Active participation, by both women and men, in making family planning (FP) decisions has proven to be a key strategy to reduce unmet need for FP. The literature exploring the potential benefits of male involvement is vast, yet few studies have assessed the role of perceived partner fertility preferences and communication among urban inhabitants, a fast growing population and one that may differ substantially from rural counterparts in terms of marital norms and practices.
The objective of this study was to describe the degree of reported spousal communication and perceived spousal agreement on fertility preferences among a sample of men and women from three urban areas of Kenya, and the association of each with current use of modern contraception. By looking at a large sample of men and women separately, whether the role of partner influence is different for women and for men in urban settings of Kenya could be determined.
Baseline data to evaluate the Tupange project were collected in 2010 from a representative sample of 2,891 married women (aged 15 to 49) and 1,362 married men (aged 15 to 59) from three major urban areas: Nairobi, Kisumu and Mombasa.
Results
- Twenty-three percent (23%) of men and 31% of women reported never discussing FP with their partner.
- Approximately 70% of participants perceived their partner as wanting the same number of children as they did.
- Approximately 20% reported a perception that their partner’s fertility preferences were not the same as their own.
- Sixty-one percent (61%) of women in union reported current use of a modern contraceptive method while slightly fewer men in union (54%) reported the same.
- Approximately 40% of both men and women reported not wanting (more) children.
- Despite the large numbers of men and women who desired to limit future pregnancy, only 7% of both men and women were using a long-acting or permanent method of contraception.
Results among men: In the multivariate regression analysis, male perceptions of their partner’s fertility preferences appeared to significantly influence male contraceptive behavior, when men perceived their partners to want fewer children than them. Where the male believed his wife wanted fewer children than him, contraceptive use nearly doubled. Even more promising, men who had discussed use of FP with their partners had greatly increased odds of contraceptive use. This finding was similar among women, confirming that spousal communication on the topic of FP leads to increased use.
Results among women: The results showed that women who believed their partners preferred fewer children than they did had nearly twice the odds of using a modern method of contraception, compared to women who believed their partners wanted the same. And surprisingly, women who perceived that their partners wanted more children than them also had increased odds of contraceptive use. This finding suggested that, among couples who did not share the same fertility preference, the perceived preferences of the male did not always appear to dominate decisions about contraceptive use.
Women at an inreach facility in Mombasa are counseled about family planning before having to make any decisions regarding contraception. Image Credits: Tobin Jones, 2012.
Association of spousal communication and perceived fertility preferences on contraceptive use: The impact of perceived partner preference varied based on the presence or absence of spousal communication. The overall findings here contrast with previous evidence from several other studies in Asia and Africa that contraceptive use is lower when husbands and wives disagree about fertility preferences.
Among women who believed that their partner wanted the same number or fewer children, or who did not know their partner’s preference, the probability of contraceptive use was significantly higher if these women had ever discussed FP with their partner. This finding is not surprising and is strongly supported by numerous other studies.
However, for women who believed their partner wanted more children, discussion did not significantly increase the likelihood of contraceptive use. In other words, among this group of women, where the partner was thought to want more children than his partner, contraceptive behavior was similar, whether or not the couple had ever discussed FP.
These findings suggest that, among urban males in the three Kenyan cities, the preferences of men who wanted more children than their partners did not always dictate decisions regarding future fertility or current contraceptive use. The results suggest a weakening in the influence of men on contraceptive behavior in the urban Kenyan environment. This finding is in line with a handful of studies from Nigeria, Taiwan and South Africa, and is an encouraging result given the relatively large proportion (one-fifth) of participants with perceived fertility goals that were not shared.
Programmatic Implications
A proud father waits outside with his newborn child at an inreach facility while his wife receives an implant from the doctor. Image Credits: Tobin Jones, 2012.
The results indicate that there is a sizable proportion of the urban population in Kenya not currently discussing FP with their partners and that such discussions, if they occur, have the potential to greatly increase contraceptive use. Therefore, interventions designed to increase partner communication on FP have the promise of raising contraceptive prevalence in this setting as well as in other urban environments.
Increasing partner communication is vital to increasing FP use.
Previous interventions to increase partner communication have used peer-delivered education and a multimedia communication campaign with proven success. Perceptions of male fertility preferences appear to have the most influence on their partner’s contraceptive behavior in situations where the woman perceives that her partner prefers fewer children than her. As such, interventions designed to inform men of the significant health benefits of spacing and limiting births may influence reductions in ideal family size among urban males that, in turn, may increase contraceptive prevalence among discordant couples.
Interventions should be designed to inform men of the significant health benefits of spacing and limiting pregancies and births.
This story was originally written by the Measurement, Learning & Evaluation Project, which evaluated the Urban Reproductive Health Initiatives (UHRIs) in Kenya, Senegal, Nigeria and India. The Challenge Initiative is charged with expanding access to the proven solutions and successes developed under the UHRIs.
