Husband-Wife Communication about Family Planning and Contraceptive Practice in Nepal: A Comparative Analysis of 1996 and 2001 DHS Survey

Devendra P. Shrestha, Tribhuvan University
Bhanu B. Niraula, United Nations Population Fund (UNFPA)

CONTEXT The role of husband – wife communication in the adoption of contraceptive methods has been well documented (Beckman, 1978; Mukherjee, 1975; Lasee and Becker, 1997; Sharan and Valente, 2002). The successful practice of contraception to a large extent depends upon the spousal communication regarding fertility desires and contraceptive choices. The frequency of couple's discussion is positively related to contraceptive use in general and method choice and effectiveness in particular (Bean et al., 1983; Kasarda et al., 1986; Sakyi, 1992; Ullah & Chakraborty, 1993; Nyblade and Menken, 1993). Studies have also documented that in case of differences between husband and wife about desired family size and attitudes towards family planning, the husband's preference often dominates (Cain, 1984; Axin, 1992). Inter-spousal communication has thus been considered a sensitive indicator of contraceptive use due to three important reasons (Srikantan, 1993). They are: (i) child bearing, instead of being a cultural imperative, has come within the scope of conscious choice for the communicating couples, (ii) women's role are no more confined to child bearing and rearing among such couples, (iii) the wife's preferences are taken into account in making the couple's reproductive decisions. It is in this background, using two sets of nationally representative survey data, the paper attempts to further widen our understanding on the role of husband – wife communication and wife's perception of her husband's approval of family planning on contraceptive practices in Nepal. We hypothesize that family planning practice is positively associated to husband–wife communication and husbands approval of contraceptive use. DATA AND METHODS We use data from Nepal Family Health Survey 1996 and Nepal Demographic and Health Survey 2001 for our analysis. The 2001 survey data was released recently. In both the surveys sample was nationally representative. In 1996 survey a total of 8,429 and in 2001 survey 8726 ever-married women between 15-49 ages were interviewed.. Both 1996 and new wave of 2001 Nepal DHS survey data were analyzed and compared to examine the temporal changes in the effect of husband –wife communication on family planning use. In this paper we restricts our analyses to 7214 and 7587 currently married and non-pregnant women of both the surveys respectively. We use multivariate logistic regression analysis to examine the effect of spousal communication together with some other variables on family planning practice in Nepal. PRELIMINARY RESULTS Table 1 compares the contraceptive use patterns by selected demographic and socio-economic characteristics among currently married women between 1996 and 2001. The results indicate significant temporal changes in contraceptive practices among women with different socio-economic and demographic characteristics. Preliminary results of our multivariate analysis in Table 2 and 3 show that husband wife communication, husbands approval of family planning practice, child loss, desire for additional children, availability of electricity in the household, and television watching are all significantly associated with contraceptive use in both the periods. The result further demonstrates that spousal communication about family planning has a significant effect on current use of birth control methods.. Couples who discuss about family planning are more likely to practice contraception than couples that never discusses. The impact of spousal communication is more pronounced in 2001 than in 1996 (odds ratio 1.13 vs 1.80). The finding has supported our hypothesis and has endorsed the findings of the previous studies on the effect of spousal communication on contraceptive use (Mahmood & Ringheim, 1993; Ullah & Chakraborty, 1993; Sakyi, 1992). Women's current employment is another significant predicator of contraceptive use in 2001. Those who are currently employed are 48 percent more likely to use family planning techniques to limit fertility than those women who are not employed. Child loss has turned out yet another significant predicator of contraception in both the surveys. Women who have experienced child loss are 23 percent less likely to use any contraceptive methods than those women who did not experience. CONCLUSIONS The results of our analysis revealed that husband wife communication and wife perceptions of her husband approval of family planning are the strongest predictors of current use. This finding has significant policy implications. It is very essential to understand some of the necessary conditions that could facilitate the spousal communication resulting to the adoption of contraceptive methods. Any IEC program of family planning should also focus to male as the results have revealed the significant impact of husband's approval on contraceptive adoption. This evidence thus suggests that any program effort should be focused on encouraging and motivating couples to discuss contraceptive matters.