Perceived gender inequality, sexual communication self-efficacy, and sexual behaviour among female undergraduate students in the Mekong Delta of Vietnam

Background: Worldwide, the literature on sexual behaviour has documented associations between gender-based relationship inequality and sexual communication ability and the actual use of condoms or other contraceptives among young women. This study aimed to examine these associations among undergraduate female students in the Mekong Delta of Vietnam. Methods: A cross-sectional survey of 1181 female third-year students from two universities in the Mekong Delta was conducted. Latent variable modelling and logistic regression were employed to examine the hypothesised associations. Results: Among the 72.4% of students who had ever had boyfriends, 44.8% indicated that their boyfriends had asked for sex, 13% had had penile-vaginal sex and 10.3% had had oral sex. For those who had had penile-vaginal sex, 33% did not use any contraceptive method, including condoms, during their first sexual intercourse. The greater a student's perception that women were subordinate to men, the lower her self-efficacy for sexual communication and the lower her actual frequency of discussing safer sex matters and asking her partner to use a condom. Sexual communication self-efficacy was associated with actual contraceptive use (P = 0.039) but only marginally with condom use (P = 0.092) at first sexual intercourse. Conclusion: Sexual health promotion strategies should address the influence of gender relations on young women's sexual communication self-efficacy and the subsequent impact on actual contraceptive and condom use.