EFFECTIVE SPOUSAL FAMILY PLANNING COMMUNICATION, DETERMINANTS AND ITS ASSOCIATION WITH MODERN CONTRACEPTIVE USE IN HARAR, EASTERN ETHIOPIA

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 xvii 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.