Male\u2013female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India

Anvita Dixit,Sarah Averbach,Shahina Begum,Nicole E Johns,Niranjan Saggurti,Mohan Ghule,Madhusudana Battala,Tarik Benmarhnia,Jennifer Yore,Jay G Silverman,Elizabeth Reed,Anita Raj

doi:10.1186/s12978-021-01187-8

Abstract

ObjectiveWomen’s involvement in contraceptive decision-making increases contraceptive use and reduces unmet need, but study of this has been limited to women’s self-reports. Less research is available examining couple concordance and women’s involvement in contraceptive decision-making as reported by both men and women.Study designWe carried out a cross-sectional study using data from rural India (N = 961 young married couples). Using multivariable regression we examined the association between concordance or discordance in spousal reports of wife’s involvement in contraceptive decision-making and modern contraceptive use, adjusting for demographics, intimate partner violence, and contraceptive use discussion.ResultsMore than one third (38.3%) of women reported current modern contraceptive use. Report of women’s involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone (categorized as Concordant 1), 4.2% agreed women were not involved (categorized at Concordant 2), 13.2% had women report involvement but men report women were uninvolved (categorized as Discordant 1), and 12.2% had women report uninvolvement but men report that women were involved (categorized as Discordant 2). Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples (adjusted RR = 0.61, 95% CI 0.45–0.83). No other significant differences between Concordant 1 couples and other categories were observed.ConclusionOne in four couples indicated discordance on women’s involvement in contraceptive decision making, with Discordant 2 category having lower odds of contraceptive use. Couples’ concordance in women’s involvement in contraceptive decision-making offers a target for family planning research and interventions to better meet their needs.Trial registration ClinicalTrial.gov, NCT03514914. https://clinicaltrials.gov/ct2/show/NCT03514914

Highlights

India is home to 20% of the world’s married couples with unmet need for contraceptives, with an estimated 50% of all pregnancies being unintended [1, 2]
Report of women’s involvement in contraceptive decision-making showed 70.3% of couples agreed that women were involved, jointly or alone, 4.2% agreed women were not involved, 13.2% had women report involvement but men report women were uninvolved, and 12.2% had women report uninvolvement but men report that women were involved
Discordant 2 couples had lower odds of modern contraceptive use relative to Concordant 1 couples

Summary

Introduction

India is home to 20% of the world’s married couples with unmet need for contraceptives, with an estimated 50% of all pregnancies being unintended [1, 2]. Some evidence suggests that women’s control over reproductive decision-making is associated with increased likelihood of contraceptive use in India, though there have been mixed results across studies and other nations [6,7,8,9,10]. This may be a result of women’s control being assessed using women’s self-report only, but couples’ contraceptive decision-making can be better understood by assessing both women and their husbands’ reports. Little research exists examining contraceptive decision-making agency as measured by dyadic couples’ reports

Methods

Results

Discussion

Conclusion