Post-traumatic stress disorder among rural widows in Nsukka: risk factors and wellbeing domains

Abstract

Losing a spouse to death is recognized as the most adverse life event that may increase the risk of depression, post-traumatic stress disorder, and other psychopathology with studies demonstrating that widows experienced more post-traumatic stress disorder symptoms than their non-widowed counterparts. Although the adverse effect of post-traumatic stress disorder may be stronger for widows in rural areas, the existing literature has shown the need for greater research on post-traumatic stress disorder experiences among vulnerable Igbo rural widows in Nsukka, South Eastern Nigeria. Against this backdrop, this study examined factors that predict post-traumatic stress disorder and the effect of post-traumatic stress disorder on the wellbeing domains of Igbo rural widows. Among the 177 participants, partner intimacy (β = .300, p < .001), cause of husband’s death (sudden vs. anticipated) (β = .183, p < .01), perceived social support (β = –.300, p < .001), number of surviving children at the time of husband’s death (β = .210, p < .01), and age of last child as at the time of husband’s death (β = .355, p < .01) all significantly predicted post-traumatic stress disorder. Domains of wellbeing most negatively affected by post-traumatic stress disorder included general life satisfaction (66.10%), family relationship (62.71%), and overall functioning (61.02%). The findings suggest that post-traumatic stress disorder among Igbo rural widows is a serious health concern that requires mental health professionals identifying high-risk rural widows early for intervention and developing programs aimed at educating and training rural community members on post-traumatic stress disorder and where to seek help on onset.

Keywords

Mental health Nsukka PTSD rural health wellbeing widows

Losing a spouse to death has long been recognized as one of the most adverse life events, with increased risk of depression and other pathology (Zisook & Shuchter, 1991) and studies have shown compelling evidence that experiencing bereavement can be a major source of post-traumatic stress disorder (PTSD) (Brady et al., 2004; Saiyad et al., 2013) with widows experiencing more PTSD symptoms than their non-widowed counterparts (Brady et al., 2004). Although research on gender difference and the experience of PTSD has remained inconclusive, studies have shown that being a female is a higher risk factor (Jenkins et al., 2015) especially among women who continue to experience the negative socio-economic consequences of bereavement. Unfortunately, these categories of women are basically the rural widows whose population has continued to increase with increasing demand for more attention by researchers. This study examined risk factors for PTSD among rural widows in Nsukka and how PTSD affects their wellbeing domains.

Socio-cultural beliefs and practices in Nsukka

In Nsukka, there exists a unique family structure that encourages and sustains patrilineal traditions that value and assign the role of heads of household, custodians of family lineage/identity, protectors, and providers of families to men (Isiugo-Abanihe, 1994). But unlike the past, in recent times, these responsibilities have become onerous for men to accomplish successfully as large population of rural dwellers live below poverty level while the tradition demands that the women and family members depend on the men socially and economically.

The rural family system is also essentially extended and collectivist in nature with greater number of dependents and increased responsibilities. Most rural men thus engage in several ventures simultaneously (e.g., combining farming and other menial and low paying jobs) thus working longer hours and having little rest. Rural Nsukka Igbos also value and endorse having a large family size. For example, it is important that family lineage is sustained over generations and given the traditionally patrilineal family structure where the men are the dominant decision makers, they tend to gain socially and economically from having large number of children (Isiugo-Abanihe, 1994). Aside from sustaining the family lineage, large family size also provides security, labor, and other benefits. Although some studies reported a nonsignificant correlation between number of children and PTSD (Ibrahim & Hassan, 2017), some other studies suggest that individuals from large families are more likely to report PTSD (Green & Griffiths, 2013) especially within rural areas.

This unique socio-cultural environment has significantly increased work burden and responsibilities for men who in recent times resort to taking locally brewed gin and other types of alcohol to cope with the accompanied stress and which further contributes to high mortality rates among men. Although there is no documented record, it is evident from simple observation that today, compared to men, the number of women that wear the traditional mourning cloth of black or white to show that they have lost their spouse has tripled indicating that more men are dying than women and which has increased the population of rural widows.

What happens when a rural woman loses a spouse that she is traditionally expected to be financially and emotionally dependent on? They are suddenly faced with the task of taking over the role of the head of the household especially with the task of taking family decisions, a situation that can lead to mental exhaustion, anxiety, and fear of making wrong decision that can negatively affect the family. They become providers to a large family and pay community and religious levies usually with little finance and with people around them ignorant of challenges of rural widowhood. These incidents are extremely challenging and can trigger the development of intrusive memories of the dead that are often accompanied by emotional numbness, dissociation, preoccupation with the thought of the dead in form of flash backs and dreams, lower levels of happiness (Veenhoven, 1989), and loneliness of which adjusting to can be a major problem. There is also the depletion of emotional energy that can impact negatively on widows’ wellbeing domains such as work, household duties, friendship, family relationship, sex life, overall function, and general life satisfaction.

Research on PTSD

Marital intimacy has been one line of research on PTSD that has received considerable attention. It has been conceptualized as “the ability to be sensitive and aware of each other’s psychological, emotional, physical, operational, social and spiritual needs” (Mills & Turnbull, 2001, p. 301). Research have demonstrated that high intimacy is associated with positive relational outcomes such as sexual satisfaction (Haning et al., 2007; Hordern & Street, 2007), specific aspects of marital satisfaction (Dandurand & Lafontainem, 2013), general marital satisfaction (Greeff & Malherbe, 2001), psychological and physiological wellbeing (Haning et al., 2007).

Research has furthermore shown that factors that precipitate PTSD among widows vary according to the context of the death, that is, whether the death was sudden (unexpected) (i.e., death through auto accident, suicide, etc.) or anticipated (amount of forewarning prior to spouse’s death) (Carr et al., 2001), and age of the bereaved (O’Connor, 2010). For example, in a study of 19 World Mental Health Surveys, 30.2% representing 2813 participants indicated that their PTSD was triggered by the unexpected death of a loved one with women and widows having three times greater odds of experiencing PTSD following the unexpected death of a loved one compared to men (Atwoli et al., 2016). Although the results concerning sudden and anticipated death seem to contradict, the general conclusion is that unexpected death of a spouse could be implosive and is more often associated with psychological distress associated with heightened anxiety, grief reactions and incapacitation of social and physical functioning.

Social support has also featured in the literature. For example, having significant others around at moment of grief leads to a de-elevation of emotional distress generated by traumatic events including bereavement. This position has been well documented (Schroevers et al., 2010). In the event of traumatic experience, social support encourages effective use of positive coping strategies and promotes the experience of higher level of general life satisfaction (Chan et al., 2015; Lou, 2010). Other risk factors that can predict the development of PTSD among rural widows include age of first and last child at the time of spouse’s death. Having children implies that the widow has the responsibility of managing her own grief and those of the children as well. The toll can be distressing when the first or last child is under aged (e.g., below 5 years of age) as this can significantly limit the woman’s mobility since the woman has to pay special attention to the child. Duration of widowhood was also considered as a significant factor in PTSD research with the assumption that rural widows with shorter duration of widowhood may be at a higher risk of PTSD than those with longer duration of widowhood.

Although PTSD constitutes a serious health concern there still exists a dearth of research in that area among Igbo rural widows especially in Nsukka context. This study therefore examined PTSD risk factors among Igbo rural widows and how PTSD impacts on rural widows’ wellbeing domains such as the domains of work, household duties, friendship, family relationship, sex life, overall function, and general life satisfaction. The study is further aimed at enlightening global researchers and mental health workers on the need for the development and implementation of intervention measures to assist vulnerable rural women. To achieve these aims, the following hypotheses were tested: Among rural widows in Nsukka, the loss of an intimate partner will engender greater PTSD symptomatology for widows who were intimate with their late spouses than their counterparts who were not intimate with their partners (Hypothesis 1). Widows whose spouses died suddenly (unexpectedly) will report more PTSD symptomatology than those who anticipated the death of their spouses (Hypothesis 2). Widows who lost a younger partner will have greater odds of experiencing PTSD compared to those who lost an older partner that may possibly have grown up children who may help to mitigate grief reactions for the widow (Hypothesis 3). Widows who have higher social support will experience less PTSD symptomatology than those who have lower social support (Hypothesis 4). Widows with large family size characterized by large number of surviving children will experience more PTSD symptoms than their counterparts with small family size (Hypothesis 5). Age of first child will predict PTSD among rural widows such that the younger the first child the higher the chance of experiencing PTSD (Hypothesis 6). Age of last child will predict PTSD such that the younger the last child the higher the chance of experiencing PTSD (Hypothesis 7). Shorter duration of widowhood will predict PTSD among rural widows more than longer duration of widowhood (Hypothesis 8). The experience of PTSD among rural widows will impact negatively on their wellbeing domains (Hypothesis 9).

Method

Participants

A cross-sectional study was conducted to examine PTSD among rural Igbo women of Nsukka using a convenience sample. In this situation, a random sample is improbable due to access and contextual concerns. A total of 177 widows were thus recruited from 12 rural areas in Nsukka, Enugu state, Nigeria. Ages of participants ranged from 25 to 68 years (M = 49.3, SD = 5.24). Demographic characteristics of participants are shown in Table 1.

Table 1.

Demographic characteristics of participants.

Characteristics	n	%
Occupation
Farmers	120	67.80
Traders	48	27.12
Civil servants	6	3.39
No handwork	3	1.69
Religious affiliation
Catholics	69	38.98
Protestants	99	55.93
Traditionalists	9	5.08

Instruments

PTSD Checklist—Civilian version

The PTSD Checklist—Civilian Version (PCL-C; Weathers et al., 1993) was used to measure PTSD. The PCL-C is a 17-item self-report measure that reflects DSM-IV symptom criteria for PTSD. Participants were instructed to consider their widowhood experience and to rate how much they had been bothered by each symptom since the death of their spouse using a 5-point scale ranging from 1 = not at all to 5 = extremely. Adding up all items for the PCL-C yields a total severity score and total score of 50 and above indicate the likelihood of meeting DSM-IV criteria for PTSD (Weathers et al., 1993). The PCL-C has demonstrated a high internal consistency during the initial administration (α = .94, p < .001) and the retest administration (α = .92, p < .001) and a good retest reliability (r = .66, p < .01) after a 2-week interval (Weathers et al., 1993). Convergent and Discriminant Validity of the PCL-C has also been reported (Conybeare et al., 2012). This scale has been validated and variously used with Nigerian samples (see Nwoga et al., 2016; Olashore et al., 2018; Onyedire et al., 2017).

Intimacy Scale

The Intimacy Scale (IS; Walker & Thompson, 1983) is a measure of intimacy between two individuals that reflects the quality of their relationship. Initially, Walker and Thompson developed the scale to measure the intimacy between mother and daughter but the scale has been variously used to measure affection and closeness in other adult relationships. It consists of 17 items, each rated on a scale of 1 to 7. A higher score represents greater intimacy/affection. Walker and Thompson (1983) reported good reliability of this scale in the original study (α coefficient from .91 to .97). Walker and Thompson (1983) also found a significant positive relationship between intimacy and frequency of contacts between mothers and daughters which is a demonstration of construct validity. The psychometric properties of IS has also been reported in different cultures, for example, among Chinese (Chan et al., 2015) and Iranian (Davoodvandi et al., 2018) adults. In the present study, the Cronbach alpha reliability of the scale was found to be .86.

Measure of wellbeing domains

Wellbeing domains were operationalized as domains of work, household duties, friendship, family relationship, sex life, overall functioning, and general life satisfaction. To measure the wellbeing domains in line with the operationalization, participants were asked to rank the extent to which they have experienced severe challenges in those domains after their spouse’s death on a 7-point semantic differential scale. After that, the frequency of highest rankings was determined for each domain. Frequency was used because a widow can experience the severity of a domain just once. Finally, percentage and ranking were used to interpret the widow’s responses. The scale was pilot tested with 50 widows and a test–retest reliability coefficient of .89 was obtained with an interval of 1 month.

Cause of death

To determine cause of death, participants were asked to indicate whether death was sudden (through accident, cardiac arrest, suicide, murder, and illness that did not last up to a week) or anticipated (through illness that lasted more than a week).

Multidimensional Scale of Perceived Social Support

The Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988) was used to determine the level of support that participants receive from significant other, family, and friends. The MSPSS is a 12-item scale and participants are asked to rate their level of perceived social support on a scale that ranged from 1 = very strongly disagree to 6 = very strongly agree. The maximum score a participant can make is 72 with higher score indicating greater perceived social support. Items from this scale include: “There is a special person around when I need them”; “I can count on my friends when things go wrong”; and “I can talk about my problems with my friends.” The MSPSS has demonstrated high reliability and validity (Eker et al., 2000; Stewart et al., 2014) and has been validated among Nigerian samples (see Akosile et al., 2018; Aloba et al., 2019).

Age of husband at the time of death

To determine the age of husband at the time of death, age was grouped in intervals of 20 years as follows: 20–40, 41–61, and 62+ years.

Number of children

To determine number of children, participants were asked to indicate the actual number of surviving children.

Age of first child/age of last child

To determine age of first child/age of last child, participants were asked to indicate the current actual ages of their first and last child.

Duration of widowhood

To determine the duration of widowhood, the number of years were grouped in intervals of 10 years as follows: 0–10, 11–20, and ⩾21 years.

Procedure

Rural communities in Nsukka, Southeastern Nigeria consist of villages where the inhabitants live in a clustered setting with usually very few outsiders. In the event of death in a village, the entire members become aware and involved. To recruit the participants for this study the researcher with assistants approached each village head and informed him of the purpose of the study. With the help of the village heads widows who were available and willing to participate were recruited from 12 rural areas. They were then administered the PCL-C, IS, and MSPSS. The instruments were clearly read out to them with the instruction that they respond honestly as the items apply to them. Administration of the instruments and collation of responses took 13 days to complete.

Ethical considerations

This research work received Ethics approval from the Department of Psychology, Faculty of the Social Sciences, University of Nigeria, Nsukka Ethics Committee. The purpose of this research and the research process were explained to the participants. The informed consent was read to them and they were allowed to ask questions throughout the data collection process. To create a relaxed atmosphere that is devoid of anxiety and possible depression they were assured of confidentiality and given enough time to respond to the items. At the end of each visit participants were debriefed and given the number of the researchers to call in the event of a need and finally. They were also given some snacks.

Data analysis

To examine the factors that predict PTSD among rural widows, hierarchical multiple regression analysis was conducted using IBM SPSS Statistics version 20. Hierarchical multiple regression analysis was used so as to isolate predictors and ascertain whether the addition of a variable of interest will significantly improve the model’s ability to predict PTSD among rural widows.

Results

Table 2 shows the correlation between variables.

Table 2.

Table of inter-correlation of factors predicting PTSD among rural widows.

	M	SD	1	2	3	4	5	6	7	8	9
1. PTSD	56.64	10.61	–
2. I	92.90	26.49	.30***	–
3. C of D	–	–	.18**	−.03	–
4. SS	31.20	14.65	−.27***	−.10	.24**	–
5. A of H	69.63	19.96	−.11	.01	−.27***	−.25***	–
6. N of C	–	–	.38***	.39***	.12	−.26***	.01	–
7. A of 1st C 34.42	13.53	−.09	−.05	−.25***	−.32***	.71***	.19**	–
8. A of L C 20.14	11.47	−.03	−.04	−.20**	−.28***	.69***	.09	.89***	–
9. D of W	13.97	12.279	−.13*	−.03	−.21**	−.10	.35***	−.15*	.62***	.62***	–

PTSD: posttraumatic stress disorder; I: intimacy; C of D: cause of death; SS: social support; A of H: age of husband; N of C: number of children; A of 1st C: age of first child; A of L C: age of last child; D: duration of widowhood.

p < .05; **p < .01; ***p < .001.

Table 3 revealed that PTSD is positively related to partner intimacy (p < .001), cause of death (p < .01), and number of surviving children (p < .001) but negatively related to social support (p < .001). Also, partner intimacy is positively related to number of surviving children (p < .001). Cause of death is positively related to social support (p < .001) and negatively related to age of husband (p < .001), age of first child (p < .001), age of last child (p < .01), and duration of widowhood (p < .01). Social support is negatively related to age of husband, number of surviving children, age of first child, and age of last child. Furthermore, age of husband is positively related to age of first child, age of last child, and duration of widowhood while number of surviving children is positively related to age of first child, age of last child, and duration of widowhood. Age of first child is also positively related to age of last child and duration of widowhood while age of last child is positively related to duration of widowhood.

Table 3.

Summary of hierarchical regression analysis for factors predicting PTSD among rural widows in Nsukka zone.

Variables	B	SE	β	R	R ²	ΔR²
Step 1				.300	.090	.090
Mint	0.120	0.029	.300***
Step 2				.352	.124	.033
CofD	7.702	2.988	.183***
Step 3				.456	.208	.084
SS	−0.217	0.051	−.300***
Step 4				.472	.223	.015
AofH	−0.069	0.038	−.130
Step 5				.507	.257	.034
NofC	1.090	0.391	.210**
Step 6				.518	.268	.012
AofFC	−0.130	0.079	−.166
Step 7				.542	.293	.025
AofLC	0.329	0.134	.355**
Step 8				.542	.294	.000
DofW	0.022	0.082	.025

PTSD: posttraumatic stress disorder; MInt: marital intimacy; C of D: cause of death; SS: social support; A of H: age of husband; N of C: number of children; A of 1st C: age of first child; A of L C: age of last child; D: duration of widowhood.

p < .05; **p < .01; ***p < .001

A hierarchical multiple regression analysis was employed to build a model for predicting PTSD among rural widows. Marital intimacy contributed significantly to the regression model, F(1, 175) = 17.36, p < .001. Marital intimacy explained 9% of the variation in PTSD and positively and significantly predicted PTSD among rural widows (β = .300, SE = .029, p < .001). PTSD was found to be higher for widows who were highly intimate with their late spouse. Cause of husband’s death (illness vs. accident) explained an additional 3% of the variation in PTSD and this change in R² was significant, F(1, 174) = 6.64, p < .01, and positively predicted PTSD among rural widows (β = .183, SE = 2.988, p < .01). The direction of prediction suggests that PTSD is higher when death is accidental (coded as 1) than after an illness (coded as 0). Age of husband at the time of death was added and this addition did not predict PTSD (β = –.130, SE = .038, p = .071).

Perceived social support explained an additional 8% of the variation in PTSD and was also found to be significant, F(1, 173) = 18.41, p < .001. Perceived social support predicted PTSD negatively (β = –.300, SE = .051, p < .001) suggesting that the higher the perceived social support the less the PTSD. Number of surviving children at the time of husband’s death explained another 3% of the variation in PTSD and the R² change was found to be significant, F(1, 171) = 7.78, p < .01. Number of surviving children at the time of husband’s death was positively related to PTSD and predicted PTSD (β = .210, SE = .391, p < .01) suggesting that the more the number of surviving children the higher the PTSD. Age of first child as at the time of husband’s death did not predict PTSD (β = –.166, SE = .079, p = .101). Age of last child as at the time of husband’s death explained another 3% of the variation in PTSD and the R² change was found to be significant, F(1, 169) = 5.97, p < .01. Age of last child as at the time of husband’s death was negatively related to PTSD and significantly predicted PTSD (β = .355, SE = .134, p < .01). The result showed that the older the last child the lower the PTSD. Finally, duration of widowhood was entered and it did not predict PTSD among rural widows (β = .025, SE = .082, p = .134). PTSD effects on wellbeing domains of the widows were further assessed. Table 4 shows the frequency, percentage, and ranking of widows “yes” responses on different wellbeing domains.

Table 4.

Frequency, percentage and ranking of PTSD on domains of wellbeing.

Wellbeing domains	Frequency	%	Rank
Work	93	52.54	4.5
Household duties	93	52.54	4.5
Friendship	84	47.46	7
Family relationship	111	62.71	2
Sex life	90	50.85	6
Overall function	108	61.02	3
General life satisfaction	117	66.10	1

PTSD has more profound effect on the general life satisfaction of the rural widows (66.10%) followed by the domain of family relationship (62.71%). PTSD was also implicated on the overall function of rural widows (61.02%) followed by work (52.54%) and household duties (52.54%). The least wellbeing domains affected by PTSD include sex life (50.85%) and friendship (47.46%).

Discussion

This study examined risk factors for PTSD among rural widows in Nsukka and how PTSD impacts on their wellbeing domains. Results showed that marital intimacy positively predicted PTSD. Experiencing PTSD among rural widows was higher for those who were highly intimate with their partners prior to loss. This was expected because in rural Nsukka traditional family system women are expected to be loyal, dependent and attached to their husbands. Women’s sexuality is also configured around ritual control such that the deities are framed to punish women who have sexual relations with another man (Itufu-uku) by inducing insanity (Ezeh et al., 2019). The culture thus generally expects women to remain chaste, responsible and respectable to their husbands and the family. This explains why rural women are more loyal to their partners, are always readily available to the family, and hardly travel out.

Those who strongly imbibe these cultural values tend to have a marital relationship that revolve around their spouses making them to consider their husbands as their best friend, dependent, and source of happiness leading to high intimacy and close personal connection. For such women, losing a spouse can be very demanding as it signifies “an irreparable” loss of “a second half,” best friend and a loss of an important social network. The stress can be so excruciating for the widow and may trigger the development of hopelessness beliefs which is a maladaptive cognitive complex that can lead to several forms of psychological distress including PTSD (Abramson et al., 1989).

Cause of death (sudden vs. anticipated) was also found to predict PTSD with widows reporting higher PTSD when death was sudden. When death is forewarned, the possibility of getting prepared for the eventual death is higher and which reduces trauma effect. It is therefore suggested that being forewarned of a death provides the bereaved the time to address unresolved emotional, financial, and practical issues before the actual death. This preparation for death is believed to enable a smoother transition to widowhood. Rural widows who experience high social support also reported less PTSD. From the framework of the social-cognitive-processing model of trauma recovery (Lepore et al., 1996), successful psychological adjustment to trauma is enhanced when thoughts, feelings, and emotions embedded in the cognitive processing of such trauma-related information are shared with significant others (Lepore et al., 1996).

The benefits of social support in the event of bereavement have long been recognized in Nsukka culture. For example, traditionally, in the event of loss of a spouse, extended family members stay with the bereaved for 21 days considered as the grief period. Within this period, there is substantial social support while the trauma effects largely dissipate. Modernity and poverty have, however, impacted traditional social support system and sense of communalism in most rural areas in Nsukka. Today people go to work, live far distances with increased poverty level. This has led to a reduction of the grief period to 4 days and which has significantly reduced the desired social support for most widows.

Not having people to self-disclose, ventilate, and seek help also provide widows with fewer opportunities to process or adjust to trauma-related thoughts, images, memories, emotions, and feelings following bereavement making them more susceptible to developing PTSD symptomatology and studies have actually demonstrated that people who report low social support also report higher severity of PTSD (Jacobsen et al., 2002).

Rural widows with large number of surviving children and under aged last child at the time of spouses’ death also reported higher PTSD. This finding is of significance because rural dwellers in Nsukka habitually believe in having greater number of children by family members. Given the patrilineal traditions, rural women oblige their husbands when they make sexual demands and which further encourage large family size. But the total number of children in a particular family gets larger care givers experience more strain in providing the basic needs of dependents, increase in work burden both at home and market or paid work especially in the presence of under aged last child. There is also the problem of making out time for the children and being sensitive to their needs; all of which can be overwhelming.

From the findings, the experience of PTSD among the rural widows impacts negatively on their general life satisfaction, family relationship, overall function, work, and household duties. These are wellbeing domains that are essential for proper cognitive, emotional, physical, and interpersonal functioning that lead to trauma recovery and successful psychological adjustment to PTSD. With the effects on these wellbeing domains rural widows may neglect their own health concerns thus taking a toll on their health and emotional wellbeing (Carr et al., 2001).

The study has some limitations that are worth noting. Participants were all Igbos from Nsukka and so generalizing the findings to other contexts should be done with caution. Also, PTSD was measured at a specific period and there could be situational changes that may change PTSD experiences among the widows. This study did not consider revisiting the widows to ascertain their PTSD experience after a time period. Finally, there is the need to apply other measures of PTSD among rural widows to determine the nature of correlation with the current findings.

Conclusion

The findings show that PTSD is a major health concern among rural widows, and the results suggest the need for increased in-depth studies aimed at further understanding the mental health challenges faced by rural widows. There is also the need to identify high-risk rural widows early for intervention programs. Since among the rural Igbos community and religious leaders are two notable groups that are always in constant interaction with widows, there is the need for clinical psychologists and other mental health professionals to develop an intervention program aimed at educating and training rural women, community and religious leaders on how to recognize the onset of PTSD, what to do and where to seek help. Ministry of women affairs, religious, and nongovernmental organizations and traditional rulers should collectively sensitize rural women on the need for entrepreneurship so as to be less dependent on their spouses and to engage in family planning since these are essential for improving the well-being of rural widows. Policy makers should also enact laws that are aimed at protecting and providing support for rural widows.

Further studies should investigate the extent to which this vulnerable population is exploited in the form of sexual abuse on the part of the widows and their children in the guise of provision of financial and other social support by the public. Rural widows may likely engage in silent prostitution or encourage their daughters to go out with men who have the financial capacity to cater for their needs thus become vulnerable to contracting STDs and HIV/AIDS.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Valentine C Ezeh

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