{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:33:41Z","timestamp":1787924021186,"version":"build-2784847793"},"reference-count":36,"publisher":"Belitung Raya Foundation","issue":"4","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This study was conducted with the support of the Indonesian Education\nScholarship (BPI) and the Center for Higher Education Funding and\nAssessment (PPAPT), operating under the Ministry of Higher Education,\nScience, and Technology of the Republic of Indonesia (Kemendiktisaintek),\nalongside the Indonesian Endowment Fund for Education (LPDP)","award":["202209091540"],"award-info":[{"award-number":["202209091540"]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Female reproductive health vulnerabilities are influenced by socio-demographic factors and domestic power imbalances. In Indonesia, investigating how relational empowerment affects sexual health outcomes remains a critical public health necessity.\nObjective: This study aimed to evaluate the association between sexual autonomy, socio-demographic determinants, and self-reported sexually transmitted infection (STI) symptoms among coupled women in Indonesia.\nMethods: A secondary analysis was conducted using nationally representative data from the 2017 Indonesia Demographic and Health Survey (IDHS). The analytical sample comprised 28,264 currently married or cohabiting coupled women. A composite index for sexual autonomy was constructed based on standardized sexual negotiation indicators. Survey-weighted binary logistic regression analysis was conducted to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs).\nResults: The multivariate analysis demonstrated a significant association between sexual autonomy and self-reported STIs. Women with high sexual autonomy had 1.51 times higher odds of reporting STI symptoms than those with low sexual autonomy (AOR = 1.51; 95% CI: 1.23-1.84). Rather than indicating greater biological risk, this association suggest a symptom disclosure effect related to greater health awareness. In contrast, structural vulnerabilities independently reduced protective capacity; lower decision-making autonomy (AOR = 1.14), primary education (AOR = 1.29), and a strong justification of intimate partner violence (AOR = 2.08) were all significantly associated with higher odds of experiencing and reporting STIs.\nConclusion: The association between high individual sexual autonomy and elevated STI symptom reporting highlights a health disclosure mechanism rather than biological disease incidence. Among coupled Indonesian women, reproductive health outcomes are deeply shaped by gender power relations. Public health and community nursing interventions should therefore prioritize addressing structural domestic coercion, normalizing the rejection of violence, and creating safe environments that support health transparency.<\/jats:p>","DOI":"10.33546\/bnj.4759","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:16:42Z","timestamp":1787883402000},"page":"533-543","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Socio-demographic factors, sexual autonomy, and self-reported sexually transmitted infection\/symptoms among coupled women in Indonesia: A secondary analysis of a national survey"],"prefix":"10.33546","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0500-249X","authenticated-orcid":false,"given":"Puji","family":"Laksmini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Besral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"160781","doi-asserted-by":"crossref","unstructured":"Adetutu, O. M., Oyelakin, T. E., Kupoluyi, J. A., Oyinlola, F. F., Shittu, I. O., Akerele, P. A., & Ofili, F. L. (2024). Women\u2019s sexual autonomy as a determinant of misconception about modes of transmission of HIV in Nigeria. Journal of African Population Studies, 37(1), 5294. https:\/\/doi.org\/10.59147\/japs_tFzYd5Mv","DOI":"10.59147\/tFzYd5Mv"},{"key":"160782","doi-asserted-by":"crossref","unstructured":"Adu, C., Mohammed, A., Budu, E., Frimpong, J. B., Tetteh, J. K., Ahinkorah, B. O., & Seidu, A.-A. (2022). Sexual autonomy and self-reported sexually transmitted infections among women in sexual unions. Archives of Public Health, 80(1), 40. https:\/\/doi.org\/10.1186\/s13690-022-00796-4","DOI":"10.1186\/s13690-022-00796-4"},{"key":"160783","doi-asserted-by":"crossref","unstructured":"Aral, S. O. (2002). Determinants of STD epidemics: Implications for phase appropriate intervention strategies. Sexually Transmitted Infections, 78(suppl 1), i3-i13. https:\/\/doi.org\/10.1136\/sti.78.suppl_1.i3","DOI":"10.1136\/sti.78.suppl_1.i3"},{"key":"160784","doi-asserted-by":"crossref","unstructured":"Asabu, M. D. (2021). Women\u2019s autonomy in refusing risky sex and associated factors in Ethiopia: Evidence from 2011 to 2016 EDHS data. BMC Women's Health, 21(1), 335. https:\/\/doi.org\/10.1186\/s12905-021-01479-y","DOI":"10.1186\/s12905-021-01479-y"},{"key":"160785","doi-asserted-by":"crossref","unstructured":"Atteraya, M. S., Kimm, H., & Song, I. H. (2014). Women's autonomy in negotiating safer sex to prevent HIV: Findings from the 2011 Nepal Demographic and Health Survey. AIDS Education and Prevention, 26(1), 1-12. https:\/\/doi.org\/10.1521\/aeap.2014.26.1.1","DOI":"10.1521\/aeap.2014.26.1.1"},{"key":"160786","doi-asserted-by":"crossref","unstructured":"Crissman, H. P., Adanu, R. M., & Harlow, S. D. (2012). Women's sexual empowerment and contraceptive use in Ghana. Studies in Family Planning, 43(3), 201-212. https:\/\/doi.org\/10.1111\/j.1728-4465.2012.00318.x","DOI":"10.1111\/j.1728-4465.2012.00318.x"},{"key":"160787","doi-asserted-by":"crossref","unstructured":"Deng, M., Chen, J., Wang, Z., Zheng, R., Pang, W., Sun, R., & Bai, Z. (2025). Trends in the incidence of common sexually transmitted infections at the global, regional and national levels, 1990\u20132021: Results of the Global Burden of Disease 2021 study. Tropical Medicine and Health, 53(1), 70. https:\/\/doi.org\/10.1186\/s41182-025-00744-2","DOI":"10.1186\/s41182-025-00744-2"},{"key":"160788","doi-asserted-by":"crossref","unstructured":"Fu, L., Sun, Y., Han, M., Wang, B., Xiao, F., Zhou, Y., Gao, Y., Fitzpatrick, T., Yuan, T., & Li, P. (2022). Incidence trends of five common sexually transmitted infections excluding HIV from 1990 to 2019 at the global, regional, and national levels: Results from the global burden of disease study 2019. Frontiers in Medicine, 9, 851635. https:\/\/doi.org\/10.3389\/fmed.2022.851635","DOI":"10.3389\/fmed.2022.851635"},{"key":"160789","doi-asserted-by":"crossref","unstructured":"Hayati, E. N., H\u00f6gberg, U., Hakimi, M., Ellsberg, M. C., & Emmelin, M. (2011). Behind the silence of harmony: Risk factors for physical and sexual violence among women in rural Indonesia. BMC Women's Health, 11(1), 52. https:\/\/doi.org\/10.1186\/1472-6874-11-52","DOI":"10.1186\/1472-6874-11-52"},{"key":"160790","doi-asserted-by":"crossref","unstructured":"Ibitoye, T. R., & Ajagunna, F. (2021). Sexual autonomy and violence against women in Nigeria: Assessing the impact of Covid-19 pandemic. De Jure Law Journal, 54(1), 141-159. https:\/\/doi.org\/10.17159\/2225-7160\/2021\/v54a9","DOI":"10.17159\/2225-7160\/2021\/v54a9"},{"key":"160791","unstructured":"Indonesia Ministry of Health. (2021). Peta jalan eliminasi infeksi menular seksual Indonesia 2021-2030 [Indonesia's Roadmap for the Elimination of Sexually Transmitted Infections 2021\u20132030]. Jakarta: Indonesia Ministry of Health."},{"key":"160792","doi-asserted-by":"crossref","unstructured":"Jubayer Biswas, M. A. A., Kafi, M. A., Hemel, M. M. M., Ahmed, M. M. M., & Khan, S. I. (2022). Women empowerment and sexually transmitted infections: Evidence from Bangladesh demographic and health survey 2014. PloS One, 17(2), e0263958. https:\/\/doi.org\/10.1371\/journal.pone.0263958","DOI":"10.1371\/journal.pone.0263958"},{"key":"160793","doi-asserted-by":"crossref","unstructured":"Karahan, N., Aydemir, G., & \u015eahin, E. T. (2025). Genital hygiene behaviors in women: A cross-sectional study from Turkey. Revista Da Associacao Medica Brasileira, 71(4), e20241760. https:\/\/doi.org\/10.1590\/1806-9282.20241760","DOI":"10.1590\/1806-9282.20241760"},{"key":"160794","doi-asserted-by":"crossref","unstructured":"Kishor, S. (2012). Married women\u2019s risk of STIs in developing countries: The role of intimate partner violence and partner\u2019s infection status. Violence Against Women, 18(7), 829-853. https:\/\/doi.org\/10.1177\/1077801212455358","DOI":"10.1177\/1077801212455358"},{"key":"160795","doi-asserted-by":"crossref","unstructured":"Lumbantoruan, S. M., Eka, N. G. A., & Saputri, A. (2025). Self-reported sexually transmitted infections among women in Indonesia: Analysis of 2017 Indonesia demographic and health survey. BMC Public Health, 25(1), 4088. https:\/\/doi.org\/10.1186\/s12889-025-25193-8","DOI":"10.1186\/s12889-025-25193-8"},{"key":"160796","doi-asserted-by":"crossref","unstructured":"Masanja, V., Wafula, S. T., Ssekamatte, T., Isunju, J. B., Mugambe, R. K., & Van Hal, G. (2021). Trends and correlates of sexually transmitted infections among sexually active Ugandan female youths: Evidence from three demographic and health surveys, 2006\u20132016. BMC Infectious Diseases, 21(1), 59. https:\/\/doi.org\/10.1186\/s12879-020-05732-x","DOI":"10.1186\/s12879-020-05732-x"},{"key":"160797","doi-asserted-by":"crossref","unstructured":"Mayaud, P., & Mabey, D. (2004). Approaches to the control of sexually transmitted infections in developing countries: Old problems and modern challenges. Sexually Transmitted Infections, 80(3), 174-182. https:\/\/doi.org\/10.1136\/sti.2002.004101","DOI":"10.1136\/sti.2002.004101"},{"key":"160798","doi-asserted-by":"crossref","unstructured":"Memiah, P., Opanga, Y., Bond, T., Cook, C., Mwangi, M., Fried, J., Joseph, M. A., Owuor, K., Mochache, V., & Machira, Y. W. (2019). Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis. PloS One, 14(2), e0212413. https:\/\/doi.org\/10.1371\/journal.pone.0212413","DOI":"10.1371\/journal.pone.0212413"},{"key":"160799","doi-asserted-by":"crossref","unstructured":"Midaksa, M., Destaw, A., Addissie, A., Kantelhardt, E. J., & Gizaw, M. (2022). Women\u2019s sexual autonomy as a determinant of cervical cancer screening uptake in Addis Ababa, Ethiopia: A case\u2013control study. BMC Women's Health, 22(1), 236. https:\/\/doi.org\/10.1186\/s12905-022-01829-4","DOI":"10.1186\/s12905-022-01829-4"},{"key":"160800","doi-asserted-by":"crossref","unstructured":"Nankinga, O., Misinde, C., & Kwagala, B. (2016). Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda. BMC Public Health, 16(1), 440. https:\/\/doi.org\/10.1186\/s12889-016-3103-0","DOI":"10.1186\/s12889-016-3103-0"},{"key":"160801","unstructured":"National Population Family Planning Board, Statistical Indonesia, Ministry of Health - Kemenkes, & ICF. (2018). Indonesia Demographic and Health Survey 2017. http:\/\/dhsprogram.com\/pubs\/pdf\/FR342\/FR342.pdf"},{"key":"160802","doi-asserted-by":"crossref","unstructured":"Ningsih, P. S. (2022). Wacana otonomi seksualitas perempuan: Sisilism menolak standar ganda [The discourse on women's sexual autonomy: Sisilism rejects the double standard]. Calathu: Jurnal Ilmu Komunikasi, 4(2), 93-108. https:\/\/doi.org\/10.37715\/calathu.v4i2.3316","DOI":"10.37715\/calathu.v4i2.3316"},{"key":"160803","doi-asserted-by":"crossref","unstructured":"Osborne, A., James, P. B., Bangura, C., Williams, S. M. T., Wadsworth, R., & Lebbie, A. (2023). Knowledge, prevalence, and risk factors for self-reported sexually transmitted diseases among University Students in Sierra Leone. Sierra Leone Journal of Biomedical Research, 14(2), 81-91. https:\/\/doi.org\/10.4314\/sljbr.v14i2.11","DOI":"10.4314\/sljbr.v14i2.11"},{"key":"160804","doi-asserted-by":"crossref","unstructured":"Puspita, L. (2017). Analisis faktor yang berhubungan dengan kejadian infeksi menular seksual pada wanita pekerja seksual [Analysis of factors associated with the occurrence of sexually transmitted infections among female sex workers]. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 2(1), 31-44.","DOI":"10.30604\/jika.v2i1.30"},{"key":"160805","doi-asserted-by":"crossref","unstructured":"Refti, W. G. (2018). Faktor resiko yang berhubungan dengan kejadian infeksi menular seksual (IMS) di Klinik Voluntary Counseling Test (VCT) [Risk factors associated with the occurrence of sexually transmitted infections (STIs) at the Voluntary Counseling and Testing (VCT) clinic]. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 3(1), 47-60. https:\/\/doi.org\/10.30604\/jika.v3i1.81","DOI":"10.30604\/jika.v3i1.81"},{"key":"160806","doi-asserted-by":"crossref","unstructured":"Rowley, J., Vander Hoorn, S., Korenromp, E., Low, N., Unemo, M., Abu-Raddad, L. J., Chico, R. M., Smolak, A., Newman, L., & Gottlieb, S. (2019). Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 97(8), 548. https:\/\/doi.org\/10.2471\/BLT.18.228486","DOI":"10.2471\/BLT.18.228486"},{"key":"160807","doi-asserted-by":"crossref","unstructured":"Simbolon, W. M., & Budiarti, W. (2020). Kejadian infeksi menular seksual pada wanita kawin di Indonesia dan variabel-variabel yang memengaruhinya [Incidence of sexually transmitted infections among married women in Indonesia and the variables influencing them]. Jurnal Kesehatan Reproduksi, 7(2), 81-87. https:\/\/doi.org\/10.22146\/jkr.49847","DOI":"10.22146\/jkr.49847"},{"key":"160808","doi-asserted-by":"crossref","unstructured":"Siregar, P. A., Nasution, F., Nurhayati, N., Sitorus, M. A., Nasution, R. A., & Hayati, F. (2021). Analysis of risk factors of sexual transmitted infections. Jurnal Riset Kesehatan, 10(2), 90-98. https:\/\/doi.org\/10.31983\/jrk.v10i2.6866","DOI":"10.31983\/jrk.v10i2.6866"},{"key":"160809","doi-asserted-by":"crossref","unstructured":"Solanke, B. L., Adetutu, O. M., Sunmola, K. A., Opadere, A. A., Adeyemi, N. K., & Soladoye, D. A. (2022). Multi-level predictors of sexual autonomy among married women in Nigeria. BMC Women's Health, 22(1), 114. https:\/\/doi.org\/10.1186\/s12905-022-01699-w","DOI":"10.1186\/s12905-022-01699-w"},{"key":"160810","unstructured":"Sundari, I. A., Hartinah, D., & Wibowo, E. (2025). Hubungan personal hygiene dengan keputihan pada ibu rumah tangga di Desa Purwogondo Kalinyamatan [The relationship between personal hygiene and vaginal discharge among housewives in Purwogondo Village, Kalinyamatan]. Nusantara Hasana Journal, 5(3), 1-9. https:\/\/doi.org\/10.59003\/nhj.v5i3.1601"},{"key":"160811","doi-asserted-by":"crossref","unstructured":"Unemo, M., Bradshaw, C. S., Hocking, J. S., de Vries, H. J. C., Francis, S. C., Mabey, D., Marrazzo, J. M., Sonder, G. J. B., Schwebke, J. R., & Hoornenborg, E. (2017). Sexually transmitted infections: Challenges ahead. The Lancet Infectious Diseases, 17(8), e235-e279. https:\/\/doi.org\/10.1016\/S1473-3099(17)30310-9","DOI":"10.1016\/S1473-3099(17)30310-9"},{"key":"160812","doi-asserted-by":"crossref","unstructured":"Viswan, S. P., Ravindran, T. K. S., Kandala, N.-B., Petzold, M. G., & Fonn, S. (2017). Sexual autonomy and contraceptive use among women in Nigeria: findings from the demographic and health survey data. International Journal of Women's Health, 581-590. https:\/\/doi.org\/10.2147\/IJWH.S133760","DOI":"10.2147\/IJWH.S133760"},{"key":"160813","unstructured":"WHO. (2025a). Defining sexual health. https:\/\/www.who.int\/teams\/sexual-and-reproductive-health-and-research\/key-areas-of-work\/sexual-health\/defining-sexual-health"},{"key":"160814","unstructured":"WHO. (2025b). Sexually transmitted infections (STIs). https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections-(stis)"},{"key":"160815","doi-asserted-by":"crossref","unstructured":"Willie, T. C., Callands, T., Alexander, K. A., & Kershaw, T. (2023). Measuring women\u2019s sexual autonomy: Development and preliminary validation of the women\u2019s sexual autonomy scale. Women's Health, 19, 17455057231183837. https:\/\/doi.org\/10.1177\/17455057231183837","DOI":"10.1177\/17455057231183837"},{"key":"160816","doi-asserted-by":"crossref","unstructured":"Yamani, L. N., Astutik, E., Qurniyawati, E., Lusida, M. I., Getaneh, Y., & Kelly, M. (2025). Associations between socio-demographics, sexual knowledge and behaviour and sexually transmitted infections among reproductive-age women in Southeast Asia: Demographic Health Survey results. BMC Public Health, 25(1), 738. https:\/\/doi.org\/10.1186\/s12889-025-21962-7","DOI":"10.1186\/s12889-025-21962-7"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4759\/1406","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4759\/1426","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4759\/1406","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:06:16Z","timestamp":1787922376000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/4759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8,28]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.4759","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"2026-03-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}