Patriarchal dominance and relationship: couple communication's mediating effect on sexual and reproductive health outcomes among Rohingya refugee women.

Background: Considering the patriarchal dominance, power dynamics, and relational issues in the Rohingya society, this study used dyadic power theory and social penetration theory to examine how husbands' dominance in sexual and reproductive health (SRH) and couples' disclosure influence their couple communication about SRH. It also explored the mediated effect of couple communication on their SRH-related outcomes.

Methods: This quantitative study was designed with a cross-sectional survey (N = 408) at the Rohingya refugee camp in Cox's Bazar district of Bangladesh. Different bivariate analyses, hierarchical regression, and mediation analysis were performed.

Results: Findings show that having a job, having less children, couple's regular access to the health center, better SRH-related perceptions and beliefs, having husband's approval of family planning (FP), and broad couple relationship breadth appeared to be significant factors (p < .001) of couple communication regarding SRH. Additionally, couple communication significantly (p < .001) mediated the influence of the husband's approval of FP and couples' broad relational breadth on women's contraceptive use, SRH behavior, and husbands' support in SRH.

Conclusions: The study findings highlight that couple communication can potentially involve men in women's SRH and improve refugee women's SRH status, as husbands are the key decision-makers in the Rohingya society.