https://orcid.org/0000-0002-7448-4824
Figures
Abstract
Background
Unprotected oral sex is associated with sexually transmitted infections (STIs) including HPV and associated head and neck cancers. However, many studies lack clear definitions of oral sex and there are few data from West Africa. This study assessed the pattern and prevalence of, and factors associated with oral sex among Nigerian men and women from the general population.
Methods
The Sexual Behaviours and HPV Infections in Nigerians in Ibadan (SHINI) study was a cross-sectional study conducted among men and women aged 18–45 years. Information on oral sexual behaviours was collected during a face-to-face interview by a sex-matched interviewer. Descriptive and multivariable analyses were used to analyse factors associated with oral sex in men and women.
Results
In total, 160/626 (26%) had ever any type of oral sex. Specifically, 78/626 (12%) had ever given and 139/626 (22%) had ever received oral sex in a heterosexual relationship. Overall, 35% (112/310) men had ever engaged in oral sex compared to women 15% (48/316 –p < 0.001). More men frequently reported ever receiving oral sex than women (33% vs. 12%; p < 0.001). There was no difference in the proportion of men and women that reported ever giving oral sex. Most (94%) participants never used any barrier protection during oral sex. Most men and women participants engaged in oral sex because of romantic relationship or being married. In the adjusted models, there was a higher odds of ever receiving oral sex (Adjusted odds ratio = AOR 4.01 95% CI 2.52–6.38) or engaging in any form of oral sex (AOR = 3.12, 95%CI 2.04–4.76) in men than women.
Conclusion
Though, Nigerian men and women engage in oral sex in heterosexual relationship, but it is more commonly reported by men than women and most of them practiced it without barrier protection. It is recommended that sexually active men and women are counselled on risks associated with unprotected oral sex including STIs, HIV and HPV and associated cancers.
Citation: Morhason-Bello IO, Daniel A, Adisa A, Baisley K, Adewole I, Bakare R, et al. (2025) Prevalence of, and factors associated with oral sexual behaviours in men and women in Ibadan, Nigeria. PLoS One 20(7): e0328454. https://doi.org/10.1371/journal.pone.0328454
Editor: Shadab Shahali, Tarbiat Modares University, IRAN, ISLAMIC REPUBLIC OF
Received: November 1, 2024; Accepted: June 29, 2025; Published: July 16, 2025
Copyright: © 2025 Morhason-Bello et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data related to this study are available here: Imran O. Morhason-Bello. (2025). Oral Sex Among Adult Populations in Ibadan, Nigeria [Data set]. Kaggle biorepository. https://doi.org/10.34740/KAGGLE/DS/7621593
Funding: “[IMB received grant support from the University of Ibadan, Ibadan, Nigeria for his PhD programme at London School of Hygiene and Tropical Medicine, London. IMB, IFA, LH and RM received support from Epigenetic study of oral HPV infection-associated oral cancer in people living with HIV in Nigeria (EpOOCH) R01CA274952 (MPIs: Hou, Morhason-Bello, Murphy). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this manuscript
Competing interests: The authors have declared that no competing interests exist.
Background
Oral sex is defined as a sexual behaviour when a person uses his/her mouth or tongue touch the genitals or anus of another person. Cunnilingus involves licking or sucking the clitoris, vulva or vagina, while fellatio refers to licking or touching of penis and or scrotum and anilingus is sexual stimulation of the anus using the tongue [1]. Unprotected oral sex is associated with acquisition and transmission of sexually transmitted infections (STI) such as Neisseria gonorrhea, Chlamydia trachomatis, Hepatitis B, Herpes simplex, and human papillomavirus (HPV) amongst others. [2–7]. Oral sexual practices without barrier contraceptive methods increase the risk of oral HPV infection acquisition and transmission and has a direct association with the persistence of high-risk HPV, oral potentially malignant disorders (OPMD), and incidence of HPV-associated cancers of oral and oropharyngeal sites [4,8–11]. Generally, health risks associated with oral sexual behaviours depend on the role played by individuals during the sexual act [8]. For example, a woman or man giving oral sex is believed to be at a higher risk of acquiring STI and HIV than the person receiving it [8]. Risky oral sexual practices are more commonly reported in adolescents and younger adults relative to older adults, in men than in women and in people involved in same sex relationships than those involved in heterosexual relationships [12,13].
In over two decades, studies in high income countries such as the United States of America (USA), United Kingdom (UK), Europe and Australia have shown an increase in the prevalence of oral sex in addition to penetrative vaginal sex particularly, among young people, female sex workers and men who have sex with men [14–16]. In Europe, UK and the USA, the prevalence of ever performing oral sex (given or received) ranges from 67–94% in adolescents and adults with higher proportion in men compared to women [15,17–19]. The National Health and Nutrition Survey (NHANES) between 2009–10 found that of 2,116 men and 2,140 women, 85% of men and 83% of women had ever performed oral sex [15]. Additionally, the prevalence of ever performing oral sex in the analysis was significantly higher (90.3%) among the younger age group (30–44 years) compared with older age group and decreased with age [15]. A study in UK compared trends of fellatio and cunnilingus using the National Survey of Sexual Attitudes and Lifestyles (NATSAL 1, 2, and 3) among young people aged 16–24 years from 1990–2012 [20]. The findings showed that the proportion of male and female participants that reported fellatio increased from the first (66% vs 64%) to second (72% vs 73%) and third (75% vs 73%) surveys [20]. A similar report was noted on cunnilingus from 67% in males and 66% in females in NATSAL 1–69% and 74% in NATSAL 2, and 71% and 72% in NATSAL 3, in males and females respectively [20]. In another study, a similar trend of increasing report of oral sexual behaviours was reported among adults across the three NATSAL surveys [17].
In 2019, a systematic review involving 103 articles from Sub-Saharan Africa (SSA) showed that oral sexual behaviours, largely without barrier contraceptive methods, were commonly reported among young people and female sex workers involved in heterosexual relationships [21]. In the same review, the prevalence of oral sex in younger population particularly among the university students was up to 46% and 80% among female sex workers relative to less than 40% among adults in general population. Less than 17% ever used condom or any barrier methods during oral sex. Furthermore, only four out of 103 studies reviewed clearly defined and correctly classified oral sex by the actions of participants (given or received) [21]. This makes it difficult to appreciate potential health risks associated with the oral sex reported in those studies. Despite the increasing reports of oral sex in adolescents and adults involved in heterosexual relationships in Nigeria and many countries in West Africa, none of these studies was conducted at the population level and adequately powered for a generalizable conclusion [21,22]. This study aimed to determine the pattern and prevalence of, and factors associated with oral sex among men and women in the general population using a validated tool.
Methods
Study design, population, and site
This study analyses data collected from the Sexual Behaviours and HPV Infections in Nigerians in Ibadan (SHINI) study [23]. Briefly, the SHINI study was a mixed methods study that explored the association between different sexual behaviours and the human papillomavirus infections in men and women aged 18–45 years from the general population in Ibadan metropolis and in brothel-based female sex workers (FSW) of the same age in Ibadan. The methods for this study have been previously described [23]. In brief, SHINI was a cross-sectional household survey conducted among 315 males and 310 females aged 18–45 years living in Moniya and Sasa in Akinyele and Mokola in Ibadan North LGAs and 316 FSW recruited from brothels in LGAs within Ibadan metropolis. The study excluded young adolescents (<18 years), pregnant or nursing mothers, women not resident at the study sites and those that declined participation including refusal for biological sample collection.
Men and women in the general population were recruited by using a two-stage sampling technique. In the first stage sampling, 4 EAs in Ibadan North while 5 EAs in Akinyele LGAs were selected by probability proportion to size from the list of National Population Commission Census [24]. Houses located in the 9 selected EAs were listed and a census of participants aged 18–45 years living in those houses was done to form the sampling frame. A systematic random sampling technique was used in the second stage to select eligible males and females in the general population. The FSWs selected by simple random sampling in brothels that had 11 persons while total sampling was done for brothels that had 10 or less persons. The detailed descriptions of sampling techniques had been published previously [25–27].
Prior to this study, research assistants and nurses had two intensive trainings on research methods including good clinical practices, research ethics and study protocol. After, a pilot study was conducted to test the research tools and for any possible revisions.
Male and female participants consented to face-to-face interviews by trained sex matched research assistants, a physical examination and collection of biological samples from penile, cervical, vulva, anal and oral cavity by sex matched research nurses for HPV genotyping [23,25–27]. Participants were seen at primary healthcare facilities in their communities. The original sample size of 300 was calculated based on the assumption of an alpha of 0.05 and a design effect of 2 for the clustered sampling design, to be able to estimate the prevalence of HPV and determine associated risk factors in each of the four anatomic sites. The determination of oral sex was a secondary outcome in the SHINI study.
Data source
Data for the analyses of oral sex were taken from the general population of men and women including FSWs in the brothels. In this study, we used validated definitions of oral sex from the in NATSAL survey [28]. Oral sex was defined as using the mouth or tongue to touch any parts of the genital area of a sexual partner. A person was reported to have given oral sex when he/she used his/her mouth or tongue to touch any part of the genital area of the sexual partner. Ever receiving oral sex was defined as a history of allowing a sexual partner to touch the partner’s genital area with his/her mouth or tongue. Briefly, we extracted information on sociodemographic characteristics, sexual relationships including oral sex, partnerships, lifestyle practices (alcohol consumption and tobacco and illicit drug use), awareness of HPV and any report of ever having had an HIV test.
Data management
We conducted a double data entry with REDCap software (Vanderbilt University, Nashville Tennessee, USA). The data were exported and imported into STATA 16.0 (Stata 2019. Statistical Software: Release 16. College Station, TX: StataCorp LLC) software for analysis. Exploratory analysis involved description of frequencies and proportions for categorical variables and mean and standard deviations for continuous variables to check for missingness and implausible responses.
The primary outcome was any report of ever had oral sex (yes/no) among men and women in this study. We calculated the prevalences of ever having oral sex and ever giving or receiving oral sex by men and women. A conceptual framework for the assessment of associated factors was developed (Fig 1).
Due to the small numbers of observations, we performed analysis of factors associated with ever having oral sex by combining data on ever giving or receiving oral sex. Univariate and multivariable logistic regression models were performed to obtain unadjusted and adjusted estimates using a hierarchical modelling approach for ever having oral sex. The sex of participants (level 1 factor) was included in the adjusted estimates a priori. Each variable of sociodemographic characteristics (level 2 factors – age, ethnicity, religion, highest formal education, quranic education (y/n), other occupation, monthly income, current marital status, own media related materials – TV or Radio) was added one by one to the model that included sex and p-values obtained by likelihood ratio tests. Variables with a p value ≤ 0.10 were included in the adjusted model. Next, any proximate factors (Level 3 – history of masturbation, female genital mutilation, history of alcohol intake and cigarette, HIV test and knowledge of HPV) that met a p value cut off ≤ 0.1 was included with the level 1 and 2 ‘core variables’ in the level 3 adjusted model.
Ethics approval and consent to participate
Each participant signed written or witnessed informed consent after reading the information leaflet including the objectives and procedures of the study with clarifications by the research assistants. Participants were assured of confidentiality and anonymity on their response including data provided. Specifically, each participant had a face-to-face interview in a private room in the clinic with a sex-matched research assistant, and case report forms had no identifier and were kept in a locked cabinet in the office of principal investigator with restricted access.
Ethical approvals were obtained from the ethical committees of the London School of Hygiene and Tropical Medicine, London (LSHTM 9736); the University of Ibadan/the University College Hospital, Ibadan (UI/EC/16/005); and the Oyo State Government (AD13/479/712) in Nigeria. The team received concurrence of the leadership of Ibadan North and Akinyele LGAs and owners of the brothels where the study was conducted. The recruitment and data collection of quantitative data of SHINI study was conducted between 23rd of March and 30th July 2018.
Results
Participant characteristics
A total of 626 participants, 310 (49.5%) women and 316 (50.5%) men, were included in the study. The median age of men and women was 26 years with interquartile ranges of 21–35 years and 23–35 years, respectively. There were slightly higher proportions of men (52% vs 48%) and women (51% vs 49%) in Ibadan North than in Akinyele LGAs. There were more men (72%) with secondary education than women (58%) (p < 0.001). Women had higher proportions of semi-skilled workers relative to men (72% vs 64%), but there were more skilled people among men than in women (14% vs 6%). A little above half (52%) of women and a third of men (33%) either earned no income or less than 10,000 Naira (<28 USD) per month (p < 0.001). More men were single and living alone compared to women (63% vs 27%). There were more men that personally owned mobile phone (95% vs 85%), television (75% vs 52%), and radio (64% vs 40%) relative to women (p < 0.001) (Table 1).
There were more men (112/316–35%) compared to women (48/310–15%) that had ever engaged in any form of oral sex with a heterosexual partner (p < 0.001) (Table 2; Fig 2).
Furthermore, there were more reports of fellatio than cunnilingus (33% vs 12%, p < 0.001). Thirty-four out of 316 (11%) men and 23/310 (7%) women had engaged in both fellatio and cunnilingus, but 204/316 (65%) men and 262/310 (85%) had never had fellatio or cunnilingus (data not shown). The median age at first oral sex was received was lower in men than women (p = 0.028), but there was no significant difference age at first oral sex was given in the two populations (p = 0.108) (Table 2). Men reported having more multiple lifetime oral sex partners relative to women (40% vs 17%, p = 0.031).
In the past three months, over a third of women had given (13/36; 37%) and had received (13/35; 36%) oral sex. Over the same period, more men had received oral sex (27/103; 26%) than gave oral sex (7/43; 16%) with their partners. Only very few participants had ever used barrier methods while giving or receiving oral sex in men and women. There were more men that ever-practiced anal sex relative to women (5% vs 0%, p < 0.001) (Table 2). Regarding penile-vaginal sex practices, the current age of the main sexual partner was younger in men than women (p < 0.001). Men reported a relatively younger age at first penile-vaginal sex than women (p < 0.001) and more men than women reported having multiple lifetime sexual partners (p < 0.001). More men than women had history of self-masturbation (p < 0.001), circumcision (p < 0.001), alcohol intake (p < 0.001), cigarette (p < 0.001) and illicit drug use (p < 0.001).
Reasons for engaging in oral sex
The most common reasons reported by men for cunnilingus was to have fun or for pleasure (91%) followed by being in love (70%) (Table 3). Most women reported being in love (91%), followed by having fun or pleasure (60%), as their most common reasons for their first fellatio experience. Over a third of women (37%) and nearly one in ten (9%) men mentioned being married as the reason for giving their first oral sex to women. The reasons for first receiving oral sex from a sexual partner were similar. Men mentioned pleasure or fun (80%) and women (86%) mentioned being in love as the most common reasons for their first experience of receiving the oral sex from their partner.
Factor associated with oral sex among sexually active men and women
The results of the unadjusted and adjusted models of risk factors analyses forever giving oral sex and ever receiving oral sex and ever having had oral sex (a combination of ever given and received oral sex) in men and women is shown Tables 4 and 5.
In the adjusted model, participants aged 25 years and older had 1.89 times (95% CI, 1.06–3.37) odds of reporting ever giving oral sex compared with those aged 18–24 years (Table 4). History of ever having performed mutual masturbation (AOR = 23.71, 95%CI, 3.24–17.36) and alcohol use (AOR = 2.15, 95%CI, 1.15–4.02) were associated with higher odds of ever giving oral sex compared with those who did not report these behaviours.
Furthermore, men relative to women in the general population had 4.01 times (95%CI, 2.52–6.38) odds of reporting ever receiving oral sex. Living in peri-urban setting (Akinyele LGA) was associated with lower odds (AOR = 0.62, 95%CI, 0.40–0.95) than those living in urban setting (Ibadan North LGA). Participants with any tertiary level education had a higher odds (AOR = 2.22, 95%CI, 1.03–4.79) of ever receiving oral sex than those with up to any secondary educational level. There was a weak relationship (AOR = 1.89, 95%CI, 0.97–3.66) between participants with paid job and report of ever receiving oral sex relative to those with no current paid job. History of ever having masturbation (AOR = 8.10, 95%CI, 3.37–19.44) and alcohol use (AOR = 2.25, 95%CI, 1.33–3.81) were associated with higher odds of ever receiving oral sex. There was also a weak relationship between reporting of ever having HIV test (AOR = 1.50, 95%CI, 0.94–2.39) and history of receiving oral sex.
Concerning risk factors associated with history of ever having oral sex in the adjusted model (Table 5), men had 3.12 times (95% CI, 2.04–4.76) odds of ever reporting any type of oral sex compared to women. There was a weak positive relationship between ever reporting oral sex and having any tertiary education (AOR = 1.82, 95%CI, 0.90–3.69) relative to secondary education and below. History of ever reporting mutual masturbation was associated with higher odds (AOR = 7.53, 95%CI, 3.51–16.14) of ever reporting any form of oral sex. There was 1.93 times (95%CI, 1.19–3.14) odds of ever having any oral sex in people that had ever drank alcohol than those with no such history.
Discussion
This study provides scientific evidence that sexually active Nigerian men and women in heterosexual relationships commonly engage in oral sexual behaviours, although at a lower reported prevalence than surveys on sexual behaviours in the UK and USA [15,20]. Generally, three out of ten men compared to one in ten women reported ever engaging in any form of oral sex with a heterosexual partner, and most were performed without using any barrier methods. There were significantly higher odds of men reporting ever having or receiving oral sex than women. However, there was no sex difference in proportions of men and women that ever gave oral sex to their heterosexual partners. Men had their first oral sex experience at younger age and had higher proportions of number of lifetime partners relative to women.
The higher prevalence of any oral sex, history of ever receiving or giving oral sex in men than women in this study are similar to most studies in high-income countries and some studies in South Africa [9,17,20,29]. Despite the similarity in framing of questions to elicit response on oral sexual practices and the observed differences in men and women in our findings with similar surveys in UK and US, the prevalence of oral sexual practices (given or received or any oral sex) in men and women were more than two folds higher in the NATSAL and NHANSE surveys than the prevalence reported in this study [15,20,30]. The higher proportion of ever receiving oral sex and engaging in any form of oral sex in men than women may be due to some of these explanations. Men generally tend to openly discuss and sometimes exaggerate their sexual activities including oral sex than women [31,32]. The same trend was reported even in high-income countries that have more liberal disposition to open discussion of sexual activities and with limited or no sex discrimination [33]. In many countries in SSA including Nigeria, men are culturally permissive to flaunt their sexual practices to portray their dominance and prowess within heterosexual relationships whereas women/girls do not enjoy such traditional rights and are shy to express themselves [33,34]. Rather, most cultural beliefs and practices in Nigeria expect women not to openly discuss their sexual behaviours and exploits including oral sexual practices [33].
In this study, the reported younger age for any pattern of oral sex initiation (ever had, and ever given or received) and higher number of lifetime oral sexual initiation in men compared with women are consistent with previous studies on oral sex and penile-vaginal sexual behaviours [35]. Generally, reports of earlier oral sexual initiation in men relative to women are associated with history of other sexual behaviours and sexual risk behaviours including engaging in unprotected sexual behaviours and multiple sexual partnership. The higher sexual risk behaviours including oral sex in men relative to women had also been associated with increasing use of alcohol, illicit drugs, and other psychoactive substances by them [36,37].
Regarding factors associated with different patterns of oral sexual behaviours, men tend to engage in receiving oral sex more than women but there is no difference in the odds of ever giving oral sex between men and women in this study. In 2009–10 NHANSE survey conducted among adults aged 20–69 years in USA, the result showed that men had 1.03 (95% CI 1.01–1.05) higher risk of ever performing oral sex than women [15]. In this same study men also had 1.84 (95% CI 1.54–2.20) higher risk of having five lifetime oral sex partners and 1.10 (95% CI 0.99–1.22) higher risk of history of performing oral sex during their first oral sex compared to women [15].
The most common reasons in this study for engaging in oral sex was being in a romantic relationship or married among men and women. It is plausible that people who engaged in oral sexual act perform it as a reflection of trust in their relationships and could possibly explain the reason why majority of them did not use barrier method/condom during the act. Previous studies including a qualitative study in Nigeria showed that people engaged in oral sex as a mark of love and to sustain their romantic relationship [33,38,39]. In addition, oral sex was also believed to be less risky than penile-vaginal and anal sexual practices.
Although we did not specifically investigate the preference of men and women on the pattern of oral sex, some studies showed that men preferred receiving than giving oral sex to women due to their fear of contracting infections including risk of mouth and throat cancers, better sexual satisfaction, and social cultural taboo against giving oral sex to women [33,40].
Some studies have associated the increased oral sexual practices in men than women to a higher risk of oral sexually transmitted infections including oral HPV infections and associated HPV-associated cancers [2,8,41]. In some African culture and religious beliefs, there are taboos that men who give oral sex are at a risk of losing their spiritual power and societal respect [34,42,43]. This cultural or religious beliefs will require further studies including qualitative design to explore the reason and interpretations of why men engage more in receiving than giving oral sex with their heterosexual partners.
We observed subtle differences in other factors associated with the pattern of oral sexual behaviours in addition to the observed sex differences between participants in this study. For example, participants with tertiary education, positive history of performing mutual masturbation, and alcohol use had higher odds of having a history of ever reporting any oral sex or ever receiving oral sex. The higher odds of oral sex in men and women with tertiary education could be due to their relatively better access to modern or “westernised” lifestyle including different sexual behaviours such as oral sex compared to those no western education [44]. In addition, there was an inverse relationship between living in peri-urban settings and history of ever receiving oral sex. The history of ever giving oral sex was associated with being 25 years and above, history of mutual masturbation and alcohol use. History of alcohol intake, use of illicit drug and ever engaging in risky sexual behaviours have been shown to be risk factors for engaging in oral sex in both heterosexual men and women [45,46]. The protective effect of living in rural/peri-urban area on oral sexual practice might be due to the general perception among some Nigerians in rural settings that oral sex is “alien” to their culture [33]. This belief might have accounted for the reduced odds of participants living in such settings. Unlike other similar studies that reported an increased risk of oral sex in younger population especially among the adolescents, however, we observed that older young adults aged 25 years and above are more likely to have had history of ever giving oral sex to their partner. It is plausible that the observed difference could be due to the variation in the age range used in these studies to categorise young people.
Unlike most studies in SSA that reported oral sexual behaviours within heterosexual relationships without using a clear definition of the sexual act, this study used a validated tool similar to the questionnaire used for NATSAL and NHANSE surveys. We translated our tool into local languages for better comprehension and to avoid any ambiguity. Therefore, we were able to distinguish reports of ever giving oral sex from history of ever receiving oral sex within heterosexual relationship among our participants. These categorizations are vital to the understanding of potential health risks associated with oral sex in men and women. We used sex matched interviewers to conduct our face-to-face interviews with our participants to minimise the risk of social desirability bias that might be associated with answering sensitive questions [47–49]. Despite these strengths, there are some potential limitations. Oral sex is not openly admitted like penile-vaginal sex especially among adult women and those that perceived oral sex as a taboo or socially unacceptable sexual practice due to cultural or religious leanings [33]. It is plausible that some of our participants with such perception or belief may have under reported their personal experience about oral sex. Men tend to over report their sexual practices to reflect dominance within heterosexual relationships whereas women often shy away from discussing their sexual experiences to avoid backlash or societal disrespect on them. Our study did not report on the pattern of oral sex among men and women involved in the same sexual relationships. Evidence suggests that oral sex may be more common in men and women involved in same sex relationship than those in heterosexual relationship [50].
Conclusion
In conclusion, this study shows that oral sex is a common sexual behaviour among sexually active Nigerian men and women and is largely performed without using any barrier method. In heterosexual relationships, men tend to engage and report more on oral sex compared to women. The most common reason for engaging in oral sex was being in romantic relationship or married in men and women. We recommend that future studies should use mixed methods design to investigate deeper on the reasons or motivations and barriers for engaging in oral sex including those in same sex relationships. It equally important that the role of socio-cultural and religious beliefs on oral sexual practices might provide further meanings and interpretations on attitude of Nigerians towards this sexual act. The growing reports of oral sex should necessitate healthcare providers to include documenting history of this sexual act as part of the complement of sexual behaviour repertoire and its health-related consequences.
Supporting information
S1 Checklist. Inclusivity in global research.
https://doi.org/10.1371/journal.pone.0328454.s001
(DOCX)
Acknowledgments
We appreciate the technical support of the staff of National Population Commission, Oyo State; the office of the Surveyor General in Oyo State; Dr M. Olatunji, the Executive Director of Oyo State Primary Healthcare Board (formerly Medical Officer of Health, Akinyele LGA); Dr A. Famakin (Medical Officer of Health, Ibadan North LGA; and Dr Bunmi Ayinde (Director, Ministry of Health, Oyo State). The research team is also grateful to men and women that participated in this study.
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