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African Journal of Reproductive Health, Vol. 12, No. 1, April 2008, pp. 96-100 Postpartum Sexual Abstinence and Breastfeeding Pattern in Sagamu, Nigeria Abstinence sexuelle du postpartum et les types d’allaitement a Shagamu, Nigeria A.O. Sule-Odu, T. A Fakoya, F.A. Oluwole1, O.A. Ogundahunsi2, A.O. Olowu3 , D.M. Olanrewaju3, F.A. Akesode3, O.A. Dada4, E.A. Sofekun4 Departments of Obstetrics and Gynaecology, Community and Primary Health Care1, Chemical Pathology2, Paediatrics3 and Centre for Research in Reproductive Health4 Obafemi Awolowo College of Health Sciences/Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Code Number: rh08014 ABSTRACT This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. KEY WORDS: Postpartum, Sexual, Abstinence, Breastfeeding, Sexually Transmitted Infections. RÉSUMÉ Il s’agit d’une étude prospective concernant 371 mères. L’âge moyen de ces mères était de 27,5 (.3,5) ans ainsi qu’un âge moyen à l’école (des années scolaires) de 11,3 (2,9) ans. Toutes les mères ont allaité au moins un de leurs enfants pendant six mois alors que les mères ont aussi allaité leur dernier enfant pendant un moyen de 10,3 (4 mois). Le moyen global des naissance vivantes précédentes était de 1,9 (0,8). En ce qui concerne le postpartum du premier mois, 84,6% des mères se sont abstenues des rapports sexuels mais vers les 4ème et 5ème mois, le chiffre a chuté jusqu’ à 18,1%, mais il n’y avait que 2,1% de la population étudiée qui se sont abstenues des rapports sexuels au cours de la période de 11 – 15 mois du postpartum. Quarante – sept (13,5%) 30 (8,6%) et 3 (0,9%) mères appartenant aux clases sociales 2,3 et 1 respectivement ont repris les rapports sexuels après 4-5 mois, alors que (12 (3,4%) et 4 (1, 1%) dans les classes sociales 2 et 3 respectivement ont continué les rapports sexuels après 11 – 15 mois. Il y a eu encore des mères qui ont repris les rapports sexuels à partir d’un mois jusqu’à 15 mois du postpartum quand elles ont allaité pour 6 – 10 minutes et 11 – 15 minutes plus que celles qui ont allaité pour 1 – 5 minutes 16 – 20 minutes et 21 – 25 minutes. Il y avait plus des femmes du groupe d’âge de 25 – 29 ans qui avaient repris les rapports sexuels à partir du premier mois jusqu’au quinzième mois du postpartum que les mères dans d’autres groupes d’âge. Introduction Abstinence from sexual intercourse after childbirth is a common practice deep rooted in the cultures of different communities World wide with varying duration2, 6,10. In the culture of the Yoruba of South West Nigeria and the Benin of South-South, Nigeria, it is a taboo to engage in sexual intercourse with a woman who has just given birth1. This is because the body of the woman is said to be “Wet” and the body need to settle down properly and dry up. Also, it is believed that seminal fluid or ejaculate of the man will go directly into the breast milk which is considered injurious to the infant2, while the woman herself is said to be well predisposed to infection, which hitherto has been dormant in the woman and or infected men can easily spread the disease during this period9. In the past, men are generally married to several wives, who after birth are requested to stay away from the husband to allow other wives be mated with. This allows the woman to breastfeed the child exclusively for as long as 3 years or more without any intercourse with the husband, which eventually led to well spacing of her children4. The introduction of Western Family Planning methods coupled with men now taking only one wife, the global economic situation and intensified programme on exclusive breastfeeding have led to shift in the Socio-cultural practice of the people. Other reasons for post-partum abstinence are that sexual desire decreases in the third trimester and postpartum period which leads to decreased frequency of sexual intercourse3 .The study was undertaken to review the postpartum sexual practices in the Community, predominantly inhabited by the Yorubas10 Methods and Clinical Materials Five hundred and twenty mothers who have just given birth to singleton babies and who had previously breastfed at least one child for not less than 6 months were randomly recruited into the study if they met with the inclusion criteria and without bias for their ethnic background10. One hundred and forty nine (28.7%) were excluded from this study because they did not have detailed records of post-partum sexual intercourse and so 371(71.3%) mothers were included in this study. On admission, anthropometric measurements were made on the mothers and infants. Information were also collected on the mothers’ health and diets. The mother – infant pairs were followed up at two weekly interval at which time, details of frequencies, timing and duration of breastfeeding episodes, supplementary feeding and sexual activities including use of contraceptive methods were collected, collated and analysed. There was no record of death among the mothers and the infants. The figures in parenthesis are standard deviation. Sagamu is a fast growing urban town in Ogun state in the Western part of Nigeria .It is about 60 km from Lagos, the former capital city and the commercial city of Nigeria. It is also about 70 km to Ibadan, one the largest cities in Africa. The population is mainly of the Yoruba ethnic stock but with a sizeable population of the Hausas and the Igbos(Ibo).The biggest cement factory in Nigeria and a major petroleum depot are also sited in Sagamu. Results On admission, the mean age of the mothers was 27.5 (3.6) years and their educational years was 11.3 (2.9)years. Their previous live births averaged 1.9 (0.8), while the mean duration of breastfeeding of last child was 10.3 (4.0) months. In Table I, proportion of breastfeeding mothers abstaining from sexual intercourse after childbirth by time post-partum was reviewed. In the first month post-partum, 84.6% had abstained from sexual intercourse, but by the 4th – 5th month only 18.1% had abstained and by the 11th – 15th month, the number had further dropped to 2.1%. Table II, showed resumption of sexual intercourse after childbirth by breastfeeding mothers by social class. Forty seven(13.5%), 30(8.6%) and 3(0.9%) mothers in social classes 2, 3 and 1 respectively have resumed sexual intercourse at 4 – 5 months, while at 11-15 months, only 12 (3.4%) and 4 (1.1 %) of mothers in social classes 2 and 3 respectively continued having sexual intercourse. More mothers resumed sexual intercourse from the first to the fifteenth month post-partum when they breastfed for 6 10 minutes and 11 – 15 minutes per episode than mothers who breast fed for 1 – 5, 16 -20 and 21 -25 minutes respectively.(Table III). In Table IV, age distribution in respect of resumption of sexual activity was reviewed. More mothers within 25 -29 years age group resumed sexual intercourse from the first to the fifteenth month post-partum than mothers in each of the other age groups. Discussion Post-partum sexual abstinence is a common practice by various communities world over with varying duration. Various reasons have been put up for this practice from taboo to ease of transmission of sexually transmitted infection. Sexual desire in majority of women generally decreases during third trimester and post-partum period, with decrease in frequency of sexual intercourse3. Reduced sexual desire, frequency of sexual intercourse and level of sexual satisfaction experienced during post-partum period are also affected by social role (work and mother’s role)) marital satisfaction, mood, fatigue, physical changes and breast feeding3. In the South West of Nigeria inhabited mainly by the Yoruba speaking ethnic group, abstinence is practiced for as long as the infant is still on the breast and this is very possible because the husband is usually married to several wives. This practice usually lead to well spacing of the children. The drawback of this practice is that the woman, because of the desire for large family continue to procreate into her late forties with resultant complications and hazards of pregnancy and labour at that age. The other drawback is as it affects the husbands, in respect of extra-marital contacts and sexually transmitted infection / HIV infection and the high risk of the woman contacting these infections. In a survey by Cleland, Ali and Capo-Chichi in 1999 3 they found half of the married men had experienced post-partum abstinence in the past 12 months. Thirty two percent (32%) of this men reported one or more extra marital contacts compared with twenty per cent (20%) among those who experienced no abstinence with a significant difference (p<0.001). In this study, resumption of sexual intercourse after birth was more prevalent in the 25 -29 and 30 -34 years age groups and this is similar to findings by other authors9, where difference on the basis of age was demonstrated in their study with the younger generation reporting significantly shorter period of abstinence. We agree with Isenalumhe and Oviawe6, that sexual activity of the mothers in their study may signify a shift from people’s traditional regard for sexual intercourse between couples as almost exclusively for the purpose of child-bearing, as we also observed a high percentage (65%) of our study population engaged in sexual activity by the 3rd month postpartum, an almost impossible situation in the past. We may also attribute this observation to the fact that Sagamu being a multi-ethnic Community with fairly large population of the Hausa and Igbo ethnic groups, might have diluted the practice peculiar to the Yorubas due to inter ethnic marriages and due to the increasing number of working mothers in our community. Educational and Industrial growth in the country in the past four decades opened up huge employment opportunities, with a resultant drift of people from the country-side to the cities. This sudden affluence also manifested in form of traffic hold up and late home coming, eventually leading to most mothers in the urban area abandoning breastfeeding for artificial milk, which in turn alter the sexual behaviours of the couples. Most mothers in this series are in the social classes 2 and 3 (98%) and by the 2nd month post partum, 26.4% have resumed sexual intercourse. Breastfeeding duration (per episode) is the time a child spends on the breast per feeding session. The longer the duration, the better. This is because of the amount and nutritional values of the milk and the effect on involution of the uterus and the prolonged post-partum amenorrhoea, which in turn prevent unwanted pregnancy. In this study, more mothers resumed sexual intercourse all through the postpartum period when they breastfed for 6-10 minutes and 11-15 minutes than mothers who breastfed for 1-5 minutes and 16-20 minutes and 21-25 minutes. This observation may be due to the fact that, the longer the child stays on the breast per day, the less period of time available to the couple to mate and or simply, the mother is so exhausted to be bothered with intercourse advances from the husband5. The shorter episodes (1-5 minutes) may attract more frequent breastfeeding which also keeps the mother busy throughout the day. Also, the Yoruba culture does not allow a child to be on the same bed with a couple having intercourse, so if the child is found on the bed beside the mother, it is a sign to the gentleman that he is not wanted around. In conclusion, resumption of sexual intercourse postpartum was age influenced in this study. It also allows the man to “stay more at home” in view of high prevalence of Sexually Transmitted Infection. The consequences on the other hand, like unwanted pregnancy may be undesirable especially if allowed to go on without the use of a contraceptive method after 6 months post-partum. REFERENCE
Copyright 2008 - Women's Health and Action Research Centre, Benin City, Nigeria The following images related to this document are available:Photo images[rh08014t4.jpg] [rh08014t3.jpg] [rh08014t2.jpg] [rh08014t1.jpg] |
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