analyses. Qualitative information was analyzed manually using thematic content analysis approach. Result: The data reveals that unemployed women and those in traditional union were less likely to agree that women can demand or reject sex from their husbands. Rural women and those in arranged marriages showed lack of autonomy in decisions on when to have sex and family size. Gap in knowledge of condom efficiency and the usage seems to stem from lack of spousal communication. Qualitative data revealed that sexual control are intertwined with cultural, religious belief and perception that husbands have sexual right over their wives. Fear of accusation and violence impaired the ability of women to suggest condom use to their partners. Conclusion: It may be concluded that limited control women had over their sexuality (sexual and reproductive health decision-making) stemmed from poor economic status, cultural gender norm and patriarchal dominance. These may have negative implications on women's sexual and reproductive health. Recommendation: Sexual and reproductive health decision-making in marital or cohabiting relationships cut across secular, cultural and religious domain. Government strategy to improve married women's control over sexuality need partnerships of their husbands, traditional and religious leaders which should focus on empowering women with income earning skills and bridging sexual communication gap between couples. Doctoral