Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study

Abstract

BackgroundPersistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting.MethodsUsing data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men’s and women’s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women’s empowerment (household and fertility decision-making, women’s education, and women’s knowledge of contraception).ResultsWhen individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women’s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband’s education, husband’s familiarity with contraception, and number of children.ConclusionsOverall there were clear patterns to differential reporting. Associations with women’s empowerment and contraceptive communication and use suggest a strategy of women’s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences.Trial registrationClinical Trials Number: NCT01593943, registered May 4, 2012 at clinicaltrials.gov.

Contraceptive nonuse among women in Uganda: a comparative assessment of predictors across regions

“…Further, respondents' number of living children differently predicted contraceptive nonuse across regions as earlier noted. Remarkably, no study in Uganda explains this result; although, studies elsewhere indicate that women with one, or more children have a higher chance of limiting child bearing compared to the women with no children who want to have a child [10,[40][41][42][43][44]. However, more research should be directed towards understanding the effect of respondents' number of living children on contraceptive nonuse in the four regions.…”

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

“…However, husbands usually do not attend the SRH clinics with their wives and therefore do not have the same access to accurate information about contraception. Their level of erroneous beliefs might be greater and at the same time have larger influence on the decision to use contraception; a trend also seen in other global studies [18, 20, 36–38]. On the other hand, male support for contraceptive use increased female uptake [39–41].…”

The Association Between Early in Marriage Fertility Pressure from in-laws’ and Family Planning Behaviors, Among Married Adolescent Girls in Bihar and Uttar Pradesh, India.

“…Report of communication between girls and their husbands may suggest increased female reproductive agency, however, we do not know the nature of their reported communication and whether it is by choice. Spousal communication needs further scrutiny since couples' decision-making concordance and quality of relationship have a direct bearing on contraceptive use (20,31), especially for married adolescent girls with limited agency in a gender unfriendly context. These reports of communication could have been due to in-laws' pressure, con icts with husbands, or pressure from husbands.…”

“…Further, assessments have not looked at whether women report their perception of feeling in-laws' pressure to have a child immediately after marriage, or whether in-laws' pressure may in uence couple communication on family size and actual number of children. It is well established that women's decision-making, couple communication, and agreement on contraception and fertility leads to increased contraceptive use (20,21). Even though couple communication is associated with contraceptive use, research has not examined whether in-laws' fertility pressure affects this communication.…”