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

Abstract

Background: Persistent 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.

Methods: Using 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).

Results: When 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.

Conclusions: Overall 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 registration: Clinical Trials Number: NCT01593943 , registered May 4, 2012 at clinicaltrials.gov.

Keywords: Contraceptive use; Fertility preferences; Gender inequality; Gender norms; India; Spousal concordance.

Conflict of interest statement

Ethics approval and consent to participate

All research study procedures were approved by the Institutional Review Boards at the University of California San Diego and the National Institute of Research in Reproductive Health, Indian Council of Medical Research, Mumbai, India. Due to low literacy rates in the population, consent forms were read to participants in full, and then participants were asked to sign their consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

The left panel shows the mean education level reported by women across all four contraceptive communication categories. The right panel shows the mean value of the women’s autonomy scale across all four contraceptive communication categories. In both examples, when both couples report communication or women only report communication, the mean values are higher than for couples in which neither report communication suggesting a positive relationship between women’s empowerment and their communication regarding contraception use. Note also that in couples with more educated women, men are also more likely to report discussing contraception when their wives do not

Fig. 2

shows the relationship between women’s empowerment and contraceptive use reporting across four different empowerment variables. While women’s education, contraceptive familiarity, and perception of fertility equality is associated with contraceptive use across all three reporting categories, women’s autonomy is associated with concordant and Wife+ discordant reporting

Fig. 3

illustrates the distribution of contraceptive communication and family size preferences across contraception use categories. On the left, we see that discrepancies in reporting of contraception communication and contraception use are consistent. Colored bars represent what proportion of each contraception use category is comprised of each contraception communication category. For instance, Wife + discordance in contraception use reporting is most strongly associated with Wife + discordance in contraceptive communication (the largest yellow bar). On the right we see that over 20% of the Wife+ discordant on contraceptive use couples are those in which women prefer more children than their husbands, the largest proportion across all four categories