- Email: [email protected]
Polygamy and the use of contraceptives
International Journal of Gynecology and Obstetrics (2008) 101, 88–92
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
w w w. e l s e v i e r. c o m / l o c a t e / i j g o
SOCIAL ISSUES IN REPRODUCTIVE HEALTH
Polygamy and the use of contraceptives Bala Audu a , Shaibu Yahya b , Ado Geidam a,⁎, Hadiza Abdussalam a , Idrisa Takai a , Othman Kyari a a b
Department of Obstetrics and Gynecology, University of Maiduguri, Nigeria Department of Community Medicine, University of Maiduguri, Nigeria
Received 8 July 2007; received in revised form 25 September 2007; accepted 26 September 2007
KEYWORDS Contraceptives; Co-wives; Monogamy; Polygamy
Abstract Objectives: To compare contraceptive use among women in monogamous and polygamous marriages in Nigeria. Methods: Structured questionnaires administered to married women enquired about their marriage type, sociodemographic characteristics, and contraceptive use. Results: Of the 532 respondents, 33.6% were in polygamous marriages. There was a statistically significant association between monogamy and nonutilization of contraception (P = 0.03); however, women in polygamous marriages were more likely not to use contraception when they were older than 35 years, had 4 or more living children, had no male child, had 3 or more female children, or lived in rural areas. There was also a statistically significant association between nonutilization of contraception and number of male children of co-wives (P = 0.003), number of female children of co-wives (P = 0.05), and use of contraception by co-wives (P = 0.002). Conclusion: Polygamy influences contraceptive use and the role of co-wives in this regard merits further study. © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
1. Introduction It is agreed that regulating fertility goes along with socioeconomic development, and yet surveys in Africa have revealed that most women want more children [1]. This trend is not good for a continent that is already ravaged by war, political instability, and corruption, each of which prevents socioeconomic development. Although contraception
⁎ Corresponding author. Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri Borno State, Nigeria. E-mail address: [email protected] (A. Geidam).
has become a generally acceptable means of controlling family size worldwide, sub-Saharan Africa has the lowest rate of contraceptive use worldwide [2]. In Nigeria the prevalence of contraceptive use varies from 7% to 11.1% [3,4], and is lowest in the northern part of the country [4]. It is therefore pertinent to identify factors hindering acceptance of contraception. Polygamy, a marriage system in which husbands have more than one wife, is frequent in most of West and Central Africa [5]. In line with evolutionary theory, polygamy is said to be beneficial to male reproductive success as it leads to larger numbers of surviving offspring [6]. Studies have shown that women in polygamous marriages (the form of marriage prevalent in the area where this study was conducted) are less likely to use contraception
0020-7292/$ - see front matter © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2007.09.036
Polygamy and the use of contraceptives Table 1
Demographic characteristics of the 532 respondents
Characteristic
No. (%)
a
Age, y 15–24 25–34 ≥ 35
135 (25.4) 288 (54.1) 109 (20.5)
Contraceptive use Yes No
377 (70.9) 155 (29.1)
Marriage type Polygamy Monogamy
179 (33.6) 353 (66.4)
Parity b 0 1–4 ≥5
65 (12.2) 324 (60.9) 143 (26.9)
Religion Islam Christianity
427 (80.3) 105 (19.7)
Education Educated Uneducated
413 (77.6) 119 (22.4)
Occupation Employed Unemployed
168 (31.6) 364 (68.4)
Place of residence Rural Urban
144 (27.1) 388 (72.9)
a b
Mean ± SD, 29.5 ± 7.9 years (range, 15–50 years). Mean ± SD, 3.4 ± 3.0 (range, 0–15).
89 houses already numbered for primary health care. A total of 150 households were visited in Maiduguri (the urban area) and approximately 70 households in each of the rural areas. The survey was conducted as a face-to-face interview with the married women living in these households. A pretested questionnaire enquired about their demographic characteristics, number and sex of their living children, desired number of children, and type of marriage (monogamous or polygamous). If the marriage was polygamous, the questionnaire further enquired about the number of co-wives, the number and sex of the co-wives' living children, and the husband's characteristics (educational level, number and sex of his living children, etc). The influence of all these variables on the attitude toward and use of contraception was determined. The statistical software SPSS, version 11 (SPSS, Chicago, IL, USA), was used for statistical analysis. The sociodemographic characteristics of the study population are given as number and percentage and the χ2 test was used to determine whether there were associations between the categorical variables. Stratified analysis was used to determine the effect of individual factors on contraceptive use in polygamy. The effects of confounders on contraceptive use in the 2 marriage types were identified by multivariate analysis. P b 0.05 was considered significant.
3. Results Of the 550 married women contacted, 532 (96.7%) agreed to an interview. Of these, 155 reported ever using contraception, for a contraception prevalence of 29.1%. The demographic factors of the respondents are shown in Table 1. The mean age of the study population was 29.5 ± 7.9 years; most of the respondents (54.1%) were between 25 and 34 years old but 109 (20.5%) were 35 years or older. The parity range was Table 2 Comparison between family type and sociodemographic factors of the 532 respondents Characteristic
Marriage type Polygamy
[7,8], and competition for more and more children among cowives may be a major factor in their avoiding contraception. Moreover, in polygamy, women depend more on their children in later years than do men, who can receive support from younger wives, and may therefore want to have many children. Education, occupation, a preference for having children of a particular sex, and other socioeconomic variables may also have an impact on contraception in polygamous cultures [9]. It was postulated that in polygamy women compete for control in household matters by having more children, and that the rate of women using modern methods of contraception would be significantly lower among those in polygamous marriages than those in monogamous ones. The objective of the study was to test this hypothesis.
2. Methods The respondents were married women of reproductive age living in urban (Maiduguri) or rural (Gwoza, Konduga, and Madgali) settings in north-eastern Nigeria. A survey was carried out at
Monogamy
χ2 P value
Age, y 15–24 25–34 ≥ 35
35 (25.9) 86 (29.6) 59 (54.1)
100 (74.1) 202 (71.4) 50 (45.9)
25.9 0.000
Parity 0 1–4 ≥5
8 (12.3) 93 (28.7) 79 (55.2)
57 (87.7) 231 (71.3) 64 (44.8)
46.5 0.000
109 (26.4) 71 (59.7)
304 (75.6) 48 (40.3)
45.7 0.000
40 (23.8) 140 (38.5)
128 (76.2) 224 (61.5)
11.0 0.001
No. of living children 0 8 (9.7) 1–3 73 (26.5) ≥4 99 (6.6)
74 (90.3) 202 (73.5) 76 (43.4)
68.2 0.000
Education Educated Uneducated Occupation Employed Unemployed
90 Table 3 use
B. Audu et al. Comparison between family type and contraceptive
Contraceptive use Yes No
Marriage type Polygamy
Monogamy
63 (35.2) 116 (64.8)
92 (26.1) 261 (73.9)
χ2 P value
Factor in co-wives
Yes
No
4.8 0.03
Number 1 2 3
30 (32.6) 25 (48.1) 9 (25)
62 (67.4) 27 (51.9) 27 (75)
5.7 0.06
No. of children 0 1–3 ≥4
1 (33.3) 11 (24.4) 51 (39.5)
2 (66.7) 31 (75.6) 83 (61.5)
3.4 0.18
No. of male children 0 1 (33.3) 1–3 23 (24.4) ≥4 40 (48.8)
6 (85.7) 68 (75.6) 42 (51.2)
11.8 0.003
No. of female children 0 9 (20.9) 1–3 47 (42) ≥4 8 (32)
34 (79.1) 65 (58) 17 (68)
6.2 0.005
Use of contraceptives Yes 17 (43.7) No 10 (17.5) Don't know 37 (42.5)
18 (56.3) 47 (82.5) 50 (57.5)
2.0 0.002
Values are given as number (percentage) unless otherwise indicated.
0–15 overall (mean ± SD, 3.4 ± 3.0) but it was 1–4 for 60.9% of the respondents; 12.2% were nulliparous. There were 199 women (22.4%) with no formal education, 427 Muslim women (80.3%), 179 women (33.6%) in polygamous marriages, and 144 women (27.1%) living in rural areas. Table 2 shows relationships between marriage type and sociodemographic characteristics in the study population. There was a statistically significant difference between marriage type and age (P = 0.000), parity (P = 0.000), educational status (P = 0.000), occupation (being employed or not) (P = 0.001), and number of living children (P = 0.000). Table 3 shows relationships between marriage type and contraception use. There were 261 (73.9%) of the 353 women in monogamous marriages and 116 (64.8%) of the 179 women in polygamous marriages who had never used contraception. There was a statistically significant association between monogamy and nonutilization of contraception (χ2 = 4.8, P = 0.03). This association persisted even after controlling for the various confounding factors identified from multivariate regression analysis. Table 4 Comparison of factors influencing nonutilization of contraception by women in polygamous and monogamous marriages Factor
Odds ratio (95% P confidence interval) value
Age ≥ 35 years Being employed
1.42 (1.04–2.00) 1.16 (0.96–1.41)
0.02 0.17
Parity 0 ≥5
1.39 (1.18–1.64) 1.24 (0.94–1.63)
0.08 0.12
No. of living children 0 ≥4
1.28 (1.13–1.44) 1.30 (0.99–1.72)
0.14 0.05
1.24 1.14 2.60 1.58
0.02 0.52 0.000 0.007
No. of living male children 0 ≥3 No. of living female children ≥3 Husband's no. of living children ≥5 Husband's no. of male children 1–4 Husband's no. of female children ≥ 5 Rural residence
(1.10–1.39) (0.76–1.72) (1.71–3.96) (1.08–2.32)
Table 5 Factors in co-wives influencing nonutilization of contraception by other wives in polygamous marriages
1.15 (0.99–1.33)
0.10
2.03 (0.66–6.37)
0.09
1.28 (1.04–1.59)
0.02
Contraceptive use
χ2 P value
Values are given as number (percentage) unless otherwise indicated.
To evaluate the influence of sociodemographic variables on contraception use, marriage type was cross-tabulated with contraception use while controlling for each of those variables. The factors associated with nonutilization of contraception by polygamous women compared with their monogamous counterparts are shown in Table 4. Factors associated with statistically significant nonutilization of contraception by polygamous women include being 35 years or older (P= 0.02), having 4 or more living children (P= 0.05), having no living male child (P = 0.02), having 3 or more living female children (P= 0.000), having a husband who has 5 or more living children (P= 0.007), and living in a rural area (P= 0.02). Table 5 shows the effect of co-wives on nonutilization of contraception among polygamous women. There was a statistically significant association between contraceptive use and the number of male children of co-wives (P = 0.003), number of female children of co-wives (P = 0.05) and contraception use by co-wives (P = 0.002), but not with the number of co-wives (P = 0.06) or the total number of living children of co-wives (P = 0.18).
4. Discussion The 20.5% prevalence of contraception use found in this study was higher than rates reported in other studies from the same country [3,4], and in studies done in the Republic of Niger, a neighboring country [8], and Pakistan, a low income country like Nigeria [10]. This higher prevalence of contraceptive use may be related to the composition of the study
Polygamy and the use of contraceptives population, 77.6% of whom was educated. The age of the women ranged between 15 and 50 years (mean ± SD, 29.5 ± 7.9 years), which was similar to the age reported in a study done in the southern part of Nigeria [11] and another study done in Ghana, a neighboring country [12]. Most (54.1%) of the respondents were aged between 25 and 34 years in the present study, which probably represents the most actively reproductive age group. The mean parity of 3.4 was lower than the mean parity reported in the southern Nigeria study [11] but was similar to that reported for Malawi, another African country [13]. In the present study a parity of 1 to 4 was reported by most women (60.9%), whose fertility was surprisingly lower than that estimated in other studies conducted in the region [11,14,15]. A higher percentage (77.6%) of the respondents were educated in this study than in other studies from the same region, yet most (68.4%) were unemployed. Although a formal education is generally viewed as fundamental to good psychological balance and individual adaptation to the modern world, in Africa formal education alone may not contribute much to the empowerment of women unless it enables them to generate an income [16]. The 33.6% prevalence of polygamy found in our study was higher than that reported for other parts of Africa [5,8] and for Bangladesh [17] and Peru [18], but it was similar to that reported for a neighboring country and also for other parts of Nigeria [19,20]. The high prevalence of polygamy in the study population, most of whom practiced Islam, may be related to local cultural and religious norms. Polygamy is considered a symbol of higher status in the part of Nigeria where the study was conducted; and contrary to expectations based on social changes, it was reported that the incidence of polygamy is increasing in Africa [5]. The analysis of the relationship between family type (polygamy vs monogamy) and contraceptive use revealed a statistically significant association between monogamy and nonutilization of contraception (P = 0.03). This association persisted even after controlling for confounding factors by multivariate analysis. This finding was in agreement with the findings of a study from the southern part of Nigeria [21] and another from Jordan [22]. It was expected that contraceptive use would be lower among polygamous women because of the competition among them for having more children, and hence more control in household matters. The effect of polygamy on fertility and therefore on contraception use has puzzled demographers, who are still divided on the issue. Some studies have concluded that polygamy has no effect on contraception use and therefore on fertility [19,23], whereas others have concluded that polygamy is associated with nonutilization of contraceptives [7,8]. It was suggested that changes in reproductive behavior are taking place in Nigeria, and that these changes are restricting fertility in polygamous marriages [21]. Because contraceptive practices may be influenced by a number of socioeconomic factors, this study analyzed the influence of these factors on contraceptive use in relation to family type (polygamy vs monogamy). There was a statistically significant association between polygamy and nonutilization of contraception (P ≤ 0.05) in women who were 35 years and older. Because maternal age is a great determinant of fertility, older wives may shun contraception to
91 maintain their lead among co-wives for the number of children. However, this finding contrasts with the report of a study that showed that older women were more likely to use contraception [24]. Although a higher rate of contraceptive use is expected among large families, our study revealed that women having 4 or more children were less likely to use contraception when they were in polygamous marriages (odds ratio, 1.30, P = 0.047). This may be another indication of competition among co-wives. Moreover, it is commonly assumed that male children are more desired in Africa for economic reasons, and that women in polygamous marriages may be less likely to use contraception if they have no male child or if most of their children are female. This study verified this assumption, as a statistically significant association was found between polygamy and nonutilization of contraception for wives with no living male child, and also for wives with 3 or more living female children. As in other studies [9,25], women living in rural areas were found to be less likely to use contraceptives when they were in polygamous rather than in monogamous marriages (odds ratio, 1.28, P = 0.02). In developing countries such as Nigeria, rural residence is especially associated with a poor provision of health services. The co-wives factor is an important determinant of contraceptive practice in polygamous families. This study revealed a statistically significant association between contraception use and number of male children of co-wives, number of female children of co-wives, and use of contraception by co-wives— depicting possible competition among co-wives. However, as in another study in Nigeria [20], there was no statistically significant association between contraception use and number of co-wives. In conclusion, contraception was found to be more widely used by women in polygamous than in monogamous marriages. Older age, having 4 or more children, having no living male child, having 3 or more living female children, and living in a rural area, however, were found to be factors that make women in polygamous marriages more likely not to use contraception. Along with women in monogamous marriages, women with these characteristics should be targeted during advocacy when they are in polygamous marriages. Further research is needed to address the cowives issue with regard to family planning in places where polygamy is prevalent.
References [1] Frank O. The demand of fertility control in sub-Saharan Africa. Stud Fam Plan 1987;18:181–201. [2] Globalis Indicator: An Interactive World Map. Contraception prevalence: modern method—2003. Bar chart at: http:// globalis.gvu.unu.edu/indicator.cfm?IndicatorID=129&country= BI#rowBI. Accessed November 10, 2007. [3] Oye-Adeniran BA, Adewole IF, Odeyemi KA, Ekanem EE, Umoh AV. Contraception prevalence among young women in Nigeria. J Obstet Gynaecol 2005;25:182–5. [4] National population commission (NPC), Federal republic of Nigeria, and ORC Macro. Nigerian demographic and health survey 2003. Maryland: Macro; 2004. USA, Calverton, NPC and ORC. [5] Peblev A, Mbugua W, Goldman N. Polygamy and fertility in subSaharan Africa. Fertil Determ Res Notes 1988;21:6–10.
92 [6] Gibson MA, Mace R. Polygamy, reproductive success and child health in rural Ethiopia: why marry a married man? J Biosoc Sci 2007;39:287–300. [7] Johnson NE, Elmi AM. Polygamy and fertility in Somalia. J Biosoc Sci 1989;12:127–34. [8] Peterson SA. Marriage structure and contraception in Niger. J Biosoc Sci 1999;31:93–104. [9] Ananta A, Lim T, Molyneaux JW, Kantner A. Fertility determinant in Indonosia: a sequential analysis of the proximate determineants. Maj Demogr Indones 1992;37:1–26. [10] Sathar ZA, Mason KO. How female education affects reproductive behavior in urban Pakistan. Asian Pac Popul Forum 1993;6:93–103. [11] Konje JC, Oladini F, Otolorin EO, Ladipo OO. Factors determining the choice of contraceptive methods at the Family Planning Clinic, University College Hospital, Ibadan, Nigeria. Br J Fam plann 1998;24:107–10. [12] Tawiah EO. Factors affecting contraceptive use in Ghana. J Biosoc Sci 1997;29:141–9. [13] Lema VM, Mtimavalye LA, Msiika FS. Socio-demographic of family planning clients and their possible influence on contraception in Malawi. East Afr Med J 1998;75:41–6. [14] Hogan DP, Berhanu B, Assefa H. Household organization, women autonomy and contraceptive behaviors in southern Ethiopia. Stud Fam Plann 1999;30:302–14. [15] Ayangade O. Characteristics of contraceptive acceptors in an urban Nigerian setting. Int J Gynecol Obstet 1984;22:59–66.
B. Audu et al. [16] Mason KO. The impact of women's social position on fertility in developing countries. Sociol Forum 1987;24:718–45. [17] Shaikh K, Aziz KM, Chowdhury AI. Differentials of fertility between polygynous and monogamous marriages in rural Bangladesh. J Biosoc Sci 1987;19:49–56. [18] Hern WM. Cultural change, polygyny, and fertility among the Shipibo of the Peruvian Amazon. South Am Indian Stud 1994;4:77–86. [19] Sichona FJ. The polygyny–fertility hypothesis revisited: the situation in Ghana. J Biosoc Sci 1993;25:473–82. [20] Ahmed J. Polygyny and fertility differentials among Yaruba of western Nigeria. J Biosoc Sci 1986;18:63–73. [21] Adewuyi AA. Marital fertility in polygynous unions in Nigeria. J Biosoc Sci 1988;20:393–400. [22] Sueyoshi S, Ohtsuka R. Effect of polygyny and consanguinity on high fertility in the rural Arab population in south Jordan. J Biosoc Sci 2003;35:513–26. [23] Cocker J. The co-wife factor: can polygamy create child bearing competition. Worldview Mag 2006;19(3) on Line http://www.worldviewmagazine.com/issues/article.cfm? id=189&issue=43 Accessed November 2007. [24] Utomo B, Alimoeso S, Park CB. Factors affecting the use and non use of contraception. Maj Demogr Indones 1983;10:19–48. [25] Hussain R, Bittles AH. Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan. J Biosoc Sci 1999;31:121–38.
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
w w w. e l s e v i e r. c o m / l o c a t e / i j g o
SOCIAL ISSUES IN REPRODUCTIVE HEALTH
Polygamy and the use of contraceptives Bala Audu a , Shaibu Yahya b , Ado Geidam a,⁎, Hadiza Abdussalam a , Idrisa Takai a , Othman Kyari a a b
Department of Obstetrics and Gynecology, University of Maiduguri, Nigeria Department of Community Medicine, University of Maiduguri, Nigeria
Received 8 July 2007; received in revised form 25 September 2007; accepted 26 September 2007
KEYWORDS Contraceptives; Co-wives; Monogamy; Polygamy
Abstract Objectives: To compare contraceptive use among women in monogamous and polygamous marriages in Nigeria. Methods: Structured questionnaires administered to married women enquired about their marriage type, sociodemographic characteristics, and contraceptive use. Results: Of the 532 respondents, 33.6% were in polygamous marriages. There was a statistically significant association between monogamy and nonutilization of contraception (P = 0.03); however, women in polygamous marriages were more likely not to use contraception when they were older than 35 years, had 4 or more living children, had no male child, had 3 or more female children, or lived in rural areas. There was also a statistically significant association between nonutilization of contraception and number of male children of co-wives (P = 0.003), number of female children of co-wives (P = 0.05), and use of contraception by co-wives (P = 0.002). Conclusion: Polygamy influences contraceptive use and the role of co-wives in this regard merits further study. © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
1. Introduction It is agreed that regulating fertility goes along with socioeconomic development, and yet surveys in Africa have revealed that most women want more children [1]. This trend is not good for a continent that is already ravaged by war, political instability, and corruption, each of which prevents socioeconomic development. Although contraception
⁎ Corresponding author. Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri Borno State, Nigeria. E-mail address: [email protected] (A. Geidam).
has become a generally acceptable means of controlling family size worldwide, sub-Saharan Africa has the lowest rate of contraceptive use worldwide [2]. In Nigeria the prevalence of contraceptive use varies from 7% to 11.1% [3,4], and is lowest in the northern part of the country [4]. It is therefore pertinent to identify factors hindering acceptance of contraception. Polygamy, a marriage system in which husbands have more than one wife, is frequent in most of West and Central Africa [5]. In line with evolutionary theory, polygamy is said to be beneficial to male reproductive success as it leads to larger numbers of surviving offspring [6]. Studies have shown that women in polygamous marriages (the form of marriage prevalent in the area where this study was conducted) are less likely to use contraception
0020-7292/$ - see front matter © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2007.09.036
Polygamy and the use of contraceptives Table 1
Demographic characteristics of the 532 respondents
Characteristic
No. (%)
a
Age, y 15–24 25–34 ≥ 35
135 (25.4) 288 (54.1) 109 (20.5)
Contraceptive use Yes No
377 (70.9) 155 (29.1)
Marriage type Polygamy Monogamy
179 (33.6) 353 (66.4)
Parity b 0 1–4 ≥5
65 (12.2) 324 (60.9) 143 (26.9)
Religion Islam Christianity
427 (80.3) 105 (19.7)
Education Educated Uneducated
413 (77.6) 119 (22.4)
Occupation Employed Unemployed
168 (31.6) 364 (68.4)
Place of residence Rural Urban
144 (27.1) 388 (72.9)
a b
Mean ± SD, 29.5 ± 7.9 years (range, 15–50 years). Mean ± SD, 3.4 ± 3.0 (range, 0–15).
89 houses already numbered for primary health care. A total of 150 households were visited in Maiduguri (the urban area) and approximately 70 households in each of the rural areas. The survey was conducted as a face-to-face interview with the married women living in these households. A pretested questionnaire enquired about their demographic characteristics, number and sex of their living children, desired number of children, and type of marriage (monogamous or polygamous). If the marriage was polygamous, the questionnaire further enquired about the number of co-wives, the number and sex of the co-wives' living children, and the husband's characteristics (educational level, number and sex of his living children, etc). The influence of all these variables on the attitude toward and use of contraception was determined. The statistical software SPSS, version 11 (SPSS, Chicago, IL, USA), was used for statistical analysis. The sociodemographic characteristics of the study population are given as number and percentage and the χ2 test was used to determine whether there were associations between the categorical variables. Stratified analysis was used to determine the effect of individual factors on contraceptive use in polygamy. The effects of confounders on contraceptive use in the 2 marriage types were identified by multivariate analysis. P b 0.05 was considered significant.
3. Results Of the 550 married women contacted, 532 (96.7%) agreed to an interview. Of these, 155 reported ever using contraception, for a contraception prevalence of 29.1%. The demographic factors of the respondents are shown in Table 1. The mean age of the study population was 29.5 ± 7.9 years; most of the respondents (54.1%) were between 25 and 34 years old but 109 (20.5%) were 35 years or older. The parity range was Table 2 Comparison between family type and sociodemographic factors of the 532 respondents Characteristic
Marriage type Polygamy
[7,8], and competition for more and more children among cowives may be a major factor in their avoiding contraception. Moreover, in polygamy, women depend more on their children in later years than do men, who can receive support from younger wives, and may therefore want to have many children. Education, occupation, a preference for having children of a particular sex, and other socioeconomic variables may also have an impact on contraception in polygamous cultures [9]. It was postulated that in polygamy women compete for control in household matters by having more children, and that the rate of women using modern methods of contraception would be significantly lower among those in polygamous marriages than those in monogamous ones. The objective of the study was to test this hypothesis.
2. Methods The respondents were married women of reproductive age living in urban (Maiduguri) or rural (Gwoza, Konduga, and Madgali) settings in north-eastern Nigeria. A survey was carried out at
Monogamy
χ2 P value
Age, y 15–24 25–34 ≥ 35
35 (25.9) 86 (29.6) 59 (54.1)
100 (74.1) 202 (71.4) 50 (45.9)
25.9 0.000
Parity 0 1–4 ≥5
8 (12.3) 93 (28.7) 79 (55.2)
57 (87.7) 231 (71.3) 64 (44.8)
46.5 0.000
109 (26.4) 71 (59.7)
304 (75.6) 48 (40.3)
45.7 0.000
40 (23.8) 140 (38.5)
128 (76.2) 224 (61.5)
11.0 0.001
No. of living children 0 8 (9.7) 1–3 73 (26.5) ≥4 99 (6.6)
74 (90.3) 202 (73.5) 76 (43.4)
68.2 0.000
Education Educated Uneducated Occupation Employed Unemployed
90 Table 3 use
B. Audu et al. Comparison between family type and contraceptive
Contraceptive use Yes No
Marriage type Polygamy
Monogamy
63 (35.2) 116 (64.8)
92 (26.1) 261 (73.9)
χ2 P value
Factor in co-wives
Yes
No
4.8 0.03
Number 1 2 3
30 (32.6) 25 (48.1) 9 (25)
62 (67.4) 27 (51.9) 27 (75)
5.7 0.06
No. of children 0 1–3 ≥4
1 (33.3) 11 (24.4) 51 (39.5)
2 (66.7) 31 (75.6) 83 (61.5)
3.4 0.18
No. of male children 0 1 (33.3) 1–3 23 (24.4) ≥4 40 (48.8)
6 (85.7) 68 (75.6) 42 (51.2)
11.8 0.003
No. of female children 0 9 (20.9) 1–3 47 (42) ≥4 8 (32)
34 (79.1) 65 (58) 17 (68)
6.2 0.005
Use of contraceptives Yes 17 (43.7) No 10 (17.5) Don't know 37 (42.5)
18 (56.3) 47 (82.5) 50 (57.5)
2.0 0.002
Values are given as number (percentage) unless otherwise indicated.
0–15 overall (mean ± SD, 3.4 ± 3.0) but it was 1–4 for 60.9% of the respondents; 12.2% were nulliparous. There were 199 women (22.4%) with no formal education, 427 Muslim women (80.3%), 179 women (33.6%) in polygamous marriages, and 144 women (27.1%) living in rural areas. Table 2 shows relationships between marriage type and sociodemographic characteristics in the study population. There was a statistically significant difference between marriage type and age (P = 0.000), parity (P = 0.000), educational status (P = 0.000), occupation (being employed or not) (P = 0.001), and number of living children (P = 0.000). Table 3 shows relationships between marriage type and contraception use. There were 261 (73.9%) of the 353 women in monogamous marriages and 116 (64.8%) of the 179 women in polygamous marriages who had never used contraception. There was a statistically significant association between monogamy and nonutilization of contraception (χ2 = 4.8, P = 0.03). This association persisted even after controlling for the various confounding factors identified from multivariate regression analysis. Table 4 Comparison of factors influencing nonutilization of contraception by women in polygamous and monogamous marriages Factor
Odds ratio (95% P confidence interval) value
Age ≥ 35 years Being employed
1.42 (1.04–2.00) 1.16 (0.96–1.41)
0.02 0.17
Parity 0 ≥5
1.39 (1.18–1.64) 1.24 (0.94–1.63)
0.08 0.12
No. of living children 0 ≥4
1.28 (1.13–1.44) 1.30 (0.99–1.72)
0.14 0.05
1.24 1.14 2.60 1.58
0.02 0.52 0.000 0.007
No. of living male children 0 ≥3 No. of living female children ≥3 Husband's no. of living children ≥5 Husband's no. of male children 1–4 Husband's no. of female children ≥ 5 Rural residence
(1.10–1.39) (0.76–1.72) (1.71–3.96) (1.08–2.32)
Table 5 Factors in co-wives influencing nonutilization of contraception by other wives in polygamous marriages
1.15 (0.99–1.33)
0.10
2.03 (0.66–6.37)
0.09
1.28 (1.04–1.59)
0.02
Contraceptive use
χ2 P value
Values are given as number (percentage) unless otherwise indicated.
To evaluate the influence of sociodemographic variables on contraception use, marriage type was cross-tabulated with contraception use while controlling for each of those variables. The factors associated with nonutilization of contraception by polygamous women compared with their monogamous counterparts are shown in Table 4. Factors associated with statistically significant nonutilization of contraception by polygamous women include being 35 years or older (P= 0.02), having 4 or more living children (P= 0.05), having no living male child (P = 0.02), having 3 or more living female children (P= 0.000), having a husband who has 5 or more living children (P= 0.007), and living in a rural area (P= 0.02). Table 5 shows the effect of co-wives on nonutilization of contraception among polygamous women. There was a statistically significant association between contraceptive use and the number of male children of co-wives (P = 0.003), number of female children of co-wives (P = 0.05) and contraception use by co-wives (P = 0.002), but not with the number of co-wives (P = 0.06) or the total number of living children of co-wives (P = 0.18).
4. Discussion The 20.5% prevalence of contraception use found in this study was higher than rates reported in other studies from the same country [3,4], and in studies done in the Republic of Niger, a neighboring country [8], and Pakistan, a low income country like Nigeria [10]. This higher prevalence of contraceptive use may be related to the composition of the study
Polygamy and the use of contraceptives population, 77.6% of whom was educated. The age of the women ranged between 15 and 50 years (mean ± SD, 29.5 ± 7.9 years), which was similar to the age reported in a study done in the southern part of Nigeria [11] and another study done in Ghana, a neighboring country [12]. Most (54.1%) of the respondents were aged between 25 and 34 years in the present study, which probably represents the most actively reproductive age group. The mean parity of 3.4 was lower than the mean parity reported in the southern Nigeria study [11] but was similar to that reported for Malawi, another African country [13]. In the present study a parity of 1 to 4 was reported by most women (60.9%), whose fertility was surprisingly lower than that estimated in other studies conducted in the region [11,14,15]. A higher percentage (77.6%) of the respondents were educated in this study than in other studies from the same region, yet most (68.4%) were unemployed. Although a formal education is generally viewed as fundamental to good psychological balance and individual adaptation to the modern world, in Africa formal education alone may not contribute much to the empowerment of women unless it enables them to generate an income [16]. The 33.6% prevalence of polygamy found in our study was higher than that reported for other parts of Africa [5,8] and for Bangladesh [17] and Peru [18], but it was similar to that reported for a neighboring country and also for other parts of Nigeria [19,20]. The high prevalence of polygamy in the study population, most of whom practiced Islam, may be related to local cultural and religious norms. Polygamy is considered a symbol of higher status in the part of Nigeria where the study was conducted; and contrary to expectations based on social changes, it was reported that the incidence of polygamy is increasing in Africa [5]. The analysis of the relationship between family type (polygamy vs monogamy) and contraceptive use revealed a statistically significant association between monogamy and nonutilization of contraception (P = 0.03). This association persisted even after controlling for confounding factors by multivariate analysis. This finding was in agreement with the findings of a study from the southern part of Nigeria [21] and another from Jordan [22]. It was expected that contraceptive use would be lower among polygamous women because of the competition among them for having more children, and hence more control in household matters. The effect of polygamy on fertility and therefore on contraception use has puzzled demographers, who are still divided on the issue. Some studies have concluded that polygamy has no effect on contraception use and therefore on fertility [19,23], whereas others have concluded that polygamy is associated with nonutilization of contraceptives [7,8]. It was suggested that changes in reproductive behavior are taking place in Nigeria, and that these changes are restricting fertility in polygamous marriages [21]. Because contraceptive practices may be influenced by a number of socioeconomic factors, this study analyzed the influence of these factors on contraceptive use in relation to family type (polygamy vs monogamy). There was a statistically significant association between polygamy and nonutilization of contraception (P ≤ 0.05) in women who were 35 years and older. Because maternal age is a great determinant of fertility, older wives may shun contraception to
91 maintain their lead among co-wives for the number of children. However, this finding contrasts with the report of a study that showed that older women were more likely to use contraception [24]. Although a higher rate of contraceptive use is expected among large families, our study revealed that women having 4 or more children were less likely to use contraception when they were in polygamous marriages (odds ratio, 1.30, P = 0.047). This may be another indication of competition among co-wives. Moreover, it is commonly assumed that male children are more desired in Africa for economic reasons, and that women in polygamous marriages may be less likely to use contraception if they have no male child or if most of their children are female. This study verified this assumption, as a statistically significant association was found between polygamy and nonutilization of contraception for wives with no living male child, and also for wives with 3 or more living female children. As in other studies [9,25], women living in rural areas were found to be less likely to use contraceptives when they were in polygamous rather than in monogamous marriages (odds ratio, 1.28, P = 0.02). In developing countries such as Nigeria, rural residence is especially associated with a poor provision of health services. The co-wives factor is an important determinant of contraceptive practice in polygamous families. This study revealed a statistically significant association between contraception use and number of male children of co-wives, number of female children of co-wives, and use of contraception by co-wives— depicting possible competition among co-wives. However, as in another study in Nigeria [20], there was no statistically significant association between contraception use and number of co-wives. In conclusion, contraception was found to be more widely used by women in polygamous than in monogamous marriages. Older age, having 4 or more children, having no living male child, having 3 or more living female children, and living in a rural area, however, were found to be factors that make women in polygamous marriages more likely not to use contraception. Along with women in monogamous marriages, women with these characteristics should be targeted during advocacy when they are in polygamous marriages. Further research is needed to address the cowives issue with regard to family planning in places where polygamy is prevalent.
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