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      Spousal discordance on fertility preference and its effect on contraceptive practice among married couples in Jimma zone, Ethiopia

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          Abstract

          Objectives

          To assess spousal agreement levels regarding fertility preference and spousal communication, and to look at how it affects contraceptive use by couples.

          Methods

          We conducted a cross-sectional study to collect quantitative data from March to May 2010 in Jimma zone, Ethiopia, using a multistage sampling design covering six districts. In each of the 811 couples included in the survey, both spouses were interviewed. Concordance between the husband and wife was assessed using different statistics and tests including concordance rates, ANOVA, Cohen’s Κ and McNemar’s test for paired samples. Multivariate analysis was computed to ascertain factors associated with contraceptive use.

          Results

          Over half of the couples wanted more children and 27.8% of the spouses differed about the desire for more children. In terms of sex preference, there was a 48.7% discord in couples who wanted to have more children. At large, spousal concordance on the importance of family planning was positive. However, it was the husband’s favourable attitude towards family planning that determined a couple’s use of contraception. Overall, contraceptive prevalence was 42.9%. Among the groups with the highest level of contraceptive users, were couples where the husband does not want any more children. Spousal communication about the decision to use contraception showed a positive association with a couple’s contraceptive prevalence.

          Conclusions

          Family planning programs aiming to increase contraceptive uptake could benefit from findings on spousal agreement regarding fertility desire, because the characteristics of each spouse influences the couple’s fertility level. Disparities between husband and wife about the desire for more children sustain the need for male consideration while analysing the unmet need for contraception. Moreover, men play a significant role in the decision making concerning contraceptive use. Accordingly, involving men in family planning programs could increase a couple’s contraceptive practice in the future.

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          Most cited references 9

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          Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys.

          Data for trends in contraceptive use and need are necessary to guide programme and policy decisions and to monitor progress towards Millennium Development Goal 5, which calls for universal access to contraceptive services. We therefore aimed to estimate trends in contraceptive use and unmet need in developing countries in 2003, 2008, and 2012 . We obtained data from national surveys for married and unmarried women aged 15-49 years in regions and subregions of developing countries. We estimated trends in the numbers and proportions of women wanting to avoid pregnancy, according to whether they were using modern contraceptives, or had unmet need for modern methods (ie, using no methods or a traditional method). We used comparable data sources and methods for three reference years (2003, 2008, and 2012). National survey data were available for 81-98% of married women using and with unmet need for modern methods. The number of women wanting to avoid pregnancy and therefore needing effective contraception increased substantially, from 716 million (54%) of 1321 million in 2003, to 827 million (57%) of 1448 million in 2008, to 867 million (57%) of 1520 million in 2012. Most of this increase (108 million) was attributable to population growth. Use of modern contraceptive methods also increased, and the overall proportion of women with unmet need for modern methods among those wanting to avoid pregnancy decreased from 29% (210 million) in 2003, to 26% (222 million) in 2012. However, unmet need for modern contraceptives was still very high in 2012, especially in sub-Saharan Africa (53 million [60%] of 89 million), south Asia (83 million [34%] of 246 million), and western Asia (14 million [50%] of 27 million). Moreover, a shift in the past decade away from sterilisation, the most effective method, towards injectable drugs and barrier methods, might have led to increases in unintended pregnancies in women using modern methods. Achievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs. UK Department for International Development, the Bill & Melinda Gates Foundation, and the UN Population Fund (UNFPA). Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Couples' Fertility and Contraceptive Decision-Making in Developing Countries: Hearing the Man's Voice

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              Men matter: additive and interactive gendered preferences and reproductive behavior in Kenya.

              The extent of men's roles in reproductive decision-making in Africa is a subject of contention. Despite the volume of work on the roles men play in fertility decisions, there have been few attempts to derive direct empirical estimates of the effect of men's preferences on reproductive behavior. I employ 1989 and 1993 Kenya Demographic and Health Surveys to examine the relative roles of the reproductive preferences of males and females on contraceptive use. Additive and interactive measures of preferences document a significant effect of men's preferences, which may eclipse women's preferences. The implications of these findings are discussed.
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                Author and article information

                Contributors
                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central
                1742-4755
                2014
                4 April 2014
                : 11
                : 27
                Affiliations
                [1 ]College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
                [2 ]Rhea, Research Centre on Gender and Diversity, Brussels University, Brussels, Belgium
                [3 ]International Centre for Reproductive Health, Department of Obstetrics and Gynecology, Ghent University, Ghent, Belgium
                Article
                1742-4755-11-27
                10.1186/1742-4755-11-27
                3983854
                24708827
                Copyright © 2014 Tilahun et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                Categories
                Research

                Obstetrics & Gynecology

                fertility preference, couples, contraception, spousal discordance

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