Contraceptive behaviour as a marital responsibility in the occupied Palestinian territory: a cross-sectional survey

Abstract

<h3>Background</h3> The fertility of Palestinians in the occupied Palestinian territory (oPt) has fallen substantially from 6·2 children to 4·12 children per woman during the past 20 years. Contraceptives have a major role in birth control, but husbands are usually not included in research into the use of contraception. The aim in this study was to identify determinants and outcomes of the involvement of husbands in the decision to use contraception. <h3>Methods</h3> For the 2006 Palestinian Family Health Survey in the West Bank and Gaza Strip, oPt, 4486 (81%) of 5542 women (aged 15–54 years) who were married, not pregnant, and not menopausal were interviewed about the husband's involvement and interest in family planning. The women's responses were analysed with logistic regression models. SPSS (version 17.0) was used for the statistical analysis. This study was approved by the review board of the Paris Descartes University, Paris, France. The Palestinian Central Bureau of Statistics obtained verbal informed consent from the women. <h3>Findings</h3> Three main factors—communication between the couple about contraception, desire for children, and husband's decision—determined whether and the type of contraceptive used (all types of contraceptive methods, male contraceptive, or female contraceptive). Contraceptive use was reported by 2444 (54%) of 4486 women: 1763 (39%) used female contraceptives and 681 (15%) used male contraceptives. Communication with the spouse increased the odds of contraceptive use compared with no communication (1488 [56%] of 2636 <i>vs</i> 956 [52%] of 1850; odds ratio 1·08 [95% CI 1·02–1·31). Women whose husbands wanted fewer children versus those who wanted more children were more likely to use contraception (373 [64%] of 582 <i>vs</i> 730 [52%] of 1394, 1·90 [1·41–2·56]), particularly male contraceptives versus female contraceptives (119 [32%] of 373 <i>vs</i> 189 [26%] of 730, 1·58 [1·21–2·05]). The use of contraception decreased when the husband (husband's decision 356 [44%] of 809 <i>vs</i> joint decision 1836 [58%] of 3186; 0·56 [0·46–0·69]) or the wife (wife's decision 240 [55%] of 433 <i>vs</i> joint decision 1836 [58%] of 3186; 0·76 [0·59–0·99]) made the sole decision about use of contraception. Women were less likely to decide on their own to use contraception if couples did not yet have a son (41 [8%] of 533 <i>vs</i> 248 [12%] of 2118; 0·60 [0·37–0·98]) and wanted another child (167 [8%] of 2108 <i>vs</i> 220 [12%] of 1790; 0·70 [0·52–0·95]). <h3>Interpretation</h3> Contraceptive use by Palestinians involves both husbands and wives. Communication between the couple and joint decision making lead to greater contraceptive choice, especially the use of a male contraceptive method. Thus, joint decision making is a determinant of the fertility transition in the occupied Palestinian territory, and should be considered in future research. <h3>Funding</h3> Paris Descartes University.