Disability & protective sex: Women's disability status and negotiation for protective sex in Nigeria

This paper examines the interrelationship between women's disability status and their ability to negotiate for protective sex in Nigeria, where women with disabilities face gender-based and disability-related marginalisation, which is associated with limited access to resources and well-being. The study uses data from the 2018 Nigeria Demographic and Health Survey. The analysis focuses on 15–49-year-old currently married or cohabiting women, using the Washington Group Short Set (WG-SS) to measure disability status and multinomial logistic regression to examine factors associated with women's negotiation ability. Findings show that approximately 5% of married or cohabiting women were identified as having disabilities. The primary objective is to estimate the association between disability status and women's negotiation ability for protective sex among currently married or cohabiting women aged 15-49 in the 2018 Nigeria DHS. Married or cohabiting women with disabilities are marginally associated with a higher likelihood to negotiate for either condom use or refuse sex (moderate ability to negotiate) compared to those without disabilities (aRRR = 1.21, p < 0.080, 95% CI: 0.96 – 1.52), a 21% higher likelihood. Conversely, while descriptive data suggested a higher likelihood of ‘high’ negotiation ability among women with disabilities, this association was not statistically significant in the adjusted model (aRRR = 1.04, p = 0.685), indicating that socioeconomic factors such as wealth and education largely account for this observed difference. Ability to negotiate is associated with education (where women with post-secondary education had a higher likelihood of ability to negotiate for protective sex), household wealth (where women in higher wealth quintiles exhibited greater negotiation ability), region of residence, and religious affiliation (where Muslim women were less likely to negotiate for protective sex), and participation in household decision-making. These findings underscore the urgent need for disability-inclusive sexual and reproductive health programs, empowerment interventions, and efforts to challenge stigma and discrimination. To protect the rights and promote equity for women with disabilities, existing policies and laws must be implemented with cultural sensitivity. • In Nigeria, 5% of married or cohabiting women report disabilities, revealing a significant, potentially underreported, demographic facing unique challenges. • Higher education empowers women for protective sex negotiation. Economic security, especially for women with disabilities in wealthier households, further strengthens this important autonomy. • Increase women's power in healthcare decisions, boost their ability to negotiate for protective sex. Religious affiliation matters here, as Muslim women negotiate less often than Catholic women . • Geographic disparities exist, as rural women show less ability to negotiate for high protective sex compared to their urban counterparts. • The study highlights the urgent need for disability-inclusive sexual and reproductive health programs and empowerment interventions in Nigeria.