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DESCRIPTION: Sexual coercion is an important public health issue due to its negative association with social and health outcomes.

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Sexual coercion is an important public health issue due to its negative association with social and health outcomes. The paper aims to examine the prevalence of sexual coercion perpetrated by husbands on their wives in Nepal and to identify the characteristics associated with this phenomenon.

The data used in this paper comes from a cross-sectional survey on "Domestic Violence in Nepal" carried out in A total of 1, married women were interviewed and associations between sexual coercion and the explanatory variables were assessed via bivariate analysis using Chi-square tests. Logistic regression was then applied to assess the net Sex news in nepali of several independent variables on sexual coercion.

Logistic regression analysis found that the literacy Sex news in nepali of women, decision-making power regarding their own health care, husband-wife age differences, alcohol consumption by the husband, and male patriarchal control all had significant associations with women's experience of sexual coercion. The study indicates that sexual coercion among married women is widespread in Nepal. Programs should focus on education and women's empowerment to reduce sexual coercion and protect women's health and rights.

Furthermore, campaigns against alcohol abuse and awareness programs targeting husbands should also focus attention on the issue of sexual coercion. Worldwide, two of the most common forms of violence against women are physical and sexual abuse by their husbands or other intimate male partners.

In many parts of the world, marriage is interpreted as granting men the right to unconditional sexual access to their wives and the power to enforce this access through force if necessary [ 2 ].

Many studies demonstrate that women are more vulnerable than men to sexual coercion [ 3 - 5 ]. Further research conducted among female factory workers in Nepal showed that 1 in 10 had been sexually coerced [ 11 ].

Similarly, a non-representative small scale study in Nepal [ 1213 ] found that about half the husbands had forced their wives to have sex. A qualitative study conducted in 15 countries found that women had reported profoundly troubling experiences with regard to sex within marriage. Additional studies illustrate the long-term effects of coercion as young women who reported being coerced in their first sexual experience also had an increased chance of sexual violence in subsequent relationships [ 1516 ].

Sexual coercion has profound emotional, psychological, social, physical, and health consequences both immediately and many years after the assaults [ 1718 ]. Women who have been sexually coerced are significantly more likely to experience problems such as fear of intimacy, lack of sexual pleasure, and anxiety about sexual performance than are other women [ 919 - 21 ]. Sexually coerced women may feel powerless when it comes to insisting that their partner use a condom [ 22 ] and thus their partners may be less likely to use condoms [ Sex news in nepali ].

Sexually coerced women have been found to be more likely to have unintended pregnancies [ 2223 ] and abortions [ 24 ] and more likely to experience gynecological disorders such as irregular vaginal bleeding [ 25 ], vaginal discharge, painful menstruation [ 2627 ], pelvic inflammatory disease [ 28 ], and sexual dysfunction [ 262829 ] than other women.

Coerced women are more likely to engage in risky sexual behaviour such as having sex with multiple partners [ 30 ], engaging in sex without a condom, and providing sex for money or drugs [ 891931 - 33 ]. Additionally, these women are more likely to smoke cigarettes and indulge in excessive alcohol consumption [ 92234 ]. Generally speaking, sexually coerced women have poorer physical health [ 35 ], greater health anxiety [ 3637 ] and poorer psychological health [ 919222338 ].

Since sexual coercion has negative impacts on psychological, physical, and sexual well-being, it is important to know the prevalence of sexual coercion and its determining factors. This paper aims to examine the prevalence in Nepal of sexual coercion perpetrated by husbands on their wives and to identify the characteristics associated with this phenomenon.

Limited information about sexual coercion exists, and no representative study of sexual coercion experienced by married women Sex news in nepali ever been Sex news in nepali in Nepal.

The data used in this paper were drawn from a cross-sectional survey on "Domestic Violence in Nepal" carried out in The survey was conducted with married women of reproductive age years. One-on-one individual structured interviews were conducted in the survey and a two-staged stratified random sampling technique was employed for the selection of the respondents.

Four districts Achham, Gulmi, Rupendehi, and Ilam out of Nepal's 75 districts were selected randomly with a total of 48 clusters 12 clusters times Sex news in nepali districts. Among these Sex news in nepali, one district was from each of the Eastern and Far-Western regions, and two districts from the Western region.

Education levels and socio-economic status of women in Gulmi, Rupendehi, and Ilam districts were similar to the national average, but women in Achham district had a lower socio-economic status. From Sex news in nepali cluster, 32 households were chosen, and in each household one married woman was selected for the structured interview. In the case of there being more than one married woman in the same household, one was selected randomly.

A total of 1, married women were interviewed. Structured questionnaires were used for the data collection and included questions on socio-demographic characteristics of the woman and her spouse, along with her experience of domestic violence and sexual coercion by the husband [See additional file 1 ]. Pre-testing of the questionnaires with married women of reproductive age in non-sampled areas was carried out and the necessary changes in the questionnaire were incorporated.

Researchers were trained with regards to ethical and safety considerations while conducting research on these sensitive issues [ 3940 ], and verbal informed consent was obtained from the participants before they enrolled in the study.

The interview was conducted in a private space without the presence of a third party, and researchers requested that the interviewees not share any information with others in the study. The research team did not provide any financial compensation to the interviewed women; however, those women who needed counseling or treatment services were referred to the relevant sources of such assistance.

Confidentiality of information was ensured by removing personal identifiers from the completed questionnaires, which protected respondents against adverse repercussions from participating in the study. Sexual coercion experienced by a woman during her entire lifetime is used as the dependent variable in this study.

Respondents were asked three questions:. Has your husband ever physically forced you to have sexual Sex news in nepali when you did not want to? Did you ever have sexual intercourse when you did not want to, because you were afraid of what your husband might do? Has your husband ever forced you to do something sexual that you found degrading or humiliating?

Those women who reported experiencing at least one of the three forms of sexual coercion were considered to have experienced sexual coercion by a husband during their lifetime. Sexual coercion experienced during the lifetime of a woman will be stated as "sexual coercion" hereafter. Similarly, some of the independent variables were also made into composite variables. The score for these questions ranged from 0 to 6, though after making the composite index this variable was categorized into 3 levels-high power, medium power, and low power.

Would you say it is generally true that he: The composite variable range was from 0 to 7, and once again divided into 3 categories-no control, low control, and high control. Both bivariate and multivariate techniques were applied to identify the factors associated with the likelihood of experiencing sexual coercion by a husband. The Chi-square test was used to test the association between the variables. The variables were then re-examined in multivariate analysis binary logistic regression in order to identify the significant associations.

Before the multivariate analysis, multicollinearity between the variables was assessed and the highly correlated variables were removed from the logistic model. Two thirds of the 1, women were below the age of 34 years and about half of the women were literate.

A large majority of women had 2 or more children and slightly more than a quarter of the women were in a "love marriage" a union of two individuals based upon mutual love, affection, commitment, and attraction. About a third of respondents had husbands who were more than 5 years older than they were.

Only about a fourth of women were involved in some kind of Sex news in nepali occupation, with a majority reporting that they were able to get financial or emotional support from their maternal family. More than half the women reported that their husbands consumed alcohol, and about two in Sex news in nepali women reported that their husbands did not control them at all. Combining all three forms of sexual coercion shows that Husband's background characteristics also have a significant association with a woman's Sex news in nepali of sexual coercion.

For instance, a significantly lower proportion of women whose husbands had a secondary or higher education had experienced sexual coercion compared to women whose husbands were illiterate. Logistic regression analysis was used to measure the strength of the association between various factors and the probabilities of women experiencing sexual coercion by their husbands.

Therefore the variable '"number of children ever born" was not entered in the logistic regression model. Moreover, women who experienced higher levels of patriarchal control from their husband were more likely to face sexual coercion than were women who did not face such control. This study aimed to estimate the prevalence and examine the factors associated with sexual coercion in Nepal by husbands toward their wives. As in other parts of the world, sexual coercion is a serious problem in Nepal.

Our study demonstrates that educated women were less likely to experience sexual coercion by a husband, a similar conclusion to a study conducted in India [ 41 ]. One probable reason could be that the freedom these women had to decide jointly with their husband about their own health carried over to other matters, such as when to have sex, so the probability of their being coerced was less.

Our study found that the greater the difference in age between husband and wife, the Sex news in nepali the chance of their being coerced by the husband.

This could be due to the failure of older husbands and their younger wives Sex news in nepali be able to share similar feelings and desires with respect to each other due to the Sex news in nepali age gap. Although the odds of sexual coercion were high among women who were Sex news in nepali same age or older than their husbands, this result was not significant and could be due to the small sample size in this category.

These findings will Sex news in nepali further investigation. The occupation of the husband has a significant association with sexual coercion.

Those women whose husbands worked in the public or private sectors such as business, government, and other professional positions were less Sex news in nepali to experience sexual coercion than were those whose husbands worked in agriculture or the labor sector. This result may be due to businessmen's, government workers', and professionals' work schedules and frequency of Sex news in nepali outside their home environment, which could make them more aware of their wives' sexual health and reproductive rights, though further investigation will be required.

Our study illustrates that respondents whose husbands consumed alcohol were more likely to experience sexual coercion than were those whose husbands did not consume alcohol. This finding is similar to other studies that have found alcohol to be a major cause of intimate partner violence Sex news in nepali 42 - 45 ].

The present study also found that women who were highly controlled by their husbands were more likely to face sexual coercion than were those without such controls. Feminists stress that gender and power structures in a patriarchal society are the root cause of intimate partner violence [ 46 ]. Studies conducted in the US found that the more patriarchal the Sex news in nepali is in a state, the higher the rate of intimate partner violence [ 46 ].

A study conducted in China also found that intimate partner violence is strongly associated with male patriarchal values [ 47 ]. There are some limitations in the interpretation of the results for this study. First, as pointed out previously, our sample is married women, so our results regarding the prevalence of sexual coercion should not be generalized to all women in Nepal.

Second, because the cross-sectional design of the study and all of the items analyzed in the logistic regression analysis came from information at the time of survey, the analysis can only provide evidence of statistical association between those items and sexual coercion, and Sex news in nepali show cause-effect relationships.

Third, due to the sensitive nature of the issue, the prevalence of sexual coercion may have been Sex news in nepali. However, the privacy conditions surrounding the study and the good rapport that was built before the interview are likely to Sex news in nepali minimized purposeful misreporting.

Our study indicates that sexual coercion of married women by husbands is widespread and also a serious problem in Nepal, which could lead to devastating health problems for women. This study has found that educational status of respondents, decision making with regard to women's own health care, husband-wife age differences, husband's occupation, alcohol consumption by the husband, and male patriarchal control were the variables that had a statistically significant association with sexual coercion.

Programs should focus on education for women and women's empowerment to reduce sexual coercion and to protect women's health and rights.

In addition, campaigns against alcohol abuse and awareness programs targeting husbands should also cover the issue of sexual coercion. RA and JT conceived and designed the study. Both researchers were involved in data analysis, interpretation of the data, and drafted the manuscript. Both authors read and approved the final manuscript. Questionnaire on the study entitled "Survey on Domestic Violence in Nepal".

The questionnaire includes questions on socio-demographic characteristics of the woman and her spouse, her attitude regarding gender roles and her experience of domestic violence and sexual coercion Sex news in nepali the husband. The views expressed in this article are those of the authors and not necessarily the organizations who provided the funding support.

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Our work on HIV and other sexually transmitted infections is fully integrated into our broader sexual and reproductive health programs. Poor sexual and reproductive health and HIV infection have common roots in poverty, gender inequality, stigma and cultural factors. We work with communities to spread prevention messages via educational campaigns aimed at behaviour change.

We offer voluntary testing and counselling for HIV and other sexually transmitted diseases. We diagnose and treat a range of sexually transmitted infections, and we refer HIV-positive clients to agencies that offer treatment options. Mother-to-child transmission occurs when the HIV virus passes from a woman to her baby during pregnancy, labour, delivery, or breastfeeding. Without treatment, around percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery.

A further percent will become infected through breastfeeding. Marie Stopes Nepal believes that accessible family planning is essential if women are to enjoy their sexual and reproductive rights. It is also a crucial and cost-effective public health intervention, which can promote economic development and gender equality as well as reduce poverty and maternal deaths.

We believe women everywhere, regardless of where they live, should have access to comprehensive sexual and reproductive health services — including a range of contraceptive methods and, where legal, access to safe abortion — so they can make informed choices about their reproductive health.

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