The negotiation and management of sexual and reproductive health behaviour in marital relationships in rural south-western Uganda

Tam, Ailie (2019) The negotiation and management of sexual and reproductive health behaviour in marital relationships in rural south-western Uganda. Doctoral thesis, University of East Anglia.

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Despite changes in availability and uptake of modern contraception and several decades of HIV risk behaviour change intervention, rates of fertility and HIV remain high in south-western Uganda. This thesis set out to explore the reasons why and understand the specific challenges married individuals face negotiating and managing HIV risk and family planning. Data collection took place between 2015-2016 in six villages, located in a pre-existing general population cohort run by the MRC/UVRI Uganda Research Unit on AIDS in Kyamulibwa. The dataset includes 36 life-stories of men and women at different stages of the marital life-course, focus groups with married individuals, and interviews with religious leaders, health workers and a traditional healer/birth attendant. A social determinants of health approach was used as a base to investigate drivers of sexual attitudes and practices, fertility preferences, family planning use and navigation of HIV. A framework and network mapping technique guided interpretation and data analysis.

This thesis identifies social practices that are sustaining high fertility and contributing to a risk environment, which heightens HIV susceptibility for married individuals, particularly women in this setting. Unequal gender power dynamics are played out through practices of transactional sex, early and pressurised marriage for females, gender-based violence and the commonality of male engagement in extra-marital relations. Whilst types of marriage and marital circumstances vary substantially, widespread cultural beliefs underpin expectations of marital roles and obligations relating to unprotected sex. Over the life-course, females often try multiple family planning methods, frequently favouring approaches that do not require spousal involvement. Tensions are highlighted between the ways married individuals are told they should protect against HIV and manage fertility, and the cultural and religious discourses shaping marital gender roles, as well as the context and circumstances in which sex and sexual relations take place.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Social Sciences > School of International Development
Depositing User: Users 11011 not found.
Date Deposited: 14 Nov 2019 11:46
Last Modified: 14 Nov 2019 11:46

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