How does the sex composition of children affect men's higher ideal family size preference relative to women and contraceptive use patterns among couples? A cross-sectional analysis of dyadic couple's data in India

Abstract

Introduction Son preference, an ongoing concern in India, is a known driver of ideal family size preferences and contraceptive use among couples. These associations can vary substantially with parity and can influence men and women differently. This study assesses the association of sex composition of children by parity and a) men's higher ideal family size preference relative to women and b) use of modern contraceptives by couples. Methods We used the Couples Recode dataset from National Family Health Survey (NFHS) 2015-16 and identified couples who had at least one child and had complete responses for variables used in the study (N = 56,731 couples). We developed multivariable linear and logistic regression models to study the association between sex composition of children by parity and our dependent variables. Results Our findings indicate that the sex composition of children is associated with men's higher ideal family size preference, relative to women, among couples with four or more children. We also find that couples with less than four children are less likely to use modern contraceptives when they have an equal or a greater number of daughters than sons compared to those who have no daughters. Findings suggest that couples with four or more children are more likely to use modern contraceptives when they have at least one son and one daughter and are less likely to use contraceptives when they have all daughters and no sons, than couples who have no daughters. Conclusion This study contributes to existing research on the relationship between sex composition of children with ideal family size preferences and contraceptive use by highlighting meaningful differences between higher and lower parity couples. Findings from the study can be used by family planning programs in India to customize family planning counselling messages by both sex composition and parity.

Male partner influence on Women's choices and utilisation of family planning services in Mufulira district, Zambia

“…Studies elsewhere have reported similar findings [ 42 ]. However, preference for large families can vary among men and across the regions and could be influenced by social economic status, level of education, and knowledge level on contraception and son preference by a couple [ 42 , 43 ]. For instance, Dey and others reported that couples with less than four children are less likely to use contraception when they have more daughters than sons, a decision usually made by the male partner [ 43 ].…”

“…However, preference for large families can vary among men and across the regions and could be influenced by social economic status, level of education, and knowledge level on contraception and son preference by a couple [ 42 , 43 ]. For instance, Dey and others reported that couples with less than four children are less likely to use contraception when they have more daughters than sons, a decision usually made by the male partner [ 43 ]. Other than routine counselling and dispensing of contraception, family planning services in SSA should be customised by both sex composition and parity through male-partner engagement.…”

Husband’s migration status and contraceptive behaviors of women: evidence from Middle-Ganga Plain of India

“…In contrast, our finding shows that the left behind wives who live with joint families are less likely to use any modern contraceptive methods because of family pressure of wanting children and less communication of migrated husbands for sexual relationships. In the case of marital duration, the left-behind women who have more than 20 years of marriage experience they are more preferred to use any modern contraceptive methods than the non-migrant women; this is because after those years of marriage, they get fulfil their children's sex composition or they have at least one son, and one daughter [ 37 ]. The Bihar shows significant findings that the left behind wives is less like to use any traditional contraceptive methods than the non-migrant women in the Middle Ganga Plain region; this might be a positive reason for husband migration and husband get more exposed of television, radio, and interpersonal communication from the destination places [ 22 ].…”

Using machine learning to understand determinants of IUD use in India: Analyses of the National Family Health Surveys (NFHS-4)

“…However, it is not in line with research from younger married women from Maharashtra, India, which found a trend in the association between IPV and IUD use, or with a state-representative sample of married women aged 15–49 in Uttar Pradesh that found an association between reproductive coercion and IUD use ( Chen et al, 2020 ; Tomar et al, 2020 ). Our national findings suggest that male engagement and support for IUDs, and likely couple communication, are important to support the uptake of IUDs ( Dey, Acharya, et al, 2021 ).…”

“…Despite multi-sectoral efforts to increase universal access to family planning services (Sustainable Development Goal 3.7), the world is not on track to achieving universal coverage of met demand for family planning ( Hellwig et al, 2019 ; TRACK20, 2020 ; United Nations Department of Economic and Social Affairs, 2015 ). India shows little to no improvement in the use of modern contraceptives and continues to rely heavily on female sterilization alone, which is commonly used only after the achievement of desired family size and sex composition of children ( Bankole & Singh, 1998 ; Dey, Acharya, et al, 2021 ; Ewerling et al, 2021 ; Government of India, Ministry of Health and Family Welfare & International Institute for Population Studies, 2022a ). Reversible modern contraceptive use that does occur is most often in the form of condom use rather than more effective reversible contraception such as intra-uterine devices (IUDs), impeding healthy birth spacing and consequently increasing the risk for maternal and infant mortality ( Conde-Agudelo et al, 2007 , 2012 ).…”