Nigerian women are often under pressure by family and through societal expectations to give birth to more children.
Cross-country studies led by researchers at the Johns Hopkins Bloomberg School of Public Health, revealed that most Nigerian women's motivations to become pregnant were not only based on their own values, but also shaped by external pressures from husbands, families and communities.
From the studies, it was established that Nigerian women and women from Ethiopia and Uganda who also face similar pressure, often resort to covert or indirect means of contraception to maintain some reproductive autonomy.
Nigerian women currently rate among women of the 10 most fertile countries in the world. A Nigerian woman gives birth to an average of 5.5 children in her lifetime according to FP2020.
The studies, conducted by the Johns Hopkins School of Nursing and Bloomberg School's Department of Population, Family and Reproductive Health, in collaboration with their in-country Performance Monitoring and Accountability 2020 (PMA2020), was to examine the Sexual and Reproductive Empowerment in Sub-Saharan Africa.
Findings from the studies entitled: "Covert use of family planning among sub-Saharan African women--reasons, challenges and consequences", and "The exploration of sexual health outcomes through the application of a Women's and Girl's Sexual and Reproductive Health Empowerment Framework across four settings", were presented at the at the 5th International Conference on Family Planning (ICFP) held in Kigali, Rwanda, 12th to 15th November, 2018.
Doctorate candidates in the Bloomberg School's Department of Population, Family and Reproductive Health, collaborated with others to conduct 120 in-depth interviews and 40 focus group discussions with 376 women and 64 men across four communities in Nigeria, Uganda and Ethiopia in the study that lasted from July to August 2017.
The investigations were part of a larger project known collectively as the Women's and Girls' Sexual and Reproductive Empowerment (WGE-SRH) study, designed to explore the motivations and constraints women experience and the choices they make concerning sex, contraception and pregnancy.
In an observation, Celia Karp of the Johns Hopkins Bloomberg School stated: "Women were often expected to bear children very soon after marriage, whereas premarital childbearing was negatively sanctioned. These expectations constrained women's autonomy about if and when to get pregnant.
"In northern Nigeria, motivations to bear more children were particularly prevalent in polygamous families, where wives secured their influence and children's inheritance through childbearing.
"Misconceptions and fears about contraception, such as concerns that its use would harm the womb or cause infertility, also limited women's ability to prevent unintended pregnancy or achieve their desired number of pregnancies," Karp noted.
The researchers found that both male and female respondents tended to consider sex principally a marital obligation and a means of procreation.
"Sexual pleasure was often an afterthought, and sex outside of marriage was seen as wasteful--except in Uganda, where married men frequently pursued extramarital partners and even married women could do so without sanction if their husbands failed to support them financially.
Men and women with multiple partners considered faithful monogamous relationships ideal, the studies established.
Most of the female respondents in the study, including married ones, indicated that they had a limited ability to either initiate or avoid sex.
Culturally, it was considered inappropriate for a woman to voice sexual desire directly--or to resist her husband's advances. Women, therefore, often resorted to indirect strategies for asserting their choice to have or avoid sex.
Shannon Wood, another researcher from the Bloomberg School of Public Health: "These strategies included non-verbal cues, such as singing or cooking their husband's favorite meal when they wanted to have sex, or faking menstruation or illness when they wanted to avoid sex.
The WGE-SRH team found evidence of widespread covert use of contraception, including long-acting injectable contraceptive methods, among women who felt that they could not voice their reproductive choices directly.
For some of the women, covert use of contraception resulted from disagreements with their husbands over having more children. For others, it was a strategy to delay commitment to a new partner or distance themselves from a failing relationship.
Results of the WGE-SRH study have been used to develop a cross-cultural quantitative index of women's empowerment in the realm of sex, family planning and pregnancy.
"One aspect our study results highlight, is that women's confidence in directly telling partners what they want is only a partial measure of their real self-efficacy--we also need to take into account the non-verbal and covert strategies to which they commonly resort," Wood stated.
The studies, supported by the Bill & Melinda Gates Foundation,were conducted and reported by researchers of the Johns Hopkins Bloomberg School of Public Health; Makerere University School of Public Health, Uganda; Bayero University, Nigeria, and the Centre for Research, Evaluation Resources and Development in Nigeria, and the Addis Ababa University School of Public Health