Gender-Specific Jealousy and Infidelity Norms as Sources of Sexual Health Risk and Violence Among Young Coupled Nicaraguans

Abstract

Gender inequity negatively affects health in Central America. In 2011, we conducted 60 semistructured interviews and 12 photovoice focus groups with young coupled men and women in León, Nicaragua, to explore the ways in which social norms around marriage and gender affect sexual health and gender-based violence. Participants’ depictions of their experiences revealed gendered norms around infidelity that provided a narrative to justify male expressions of jealousy, which included limiting partner autonomy, sexual coercion, and physical violence against women, and resulted in increased women’s risk of sexually transmitted infections, including HIV. By understanding and taking account of these different narratives and normalized beliefs in developing health- and gender-based violence interventions, such programs might be more effective in promoting gender-equitable attitudes and behaviors among young men and women in Nicaragua.

The World Health Organization affirms that the United Nation’s Sustainable Development Goals regarding the promotion of gender equality and women’s empowerment is essential to the achievement of better health.¹ In Nicaragua and across Latin America, however, gender inequity persists and manifests itself in the cultural conceptualizations of machismo—the masculine expectation of dominance over women, overemphasized heterosexuality, and aggression—and marianismo—the feminine expectation of submissiveness, dependence, and sexual naivety.^2,3 These conceptualizations of male hegemony trickle through all levels of Nicaraguan society and create benefits and consequences for both men and women.^4,5 Such gender norms, however, are complex, socially learned, and continually shifting.^6,7

The Theory of Gender and Power (TGP) is a social structural theory that describes how gender is used as a basis for constructing power imbalances between men and women that constrain most aspects of their lives.⁸ The TGP is used to understand gender-based health risk factors,^4,8 particularly gender-based violence (GBV) and sexually transmitted infection (STI), including HIV.^4,9,10 In Nicaragua, where high rates of economic insecurity may be exacerbating the relationship between power imbalances and GBV, poor health outcomes are pronounced.¹¹ Lifetime prevalence of physical or sexual violence among ever-married and ever-cohabitating women in Nicaragua has been reported to be between 29.3% and 52%.^12,13 GBV is tightly linked in Nicaragua and other countries to norms that endorse male use of controlling jealous behaviors toward women, male entitlement to physically chastise a woman for transgressing dominant gender norms, and male control of wealth and decision-making.^9,12–17 Masculine norms that promote multiple sex partners, commercial sex patronage, and condom nonuse place strains on men to conform to normative behaviors that increase their risk for STI and HIV.^18–20 For women in a variety of contexts, inability to affect safer sex decisions, expectations of female naiveté regarding sex, and GBV heighten vulnerability to STI or HIV.^4,21–23 Although HIV rates are low in Nicaragua (32 per 100 000 inhabitants), housewives have been indicated as a high-risk group (16.4% of new HIV cases), and women represent most new STI cases (61% of chlamydia cases, 57% of syphilis cases).^24,25

The TGP is also used to propose opportunities for intervention, which reinforces the idea that shifts in gender norms allowing for greater equity are possible.^7,23,26 In Nicaragua, acceptance of multiple gender expressions beyond the norms of machismo and marianismo is spreading.^6,7 Sternberg et al. argue, however, that Nicaraguan men are caught in a tension across conflicting masculine discourses, creating barriers for change.⁶ Among these conflicting discourses, Nicaragua’s penal code recently underwent revisions that both protect and undermine safety for women experiencing GBV.^27,28 Shifts around gender are therefore not unilateral steps forward in gender equity; rather, they are a dynamic mix reinforcing and challenging gender inequality.²⁹

Little is known about how Nicaraguan men and women themselves conceptualize the relationship between shifting gender norms and health, an integral aspect of developing effective health interventions. Using a longitudinal, multimethod qualitative approach, we aimed to capture young coupled Nicaraguans’ perceptions of how gender norms affect their health and illuminate how participants normalize this relationship.

METHODS

León is the second largest city in Nicaragua, with a population of approximately 210 000. An internationally respected research institute served as a local study partner. In León, 54.9% of women have experienced spousal violence in their lifetime (with 25.6% and 13.9% experiencing physical and sexual violence, respectively), a higher rate than in the rest of the country (50%).¹² Of these women, 39.7% attributed the violence to the husband’s jealousy and 9.5% to his being denied sex.¹² In León, 27% of women perceived themselves to be at risk for HIV infection; of these, 58.4% thought this risk resulted from their partner’s infidelity.¹²

Study Design and Recruitment

We recruited Nicaraguan young adults (aged 18–30 years), married or cohabitating with their current partner for 1 to 4 years, for interviews and focus groups, because they represent a subgroup of the population that likely has been exposed to a variety of modern and traditional gender norms and may still be establishing roles in their relationships. Nicaraguan couples in long-term, committed relationships cohabitate almost as often as they legally marry (25.7% vs 27.4%)¹²; we refer to both as “coupled.” We purposively sampled participants through door-to-door recruitment, a private clinic waiting room, and the research institute’s participant referrals. To ensure confidentiality, we did not recruit any participants who were currently in relationships with other participants.

Data Collection

We collected data between June and November 2011. Thirty young coupled men (n = 15) and women (n = 15) participated in 2 semistructured in-depth interviews, for a total of 60 discrete interviews. One interview addressed the participant’s childhood exposure to norms about the social roles of men and women, sex, domestic violence, and marriage, in order to understand the broader social context in which beliefs and behaviors developed. The other interview assessed the participant’s current relationship, including the division of roles and responsibilities, conflict management, decision-making, and health. The first and second interviews were conducted within 2 weeks of each other. The first author, an American woman who lived in León for 9 months, conducted the interviews with women and an experienced and trained Nicaraguan man conducted the interviews with men; all interviews were conducted in private spaces of community organizations, participant homes, or educational institutes. The interviews, which were conducted in Spanish, lasted 45 to 90 minutes and were audio-recorded. The semistructured interview instruments were developed, piloted with the target population, and revised as needed by the research team. After each interview, interviewers wrote and discussed reflective field notes. Verbal, informed consent was obtained before the first interview, and participants received health educational materials and a US $6 incentive upon completion of the interview. All women participants received referral information for local domestic violence and sexual assault services.

Following completion of the interviews, the same individuals who conducted the interviews facilitated a series of 12 focus groups to further explore themes that emerged from the interviews. They conducted 6 focus groups, separated by gender, with a consistent subsample of women (n = 6) and men (n = 5) who participated in interviews. The research team developed discussion topics and focus group guides based on emergent themes that needed further clarification and were iteratively shaped by the previous group discussion. Engaging the same interview participants in the focus groups increased the richness of the data as it often provided opportunities to hear a participant tell the same story twice and explore differences in how stories were told between data collection settings. Participants received US $4 per session. Focus groups lasted 2 hours each and were audio-recorded and facilitated by the same interviewers. The first author observed the focus groups with men.

Photovoice, a community empowerment research technique that enables participants to record and reflect on their community’s strengths and concerns through taking photographs, was a primary component of the focus group discussions.³⁰ At the end of each session, the research team gave participants the next session’s discussion topic and asked them to take 3 photos on that topic (e.g., “how jealousy plays a role in marriage”) with a disposable camera. Each discussion began with participants describing their photos and their relevancy to the session’s topic. Participants and all individuals captured in photos provided a signed release for the research team to publish the photos.

Data Analysis

Audio recordings of interviews and focus groups were transcribed by native Spanish speakers. The first author, involved in the study from start to finish, analyzed the data in Spanish, verifying interpretations with the study team to ensure that they resonated with their understanding of the data and local culture. After multiple readings, she defined topical and emergent codes and applied them to the data using the qualitative software ATLAS.ti version 7.5 (ATLAS.ti GmbH, Berlin, Germany). The research team compared code outputs between and within gender groups using thematic matrices, scatter plots, and analytic memos.^31–35 Additionally, they made comparisons between interview and focus group data; focus groups provided normative context to aid in understanding individual narratives.³⁶ The team analyzed photos for meaning in conjunction with the descriptive narrative provided by participants.³⁰ The first author presented preliminary results twice—once to community members in León and once with international women’s health experts in Nicaragua—to gather local input on interpretations.

RESULTS

Although we did not design the study to focus on these themes, jealousy and a double standard regarding infidelity inductively emerged from the data as a narrative through which participants described the impact of gender norms on health. After describing the study participants, we explore the way gender inequity was narrated by participants through expectations and experiences of infidelity and jealousy, and compare these across gender. We then describe how participants related their gendered experiences of jealousy to health.

Interview participants were primarily in their early 20s, were living with extended family, and had 1 child (Table 1). About half were cohabitating but not legally married. Generally, men had some postsecondary education and formal employment whereas women did not, and most participants had limited income. Three men and 2 women were studying at the university.

TABLE 1—

Participant-Reported Demographics About Themselves and Their Domestic Partners: León, Nicaragua, 2011

	Men Participants (n = 15)		Women Participants (n = 15)
Demographics	Men, Mean (Range) or No. (%)	Their Wives, Mean (Range) or No. (%)	Women, Mean (Range) or No. (%)	Their Husbands, Mean (Range) or No. (%)
Age, y	23 (20–30)	21 (16–29)	22 (18–27)	24 (19–29)
Employed (generated income)	11 (73.3)	7 (46.7)	3 (20.0)	14 (93.3)
Highest educational attainment
At least some postsecondary	9 (60.0)	5 (33.3)	5 (33.3)	4 (26.7)
At least some secondary	3 (20.0)	9 (60.0)	8 (53.3)	8 (53.3)
At least some primary	1 (6.7)	1 (6.7)	2 (13.3)	3 (20.0)
Illiterate	1 (6.7)	0	0	0
Marital status
Legally married	9 (60.0)	. . .	7 (46.7)	. . .
Cohabitating	6 (40.0)	. . .	8 (53.3)	. . .
Couple’s living situation
With relatives	10 (66.7)	. . .	10 (66.7)	. . .
Alone	5 (33.3)	. . .	5 (33.3)	. . .
No. of children with current partner	1 (0–1)	. . .	1 (0–1)	. . .

Gender Inequality Expressed in Terms of Infidelity and Jealousy

A gender-based double standard around the social acceptability of infidelity emerged as a salient concept through which participants understood and expressed gender inequity. Men and women unanimously reported this gendered double standard of infidelity, framed clearly by 1 participant, a 19-year-old woman who had completed secondary school:

Because a man is macho, they [men] think that for them, it has to be this way, that they can be unfaithful, while for the woman, no, for the women it’s like . . . like death to be unfaithful.

The gravity of the consequences for female infidelity contrasted starkly with the light regard for male infidelity that she described. Emphasizing the social support for male infidelity, one of the men, aged 20 years and with some secondary school, recalled his friends’ encouragement for him to get sexually involved with other women while he was in a committed relationship:

“If you like her well, do it,” they [male peers] would tell me, “do it with that girl, do it with her now, you’ll see you can have it your way,” they tell me, “you do bad things to her, all that you want, all that you feel like, all that you can think of, do it now.”

By contrast, participants explained that a woman who was unfaithful would be socially defamed as a “zorra [prostitute]” and rejected by her husband, forever ruining her reputation as a woman worthy of marriage, a primary means through which women gain and maintain social and economic status.

Jealousy, a concept related to infidelity, also fit into participants’ understanding of gender inequity. Jealousy was common; it was indicated as the primary source of marital conflict for 10 women and 5 men and was widely considered an inevitable part of a romantic relationship. Although some expressions of jealousy were common regardless of gender (e.g., secretly checking phones for evidence of other partners; Figure 1), the most extreme examples of jealousy were from men; one admitted to breaking into his girlfriend’s house, destroying letters from her former boyfriend, and breaking her phone’s memory chip. As an example of a less extreme but persistent form of partner monitoring, 1 woman received 3 “check-in” calls from her husband during an interview.

FIGURE 1—

Participant’s Photo of a Wife Secretly Checking Who Her Husband Is Messaging on His Phone: León, Nicaragua, 2011

The experience of jealousy was understood differently across participants. Both men and women focus group participants said that without jealousy there was no love. One man explained this concept further:

If I’m not interested in her, I don’t care what she does. If she goes out with some person, she can do what she wants with her life. But if I had feelings for her, it will affect me.

Women commented that they often interpreted male jealousy as an expression of love, feeling that it was one of the few signs that their husbands cared about them. A few, however, argued that jealousy is “suffocating,” creates a cycle of conflict, and eventually destroys the relationship.

Experiences of Jealousy by Gender

In the context of gender inequity and social acceptance of male infidelity, women reported feeling that they had little power to influence their husbands to remain faithful; 5 men and 5 women, without prompting, admitted that the husband had been unfaithful to his wife. Interestingly, no participants reported that the wife had been unfaithful, leaving it unclear with whom unfaithful husbands were having affairs. In focus groups, men talked unashamedly about their sexual “aventuras,” and those who were not involved with other women were met with doubtful questioning and described as “mangoneado [controlled]” by their wives, the antithesis of macho. Women’s requests for their husbands to remain faithful more often than not resulted in their becoming angry rather than compliant. One man explained how he would respond if his wife tried to restrict his activity: “Just the opposite. I don’t listen to her, I do it.” Instead, men in focus groups explained that their wives’ expressions of jealousy often drove them to lie about their whereabouts and interactions with other women to quiet their wives’ suspicions. Most women therefore reported trying to sound casual when they asked their husbands about their whereabouts, avoiding sounding suspicious. Others learned to swallow their concerns about infidelity; as 1 woman in a focus group described it:

I fought a lot with him, about jealousy . . . but in the end you get to a point where almost nothing, where he wouldn’t say where he was going, who he was going with, what time he’d come back. . . . It killed me inside . . . but it was better if I just swallowed it, I just stuffed it inside. So when he saw that I didn’t say a thing, he kept doing what he wanted.

Resigned, she described emotionally suffering in silence, knowing there was nothing she could do to deter him. Missing from her narrative, but essential to understanding her situation, are the social and economic costs of leaving him.

In contrast with the others, 2 wives reported that their husbands complied with their controlling jealous behavior. For example, after catching her husband exchanging text messages with a former girlfriend about their continued feelings for one another, 1 woman asked her husband to exchange cell phones with her so she could monitor who contacted him, which she said he did, albeit unwillingly.

Because most wives had limited power to deter their husbands’ infidelity, they described instead working exhaustively to please their husbands so that they could be the only woman the husbands needed. Efforts to prevent a husband’s infidelity reflected another commonly used idiom, “Se busca afuera lo que no encuentras en la casa [You look outside for what you don’t find in the home].” This phrase taught women to feel responsible for male infidelity, as described by a woman in a focus group:

As a women, well . . . you feel bad, what have I done wrong? If I do everything right, I iron his clothes, wash them, I serve him, I cook, give him food, clean, everything . . . and when you least expect it he’s with another woman. So that’s when you think . . . what have I done wrong that he finds another woman? If I serve him in bed the same way, am with him, and do the same as her.

This participant captured the internalized belief that, despite the cultural expectation of male infidelity, she has failed as a woman if she does not satisfy her husband enough to prevent his infidelity.

In this context of severe social sanctioning of female infidelity, husbands, unlike wives, received social power to control female sexuality. Ten women and 9 men described controlling husbands who were quick to punish wives if they even slightly threatened the expectation of female fidelity. One 27-year-old woman, a university graduate, reported on how she was chided for coming home late from work:

Well in my case . . . my husband asks me what time I have things, what time I start, what time I go, what time I leave, so I tell him when I’ll be back but . . . one time I got home late, right, because I got delayed preparing something, so he tells me, “This is no time to be coming home, why did you come back so late? . . . you are in my house.”

In this quote, the participant captured her husband’s belief that because she lives in his house, he is entitled to have control over her activities, reminiscent of a father–child relationship. One man captured in a series of staged photos a man’s angry reaction to his wife being greeted by a male friend with the typical cheek kiss used in Nicaragua, an example of the punishment a wife might face for interacting with another man (Figure 2). Men used the idiom “Si no cuidas a tu mujer, alguien mas la va a cuidar [If you don’t take care of your woman, someone else will]” to capture the perceived threat of male rivalry that justified their vigilance and social pressure to maintain control over their wives.

FIGURE 2—

Participant’s Staged Series of Photos of a Husband’s Jealous Reaction When His Wife Is Greeted by Another Man: León, Nicaragua, 2011

Whereas men disregarded their wives’ attempts to control them, women more commonly complied as a strategy to retain their husbands. Unlike men, most women described giving up their friendships before they began cohabitating to communicate the level of their commitment to their partner. One woman, aged 22 years and with some secondary schooling, provided an example of her compliance after marriage, something she described doing “to not get on bad terms with him”:

I have family friends that he doesn’t like and so he forbids me to go, so then . . . I don’t go, I withdraw myself, I stay at home, because I hardly go out, maybe only to visit relatives, not friends.

Such compliance resulted in the social isolation of wives, described by almost all participants. A few men made the consequences of not following their “orders” clear to their wives. One 21-year-old man with some university education reported telling his wife:

The only one that’s going to be hurt here is you. . . . Simply don’t believe that I’m going to just put up with that. . . . I am just about to finish my degree . . . so that both of us can move forward, so you’re not going to want to . . . you’re going to hurt your new life, I tell her.

This male participant’s economic power as the financial provider of the family, a typical dynamic in Nicaraguan families, provided him with leverage to enforce his rules on his wife. Whether such an economic threat was explicit or implicit, it helped elucidate why wives relinquish their social autonomy to keep their husbands happy.

Exemplifying the gender gap in power behind controlling jealousy, 1 man and 1 woman shared similar stories about their partners lying to them about going to a party. The man caught his wife dancing with his female cousins at a party. The woman caught her husband coordinating to meet up with a former girlfriend at a party. Both participants reprimanded their partners, the man with physical abuse and almost complete restriction on her recreational activity even 2 years after the incident and the woman with words and a loss of trust, yet little change in his behavior.

One 19-year-old woman, who received instruction on gender equality in school and was studying to become a lawyer, a marker of her relatively higher socioeconomic status, stood in contrast to the rest. Her husband did not limit who she spent time with, she uniquely described close friendships with female peers, and, with regard to controlling jealous behaviors, she stated, “For me, you can never do that, no, no, thank God we don’t have those problems.” Women like her, who challenged male dominance in the household and were less dependent on their husbands for social and economic power, were the exception in our sample.

Implications for Sexual Health and Violence

These gender differences in experiences of infidelity norms and jealousy were narrated as impactful on health.

Sexual health.

Seven women and 5 men reported that the wife experienced unwanted or forced sex with her husband. Although not acknowledging the context of imbalanced social and economic power, women described motivations for complying with unwanted sex in 2 ways: to prevent accusations of her infidelity and to prevent his infidelity.

Three women and 5 men explicitly said in the interviews that the wife regularly had sex when she did not want to, to prevent suspicions of her infidelity. Men felt they could gauge their wives’ fidelity by their wives’ level of desire for sexual intimacy with them, described by 1 man in a focus group:

If a woman, sexually speaking, has a lover and with the lover . . . has had sexual relations, heck, how I see it . . . you want it and she doesn’t, [she says] “I’m tired,” I have seen it in the soap operas and it’s true . . . she practically repels you.

This participant did not take his wife’s reason for refusing sex at face value, but interpreted it as indicating that she was being sexually satisfied elsewhere, supported by popular media. Women described overcompensating sexually by complying with their husbands’ sexual desires, even when they did not want to, so that their husbands would not suspect infidelity. One 25-year-old woman interviewee, a university graduate, explained why she had unwanted sex many times with her husband:

I don’t know, sometimes maybe I don’t feel like it and . . . he tells me I have another man, I don’t know, the first thing they do is accuse you, you don’t want it with me because you have another man.

For this woman, her husband’s accusations of infidelity when she refused sex were so predictable that she would acquiesce to his sexual preferences regardless of hers.

Seven women had engaged in unwanted sex in their relationships to prevent their husbands’ infidelity. They described feeling obligated to have sex and do sexual acts they did not want to do just so they would not lose their husbands to another woman. One 21-year-old woman interviewee who had completed secondary school explained why her husband’s sexual desires overrode hers:

Sometimes when I’m mad at him and I don’t want anything . . . and I say no, but he wants it so I don’t know what to do and what do I say? What do I do? But I have to do it, and maybe I have done it because I really have to, because it’s my job I mean . . . because I wouldn’t want him to find someone else and . . . say to me “The other woman does it to me better than you.”

This woman’s fear of the consequences of denying her husband sex reflects her compromised power in the relationship. It mirrors the description of a male interviewee, aged 20 years and with some secondary school, of coercing his wife to have sex:

If I already really want to do it [sex] and she answers me, well she says she doesn’t want to, that it’s not the right moment, I get mad, I get angry, and I tell her no, that I have to satisfy myself … she tells me okay, it’s fine but . . . .

His feelings of entitlement to sex led him to justify not only getting angry with his wife for refusing sex but to disregard her refusal.

In addition to unwanted sex, women described being coerced into having unprotected sex and exposing themselves to STI. Three women and 1 man reported in interviews that the husband had previously infected his current wife with an STI. Despite limited social acceptance for condom use in marriage, 7 women had asked their husbands to use condoms and were refused with anger, mocking laughter, or the question “But why if we are using birth control?” Men reported that to use a condom with their wives would break the image of love and fidelity. The only 3 women who successfully got their husbands to use condoms for STI protection were able to do so because their husbands’ infidelity had been exposed. Even in these cases, 2 of them made their husbands use condoms for only 2 weeks.

Physical violence.

Most women reported experiencing some physical violence from their husbands, with 6 women reporting frequent or injury-inducing physical abuse. Physical violence was used by some as a way to punish a wife for disobeying her husband, a tactic that enforced his dominance in the relationship. Violence was not supported by all men, but those who opposed it were challenged by their peers in focus groups with jeers and antagonistic questioning. One woman, aged 18 years and with some primary school, described ongoing severe abuse by her current partner during the first years living together:

Two years I put up with it, two years of torment, I felt, because when I got pregnant with my daughter and we still argued, he fought with me. . . . He said that the girl wasn’t his. . . . He beat me, he threw himself at me, he wanted to punch me in the face, and he hit me, even with pieces of wood. But his mom and dad grabbed me, otherwise, he would have killed me.

An unfounded yet deep fear of infidelity threatened her husband’s perceived control over her, and he used physical abuse to achieve her full compliance with his dominance.

For some men, even the thought of female infidelity was met with severe physical threats. In the interviews and, more fervently, in the focus groups, men openly said that they themselves would physically harm or even kill their wives if they were to have an affair. One interviewee, a 20-year-old man who had completed primary school, made the severity of the double standard of infidelity clear:

Participant: I like to go out with women, but if she looks for another man, there’s a problem.

Interviewer: What would you do, what things would you do?

Participant: Umm . . . kill her, I’d kill her.

This threat was expressed by 3 different men in both serious and joking tones, and in the context of focus groups was met with receptive laughter by fellow participants.

With the credibility of the threat of violence established through the societal acceptance of wife-beating, and even more by a previous instance of abuse, women learned early to take extensive measures to ensure that their husband had no reason to doubt their fidelity, and compliance with their husband’s rules offered more safety than noncompliance.

DISCUSSION

We identified infidelity and jealousy norms as expressions of gender inequity that participants themselves recognized as affecting health by increasing women’s risk of STI infection, sexual coercion, and interpersonal violence. Participants in this study depicted how strict social norms against female infidelity and lack of social power forced women to comply with their male partner’s controlling jealous behaviors. Women experienced social isolation, coerced sex, and limited ability to negotiate safer sex in the context of this phenomenon. Moreover, these norms provided an accepted narrative justifying men’s controlling jealous behavior and physical violence. These findings reflect the constrained female sexuality and economic power described in the TGP and their implications for health.^4,8 Wingood and DiClemente’s application of the TGP to health includes examples of the imbalances of power identified in our study (e.g., having a physically or sexually abusive partner, a stable but high-risk sexual partner, a partner who expresses verbal opposition to practicing safer sex) to explain women’s increased risk of HIV.⁴

Gender norms in Nicaragua are in rapid flux, however, and progress toward gender equity is not always linear.^6,7 In a study of Nicaraguan men participating in a reproductive health promotion program, Torres et al. used a spectrum to categorize the men according to their acceptance of gender equity; the spectrum ranged from “the apprentice,” “the responsible/respectful man,” “the proactive peer educator,” to “the feminist man.”⁷ Men described moving nonlinearly along this spectrum and the importance of having support from like-minded men. A few participants in our study demonstrated forms of gender equity acceptance; however, they were criticized for these expressions by fellow focus group participants (e.g., they experienced antagonistic questions or jeers). Their ability to express gender equity values seemed tightly related to socioeconomic class; these individuals were all studying at university to become professionals, a life course that gave them access to higher social status. They were, perhaps, less in need than their lower-income, less-educated counterparts of the social rewards granted to those who adhered to strict, traditional gender expectations. Confirming this, previous research in similar contexts has shown that individuals are socially rewarded for overemphasizing gender scripts, providing a more accessible means of raising one’s social status than economically based strategies.^37–40

Shifts in marriage norms that now include love as a motivation for marriage—and with it a desire to maintain the image of love and fidelity—may also have mixed impacts on health. Participants illuminated how women’s internalized belief that male infidelity was due to their shortcomings in satisfying their husband coerced women into engaging in unwanted sex, not negotiating safer sex, and risking exposure to STI to preserve the image of love and fidelity, similarly to findings in rural Mexico.³⁷ The love-based narrative around marriage may also encourage wives’ compliance with their husbands’ controlling jealousy, at the cost of limited autonomy, sexual coercion, or physical abuse.^41,42 Traditionally in some cultures, social control of wives was regarded as a right and duty of married men.⁴³ In our study, however, men and women justified social control of wives in terms of jealousy, and jealousy was interpreted as an expression of love. Most women were willing to accept this love-based narrative of their husbands’ controlling jealousy, as it was one of the few signs wives received from their husbands that they cared for them, consistent with other cultural settings.^42,44,45 In exchange, wives viewed their compliance with their husbands’ control as a reciprocal offering of love. This love-based narrative in marriage norms may be creating shame for wives of unfaithful men and fueling the interpretation of controlling jealousy as an expression of love, a new interpretation of the old tradition of male dominance of women.

The study has some limitations. Because of ethical considerations we were not able to collect data from dyads to capture couples’ perspectives on their experiences. Additionally, because this was a qualitative study, the results are not intended to be generalizable or to suggest causal relationships, but they can inform understanding of the variety of normative narratives of gender inequity present within this context.

Shifts in marriage and gender norms must be taken into account in multilevel, holistic health interventions addressing interpersonal violence, sexual assault, and STI and HIV transmission. Evidence widely supports the inclusion of gender and power in interventions to reduce GBV and HIV and STI transmission.^46,47 In Nicaragua, gender equity promotion has been incorporated into health interventions, including those by Cantera, CISAS (Centro de Información y Servicios de Asesoría en Salud), and Puntos de Encuentro.^46,48 Those exposed to the Puntos de Encuentro prevention intervention, a nationally broadcast soap opera called Sexto Sentido addressing HIV and women’s empowerment, demonstrated an overall increase in gender-equitable attitudes (e.g., less agreement with the statement, “Women should take responsibility for the house and looking after the children”). Conflicting beliefs about gender persisted, however, including judgment of women who have multiple sex partners, carry condoms, or are victims of sexual abuse, suggesting that norms are multifaceted and complex and their change is not linear or fast.^46,48,49

Integration of local narratives and normalized beliefs around infidelity and jealousy into health and GBV interventions could be a strategy to enhance their effectiveness.⁵⁰ Although the need to include gender and power in health interventions is clear, participants in this study rarely spoke directly about gender inequity. Rather, they spoke extensively about gender differences in experiences of jealousy and infidelity that they saw as affecting health. Therefore, operationalizing the concept of “gender inequity” within programming to take into consideration the locally accepted framing of gender inequity, such as the double standards of infidelity and jealousy, may resonate more with the target population and yield greater gains toward increased gender-equitable attitudes and behaviors. Individual-, family-, and community-level health programs that account for such local framing of the problem are an essential complement to structural and systemic interventions to address gender-based social and economic inequities.