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Safer Sex Negotiation Among Ghanaian Women in Sexual Unions: Does Women’s Household Decision-Making Capacity Matter?

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Abstract

Women’s ability to negotiate for safer sex has been found to be dependent on their household decision making power. However, there is paucity of studies investigating the association between women’s household decision making power and safer sex negotiation in Ghana. Thus, we examined the association between women’s household decision making autonomy and safer sex negotiation among Ghanaian women in sexual unions using the 2014 Ghana’s Demographic and Health Survey. Descriptive statistics, Chi-square test, and multivariable logistic regression models were performed. Statistical significance was set at p < .05 at 95% confidence interval. The results showed high prevalence of safer sex negotiation among women with high household decision-making capacity (91.6%). Compared to women with low household decision making autonomy, those with high autonomy in household decision making were more likely to negotiate for safer sex (aOR = 2.06; CI = 1.32–3.21). Women aged 25–34 were more likely to negotiate for safer sex compared to those aged 15–24 (aOR = 1.50; CI = 1.07–2.11). Higher odds of safer sex negotiation were found among women with comprehensive HIV and AIDS knowledge (aOR = 1.49; CI = 1.09–2.05), women who had tested for HIV (aOR = 1.57; CI = 1.27–1.95) and those exposed to newspaper (aOR = 1.80; CI = 1.17–2.78) compared to those who had no comprehensive knowledge on HIV and AIDS, those who had never tested for HIV and those who were not exposed to newspaper, respectively. However, women who belonged to other ethnic groups and the Islamic religion had lower odds of safer sex negotiation compared to Akans (aOR = 0.68; CI = 0.48–0.96) and Christian women (aOR = 0.63; CI = 0.46–0.85). Women empowerment programmes need to be intensified to enable Ghanaian women with low household decision making autonomy to negotiate for safer sex with their partners. Ghana could achieve the Sustainable Development Goals (SDGs), particularly, SDG 3.7 (universal access to sexual and reproductive health services), and SDG 5 (achieve gender equality and empower all women and girls) when household decision-making capacity among women is further strengthened.

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Funding

The authors declare that we did not obtain funding for the study.

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Authors and Affiliations

  1. Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong

    Francis Arthur-Holmes

  2. Department of Psychiatry, University of Cambridge, Herchel Smith Building, Robinson Way, Cambridge, CB2 0SZ, UK

    Francis Arthur-Holmes

  3. School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia

    Bright Opoku Ahinkorah

  4. Department of Population and Health, University of Cape Coast, Cape Coast, Ghana

    Wonder Agbemavi & Abdul-Aziz Seidu

  5. School of Demography, Australian National University, Canberra, Australia

    Wonder Agbemavi

  6. Directorate of Academic Planning and Quality Assurance, University of Cape Coast, Cape Coast, Ghana

    Dickson Okoree Mireku

  7. College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Australia

    Abdul-Aziz Seidu

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  1. Francis Arthur-Holmes
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  2. Bright Opoku Ahinkorah
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  3. Wonder Agbemavi
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  5. Abdul-Aziz Seidu
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Correspondence to Francis Arthur-Holmes.

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Ethical Approval and Informed Consent

The DHS reported that ethical approval was granted by the Institutional Review Board of ICF International and Ethical Review Committee of Ghana Health Service. We further obtained permission from the DHS Program for use of this data for the study.

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Arthur-Holmes, F., Ahinkorah, B.O., Agbemavi, W. et al. Safer Sex Negotiation Among Ghanaian Women in Sexual Unions: Does Women’s Household Decision-Making Capacity Matter?. Arch Sex Behav 52, 1379–1387 (2023). https://doi.org/10.1007/s10508-023-02546-1

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