Respondents’ characteristics
We obtained data from 811 couples corresponding to a response rate of nearly 95%. The vast majority of couples consisted of farmer husbands and farmer wives, whereas nearly eight per cent of the couples were farmer husbands and housewives. Among the couples, the predominant religion was Islam, and only in 18 (2.2%) couples, husband and wife belonged to different religious groups. In terms of education, 159 (19.6%) couples reported not being able to read nor write, in 373 (46.0%) couples, the wife was illiterate while the husband had received education, and in 148 (18.2%) couples, both spouses attended primary education.
Husbands were on average 8.3 years older than their wives, even though wives were older than their husbands in 58 (7.2%) couples. Similarly, men are 5.8 years older when they marry the very first time than women who marry the very first time. Women had more children than their husbands in 178 (21.9%) couples, less than their husbands in 111 (13.7%) couples and the same number in 522 (64.4%); overall, women had on average 0.17 children more than their husbands (p = 0.002) (see Table
1).
Table 1
Selected demographic characteristics of 811 couples, Jimma zone, Ethiopia, 2014
Mean age (years)
| 38.5 (37.7; 39.4) | 30.3 (29.6; 30.9) | 8.3 (7.6; 8.9) |
<0.001
|
Mean age at first marriage (years)
| 23.5 (22.9; 24.2) | 17.7 (17.1; 18.4) | 5.8 (4.9; 6.6) |
<0.001
|
Mean number of children from all marriages
| 3.2 (3.1; 3.4) | 3.4 (3.3; 3.6) | -0.17 (-0.28; -0.07) |
0.002
|
Mean ideal number of children before starting family planning
| 4.3 (4.1; 4.5) | 4.6 (4.5; 4.7) | -0.37 (-0.15; -0.59) |
<0.001
|
Fertility preferences
On average, women envisaged to start limiting the number of pregnancies through family planning after bringing forth 4.6 children. This was 0.37 children more than their husbands (p < 0.001).
Table
2 shows the levels of concordance for indicators of fertility preference. Overall, there is a slight to fair agreement between the spouses with Cohen’s κ values between -0.057 and 0.374, but prevalence-and-bias-adjusted κ (PABAK) values between 0.189 and 0.445 (see Table
2). Among the couples that disagreed with respect to the desire for having additional children, twice as many couples consisted of a husband wanting an additional child compared to those where it was the wife desiring another child (150 (18.5%) vs 75 (9.2%)).
Table 2
Spousal agreement on fertility preference and their perceptions on family planning importance among couples in Jimma zone, Ethiopia, 2014
Desire for more children (N = 811)
| 586 (72.2%) | 225 (27.8%) | 0.374 | 0.445 |
Sex preference (N = 429)
| 224 (52.2%) | 209 (48.7%) | 0.183 | 0.189 |
Had ever received information on abortion (N = 809)
| 564 (69.3%) | 245 (30.7%) | -0.057 | 0.394 |
Discussed family planning in the couple in the 3 months prior to the survey (N = 394)
| 273 (69.3%) | 121 (30.7%) | 0.212 | 0.373 |
FP is very important for…
|
Husband (%)
|
Wife(%)
|
Spouses agree it is very important (%)
|
Spouses agree it is not very important (%)
|
Kappa
|
PABAK
|
…delaying the first child.
| 73.2 | 52.5 | 39.8 | 14.1 | 0.055 | 0.078 |
…spacing births.
| 81.4 | 62.9 | 54.4 | 10.1 | 0.153 | 0.290 |
…limiting the number of children.
| 77.7 | 62.9 | 52.7 | 12.1 | 0.177 | 0.295 |
…the benefit of family members.
| 71.3 | 56.2 | 44.3 | 16.8 | 0.177 | 0.221 |
…economic reasons.
| 79.4 | 67.0 | 54.9 | 8.5 | 0.085 | 0.268 |
…the mother’s health.
| 87.7 | 72.1 | 62.6 | 2.8 | 0.036 | 0.309 |
…children’s health.
| 88.2 | 74.8 | 65.6 | 2.4 | 0.038 | 0.358 |
We asked all spouses if family planning had been discussed previously within the couple. In 211 (26%) cases, we obtained different answers from husband and wife (Cohen’s κ = 0.45; PABAK = 0.48). In 145 (17.9%) couples, the husband answered positively while the wife did not, and in 66 (8.1%) it was the opposite. In the 394 (48.7%) couples where previous discussion was reported by both spouses, 273 (69.3%) agreed that family planning had been discussed in the course of the last 3 months. Among this group, the concordance with respect to the desire for more children was not higher than in the rest of the sample (Concordance rate: 72.1% vs 70.0%; Cohen’s κ = 0.307 vs 0.322).
The variable that showed the lowest level of agreement was with respect to preference for the sex of the next child. Out of the 429 couples where both spouses wanted more children, there were 139 (32.4%) who showed no preference at all; in 61 (14%) couples, both spouses desired a boy, while in 20 (4.6%) couples, they both desired a girl. In 183 (42.7%) couples, discordance existed, since one of the spouses had a preference for one particular sex while the other spouse preferred another. True discordance was found in 26 (6%) couples of which 22 (5.1%) consisted of the husband desiring a boy and the wife desiring a girl. Among the 150 husbands who wanted more children while their wives did not, 65 (43.3%) wanted an additional boy and 17 (11.3%) a girl; among the 75 women wanting more children in spite of their husband, 16 (21.3%) had a preference for a boy and 7 (9.3%) for a girl. These findings suggest that the desire – in particular the husband’s desire - for another son is a critical element resulting in discordance within the couple, both with respect to having another child as to the sex of the next child.
Most of the couples agreed that family planning was a good thing to limit pregnancies; 52.7% (427) of the couples were unanimously in favour of it (see Table
2). The degree to which husbands and wives were able to correctly evaluate their spouse’s attitude towards family planning, was 82% (665) among women and 79.3% (643) among men. We observed higher levels of correctly evaluating the spouse’s attitude in couples that reported having discussed family planning in the past compared to those that had not (among women: 89.6% vs 76% (χ
2 (1, N = 780) = 24.007, p < 0.001); among men: 89.9% vs 75.1% (χ
2 (1, N = 754) = 27.323, p < 0.001)).
Family planning was seen by most of the husbands as very important, with proportions ranging from 71.3% to 88.2% (see Table
2). In most cases, importance to family planning was given in common by both spouses for the purpose of preserving the mother’s and the children’s health. These motives showed the highest level of concordance, with 62.6% for the mother’s and 65.6% for the children’s health (see Table
2). However, there was prioritization alteration in spousal report about the benefits of family planning; husbands tend to say family planning is important for demographic and health reasons whereas women put forward economic explanations. On top of that, limiting the number of children was given as an advantage of family planning by men, while women chose family planning for spacing purposes.
An additional factor significantly associated with spousal discordance is a previous unintended pregnancy (χ2 (3, N = 811) =22.376, p = ≤0.001); Cohen’s κ was 0.41 (PABAK = 0.47) for couples that had never faced an unintended pregnancy (N = 687) with 505 (73.5%) couples concurring, as opposed to 0.15 (PABAK = 0.31) among couples that had (N = 124; with 81 (65.3%) concurring). In 37 of the latter couples (30%), it was the husband who wanted more children when the wife did not, while in 6 couples (4.8%), the opposite was true.
The level of discordance was positively associated with an increasing age of the wife (χ2 (6, N = 806) = 33.103, p < 0.001) and to a lesser extent with an increasing age of the husband (χ2 (11, N = 808) = 19.895, p = 0.047), as well as with higher numbers of children the woman (χ2 (7, N = 811) = 35.247, p < 0.001) and the husband had (χ2 (7, N = 811) = 42.166, p < 0.001). These findings suggest that discordance is of bigger importance in older couples than in younger ones where fertility preferences seem to concur.
Family planning
In 748 (92.2%) couples, both spouses had heard of ways or methods they could use to limit pregnancies; in another 47 (5.8%) couples, only the woman had ever heard of it, while in 12 (1.5%) couples, only the man had. On average, no difference was found between the number of contraceptive methods the husband and wife knew (Wilcoxon’s W = 133764, p = 0.072); in 107 (13.2%) couples, the wife knew as many methods as the husband, in 326 (40.2%) she knew more and in 378 (46.6%) she knew less. The better knowledge of husbands compared to their wives was negatively correlated to increasing age (p < 0.001), meaning that in younger couples, the husband knows more methods than the wife.
Contrary to the knowledge of methods, we noticed a difference between spouses in knowledge of the use of contraceptives, with women having a better knowledge than their husbands (McNemar’s χ2 (1, N = 756) = 81.679, p = ≤0.001). Of the 748 couples that had heard of family planning methods before, 389 (45.1%) consisted of both spouses knowing how to use contraceptives, in 261 (34.9%), the husband did not know how to use them, in 90 (12%) the wife did not. Finally, 14 (1.7%) couples did not know if a woman could get pregnant or not while using contraceptives.
Out of 811 couples, 350 (43.1%) reported that they were currently using a method of family planning; in 348 (42.9%) of these, it was only the woman who was using a method, while in 2 (0.2%) couples, it was both the husband and the wife (see Table
3). Among the 461 couples in which no type of family planning was currently used, 96 (20.8%) couples concurred that they did not desire another child, while in 122 (26.5%) couples, it was only one of the two spouses who did not. There were 451 (97.8%) and 442 (95.9%) couples that agreed that they were not deterred by the cost nor by the lack of knowledge of where to get access to family planning services, respectively. On the other hand, husbands in 148 (32.1%) couples mentioned that the lack of knowledge of the most appropriate method was the reason for not using any method at all, even though their wives did not mention this reason, and 90 (19.5%) women said that fear of side effects contributed to not using any type of contraception, while their husbands did not express this fear. These two reasons were more frequently reported by older men (defined as equal or older than the male sample’s mean age of 39) (κ
2(1, N = 806) = 3.681, p = 0.055) and older women (defined as equal or older than the female sample’s mean age of 30) (χ
2 (1, N = 459) = 4.656, p = 0.031) respectively.
Table 3
Univarate analysis of age, attitude towards family planning and unadjusted odds ratios for current contraceptive use, Jimma zone, Ethiopia, 2014
N | 811 | 151 | 150 | 75 | 435 |
Median age wife (yrs) | 30 | 38 | 32 | 30 | 25 |
Median age husband (yrs) | 36 | 45 | 40 | 38 | 32 |
Current contraceptive use | 42.9% [39.5;46.3] | 36.4% [28.8;44.6] | 38.7% [30.8;47] | 60.0% [48;71.2] | 44.1% [39.4;48.9] |
Attitude towards FP
| | | | | |
Husband is favourable to his wife using a FP method
| | | | | |
Reported by the husband | 6.24*** [3.60;11.61] | 9.84*** [2.27;88.36] | 3.29 [0.85;18.57] | 11.00* [1.19;515.7] | 5.96*** [2.7;14.9] |
Reported by the wife | 2.60*** [1.95;3.49] | 3.81*** [1.77;8.22] | 2.25* [1.09;4.65] | 6.00** [1.91;19.26] | 2.46*** [1.64;3.71] |
Husbands and wives were asked who in the couple had the final decision on using family planning methods. In 573 (71.1%) out of 805 couples, both spouses concurred that the final decision should be made by both of them. In 129 (16.0%) couples, however, the wife stated the final decision is with the husband while the husband answered it was a shared decision; we observed the opposite in 44 (5.5%) couples. We assessed male involvement using three questions: intention to go to family planning services, intention to pay for contraception, and actual presence during family planning consultation with the wife. In the 350 (43.1%) couples where a method of family planning was currently used, 99 (28.3%) spouses reported that the husband had the intention to participate in a consultation; in 58 (16.6%) couples, the husband stated he intended to participate in such a consultation, while the wife said he was not, and in 91 (26%), the wife said he would participate, while he said the opposite.
Factors associated with current use of contraception
Table
4 shows the odds ratios for current use of any method of contraception in four distinct groups: 1) couples in which both spouses do not desire more children (group
1; N = 151); 2) couples in which the wife does not want additional children, but the husband does (group
2; N = 150); 3) couples in which the husband does not want additional children, but the wife does (group
3; N = 75); and 4) couples in which both spouses desire more children (group
4; N = 435). The group in which the husband was the only one not desiring more children had a significantly higher level of current contraception use than the other groups (see Table
4).
Table 4
Univarate analysis of perception of spouses on family planning importance, male involvement and unadjusted odds ratios for current contraceptive use, Jimma zone, Ethiopia, 2014
Perception of the husband
| | | | | |
Husband considers FP is very important for…
| | | | | |
…Delaying the first child. | 1.65 | 2.00 | 0.42 | 2.05 | 2.46*** |
[1.20;2.29] | [0.87;4.86] | [0.2;0.87] | [0.4;11.25] | [1.5;4.07] |
…Spacing births. | 1.72** | 6.38*** | 0.47 | 0.89 | 2.05* |
[1.19;2.52] | [2.05;26.15] | [0.2;1.09] | [0.13;5.02] | [1.16;3.7] |
…Limiting the number of children. | 1.81*** | 3.37** | 0.78 | 1.6 | 1.96* |
[1.28;2.58] | [1.36;9.15] | [0.36;1.74] | [0.33;7.68] | [1.16;3.37] |
…The benefit of family members | 1.16 | 2.06 | 0.49 | 0.5 | 1.48 |
[0.85;1.58] | [0.97;4.5] | [0.22;1.09] | [0.15;1.56] | [0.92;2.38] |
…Economic reasons. | 1.40 | 3.07** | 0.33* | 0.5 | 2.4** |
[0.99;1.99] | [1.28;7.93] | [0.13;0.83] | [0.14;1.64] | [1.34;4.41] |
…The mother’s health. | 1.70* | 2.97 | 0.33* | 0.73 | 3.17** |
[1.10;2.68] | [1;10.65] | [0.11;0.94] | [0.06;5.54] | [1.48;7.34] |
…Children’s health. | 1.73* | 4.31** | 0.24** | 1.59 | 2.59* |
[1.11;2.77] | [1.35;17.98] | [0.07;0.73] | [0.11;23.04] | [1.23;5.83] |
Perception of the wife
| | | | | |
Wife considers FP is very important for…
| | | | | |
…Delaying the first child. | 2.24*** | 2.74** | 3.59** | 1.49 | 2.19*** |
[1.68;2.98] | [1.31;5.74] | [1.57;8.6] | [0.53;4.21] | [1.46;3.29] |
…Spacing births. | 3.22*** | 2.23* | 3.43** | 3.06* | 3.7*** |
[2.36;4.41] | [1.06;4.76] | [1.5;8.24] | [1;9.46] | [2.36;5.87] |
…Limiting the number of children. | 2.71*** | 3** | 1.93 | 4.75** | 2.63*** |
[2.00;3.68] | [1.41;6.54] | [0.9;4.22] | [1.44;16.41] | [1.7;4.08] |
…The benefit of family members | 2.60*** | 2.54* | 2.21* | 4.58** | 2.53*** |
[1.94;3.49] | [1.22;5.3] | [1.03;4.81] | [1.5;14.2] | [1.67;3.85] |
…Economic reasons. | 3.31*** | 3.82*** | 3.5** | 4.15* | 2.98*** |
[2.40;4.60] | [1.73;8.71] | [1.46;9.04] | [1.25;14.4] | [1.88;4.77] |
…The mother’s health. | 3.03*** | 3.11** | 3.99** | 3.06 | 2.96*** |
[2.16;4.29] | [1.36;7.46] | [1.47;12.56] | [0.97;9.76] | [1.81;4.9] |
…Children’s health. | 3.41*** | 6.35*** | 6.21*** | 1.59 | 3.2*** |
[2.39;4.96] | [2.38;19.67] | [1.98;25.6] | [0.52;4.81] | [1.89;5.56] |
Involvement of the husband
| | | | | |
Husband makes plans…
| | | | | |
Intention to go jointly to get family planning delivery. | 4.17*** | 6.17*** | 1.62 | 8.5*** | 4.67*** |
[3.07;5.70] | [2.81;13.66] | [0.78;3.36] | [2.46;31.3] | [2.94;7.47] |
Intention to finance and purchase contraception. | 5.13*** | 7.09*** | 2.07 | 10.86*** | 6.21*** |
[3.76;7.05] | [3.17;15.98] | [1.00;4.34] | [3.19;38.5] | [3.83;10.23] |
Actual presence during family planning consultation. | 1.46** | 2.2 | 1.83 | 0.59 | 1.55* |
[1.10;1.94] | [0.89;5.42] | [0.89;3.75] | [0.17;2.12] | [1.04;2.3] |
Practices within the couple
| | | | | |
FP was previously discussed within the couple
| | | | | |
Reported by the husband | 5.62*** | 5.85*** | 3.01** | 14*** | 5.98*** |
[3.98;8.07] | [2.55;14] | [1.31;7.23] | [3.19;82.42] | [3.57;10.27] |
Reported by the wife | 12.55*** | 20.87*** | 11.56*** | 21*** | 10.21*** |
[8.79;18.25] | [7.57;64.95] | [4.82;28.99] | [4.74;122.9] | [6.17;17.17] |
Wife can use FP method without husband's consent
| | | | | |
Reported by the husband | 0.97 | 1.38 | 0.85 | 0.74 | 0.97 |
[0.70;1.35] | [0.6;3.11] | [0.37;1.93] | [0.19;3.01] | [0.61;1.53] |
Reported by the wife | 0.75 | 1.01 | 1.21 | 0.85 | 1.05 |
[0.56;1.01] | [0.48;2.07] | [0.59;2.47] | [0.27;2.72] | [0.69;1.61] |
Husband is responsible for final decision-making regarding FP
| | | | | |
Reported by the husband | 0.41** | 0.32 | 0.49 | 0* | 0.58 |
[0.23;0.73] | [0.03;1.62] | [0.11;1.75] | [0;0.67] | [0.24;1.33] |
Reported by the wife | 0.81 | 1.15 | 1.08 | 0.36 | 0.74 |
[ 0.56;1.17] | [0.4;3.1] | [0.46;2.48] | [0.05;2.05] | [0.44;1.25] |
A positive attitude of the husband towards family planning was consistently associated with a higher contraceptive use. Furthermore, ANOVA analysis showed that this factor explained a larger share of the variance in the two groups where the husband did not desire more children (group
1 = 17%; group
3 = 13% vs. group
2 = 2%; group
4 = 8%) (Table
4).
In group
1 and group
4, we observed odds ratios for the association of current contraceptive use with husbands’ positive perceptions of family planning that were consistently greater than 1. Within group
1, the most significant odds ratios were found for husbands deeming family planning very important for spacing births, limiting the number of children, economic reasons and children’s health. Within group
4, 6 out of the 7 enquired aspects of husband’s perception showed significance levels inferior to 0.05. The odds ratios for group
2, on the other hand, were consistently inferior to 1 ranging from 0.24 to 0.78. For group
3 no statistically significant odds ratio was found. Finally, as far as women’s perceptions are concerned, all odds ratios were greater than 1, without major differences across the groups (see Table
4).
Husband involvement, in particular his willingness to finance and purchase contraception, was almost consistently linked to higher contraceptive use, with odds ratios greater than 1. It was however of less significant importance in group2. A very high association was found between current contraceptive use and having discussed family planning within the couple in the past. Other variables related to decision-making practices within the couples were generally speaking not statistically significantly related to current contraceptive use. One exception however was the fact that in group3, we observed an odds ratio of zero (means showed larger difference) for current contraceptive use and having husbands as the only final decision-maker on family planning issues.
Multivariate analysis was performed in this study to examine the link between several factors and contraceptive use. Accordingly, variables showing a significant contribution to contraceptive use are wife’s age, husband’s desire for more children, husband’s favourable attitude towards family planning and husband’s preparedness to accept his wife’s use of contraceptives without his consent. In regard to the wife’s age, the result of the multivariate model displays that the younger the age of a woman, the better the woman experienced contraceptives. (p < 0.001 OR = 0.95).
The second factor that was identified as an important predictor of contraceptive use, is the husband’s desire for more children. In the groups where the husband does not want more children but the wife does, there is a 40% likelihood to use contraceptives (p = 0.03). When a husband has a favourable attitude, the women is twice more probable to practice family planning (OR = 2.17, p < 0.001) (see Table
5).
Discussion about family planning is associated with contraceptive practice. Compared to husbands’, wives’ experience of spousal discussion about family planning were nearly three times more likely to be related with the use of contraception by these couples (husbands OR = 2.39 p < 0.001 and wives OR = 5.37 p < 0.001). Willingness for his wife to use contraceptives without his consent was statistically significant with contraceptive use (OR = 1.54 p = 0.05) (see Table
5).
Table 5
Multivariate analysis of factors associated with couples contraceptive practice, Jimma zone, Ethiopia, 2014
Age (yrs)
| | | | | | | | |
Husband | 1.01 | 0.99 | 1.04 | 0.35 | | | | |
Wife | 0.94 | 0.9 | 0.97 | <0.001 | 0.95 | 0.92 | 0.98 | <0.001 |
Desire to have more children
| | | | | | | | |
Husband | 0.64 | 0.4 | 1.02 | 0.06 | 0.6 | 0.38 | 0.94 | 0.03 |
Wife | 0.9 | 0.57 | 1.41 | 0.64 | | | | |
Husband supports his wife to use FP
| 2.07 | 1.29 | 3.63 | 0.01 | 2.17 | 1.37 | 3.79 | <0.001 |
FP was previously discussed within the couple
| | | | | | | | |
Reported by the husband | 2.48 | 1.54 | 4.02 | <0.001 | 2.39 | 1.5 | 3.82 | <0.001 |
Reported by the wife | 5.79 | 3.78 | 9.01 | <0.001 | 5.37 | 3.56 | 8.21 | <0.001 |
Husband is responsible for final decision-making regarding FP
| | | | | | | | |
Reported by the husband | 0.74 | 0.34 | 1.6 | 0.44 | | | | |
Reported by the wife | 0.69 | 0.42 | 1.13 | 0.14 | 0.7 | 0.44 | 1.13 | 0.15 |
Wife can use FP method without husband’s consent
| | | | | | | | |
Reported by the husband | 1.45 | 0.92 | 2.28 | 0.11 | 1.54 | 1.01 | 2.36 | 0.05 |
Reported by the wife | 1.23 | 0.82 | 1.86 | 0.33 | | | | |