Academic journal article International Perspectives on Sexual and Reproductive Health

Relationship Characteristics and Contraceptive Use among Couples in Urban Kenya

Academic journal article International Perspectives on Sexual and Reproductive Health

Relationship Characteristics and Contraceptive Use among Couples in Urban Kenya

Article excerpt

In 1994, participants at the International Conference on Population and Development (ICPD) were encouraged to think of new ways to improve family planning in the developing world. The ICPD's Program of Action emphasized that the active participation of both men and women is essential for reducing unmet need for family planning. (1), (2) As a result, men's role in family planning has been highlighted at various public health conferences and in messages from donor agencies, governments and the media. This is particularly important because, in certain societies, women require a man's consent to make reproductive health decisions, (3), (4) and lack of male involvement places the heavy burden of reproductive health decision making solely on the woman. (5) Husbands' opinions on family planning may, therefore, result in additional barriers to its use. For example, analysis of 1992 Morocco Demographic and Health Survey (DHS) data found that husbands' fertility desires were associated with women's contraceptive use, after models were adjusted for the women's own fertility desires. (6) Hence, men's involvement in family planning programs and policies is necessary to increase contraceptive uptake. (7)

It is also important that surveys on sexual and reproductive health interview both members of a couple to identify their family planning needs and to account for the different attitudes, views and needs of the two partners. In a couples study conducted in rural India, spouses gave highly consistent responses on reproductive health events, such as current use of contraceptives (97%), but gave less consistent responses about attitudes toward contraception (84%) and fertility desires (88%). (8) Unfortunately, many studies purported to be on couples indude only one partner's responses and assume that interviewees are fully aware of their partner's thoughts and desires. For example, DHS data obtained from 35 countries included only wives' responses about the couple's approval or disapproval of contraceptive use. (9) Because a woman may not truly know her partner's attitudes and desires, information from both partners is needed to produce a more precise understanding of husband-level factors affecting contraceptive use.

In this study, we investigated associations between relationship characteristics and contraceptive use among married and cohabiting couples in three Kenyan urban centers: Nairobi, Mombasa and Kisumu. We hypothesized that couples in which neither spouse desires another child within the next two years will be more likely than others to use contraceptives. Furthermore, couples in which both partners acknowledge having communicated about their desired number of children and about their use of family planning would be more likely than others to use contraceptives, as better communication may increase partner support in using contraceptives to space or limit childbearing.

Theoretical Basis

We based our study on social ecological theory, which suggests that an individual's behavior is associated with at least three spheres of influence: individual characteristics, interpersonal features and environmental factors (10), (11) We chose social ecological theory because of its relevance, inclusivity and comprehensibility.

Several demographic studies have identified individual-level traits or social and demographic characteristics that affect contraceptive use, most notably formal education; (12) however, findings on the relative importance of husbands' and wives' education are inconsistent. (13), (14) According to a study from Nepal, a husband's education has a greater influence on contraceptive use than his wife's, especially in relation to male-controlled methods such as male sterilization and condoms. (13) An analysis of Bangladesh DHS data found that both partners' education levels were significant determinants of reported contraceptive use. (12) In another study from Bangladesh, as a woman's education level increased, her husband's preference for more children had less effect on her decision to use contraceptives (14) Unlike the previously mentioned Nepali study, an analysis of data from 14 Sub-Saharan African countries suggests that a woman's education is a stronger predictor of contraceptive use than her husband's education. …

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