Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Husband–wife fertility preference and contraceptive use in Pakistan"
Batool Zaidi, Syeda Saman Naz, and Arshad Mahmood

Significance/Background
Pakistan’s latest demographic and health survey shows a slowdown in the rate of fertility decline and a stagnant contraceptive prevalence rate of around 30 percent. While more and more women are expressing the desire to control their fertility, less than half of them are using a contraceptive method. This is reflected in the high unmet need for family planning at 25 percent.
Several studies attempting to determine the obstacles to uptake of contraceptive use have found husband disapproval to play a major role (N.M Shah, 1974; Casterline et al 2001). Even the two rounds of the Pakistan Demographic and Health Survey show an increasing proportion of women reporting 'husband disapproval' as the primary reason for not intending to use any form of contraception in the future. However, research on reproductive health, globally and particularly in Pakistan, remains woman-centric largely ignoring men; even the PDHS 2006–07 lacks information on men’s fertility preferences and practices. Relying solely on women’s reports of husband disapproval makes it difficult to assess the accuracy of women’s perception of husband’s attitudes.

Main Question/Hypothesis
Study inter-spousal communications influence on couples' perceptions and fertility preferences and how these factors in turn influence fertility behavior, i.e. the practice of contraception. This study also examines how couples’ fertility desires influence contraceptive use. Given that gender norms play an important role in couples’ negotiation of contraceptive use, the study attempts to understand the difference of couples' power dynamics.

Data and Methods
The data for this analysis are drawn from FALAH baseline survey, based on a stratified, clustered and systematic sample of urban and rural households in 29 districts across all four provinces of Pakistan. The survey yielded information on 17,124 married women of reproductive age (15–49) and a subsample of 5,208 of their husbands. We have selected a matched set of currently married women and their husbands for our analysis. First we explore the level of concordance between wives' and husbands’ responses. For this purpose, we used simple percentage agreements and the kappa statistic, which adjusts for agreement that might be attributed to chance. Next we examine how adoption of contraceptive use is influenced by couples' attitudes and discussion of family planning, their perceptions of each other’s attitudes, and their fertility preferences. After establishing the bivariate relationships between contraceptive use and the variables of interest we studied the multivariate relations using multiple logistic regressions.

Results/Key Findings
Less than half the men (48%) and women (45%) in the sample reported having discussed family planning with their spouse at least once in the past year. While 65 percent of couples gave matching responses, overall the couples where both husband and wife reported having discussed family planning were less than 30 percent. Interestingly, although significantly more women report wanting to limit childbearing, the concordance between couples is high, with 80 percent of couples having similar fertility preferences. Couples who reported having discussed family planning issues had more concordant responses than those who did not. Of the couples where both partners reported having discussed family planning, 90 percent of the wives correctly perceived their husbands’ opinion regarding FP. On the other hand, of the couples where both partners reported no discussion of FP, only 68 percent of wives and 72 percent of husbands had correct perceptions regarding their spouses’ opinions. To predict contraceptive use multivariate regression model included: woman’s approval of family planning; woman’s perception of husband’s approval of FP; couple’s desire for no more children; and discussion of family planning over the last year as reported by either spouse. This model also controls for region, woman’s education, household socio-economic status, and the number of children a woman has. Results show that female perception of approval is the strongest predictor of contraceptive use. Whereas couple’s desire to limit childbearing becomes the second strongest predictor, increase the odds of using threefold. All associations are significant at the 95 percent confidence level. Multivariate results also show that the contraceptive use is three times higher if the wife does not want more children but husband wants than if wife wants and husband doesn’t want. This indicates that women’s fertility preferences are stronger than their husbands.

Knowledge Contribution
The policy implications of these findings are evident. Family planning programs need to proactively encourage inter-spousal communication because as the data show, most men do in fact approve of family planning. Therefore the obstacle is not so much men’s disapproval but the lack of communication on fertility preferences and attitudes between husbands and wives that lead to inaccurate perceptions.

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