Prevalence and determinants of multiple sexual partners in India: Results from the national family health survey (2019–2021)

Background Multiple sexual partnerships (MSP) are an important public health concern associated with increased risks of sexually transmitted infections (STIs), HIV transmission, reproductive complications, and adverse psychosocial outcomes. However, nationally representative evidence on gender-specific determinants of MSP in India remains limited. This study assessed the prevalence, regional distribution, and determinants of MSP among Indian men and women using NFHS-5 data. Methods This secondary cross-sectional analysis used data from the National Family Health Survey (NFHS-5, 2019–2021). A total of 58,465 men aged 15–54 years and 80,313 women aged 15–49 years with complete data on sexual partners within last 12 months were included. MSP was defined as having more than one sexual partner within last 12 months. Demographic, socioeconomic, health-related, and behavioural variables were assessed. Weighted prevalence estimates were generated, and state-wise distributions were mapped using choropleth analysis. Associations between MSP and explanatory variables were examined using bivariate analysis and nested multilevel logistic regression models accounting for clustering and complex survey design. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results The prevalence of MSP was substantially higher among men (14.41%) than women (3.06%). After adjustment for socio-demographic, behavioural, and health-related factors, employment (AOR: 1.27; 95% CI: 1.17–1.38) and urban residence were associated with higher odds of MSP among women, whereas higher education, higher wealth status, and comprehensive HIV/AIDS knowledge (AOR: 0.74; 95% CI: 0.66–0.82) were associated with lower odds. Among both genders, tobacco use, alcohol consumption, domestic violence, hypertension, and diabetes were positively associated with MSP. Married participants had lower odds of MSP among both men (AOR: 0.40; 95% CI: 0.37–0.42) and women (AOR: 0.49; 95% CI: 0.43–0.55). Marked regional heterogeneity in MSP prevalence was observed across Indian states and union territories. Conclusions MSP was more prevalent among Indian men than women and demonstrated important gender-specific socio-demographic and behavioural determinants. The findings support the integration of behavioural counselling, substance-use reduction measures, domestic violence prevention strategies, and region-specific sexual health services within reproductive and public health programs.