Abstract
ObjectivesThis study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband’s knowledge), and covert modern contraceptive use (without husband’s knowledge) among adolescent wives and their husbands in Niger.Study designCross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13–19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples’ reports of spousal communication about contraception with wives’ reports of contraception (overall, overt, and covert).ResultsAbout one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples’ reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples’ reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives’ reports of spousal communication were marginally associated with covert use compared to no use but husbands’ reports were not.ConclusionAmong a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives’ and husbands’ reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions.
Highlights
In Niger, one-fourth of girls are married by age 15 years and three-fourths by age 18 years [1]
Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use and negatively with covert use but wives’ and husbands’ reports showed differential associations with covert use compared to no use
Results examining associations between demographic characteristics and spousal communication about contraception in a multivariable model (S1 Table) showed that adolescent wives had lower odds of spousal communication about contraception as age of marriage increased (AOR: 0.89, 95% confidence intervals (95% CIs): 0.80, 0.98, p = 0.02) but higher odds of communication about contraception as age increased (AOR: 1.23, 95% CI: 1.07, 1.41, p = 0.004), as number of children increased (AOR: 1.43, 95% CI: 1.16, 1.77, p
Summary
In Niger, one-fourth of girls are married by age 15 years and three-fourths by age 18 years [1]. Studies have shown that child marriage can lead to negative sexual and reproductive health (SRH) outcomes for girls [2, 3]. In Hausa communities, the predominant ethnic group in Niger [6], these gender norms ascribe to women the role of bearing and raising children while men’s roles are as providers and strictly not as homemakers [5, 7, 8]. Social status in Hausa communities has been shown to be largely determined by gender, age, and wealth, placing young married girls in disadvantaged positions [7]. In the context of such societal structures where inequitable gender norms prevail, male dominance over decision-making remains prevalent, preventing girls from negotiating for their SRH. Ethnographic research in the Maradi region of Niger has demonstrated the continuing hold that men have over decisions at all levels from political leadership to household assets and extending to matters of reproduction [7]
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