Abstract
Sexual risk-taking and reproductive morbidity are common among rapidly modernizing populations with little material wealth, limited schooling, minimal access to modern contraception and healthcare, and gendered inequalities in resource access that limit female autonomy in cohabiting relationships. Few studies have examined how modernization influences sexual risk-taking and reproductive health early in demographic transition. Tsimane are a natural fertility population of Bolivian forager-farmers; they are not urbanized, reside in small-scale villages, and lack public health infrastructure. We test whether modernization is associated with greater sexual risk-taking, report prevalence of gynecological morbidity (GM), and test whether modernization, sexual risk-taking and parity are associated with greater risk of GM. Data were collected from 2002–2010 using interviews, clinical exams, and laboratory analysis of cervical cells. We find opposing effects of modernization on both sexual risk-taking and risk of GM. Residential proximity to town and Spanish fluency are associated with greater likelihood of men’s infidelity, and with number of lifetime sexual partners for men and women. However, for women, literacy is associated with delayed sexual debut after controlling for town proximity. Fifty-five percent of women present at least one clinical indicator of GM (n = 377); 48% present inflammation of cervical cells, and in 11% the inflammation results from sexually transmitted infection (trichomoniasis). Despite having easier access to modern healthcare, women residing near town experience greater likelihood of cervical inflammation and trichomoniasis relative to women in remote villages; women who are fluent in Spanish are also more likely to present trichomoniasis relative to women with moderate or no fluency. However, literate women experience lower likelihood of trichomoniasis. Parity has no effect on risk of GM. Our results suggest a net increase in risk of reproductive morbidity among rapidly modernizing, resource-stressed populations.
Highlights
A woman’s greatest risk of contracting a sexually transmitted infection (STI) is through unprotected sex with a long-term male partner [1]
gynecological morbidity (GM) can lead to infertility or adverse pregnancy outcomes including fetal loss, infant morbidity, and infant death [14,15]
The effect of modernization on sexual risk-taking and risk of GM early in demographic and epidemiological transition remains poorly understood. We examine these relationships in a society with limited variance in socioeconomic status, no consistent use of modern contraceptives, and limited exposure to Western norms, all of which may influence sexual risk-taking and reproductive health
Summary
A woman’s greatest risk of contracting a sexually transmitted infection (STI) is through unprotected sex with a long-term male partner [1]. While married women are less likely to have multiple concurrent partners compared to their unmarried sexually active peers, married women may have higher rates of reproductive tract infections including STIs [5,6,7,8,9]. Married women’s risk of STI may be independent of their own sexual behavior [10], suggesting that husbands’ sexual risk-taking mediates the effect of marriage on women’s poor reproductive health. Husbands’ infidelity is associated with increased risk of gynecological morbidity (GM) [8,11,12]. GM can lead to infertility or adverse pregnancy outcomes including fetal loss, infant morbidity, and infant death [14,15]
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