Covert Contraceptive Use: Prevalence, Motivations, and Consequences

Abstract

This article examines women's covert use of contraceptives, that is, their use of a method without their husbands' knowledge. Three questions are addressed: (1) How is covert use measured? (2) How prevalent is it? and (3) What are the factors underlying covert use? Existing studies are used together with survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and their husbands. Women's covert use of contraceptives is estimated to account for 6 to 20 percent of all current contraceptive use, and it is more widespread when contraceptive prevalence is low. The multivariate analysis indicates that difficult spousal communication about contraception is the strongest determinant of covert use. Husbands' disapproval of contraception works through spousal communication rather than as a direct influence on covert use. Husbands' pronatalism had no significant effect. The article concludes with implications of covert use for reproductive health and family planning programs, especially women's (and men's) needs for confidential services.

Barriers to the Use of Modern Contraceptives and Implications for Woman-Controlled Prevention of Sexually Transmitted Infections in Madagascar

“…Correspondingly, the husband's approval of contraception was positively associated with contraceptive use in Ghana (Oheneba-Sakyi & Takyi, 1997) and with good communication between the spouses in previous studies (Oni & McCarthy, 1991;Oheneba-Sakyi & Takyi, 1997). Even if women have access to womancontrolled, covert methods of protection, discussion of contraceptive use with the primary male partner is likely (Biddlecom & Fapohunda, 1998;Castle et al, 1999;Green et al, 2001). Thus, it is widely believed that male involvement in family planning is necessary for improved contraceptive use (Sternberg & Hubley, 2004), and there is evidence that interventions targeting men have improved men's acceptance of contraception, including the use of condoms (Piotrow et al, 1992;Celentano et al, 1998;Laukamm-Josten et al, 2000;Leonard et al, 2000;Sternberg & Hubley, 2004).…”

Factors associated with contraceptive use in a rural area in Western Cape Province

“…[18] Globally low SES is associated with poor and inconsistent contraceptive use. [17,19] Lower SES women, and particularly those in rural areas, have limited access to health services, which may limit their contraceptive access. [3,13] A number of difficulties may explain the the low CPR.…”

“…A Zambian study found that only 20% of men approved of contraceptive use, believing that contraception will prevent women having the number of children they desire. [19] The study involved a rural site that is a commercial farming area, unlike traditional rural areas where men are the decision makers, [14] which may explain our inconsistent finding. Injectables enable a woman to be on contraception without the knowledge of her partner.…”

The Potential Impact of Community-Based Distribution Programmes on Contraceptive Uptake in Resource-Poor Settings: Evidence from Ethiopia

“…[30][31] Women can take injections of depo-provera while visiting a health facility and remain protected against unwanted pregnancies for three months. This may be done without their husband's knowledge and without the bother of having to remember to take the pill or to undergo clinical procedures that are involved when opting for implants or intrauterine devices.…”