Alfred A. Adewuyi

Indicators for measuring the quality of family planning services in Nigeria.

This article presents the Situation Analysis approach as a means of collecting data that can be used to assess the quality of care provided by family planning service-delivery points (SDPs), and describes the quality of services offered in Nigeria. Elements of the quality of services provided at 181 clinical service-delivery points in six states of Nigeria are described. The substantive results from the study suggest that although most of the 181 service points sampled are functional, the quality of care being provided could be improved. Illustrative scores for these indicators and elements of the Bruce-Jain framework are given. By comparison with contraceptive prevalence surveys, the Situation Analysis approach is still in its early stages. Some methodological issues are raised here and future directions for strengthening the validity and applicability of the approach are discussed.

Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria.

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Urban Nuptiality Patterns and Marital Fertility in Nigeria

This study indicates that urban marital patterns in nine Nigerian cities influence fertility. Fertility is also influenced by age at marriage, region of residence, ethnicity and religion; education and employment lead to marriage delay and tend to conflict with childbearing by enhancing the status of women.

Social and proximate determinants of sexual activity in rural Nigeria

This study analyses the social, physiological and motivational determinants of sexual activity for 644 married women in rural areas of Osun State, Nigeria. The data come from the Fertility Awareness and Pregnancy Avoidance study conducted in 1993-94. Sexual activity is measured by three continuous variables: weekly frequency of (1) total sexual activity, (2) coital-only sex and (3) both coital/non-coital sex. Analyses of variance were performed to test the difference in group means between the predictor variables and measures of sexual activity. Ordinary least squares regression analyses were then performed for the three dependent variables. Two models are used: the first contains only those variables associated with an individuals demographic, social and economic status, and the second adds predictor variables associated with motivational and physiological factors. Results show that while many socioeconomic variables by themselves are significantly associated with sexual activity measures, the addition of physiological and motivational variables weakens their effects and lessens their original statistical significance. Additionally, the socioeconomic and demographic factors associated with frequency of sexual activity are not necessarily the same ones significantly associated with coital-only or combined coital/non-coital sex. While other studies have tended to focus either on socioeconomic or physiological factors, the joint examination of both types of influences seems to indicate that the latter have more proximate effects on the frequency of both coital and non-coital sexual activity of married women in this population. Contraceptive protection is shown to be highly positively associated with all three of the sexual activity measures, empirically confirming the important relationship between contraception and both coital and non-coital forms of sexual activity.

Marital fertility in polygynous unions in Nigeria.

The effect of polygyny on fertility, by age cohort, was examined in 4 regions of Nigeria through use of data from the 1981-82 Nigerian Fertility Survey. Simple tabulation of numbers of live births by maternal age and type of marriage union indicated that, with the exception of the 30-39-year age group, fertility in polygynous unions tends to be higher than that in monogamous marriages. Overall, such tabulations reveal an average of 3.90 births among polygynous women and 3.47 births among monogamous women. However, when age-specific fertility rates were compared, except for women under 20 and over 40 years of age, rates were higher in monogamous unions (7.286 overall) than for women in polygynous households (7.200 overall). Mean completed fertility, taking into account marriage duration as well, shows a tendency for women in polygynous unions to be more fertile (with the exception of women aged 25-44 years who had been married 10-19 years). The absolute difference in fertility between the 2 types of marital unions ranged from 0.32 children in the northwest to 0.64 in the southeast. With adjustment for independent variables such as education, the absolute mean differences were reduced, from between 0.28 children in the southeast to 0.42 in the northeast, but the direction of high fertility was still in favor of women in polygynous unions. But when the covariates (e.g., age at marriage) were taken into account as well as the independent variables, there was a dramatic reduction in the mean difference between the fertility of these 2 groups of women. These findings suggest that some changes in reproductive behavior are taking place in Nigeria that are restricting the fertility of women in polygynous unions. These changes are hypothesized to reflect the spread of formal education in Nigeria, with the expectation that women will contribute to the costs involved in educating their children.

Breast feeding, birth interval and polygyny in Nigeria

Polygyny has routinely been claimed to facilitate rules and taboos relating to postpartum sexual abstinence. However, in Nigeria polygyny cannot wholly explain length of postpartum taboo following child birth on the ground that competition among cowives to out do one another in child-bearing results in a tendency of higher fertility and hence shorter postpartum taboo in polygynous households than that in monogamous families. Economic factors have been adduced as reasons explaining the recent tendency for mothers in polygynous families to have longer postpartum abstinence than their counterparts in monogamous households. Specifically, for young mothers aged 15-34, bearing children in quick succession is no longer attractive as in essentially traditional cultures where husbands commitment to caring for children is taken for granted. Hence, the tendency for women in polygynous households to adhere more strictly to rules and taboos relating to postpartum abstinence could be associated to the changing roles of women as they affect their responsibility with respect to the maintenance and training of their children rather than to the institution of polygyny per se.