Perceived fertility desires of spouses and use of modern contraception among women in Rakai, Uganda

Most societies in Sub Saharan Africa are patriarchal with major decisions made by men. However studies on family planning mostly focus on women and ignore power dynamics within relationships. Here we use data collected between 2013 and 2015 from 2636 couples, part of a community based cohort, with the aim of assessing how women’s perception of their spouse’s fertility desires affects her use of modern contraception. We used mediation analysis for this. We also used Chisquare tests to assess how accurate women’s perception of her spouse’s fertility desires was by comparing it with her partner’s reported fertility desires. We found that in 53.9% of the couples there was concordance between the female’s perception of their male spouse’s fertility desires and the reported fertility desires of the male spouse. However is 28.9% of couples females thought the man desired a child while the male did not desire a child. We also found that female’s fertility desires were indirectly influenced by their perceptions of the male spouse’s fertility desires which affected their use of modern contraception. This indirect effect was statistically significant (11%; p<0.001). There is a need to promote increased spousal communication which would help merge perceptions and actual desires within a couple in this setting. This would help reduce the high rates of unmet need for contraception observed in similar settings. Correspondence to: Tom Lutalo, Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda. Emailtlutalo@rhsp.org Received: September 17, 2017; Accepted: October 06, 2017; Published: October 09, 2017 Introduction Many Sub Saharan Africa (SSA) societies are patriarchal with social power held by men [1,2]. However family planning (FP) programs generally do not recognize the role of male attitudes and attributes in fertility-related decision making [3,4,5,6,7]. There is a need to explore how power dynamics within relationships affect women’s reproductive aspirations and behaviors and how women’s contraceptive behaviors are affected by the perceived fertility desires of their male partners. This information can be used by programs to help women control their fertility [9]. Men tend to have the dominant influence in household decision-making, including fertility and family planning, but surveys in Africa suggest that men and women do not necessarily have similar fertility attitudes, perceived roles, and goals [3,4,8,9]. Exploration of couple’s fertility dynamics is urgently needed for program strategies to reduce unmet need, unintended pregnancies and expand family planning use. Although current literature on fertility decision making in SSA strongly suggests that men play an important and often dominant role in couples’ adoption of contraception [10,11], there is limited empirical data on whether male attitudes are either perceived or true barriers to use of contraception by women. We know little about how women reconcile the desire for children within patriarchal families where they are less empowered to make important fertility and contraceptive decisions for themselves. Uganda, is a patriarchal society, with one of the highest annual population growth rates in the world (3% per annum), the highest Total Fertility Rate (TFR) in East Africa of 5.4 children per woman, and a modern contraceptive prevalence among married women of 35% [12,13]. The aim of this analysis was to conduct a prospective assessment on couples to understand how the women’s perception of their spouse’s fertility desires affects her use of female controlled modern contraception. The strength of our couple’s analyses is that we were able to assess how accurate a woman’s perception of her spouse’s fertility desires was, by examining her partner’s fertility desires. This study fills an important gap in our understanding of the role of male desires and decision making around fertility decisions and to assess to what extent women’s perceptions of their spouse’s attitude is a barrier to use of contraception.