Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America.
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, United States of America.
PLoS One. 2019 Oct 9;14(10):e0223455. doi: 10.1371/journal.pone.0223455. eCollection 2019.
Nigeria has a plural legal system in which various sources of law govern simultaneously. Inconsistent and conflicting legal frameworks can reinforce pre-existing health disparities in sexual and reproductive health (SRH). While previous studies indicate poor SRH outcomes for Nigerian women and girls, particularly in Northern states, the relationship between customary and religious law (CRL) and SRH has not been explored. We conducted a state-level ecological study to examine the relationship between CRL and SRH outcomes among women in 36 Nigerian states and the Federal Capital Territory of Abuja (n = 37), using publicly available Demographic and Health Survey data from 2013. Indicators were guided by published research and included contraception use among married women, total fertility rate, median age at first birth, receipt of antenatal care, delivery location, and comprehensive knowledge of HIV. To account for economic differences between states, crude linear regression models were compared to a multivariable model, adjusting for per capita GDP. All SRH outcomes, except comprehensive knowledge of HIV, were statistically significantly more negative in CRL states compared to non-CRL states, even after accounting for state-level GDP. In CRL states in 2013, compared to non-CRL states, the proportion of married women who used any method of contraception was 22.7 percentage points lower ([95% CI: -15.78 --29.64], p<0.001), a difference that persisted in a model adjusting for per capita GDP (b[adj] = -16.15, 95% CI: [-8.64 --23.66], p<0.001.). While this analysis of retrospective state-level data found robust associations between CRL and poor SRH outcomes, future research should incorporate prospective individual-level data to further elucidate these findings.
尼日利亚实行多元法律体系，各种法律渊源同时适用。不一致和相互冲突的法律框架可能会加剧性健康和生殖健康方面已有的健康差距。尽管先前的研究表明尼日利亚妇女和女孩的性健康和生殖健康状况较差，尤其是在北部各州，但习惯法和宗教法与性健康和生殖健康之间的关系尚未得到探讨。我们进行了一项州一级的生态研究，使用 2013 年公开的人口与健康调查数据，检查了 36 个尼日利亚州和阿布贾联邦首都区（n=37）的习惯法和宗教法与妇女性健康和生殖健康结果之间的关系。指标是根据已发表的研究制定的，包括已婚妇女的避孕措施使用情况、总生育率、初育年龄中位数、接受产前护理的情况、分娩地点以及对艾滋病毒的综合认识。为了说明各州之间的经济差异，我们比较了粗略线性回归模型和多变量模型，调整了人均国内生产总值。除了对艾滋病毒的综合认识外，所有性健康和生殖健康结果在习惯法州都比非习惯法州更差，即使考虑到州一级的国内生产总值也是如此。在 2013 年的习惯法州，与非习惯法州相比，使用任何避孕方法的已婚妇女人数低 22.7 个百分点（[95%置信区间：-15.78 --29.64]，p<0.001），在调整人均国内生产总值的模型中，这一差异仍然存在（b[adj] = -16.15，95%置信区间：[-8.64 --23.66]，p<0.001）。虽然对回顾性州一级数据的这种分析发现习惯法与性健康和生殖健康不良结果之间存在强有力的关联，但未来的研究应纳入前瞻性个人一级数据，以进一步阐明这些发现。
