Post-partum sexual abstinence in West Africa: implications for AIDS-control and family planning programmes

To assess whether the custom of prolonged post-partum sexual abstinence in Benin is associated with an increased incidence of extra-marital sexual contacts by husbands.

Cross-sectional survey of adult men and women.

Data obtained from men on their extra-marital sexual behaviour in the past 12 months were linked to data on post-partum abstinence over the same time interval reported by wives. Multivariate analysis was applied to assess the association between conjugal abstinence and husband's extra-marital sex, net of the effects of possible confounders.

Approximately half of married men experienced post-partum abstinence in the past 12 months. In this group, 32% reported one or more extra-marital sexual contacts compared with 20% among those who experienced no abstinence (OR = 1.8, P < 0.001). This association is essentially unchanged after controlling for marriage type, age, education, urban-rural residence, income and household wealth. Age, income and wealth are also significant predictors of the probability of extra-marital sex. The effects of income and wealth largely disappear when attention is restricted to extra-marital sex without using a condom on the most recent occasion.

The potentially protective effect of prolonged abstinence after childbirth in Benin (and probably in much of West Africa) is offset by an increased probability that husbands will seek extra-marital partners without using condoms. Although not quantifiable, the enhanced longer-term risks of sexually transmitted diseases/HIV infection for wives probably outweigh the short-term benefits. Family planning practitioners in this region should not hesitate to recommended the early resumption of sex and suitable methods of post-partum contraception for women who express concern or uncertainty about their husband's behaviour.