In Bangladesh, where migration is crucial to many individuals' and families' livelihood, spouses who spend time living apart because of the husband's work migration engage in higher levels of risky behavior than do those who never live apart from their families.1 The proportion of men reporting in a 2004 survey that they had ever had extramarital sex was significantly higher among those who had spent time away from home to find work than among those who had not; reports of extramarital sex were relatively uncommon among women, but were more frequent among wives whose husbands migrated for work than among others. The longer the period of separation, the more likely both men and women were to report having had an extramarital partner.
The survey was conducted in two rural areas of Bangladesh that are part of an ongoing health and demographic surveillance effort. In one area, many men travel within the country or on brief trips to India for work; in the other, temporary migration for work abroad (largely to the Middle East) is common. To study the relationship between sexual risk behavior and husbands' work migration, researchers interviewed a sample of 15–49-year-old women who had been included in the surveillance project since 1999 and their husbands. A total of 1,175 women and 703 men completed interviews. The researchers used data from the surveillance system to assess whether spouses had lived together throughout the previous five years, were currently living apart because of the husband's work migration or had lived apart for that reason at some time during the last five years; they classified couples as having lived apart if the husband had been away from home for more than 60 days.
Women were about equally divided among those whose husbands had not lived away from home in the past five years, those whose husbands were currently elsewhere in Bangladesh and those whose husbands were currently abroad. Those whose husbands were currently abroad were significantly younger and reported higher monthly household expenditures than those who had not been separated from their husbands; women who had not lived apart from their husbands had less education and had been married longer than women whose husbands had migrated either internally or abroad.
The majority of men had not lived away from home in the previous five years; 17% had worked elsewhere in Bangladesh, and 26% had traveled abroad for work. Men who had not been apart from their wives were younger than those who had returned from abroad, and reported lower monthly household expenditures than either group of men who had migrated for work.
Significantly higher proportions of men who had migrated for work than of those who had not migrated reported ever having had extramarital sex—60% of internal migrants and 67% of those who had worked outside the country, compared with 26% of men who had not lived away from their wives. Differences were reported both for intercourse with sex workers (50–59% of migrants vs. 15% of others) and for sex with a male partner (6–9% vs. 3%). Results of an analysis that controlled for socioeconomic factors confirmed that the likelihood of having engaged in extramarital sex was elevated if men had been separated from their wives (odds ratio, 4.5 for those who had lived elsewhere in Bangladesh and 6.2 for those who had lived abroad).
Women were less likely than men to report having had extramarital sex, but the proportion doing so was significantly higher among those whose husbands were living elsewhere in Bangladesh (11%) or abroad (7%) than among those who had not lived apart from their husbands (3%). Again, multivariate analysis confirmed the association; the odds of having had extramarital sex were quadrupled among both groups of women whose husbands migrated for work.
The longer spouses had lived apart, the greater the likelihood of extramarital sex. Men's odds of reporting ever having had extramarital sex were 8–9 times as high among those who had lived elsewhere in Bangladesh for six or more months and those who had lived abroad for more than four years as the odds among those who had not lived apart from their wives. Similarly, compared with women whose husbands had not migrated for work, those with husbands who had lived away from home for some period of time had 6–7 times the odds of having had an extramarital partner.
Most men who had had extramarital sex had never used a condom during those occasions, but the proportion who had done so was significantly higher among those who had been abroad (28%) than among those who had not lived away from home (17%). The last time they had had extramarital sex, 9–13% of men who had migrated for work, but only 1% of others, had used a condom. When having intercourse with sex workers, similar proportions of men in all subgroups (24–31%) had ever used condoms, but use at last sex was more common among men who had lived away from home (13–17%) than among those who had not (7%). The numbers of men who reported having had male extramarital sex partners was too small to permit analysis of condom use. Three in 10 men in each subgroup had ever used condoms with their wives; 6–12% had done so the last time they had sex.
Some 38–46% of women and 14–30% of men in the various subgroups had ever had symptoms of an STI. For each gender, in every subgroup, the proportion who had had STI symptoms was significantly higher among those reporting extramarital sex than among others. Reports of symptoms were less common among women whose husbands currently lived elsewhere in Bangladesh than among those who had not been separated from their husbands (38% vs. 45%) and were more common among men who had lived apart from their wives than among those who had not (28–30% vs. 14%).
Nearly all men (85–96%) and large majorities of women (60–75%) had heard of HIV/AIDS, but only 9–18% across subgroups had ever discussed it with their spouse. Men were significantly more likely than women to know that HIV can be transmitted through intercourse and that intercourse with sex workers is relatively unsafe, but women were more likely than men to know that monogamy and condom use can help prevent HIV transmission. One in five men who had lived apart from their wives, compared with one in 10 who had not, thought that they were at risk of acquiring HIV. According to results of multiple regression analysis, men's likelihood of considering themselves at risk was markedly elevated if they knew that HIV is transmitted through intercourse (odds ratio, 6.3) and more moderately raised if they had lived away from home, had had extramarital sex or had had STI symptoms. Fewer than 3% of women perceived themselves to be at risk; the odds of this perception were elevated for women who reported having had extramarital sex, knew that HIV is sexually transmitted or had had at least six years of schooling.
1. Mercer A et al., Sexual risk behavior of married men and women in Bangladesh associated with husbands' work migration and living apart, Sexually Transmitted Diseases, 2007, 34(5):265–273.