Husband-Wife Agreement, Power Relations and Contraceptive Use in Turkey
Kulczycki, Andrzej, International Family Planning Perspectives
CONTEXT: in Turkey, contraceptive use has become more widespread, but little is known about the concurrence of spousal reports or the relative influence of communication, decision making and power differentials on method use,
METHODS: Date from the 1998 Turkish Demographic and Health Survey (DHS) for 1,546 married couples were tested for concurrence between spousal reports on fertility and family planning variables. Multivariate regression analyses based on wives', husbands' and joint reports of current contraceptive use were used to assess the association between such use and various background, communication and interspousal variables.
RESULTS: Spousal reports on most fertility and contraceptive use measures demonstrated moderate to high concordance, whereas reports of approval of family planning showed only fair concordance. After adjusting for background factors, models based on wives' and husbands' reports showed that current contraceptive use was positively associated with the number of methods known (odds ratios, 1.2 and 1.1, respectively) and perception of spousal approval (3.3 and 2.0, respectively), and in the husbands' model, with approval of either spouse or both (3.8-5.8). In the combined model contraceptive use was positively associated with both partners approving of family planning (2A), and negatively associated with both partners wanting more than three children and with only wives wanting three or fewer (0.4 and 0.6, respectively).
CONCLUSIONS: Discrepancies between spousal reports were less significant in Turkey than in most developing countries with DHS data, but the differences were not inconsequential to explaining how spousal attitudes and preferences influence contraceptive use. No evidence was found associating interspousal power differentials with method use. Further research is needed to improve the testing and modeling of such dyadic processes.
There are very few couple-level studies of communication and decision making regarding contraceptive use in the Middle East. In Turkey--a predominantly Muslim nation that has a secular democracy and is undergoing considerable social change--fertility has declined significantly, men play a major role in contraceptive practice and women's position in society is increasingly contested. These factors make Turkey a particularly interesting country for couple-level studies.
Traditionally, the measurement of contraceptive use has been based solely on women's self-reports of current use. Although this is methodologically convenient, the individual and subjective experiences of partners may differ. A more comprehensive measure of a couple's contraceptive use requires information from each partner. Moreover, because contraceptive practice and fertility are interrelated, the married couple is the appropriate unit of analysis, especially in societies such as those in the Middle East, where the vast majority of contraceptive use and almost all births occur within marriage.
For this region, only a few fertility and family planning surveys have collected data from men or couples. The 1992 Egyptian Demographic and Health Survey (DHS) included a subsample of husbands, and the 1992 Moroccan DHS interviewed married and unmarried men aged 20-70, but we could not identify any couple-level studies using these data. The 1985 Jordan Husbands' Fertility Survey interviewed the husbands of women who were currently married when interviewed in the 1983 Jordan Fertility and Family Health Survey. Although one study presented some comparisons of spousal reports about contraceptive knowledge and family planning attitudes from these two Jordanian surveys, (1) the comparisons were purely descriptive and limited in scope, and responses for husbands and wives were from different survey years. The 1988 Turkish Population and Health Survey collected limited data from men. A comparison of spousal reports revealed a high percentage of agreement about fertility measures, but only about three-quarters of the women knew their husbands' age and level of education (72% and 78% agreement, respectively, between spouses). …