IUSSP Working Session on Research and Programs on Couples and Reproductive Health
Zoom, 5 May 2020
The IUSSP Panel on Couples’ Reproductive Health and Fertility organized this web-based working session (using zoom) on May 5, 2020 (from 15:00 to 16:30 UTC), after the in-person side event scheduled for the day before the 2020 Annual Meeting of the Population Association of America (PAA) was cancelled.
The aim of the session was to present ideas (e.g. for a future study or a brief outline of the study design or new hypotheses) and get feedback rather than to present results. The five presentations – two from North America, two from India, one from Africa – were selected through a call for papers. To keep the meeting small, as a means to encourage discussion, invitations to attend this virtual workshop were sent only to those who had registered to attend the original PAA side event as well as to participants who had attended a PAA online session organized on a related topic.
Forty-two participants attended the session, including the IUSSP Panel chair, Stan Becker, three of the Panel members – Vissého Adjiwanou, Ambrose Akinlo and Neetu John – and IUSSP Council Liaison Jean-François Kobiané.
After a welcome by the President of the IUSSP, Tom Legrand, Stan Becker gave an overview presentation of the area.
Stan Becker noted that male partners are often left out of reproductive health research and programs though they were included in family planning research in the 1950s – the reason was that almost all the contraceptive methods available then involved male participation (e.g. condoms, rhythm, withdrawal). But with the introduction of the pill and IUD contraception became medicalized and men were sidelined. Demographers followed suit as both the World Fertility Survey (with one exception) and the Demographic and Health Survey only included women in their surveys until 1987, when men were rediscovered. What happened is the realization that the major intervention to prevent HIV transmission was the condom and men use condoms! Seven longitudinal studies have shown that fertility preferences of both spouses are needed to best predict whether the couple would have a birth or not in the prospective period. Also, experimental studies of couple counseling versus woman-only counseling for contraception have usually shown significantly higher uptake of contraception with couple counseling. Of course, for female-dominated reproductive events (e.g. delivery, abortion) the woman must decide if she wants her partner involved or not. Reproductive health services can benefit from inclusion of male partners. The medical profession knows this already for infertility. But studies have shown positive effects of both partners' involvement for contraceptive sterilization, STI treatment and breast-feeding and there are probably positive effects of male involvement in programs to reduce infant and maternal mortality, though studies are lacking. (For further information watch pre-recording of Stan Becker’s introduction to the topic.)
Stan Becker’s introduction was followed by five short presentations.
Ilene Speizer: Examination of Couple-Level Fertility Desires on Family Planning and Fertility Outcomes: A Longitudinal Analysis Using Data from Select Urban Sites in Nigeria.
Using longitudinal data from couples from the Measurement, Learning and Evaluation project collected in urban sites of Nigeria, Ilene Speizer demonstrated that in this context there is a strong correlation between men’s and women’s fertility desires. Further, she showed that women’s perceptions of their partners’ desires correlated with their own desires. In multivariate analyses examining which women had a pregnancy or birth in the four-year follow-up period, it was observed that if either partner wanted to get pregnant at the baseline time period, the woman was more likely to have had a pregnancy or birth. In this context of high fertility and low family planning use, having the male data did not add significantly to the models examined. Future studies should consider in what circumstances it is most valuable to include men in family planning studies. In particular, examining men’s fertility desires may be more important in settings with lower fertility and higher contraceptive use.
Tchoubou Foba Habib: The Non-Involvement of Men in the Promotion of Family Planning in Chad.
Family planning (FP) has been a great response to controlling the rapid growth of the population as it may be a brake on development efforts. In addition, it has also played a major role in the fight against maternal and infant mortality. However, it should be noted that despite the actions undertaken in this context, the contraceptive prevalence observed in Chad (5% in 2015), remains one of the lowest in the world. Most researchers continue to explain this situation using only the different factors related to women. Yet ignoring men (as spouses) in the promotion of FP could be one of the main obstacles to contraceptive practice. Thus, the study of men's participation in the promotion of FP is fundamental because of their dominant role in family decision-making, especially with regard to the reproductive component in the socio-cultural context in Chad. To this end, the purpose of this study is to understand the explanatory factors of non-involvement of men in the promotion of FP.
Hilary Schwandt: "We discussed it together saying let’s use family planning so that our children can grow up well": Male Involvement in Family Planning in Rwanda Extends Beyond Communication about Contraceptive Use
Hilary Schwandt and Haley Morris presented the topic of spousal communication about contraceptive use in Sub-Saharan Africa. They presented some of their own research findings in this regard, as well as from the literature. Spousal communication about family planning use is such a strong predictor of current contraceptive use – but the mechanism of how these communications occur, and what transpires within them, remains poorly understood. Hilary advocates for more qualitative research into the nuances of spousal communication about contraceptive use – and particularly advocates also for research on spousal communication about coitus; this would provide a potential pathway for better understanding conversations about contraceptive use. Hilary also presented an idea to conduct qualitative interviews with both members of the couple together to better understand the conversations that occur between couples about contraceptive use and coitus.
Minakshi Vishwakarma: Husband’s Gender Attitude and Wife’s Covert Use of Modern Contraceptive Method in India
Researchers from all over the world have raised the differences in reproductive attitude and preferences between husbands and wives which leads them to have dissimilar contraceptive needs. Covert contraceptive use by women is the result of such situations and is defined as contraceptive use without informing the spouse. In recent years, a significant minority of women from many parts of the world use modern contraception without informing their husbands. In India, around 18 % of women keep their contraceptive use secret from their husbands. Men’s strong disapproval for contraceptive, husbands’ pronatalism and problematic spousal communication are a few of the explored reasons behind women’s covert contraceptive use. Also, the literature suggests that gender attitude not only contributes to shaping one's reproductive strategies but also it can magnify the effect of other background characteristics on fertility intention which ultimately affect the decision to use contraception. Since India is a patriarchal society and men are the final authority in most cases, this study proposes to examine the hypothesis that husbands’ gender attitude is associated with wives’ covert use of modern contraceptive. This study will utilize couples’ data from the recent round of the Indian Demographic Health survey (NFHS-4) to fulfil the objective. Structural Equation Modelling will be used to measure the complex relationship between wives’ covert contraceptive use and husbands’ gender attitude.
Md Juel Rana: Achieving Intended Fertility among Indian Couples: Perspectives of Gender and Sex Preference
Studies have theorized that final parity of a couple is a function of intended parity, fecundity impairments, unwanted births, long-term relationships with a marriage partner, and comparison of fertility goals with other aspirations. Unlike the developed countries, in the developing countries, especially India, the mean actual family size surpasses the mean intended family size, which is often argued as the result of unintended births due to unmet contraceptive needs. A few studies also established that son preference extends the family size in different parts of India. India is witnessing the transition from high to low fertility level, but there is wide variation in fertility across the regions. The couple’s concordance or discordance may have a crucial role in son preference, fertility intentions, and achievement of fertility intention. Hardly any study has focused on the role of couples’ dynamics of sex preference on the achievement of intended fertility. Therefore, an attempt is needed to investigate the role of couples’ discordance in son preference, fertility intentions, and fertility behaviour in India. The specific objectives are 1) to assess the patterns of couples’ discordance in son preference and fertility intention; 2) to evaluate the association of couples’ discordance between son preference and fertility intention; and 3) to document the effects of couples’ discordance in son preference and fertility intention on fertility behaviours. The last two rounds of the National Family Health Survey (NFHS) shall be used in the analyses with women and men who are at the end of the reproductive years. The variable for the mismatch between intended and achieved fertility will be grouped into underachievement, achievement, and overachievement for women and men separately and multinomial logistic regression models will be used.
Each presentation was followed by questions and answers.
Panel member Neetu John summarized the insights from the seminar. First, the couples approach can be useful but is under-studied so how and when to have such an approach needs to be determined. In addition, what would a comprehensive couples approach look like? Clearly the focus solely on women ignores the reality of a large part of their lives (i.e. in marital union). Work must be done with couples to provide an enabling environment for women and men to achieve their reproductive goals. Further research to determine what couple communication means is important. With regard to reproductive health programs and interventions, how can we best engage partners? There is clearly plenty to consider in a future session of the panel!