Imo et al. Sexual abstinence and under-five health ORIGINAL RESEARCH ARTICLE Postpartum Sexual Abstinence and its Implications for Under-Five Health Outcome among Childbearing Women in South-east Nigeria DOI: 10.29063/ajrh2018/v22i4.11 1,2 3 4 5 Chukwuechefulam K. Imo *, Ethelbert Okoronkwo , Vitalis Ukoji and Chidi Mbah Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa1; Department of Sociology, Adekunle Ajasin University, Akoko- Akungba, P. M. B. 001, Ondo State, Nigeria2; Department of Sociology/Psychology/Sociology/Criminology & Security Studies, Federal University Ndufu-Alike, Ikwo, Ebonyi State, Nigeria3; Department of Sociology, Nigerian Police Academy, Wudil, Kano State, Nigeria4; Department of Sociology, Abia State University, Uturu, Abia State, Nigeria5 *For Correspondence: Email: [email protected]; Phone: +2348069226978 Abstract Abstinence from sexual intercourse after childbirth is a common practice deeply rooted in the cultures of different communities, including Nigeria with varying duration. Despite the high level of postpartum abstinence in the South-east compared to other neighbouring regions of Nigeria, under-five mortality is relatively higher in the South-east. This paper examined postpartum sexual abstinence as a predictive factor for under-five health outcome in Abia State with data from a sample of 609 childbearing women within 15-49 years. The mean duration of postpartum abstinence was 3.1±1.5 months; shorter in rural than urban areas with 2.7±1.4 and 3.5±1.3 months, respectively. The months of abstinence from sexual activity after childbirth is significantly related to experiences of under-five mortality and childhood diseases (p<0.05). The qualitative data showed that period of abstinence from sexual activity after childbirth is rooted in culture and was alluded to have great influence on under-five health outcomes. It is concluded that most women resumed sexual activity early after childbirth mostly to secure their marriages which affect their under-five children‘s health. Proper guidelines on resumption of sexual activity after childbirth to avoid its negative effects on under-five health outcome should be instituted to facilitate the achievement of sustainable development. (Afr J Reprod Health 2018; 22[4]: 102-112). Keywords: Sexual behaviour, reproductive health, cultural practices, health consequences Résumé L'abstinence des relations sexuelles après l'accouchement est une pratique courante profondément enracinée dans les cultures de différentes communautés, y compris le Nigéria, et pour des durées variables. En dépit du niveau élevé d'abstinence post-partum dans le sud-est par rapport aux autres régions voisines du Nigéria, la mortalité des moins de cinq ans est relativement plus élevée dans le sud-est. A partir des données d'un échantillon de 609 femmes en âge de procréer âgées de 15 à 49 ans, ce document examine l'abstinence sexuelle postnatale en tant que facteur prédictif de l'évolution de l'état de santé des enfants de moins de cinq ans dans l'État d'Abia. La durée moyenne de l'abstinence post-partum était de 3,1 ± 1,5 mois; plus courtes dans les milieux ruraux que dans les milieux urbains avec 2,7 ± 1,4 et 3,5 ± 1,3 mois, respectivement. Les mois d'abstinence sexuelle après l'accouchement sont significativement liés aux expériences de mortalité des moins de cinq ans et de maladies infantiles (p <0,05). Les données qualitatives ont montré que la période d‘abstinence sexuelle après l‘accouchement est enracinée dans la culture et qu‘elle aurait une grande influence sur les résultats de santé des enfants de moins de cinq ans. On en conclut que la plupart des femmes ont repris leurs activités sexuelles tôt après l‘accouchement, principalement pour sécuriser leurs mariages qui affectent la santé de leurs enfants de moins de cinq ans. Des directives appropriées sur la reprise de l'activité sexuelle après l'accouchement afin d'éviter ses effets négatifs sur les résultats pour la santé des enfants de moins de cinq ans, devraient être mises en place pour faciliter la réalisation du développement durable. (Afr J Reprod Health 2018; 22[4]: 102-112). Mots-clés: Comportement sexuel, santé reproductive, pratiques culturelles, conséquences sur la santé African Journal of Reproductive Health December 2018; 22 (4):102 Imo et al. Sexual abstinence and under-five health Introduction less money15-16. In addition, it has been revealed that age of the child and parity are associated with Postpartum abstinence refers to the period of early resumption of sexual intercourse as voluntary sexual inactivity after childbirth and is postpartum women with few children resume mainly a period when a nursing and breastfeeding sexual intercourse earlier than women who had mother is expected to keep away from the husband many children17-18. sexually1. In the cultures of the South-east, South- Globally, every day more than 26,000 south and South-west Nigeria, it is a taboo to children under the age of five die around the engage in sexual intercourse with a woman who world; and nearly all of them, live in developing has just given birth2. During this period, the body countries19. More than one-third of these children of the woman is said to be ―wet‖ and needs to die during the first month of life, usually at home settle down properly and dry up. Also, it is and without basic attention that might save their believed that seminal fluid or ejaculate of the man lives. In Nigeria, the infant mortality rate was 69 would go directly into the breast milk which is per 1,000 live births for the five years preceding considered injurious to the infant3, while the the 2013 NDHS, the child mortality rate was 64 woman herself is said to be well predisposed to per 1,000 children surviving to age 12 months, and infection through infected men4. It has been under-5 mortality rate was 128 per 1,000 live observed that abstinence from sexual intercourse births 1. This implies that one in 15 Nigerian after childbirth is a common practice that is deeply children die within 12 months and one in eight die rooted in the cultures of different communities before their fifth birthday. In spite of the high level worldwide with varying duration and almost all of postpartum abstinence in the South-east (4.6) women desire to delay or prevent their next compared to South-west (3.8) and South-south pregnancy for two years5. It has been reported that (3.7) of Nigeria, under-5 mortality is relatively within the first year after delivery, only 68% of higher in the South-east with 131 per 1000 live women who could become pregnant are using a births, which includes Abia State, compared to modern form of contraception6. Postpartum period South-south with 91 per 1000 live births and is especially critical for newborns and mothers as South-west with 90 per 1000 live births1. This is most deaths of mothers and babies occur within far above the Sustainable Development Goals this period7-8. It is an ideal time to deliver (SDGs) targets of 25 under-five deaths per 1,000 interventions that improve the health and survival live births by 2030. of both the newborn and mother. There are Understanding the mothers‘ sexual evidences that young and postpartum women who behaviour that is inimical to child survival can be desire more children have expressed worries about very helpful in reducing under-five mortality in contraceptive side-effects, infertility, thus Nigeria. It is evident from the above reviewed reinforcing the burden of misinformation and studies that adequate social research attention has misperceptions5,9-12. not been given to the issues of postpartum sexual African women tend to follow established abstinence which plays a vital role in a child‘s community norms and traditions in making health outcome in the South-eastern Nigeria. It is decisions that influence resumption of sexual against this background that this study explores intercourse after giving birth13. Early initiation of postpartum sexual abstinence among childbearing sexual intercourse was observed in women who women as a predictor of under-five children health had spontaneous vaginal delivery and in those who outcome in Abia State. stayed at home with their mothers, then in-laws The Mosley and Chen‘s analytical and aunts14. Mothers who earned more money had framework and the socio-ecological models were early resumption of sexual intercourse during their adopted to explain infant nutrition and health postpartum period compared to those who earned outcome of under-five children. Mosley and Chen African Journal of Reproductive Health December 2018; 22 (4):103 Imo et al. Sexual abstinence and under-five health observed that the chances for child survival are The sample size for the study was increased by influenced by several variables which include 50% (N= 609) to allow for statistical analysis of maternal socioeconomic factors through different variables and direct estimation of demographic variable like methods of mortality in the study area. A multi-stage sampling breastfeeding20. On the other hand, socio- technique was adopted in selecting the sample size ecological model provides a set of conceptual and drawn from the three Senatorial Districts of Abia methodological principles, drawn largely from State, Nigeria (Abia North, Abia Central and Abia systems theory21. The model is unique in the study South). The respondents were selected using the of mortality because it takes into account the simple random selection of two Local Government physical environment and its relationship to people Areas (LGAs) each from the three Senatorial at intrapersonal, interpersonal, organizational, Districts. There was a simple random sampling of community, and public policy levels that help six roads/streets each from the urban centres and individuals make health choices in their daily three communities each from the rural areas, using lives.