Patriarchal dominance and relationship: couple communication's mediating effect on sexual and reproductive health outcomes among Rohingya refugee women.
Zakaria M, Islam M, et al. • Journal of communication in healthcare • 2025
Couple communication significantly mediated the influence of husband's approval of family planning and couples' broad relational breadth on women's contraceptive use, SRH behavior, and husbands' support in SRH among Rohingya refugee women.
Key Findings
Results
Having a job was a significant factor associated with couple communication regarding sexual and reproductive health among Rohingya refugee women.
Finding derived from a cross-sectional survey of N=408 participants at Rohingya refugee camps in Cox's Bazar district of Bangladesh
Employment status was significant at p < .001
Both bivariate analyses and hierarchical regression were used to identify this association
The study used dyadic power theory and social penetration theory as its theoretical framework
Results
Having fewer children was significantly associated with better couple communication about sexual and reproductive health.
Significant at p < .001
Finding derived from hierarchical regression analysis in the cross-sectional survey of 408 Rohingya refugee women
Number of children was included as one of several sociodemographic and relational predictors of couple communication
Results
Couples' regular access to health centers was a significant factor in couple communication regarding sexual and reproductive health.
Significant at p < .001
Assessed through cross-sectional survey methodology with N=408 participants
Regular health center access was among multiple significant predictors identified through hierarchical regression
Results
Better SRH-related perceptions and beliefs were significantly associated with couple communication about sexual and reproductive health.
Significant at p < .001
Identified through bivariate analyses and hierarchical regression among 408 Rohingya refugee women
SRH-related perceptions and beliefs were measured as part of the quantitative survey instrument
Results
Husband's approval of family planning was a significant factor in couple communication regarding sexual and reproductive health.
Significant at p < .001
Husband approval was identified both as a direct predictor of couple communication and as a variable whose effect on SRH outcomes was mediated by couple communication
Finding reflects the patriarchal structure of Rohingya society where husbands are described as key decision-makers
Mediation analysis was performed to assess the indirect effects
Results
Broad couple relationship breadth (extent of topic disclosure between partners) was a significant factor associated with couple communication about SRH.
Significant at p < .001
Relationship breadth was conceptualized using social penetration theory, referring to the range of topics couples discuss
Relationship breadth was both a direct predictor of couple communication and a variable whose effect on SRH outcomes was mediated by couple communication
Sample size was N=408 from Rohingya refugee camps in Cox's Bazar, Bangladesh
Results
Couple communication significantly mediated the effect of husband's approval of family planning on women's contraceptive use, SRH behavior, and husbands' support in SRH.
Mediation was significant at p < .001
Three SRH outcomes were examined: contraceptive use, SRH behavior, and husband's support in SRH
Mediation analysis was conducted alongside hierarchical regression in the cross-sectional sample of N=408
The mediation finding suggests couple communication is a pathway through which husband approval translates into improved SRH outcomes
Results
Couple communication significantly mediated the effect of couples' broad relational breadth on women's contraceptive use, SRH behavior, and husbands' support in SRH.
Mediation was significant at p < .001
The mediated effect was observed across all three SRH outcomes measured: contraceptive use, SRH behavior, and husband's support in SRH
Social penetration theory was used to theorize the role of relational breadth in couple communication
Cross-sectional design limits causal inference
What This Means
This research suggests that among Rohingya refugee women living in camps in Bangladesh, the way couples talk to each other about sexual and reproductive health plays a crucial role in determining health outcomes. The study surveyed 408 women and found that several factors — including whether a woman had a job, how many children she had, whether the couple regularly visited health centers, and the range of topics couples generally discussed with each other — were all linked to whether couples communicated openly about sexual and reproductive health. Most notably, whether a husband approved of family planning was strongly tied to health outcomes, and much of that connection worked through couple communication.
The study found that couple communication acted as a 'bridge' — or mediator — between a husband's attitudes and the actual health behaviors of the woman. When husbands approved of family planning and when couples had broader, more open relationships, women were more likely to use contraception, engage in positive SRH behaviors, and receive support from their husbands — but largely because these conditions also led to better couple communication. This suggests that interventions aimed at improving health outcomes for Rohingya refugee women may need to focus on improving communication within couples, not just targeting women alone.
This research matters because Rohingya society is described as strongly patriarchal, meaning husbands hold significant decision-making power over women's health and family planning choices. Simply providing women with information or resources may be insufficient if husbands are not engaged. The findings suggest that programs encouraging open dialogue between partners and increasing husband involvement could be key to improving sexual and reproductive health among this vulnerable refugee population.
Zakaria M, Islam M, Islam M, Mostafa M, Begum A, Hasan K. (2025). Patriarchal dominance and relationship: couple communication's mediating effect on sexual and reproductive health outcomes among Rohingya refugee women.. Journal of communication in healthcare. https://doi.org/10.1080/17538068.2025.2496014