Polygamy and Monogamy with Extramarital Partners Are Associated with Negative Sexual Health Outcomes Among Married, Malawian Women

Background: Sexual concurrency - the practice of having more than one sexual partner during the same period of time - is prevalent among married couples globally and impacts the sexual health of married women.

Methods: We used data from a survey conducted with 1034 women aged 15 to 39 years as part of a cohort study on sexual and reproductive health in rural Lilongwe District, Malawi. We compared sexual-health-related knowledge and outcomes across three groups of married women: women in polygamous marriages, women in monogamous marriages who knew or suspected their husbands had extramarital partners, and women in monogamous marriages who did not know or suspect their husbands had extramarital partners. We used chi-square and Kruskal-Wallis tests with Bonferroni correction to compare characteristics across marriage categories.

Results: The analysis population included 611 married women. Almost one third (31%) were in polygamous marriages; 23% were married to husbands with known or suspected extramarital partners, and 46% were married to husbands without extramarital partners. We observed no significant differences in women's HIV-prevention beliefs or awareness of cervical cancer across the three groups of married women. Compared to women married to husbands without extramarital partners, women in polygamous marriages were more likely to report a previous history of STI (6% vs 14%, p=0.02). Compared to women married to husbands without extramarital partners, women married to husbands with known or suspected extramarital partners were more likely to report STI symptoms in the past year (13% vs. 25%, p<0.01).

Conclusions: Although STI-related knowledge was comparable across groups, concurrency – polygamous marriage and monogamous marriage with husbands known or suspected to have extramarital partners - was associated with adverse sexual health outcomes among married Malawian women. In this population with a high prevalence of concurrency, knowledge may not predict uptake of STI-prevention strategies.