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MEDIA CENTER Postnatal Abstinence and Extramarital Sex in Côte d’Ivoire NEW YORK (24 October 2001)—In at least two West African countries, monogamous men are more likely to seek extramarital sex after their wives give birth—during a customary period of postnatal abstention from marital sex—than at other times. This finding, published in the latest issue of Studies in Family Planning, a peer-reviewed quarterly journal published by the Population Council, has important implications for HIV/AIDS prevention. Noting that condom use is low in the population they surveyed in Côte d’Ivoire, the study’s authors, Mohamed M. Ali and John G. Cleland, ask whether prolonged postnatal abstinence protects wives against sexually transmitted infections or increases their vulnerability. The authors conclude that any protective effect of marital abstinence is offset by a greater probability that husbands will seek sex with other partners, thereby increasing the chances that they will be exposed to HIV or other sexually transmitted diseases (STDs). Drawing from a 1994 Demographic and Health Survey, Ali and Cleland found that unprotected extramarital sex was two times more common among men who observed conjugal abstinence than it was among other men. In the study, a total of 134 monogamous husbands reported having had extramarital sex. Among these, 33 percent had used a condom during the most recent extramarital act. Noting that the results confirm earlier findings from a study done in Benin, the authors suggest that the Côte d’Ivoire results can likely be generalized to most of West Africa. The custom of prolonged postpartum sexual abstinence may have been a feature of many societies at one time, but it is now largely confined to West Africa, the authors note. The practice is justified by the belief that sperm will poison the mother’s breast milk and thereby harm the nursing infant. According to the authors, postpartum sexual abstinence could have a tremendous protective effect. In a typical West African population, women bear their first child at age 18, have a lifetime average of 5.5 births, each accompanied by a mean duration of postpartum abstinence of 15 months, and reach menopause at 45 years. In these circumstances, each woman will abstain from conjugal sex for seven years, on average, equivalent to 25 percent of her active reproductive life. “In the era of HIV/AIDS, this striking figure assumes a new significance. It provides a potentially powerful degree of protection against infection from HIV and other sexually transmitted diseases,” the authors say. However, they add that the benefit of postpartum abstinence may be overridden if it is prolonged and leads to an increased probability that husbands will have unprotected sex with extramarital partners and thus return to the conjugal bed with a greater chance of being infected with HIV or STDs. Ali and Cleland recommend ways to incorporate the finding into family planning advice. “Unless a woman is convinced of her husband’s fidelity, earlier rather than later resumption of conjugal sex should be urged together with contraceptive use to ensure adequate birth spacing. Indeed, barrier methods such as the condom may be an attractive option for couples during the period of lactation in light of the widespread belief that sperm may poison breast milk. Condoms can be clearly understood to prevent such a possibility. However, in West Africa, as elsewhere, use of condoms within marriage encounters strong resistance because of condoms’ association with illicit sex. Where such resistance is found, even the adoption of nonbarrier methods as a substitute for abstinence may be justified because it is likely to reduce the risk of the husband’s engaging in unprotected extramarital contacts.” Another possible policy response is the initiation of campaigns to undermine the custom of prolonged abstinence and its key rationale, namely that sperm poisons breast milk.Hygiene & Tropical Medicine, Department of Epidemiology and Population Health, 49–51 Bedford Square, London WC1B3DP. Other articles, reports, data, Vol. 32, No. 3, September 2001 Articles Implications for Evaluating the Impact of Family Planning Programs with a Reproductive Health Orientation, by Anrudh Jain Reports Consistency Between Survey and Interview Data Concerning Pregnancy Wantedness in the Philippines, by Lindy Williams, Teresa Sobieszczyk, and Aurora E. Perez Disobedient Distributors: Street-level Bureaucrats and Would-be Patrons in Community-based Family Planning Programs in Rural Kenya, by Amy Kaler and Susan Cotts Watkins Data Results from the Burkina Faso 1998–99 Demographic and Health Survey For subscription information on Studies in Family Planning, call 212-339-0514, fax 212-755-6052, or email: publications@popcouncil.org.
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