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  • Title: Postpartum sexual abstinence in the era of AIDS in Ghana: prospects for change.
    Author: Awusabo-Asare K, Anarfi JK.
    Journal: Health Transit Rev; 1997; 7 Suppl():257-70. PubMed ID: 10169649.
    Abstract:
    Postpartum sexual abstinence for females has been identified as one of the socio-cultural factors with the potential for creating conditions for the sexual spread of HIV in areas where it is practised. In general, women are expected to abstain from sex after childbirth in order to ensure the survival of the mother and child. Men are not similarly expected to abstain and that has been used to rationalize polygyny. With changes in socio-economic conditions making it more difficult now than before to maintain two or more wives, particularly in urban areas, some men will abstain like their wives for fear of HIV infection; but such men may press their wives to resume sex early. Some women, on the other hand, may give in to the demands of their husbands by reducing the prescribed duration of postpartum abstinence. If this happens without the use of effective modern contraception, fertility may be affected. Some may also enter short or long-term relationship outside marriage, hoping that they will be safe from sexually transmitted infection. Using data from the Ghana segment of the Social Dimensions of AIDS Infection Survey, the study examines the responses of women who reported postpartum sexual abstinence and that of their partners. Both men and women reported abstaining, but some women were aware that their partners did not abstain as they did. Some of the women knew the sexual partners of their partners. Mostly it was men who made the first move to resume sex. For any behavioural change to occur, attitudes towards socially-constructed practices such as postpartum sexual abstinence will need to be changed by intensive education of both men and women and also through community support. AIDS has been reported from all parts of Ghana and as of mid-1995, 15,980 people had been officially diagnosed HIV-positive out of an estimated population of 16.5 million. While women are generally expected to abstain from sex for some period following childbirth in the health interest of both the mother and child, men are not expected to abstain. These expectations and corresponding behavior have been used to rationalize polygyny. Difficult socioeconomic conditions, however, make it hard for men to support two or more wives. Some men following the birth of a child will therefore abstain like their wives out of fear of HIV infection, albeit entreating their wives to resume sex early. Other men may enter short- or long-term extramarital relationships. Findings are presented from the Ghana segment of the Social Dimensions of AIDS Infection Survey conducted March-April 1992 which examined the responses of women who reported postpartum sexual abstinence and those of their partners. A nationally representative random sample of 1364 men and 1034 women aged 15 to over 60 years was interviewed; 60% of the men and 56% of the women were married. Both men and women reported abstaining, but some women knew that their partners did not abstain as they did. Some women knew their husbands' sex partners and men typically made the first move to resume sex. Attitudes toward postpartum sexual abstinence must be changed through education in order for any behavioral change to occur.
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