Added: Diontae Eastin - Date: 12.03.2022 06:40 - Views: 35823 - Clicks: 4031
Despite increases in the use of modern contraceptives, Malawian women have a high unmet need for contraception. Because current understanding of contraceptive use ignores sexual pleasure and partner dynamics, this study explores the links between sexual pleasure seeking, partner dynamics and contraceptive use.
As part of a larger qualitative study conducted in , 23 focus group discussions among married women and men and 10 in-depth interviews with service providers were conducted with a total of participants in two districts of Malawi. Thematic analysis was performed to identify recurrent and patterns. Method choice and consistent use were affected by the quantity and quality of sex desired and, most important, by any perceived change in sexual pleasure for respondents or their partner.
These partner dynamics ultimately created a formidable barrier to contraceptive use or promoted contraceptive discontinuation. Family planning programs should consider the nuanced ways in which notions of sexual pleasure, partner dynamics and the broader social context are involved in decision making regarding contraceptive use.
International Perspectives on Sexual and Reproductive Health , , 41 2 —, doi: The surprisingly low level of attention given to sexuality and sexual pleasure in the field of reproductive health is well documented. In particular, she advocated for a gender-sensitive approach, one that investigates how women negotiate their sexual behavior to increase pleasure and reduce harm, and how these negotiations influence their reproductive and sexual health decision making. Another study from the United States examining the associations between class and gender and sexual risk-taking found that many poor and working-class women saw male sexual desire as innate, and believed its nonfulfillment could lead to ill health or aggression.
In Sub-Saharan Africa, although there has been an interest in broadening understanding of the relationship context of contraceptive use, this research has primarily focused on partner characteristics and interpersonal variables such as couple communication, gender power differentials and household decision making. A few studies on microbicide acceptability and condom use for HIV prevention raise concerns about sexual pleasure and the broader structural issues that affect it. Moreover, as in the West, these studies highlight that considerations of sexual pleasure, especially for women, are interconnected with broader structural realities.
In a study conducted in Malawi and Zimbabwe on microbicide acceptability, the female and male participants agreed that male sexual pleasure supersedes female sexual pleasure during sexual interactions. Regarding condom use, several studies from Sub- Saharan Africa have found a dislike for condom use because of its perceived association with reduced sexual pleasure and casual sexual relationships.
In fact, suggesting condom use in a steady relationship was often considered taboo and seen as a of infidelity. Given these findings, there is a need to systematically investigate the links between sexual pleasure and contraceptive use, and the broader partner dynamics that affect it. In this article, using qualitative data from Malawi, we explore the relationship between male and female sexual pleasure seeking and male and female contraceptive use.
We also investigate how partner dynamics are linked to these desires and are involved in contraceptive decision making and use. Malawi is a landlocked country in southeast Africa, bordered by Zambia, Tanzania and Mozambique. The country is divided into three regions northern, central and southern and 28 districts. It is one of the 20 poorest countries in the world.
The lower status of Malawian women relative to men has frequently been discussed in the literature. In a Demographic and Health Survey DHS comparative study on the status of women in 25 countries, Malawi was ranked very low on the basis of a range of indicators including education, employment and marriage.
This study was carried out as part of a larger qualitative research study conducted in Malawi between March and April to examine the dynamics of contraceptive use, especially the use of long-acting and permanent contraceptive methods. The study was conducted in two districts in the central region of Malawi, Kasungu and Dowa. To ensure socioeconomic diversity, data were collected in two nonpoor urban communities and one poor rural community in each of the districts.
In Kasungu district, the two urban sites were Linga and Mankhaka and the rural site was Gogode. In Dowa, the urban sites were Wenela and Misi and the rural site was Msakambewa. The study was conducted in health facilities within the study communities. The health facilities were selected for their high family planning client load so that providers could link the research team with potential participants. The data were collected using focus group discussions and in-depth interviews.
A total of 23 focus group discussions were conducted among men and women separated by sex and 10 in-depth interviews were conducted among service providers. Although semi-structured focus group discussion and in-depth interview guides were used to conduct the larger study, no direct questions were asked to elicit responses on sexual pleasure and contraceptive use. Local researchers who had qualitative research experience were hired to conduct the sex-matched focus group discussions and in-depth interviews. The interviews and focus group discussions were conducted in Chichewa except in the few cases in which service providers indicated that they preferred to communicate in English.
The discussions were recorded after obtaining permission from the participants. A note-taker was also present during each focus group discussion as a safety check. The focus group discussions each consisted of 8—10 participants and lasted an hour, on average; the in-depth interviews took an average of 30 minutes. We analyzed the data using accepted qualitative techniques of identification of recurrent patterns and themes. Focus group transcripts and interviews were read through by two coders to identify common events and that reoccurred across discussions.
After conflicts were resolved, a coding system based on the identified was then developed. Following line-by-line coding, the coded texts were extracted from the focus group discussions and in-depth interviews and organized in a thematic matrix. The process was repeated and the data were reanalyzed to identify additional themes or patterns. This led to a set of overarching themes that captured the essence of female and male pleasure-seeking attitudes and their links with contraceptive use. The larger study within which this study took place was approved and cleared to proceed for data collection by the Research and Ethics Committee of the College of Medicine, University of Malawi.
We followed standard ethical procedures in conducting the study. Once the study team ascertained the eligibility of the participant, a script was used to obtain informed consent prior to participation. Data collection was initiated only after participants understood the objectives and implications of the research and orally consented to participate.
During data collection, no individual identifiers were collected from participants. A total of individuals participated in the study. Although both female and male participants were interested in issues of sexual pleasure, we found differences in their concerns. The men were more likely than the women to discuss the sexual pleasure, or lack thereof, associated with a particular method. These issues ultimately created formidable barriers to contraceptive use or promoted contraceptive discontinuation.
Specific themes reappear in the data and illustrate the importance of sexual pleasure seeking in decision making on contraceptive use. These themes fall under two major : sexual pleasure and satisfaction, and partner dynamics. The effect that contraceptive methods have or could potentially have on sexual pleasure and satisfaction were important considerations in decision making on contraceptive use and method choice.
In choosing a contraceptive method, the study participants evaluated the potential effect a particular method would have on their sexual interactions and on the amount of sexual intercourse they desired to have. This made long-acting contraceptive methods especially popular among some. So you are not free. Given these preferences, methods that in any way limited the amount of sex a couple could have were deemed impractical. For instance, many study participants, especially the males, spoke of how rhythm and other methods that are based on periodic abstinence from sex were unfeasible and bound to fail.
A female focus group participant stated:. Furthermore, respondents saw the side effects, real or perceived, associated with modern contraceptive methods, such as bloating, weight gain, prolonged bleeding, and aches and pains, not just as discomforts but as very disruptive of their sexual lives and sexual enjoyment.
For instance, several respondents shared how side effects such as the constant or prolonged bleeding associated with certain methods interrupted sex and, given their sexual needs, made it impractical for couples to continue using such methods. One man in a focus group commented:. There was a common belief that women who use modern contraceptives lose their sexual appeal.
One male focus group participant said:. So they are no longer attracted to their husbands anymore. As just noted, part of this reduction in female sexual appeal was attributed to a reduction of sexual desire among those using hormonal methods, making sex with them less exciting for their partner.
A female group participant remarked:. Similarly, the male participants were greatly concerned about the perceived influence of contraceptive methods on their own sexual appeal and sexual drive, making methods such as male sterilization unpopular. As one male focus group participant stated:.
We prefer that a woman should go for sterilization than us because if we go for it, we lose our manhood. We may not feel manly so all women will know that you are not man enough since you went for sterilization. These norms and conditions can exacerbate relationship anxieties and make the adoption and continuous use of contraceptives challenging, especially for women.
The normative acceptance of extramarital relationships and polygamy, coupled with the economic dependence of women on their male partners, makes it difficult for women to neglect issues of male sexual pleasure in their marital life. Repeatedly, the women spoke about how any reduction in male sexual pleasure and enjoyment, whether real or perceived, provides the men with an additional excuse to justify extramarital sexual activity and abandonment of their families.
A female focus group participant noted:. You decide that maybe you should be like the girlfriend, who is not on family planning, then maybe the husband will not go outside your marriage. Hence, ultimately women must weigh these perceptions and attitudes, and balance concerns about sexual pleasure with the risk of unintended pregnancy or STIs, when making their decisions about contraceptive use.
As a woman in a focus group commented:. With fear that the man might run away from the house, women are forced not to practice family planning methods. Similarly, although less so than for the women, such fears were also prevalent among the men, and their decision making on contraceptive use also involved similar anxieties. The men said that they fear adopting a method like male sterilization because of its perceived impact on their sexual drive, which would ultimately encourage female sexual infidelity.
As one man in a focus group discussion said:. So when we hear such speculations, we are afraid…assuming the drive has really reduced and your wife knows it…then [she] starts going out because maybe she compares you now and before and she feels you are not there yet. So these issues bring it a lot of conflicts in the family. As opposed to their own concerns about a reduced sexual drive because of method use, the men fear that women who use discreet methods become more sexually active and are more likely to become promiscuous. These partner dynamics associated with contraceptive use were reiterated when participants discussed the benefits of female and male sterilization.
These discussions highlight the links between perceptions about trust and commitment in a marital relationship and decision making on contraceptive use, especially for those who felt more vulnerable or insecure. For instance, given current gender norms, structural inequalities and the prevalence of extramarital sex, the adoption of sterilization was fraught with anxieties about partner abandonment, especially for females.
However, at the same time, both the female and male participants viewed adoption of sterilization by a partner as ifying deep love, trust and commitment in a relationship. For example, a male discussant shared that by adopting male sterilization, a man is indicating his love for his wife and his desire to be faithful to her, increasing her trust in him.
Participants felt that a man would adopt male sterilization only if he was absolutely sure that he only wanted the relationship with his current wife and was not looking for relationships with other women. It gives trust to the woman that you are faithful to her if you go for sterilization. So, I might have to remarry and in the new marriage, I will need children.
So, she cannot go for sterilization unless she trusts her husband. Our study calls attention to the importance of sexual pleasure in decision making on female and male contraceptive use. The study participants were concerned about the logistics involved in adopting a method and how specific methods could affect the quantity of sex desired.
Moreover, prior studies suggest that perceptions of what constitutes sexual pleasure and the ways to achieve it are often context specific. In the West, where the focus of sexual intercourse is the movement and friction leading to orgasm, condom use is disliked because it reduces physical sensation by preventing direct contact.
In contrast, in Malawi, according to the study, condom use is problematic because it does not allow the mixing of bodily fluids, which is considered the essence of sexual pleasure. Interventions need to recognize the ideas associated with specific contraceptive methods to successfully promote those methods.
Additional research is required to broaden understanding of how these notions of sexual pleasure correlate with specific contraceptive methods and make the consistent use of methods challenging. Our study suggests that decision making on contraceptive use is a complex calculus in Malawi and goes beyond such commonly investigated issues as method access, method effectiveness, desire to prevent pregnancy and female negotiation skills.
Weighing current relationship dynamics, perceived levels of trust and commitment in a relationship, and how a method could affect these dynamics through its impact on sexual pleasure is important in decision making on contraceptive use.Malawi woman seeking sex
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