Abstract:
Background: Family planning plays an important public health role in preventing maternal
and child health. However, its utilization is very low in the world, especially in developing
countries. One reason for such low utilization is lack of spousal communication about family
planning and joint decision making. In Ethiopia, the association between spousal family
planning communication and contraceptive use is assessed using narrow definition of
communication which does not show effective communication. Moreover, the influence of
spousal family planning communication dynamics (contents, frequency and patterns of
initiation) on couples' family planning decision making is not examined. Studies on
determinants of spousal family planning communication are sparse. Thus, the current research
intends to fill these gaps using broader definition of communication and assessing the
influence of communication dynamics on couples' family planning decision making and
spousal communication determinants specific to the study setting. This study, therefore,
examines the level and determinants of spousal family planning communication and the
association of spousal family planning communication with couples' modern contraceptive
use.
Methods: This dissertation is based on a population based cross sectional and a matched
case-control studies. The cross sectional data were collected from 2700 married couples of
whose wives were in the reproductive age (15-49 years) and non-pregnant during the data
collection period in Harar Urban Health and Demographic Surveillance System. The matched
case-control study involved 1010 married couples of whose wives were in the reproductive
age (15-49 years) and non-pregnant during the data collection period and who were found
effective communicators (cases) and 1010 married couples of whose wives were in the
reproductive age (15-49 years) and non-pregnant during the data collection period and who
were found non-effective communicators (controls). Data were collected through face-to-face
interviews using structured questionnaires. Proportions with 95% confidence intervals were
calculated to assess the level of spousal communication about family planning in the study
area. Conditional logistic regression was carried out on the case-control data to assess factors
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associated with spousal family planning communication. The Poisson regression with robust
variance was used to estimate the association between spousal family planning
communication and current modern contraceptive use.
Results: The level of spousal family planning communication was high (89.6%) (95%CI:
89%, 91%) whereas the level of effective spousal family planning communication was low
(38%) (95%CI: 36%, 40%). Both husband's desire for more children (aPR=0.2; 95%CI: 0.11,
0.41) compared to his wife and wife's desire for more children (aPR=0.1; 95%CI:0.06, 0.34)
compared to her husband, couples' approval of family planning use (aPR=2.3; 95%CI: 0.65,
8.37), women's family planning counseling by health workers (aPR=2.1; 95%CI: 1.12, 3.80),
couples' discussion about family planning with their friends (aPR=2.2; 95%CI: 0.95, 5.18),
couples' exposure to family planning message on pamphlets (aPR=1.5; 95%CI: 1.13, 1.99)
and on community events (aPR=4.5; 95%CI: 1.32, 15.52) were found to be factors
significantly associated with couples' effective communication about family planning.
The level of current modern contraceptive use was 57.1% (95%CI: 0.53, 3.39) and effective
spousal family planning communication (aPR=1.11; 95%CI: 1.02, 1.21) was found
significantly associated with modern contraceptive use of women after controlling for
potential confounders.
Conclusion: Policies and programmes aimed at promoting family planning should give due
emphasis for men and husband-wife communication about family planning. Family planning
information, education and communication activities should be strengthened so that couples'
attitude towards large family size and fertility will decline and their approval to family
planning will increase. Family planning programmes should properly address the importance
of spousal communication about family planning and integrate men into family planning
programs to facilitate and enhance couples' communication skills.