Couple fertility and contraceptive decision-making

Utilizing the 2011 UDHS, we study the influence of perceived partner’s desire for more children and its effect on current contraceptive use among married women in Uganda. Data herein is based on 5352 married and was weighted before analysis. Descriptive statistics of women’s background characteristics were computed. Multinomial logistic regression models were run to establish the relationship between husbands’ desire for more children with different socioeconomic variables. Overall the variables found to be highly significant with husband’s desire for more children were; modern contraceptive use, wealth, religion, fertility intentions. Women who perceived their husbands to want more children and those who did not know their husbands desired number of children were less likely to use modern contraceptives. In addition, wealth, religion, respondents’ education and husbands’ education levels and are a key determinant for perceived husbands’ desire for more children. Muslim respondents were less likely to know the number of children their husbands desired. we conclude that recurrent couple communication is pertinent in reduction of high fertility levels, promotion of small families and modern contraceptive usage.

While many researches have shown that contraceptive use tends to increase where there is spousal communication and concordance on reproductive intentions, many other studies, using couple data, have equally shown that most spouses do not accurately report the views/intentions of their partners. This study is based on the baseline data from a longitudinal couple study in a peri-urban community, Ipetumodu, in Osun State, Nigeria collected between April and May, 2010. The study shows that there is a noticeable level of discordance when the response of each wife is matched with her husband’s on several issues. For instance, only 14% of couples concurred that they use contraception. The study shows that even in a patriarchal society like Nigeria, a woman’s reproductive intention is a more important determinant of her contraceptive use than her husband’s reproductive desire, and also that couples’ agreement on reproductive intentions is an important predictor of women’s use of contraception.

Engaging men in family planning (FP) has been found to improve programmatic outcomes and increase gender equality. Little is known about the influence of couple communication on FP decision-making in India. We describe an intervention that utilized existing best practices for this purpose in Jharkhand, India. 572 men received 6, 90 minute sessions every 11 days for approximately 2 months. Sessions topics addressed: 1) gender equity, 2) communication skills, and 3) family planning knowledge. Post-intervention data collection is presently underway (October, 2012). At baseline 23% of the couples were using contraception and male condoms method most reported. We will test the relationship between changes in participants’ knowledge of FP, attitudes toward FP, GEM Scale scores, ease and frequency of communication and in increases in FP use. All statistically significant changes will be reported and complemented with qualitative data (focus group discussions & IDI) from participants and providers.

Background: Bihar is the second most populous state (106 million) in India and has highest total fertility rate (3.9) and a stagnated contraceptive prevalence rate of modern methods (29 percent). The unmet need for contraception is high.
Data and Objectives: Based on a large sample survey (N=7995), including 2937 women, 723 husbands and 592 health workers, and 150 in-depth interviews of women and their husbands, the present paper attempts to understand (a) who decides and how decision of contraceptive use is taken, (b) how socio-cultural norms influence contraceptive use dynamics, (c) barriers to contraceptive use and (d) where family planning program is failing to reach young couples.
Results: A combination of qualitative and quantitative approach including multivariate analysis shows a combination of socio-cultural and a weak FP program contribute to continued low use of contraception including: (a) large family size norm and son preference, (b) subordinate status of young women, low mobility outside home and lack of decision making power, (c) early marriage/pregnancy with no knowledge of fertility return leading to unwanted pregnancies; compounded by (c) programmatic inadequacies such as failure to provide correct and complete knowledge on FP, fear of side effects, and limited access to methods within village.