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Couples' Fertility and Contraceptive Decision-Making in Developing Countries: Hearing the Man's Voice

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Context: Family planning research, policy and programs in developing countries have traditionally given little attention to men's role in reproductive decision-making. Men's exclusion from family planning efforts may have ramifications for their preferred family size and attitudes toward contraceptive use. Methods: Demographic and Health Survey data collected in 18 developing countries between 1990 and 1996 were used to directly compare husbands' and wives' attitudes toward fertility and contraception. Logistic regression analyses were conducted to examine how these attitudes affect couples' contraceptive behavior. Results: Men and women in these countries desire fairly large families; however, husbands tend to want more children than their wives and to want the next child sooner. The proportion of couples in which partners' ideal family size differs by two children or more ranges from 30% (in Bangladesh) to 72% (in Niger). In most couples, either both spouses want more children or both want no more, but in 10-26%, their desires differ. Modern method use is low in most of these countries, but husbands are more likely than their wives to report such use. Combining each spouse's fertility intentions into a couple analysis, while controlling for their demographic characteristics, significantly predicts modern method use in nine of 14 countries for which data are available; in six of these countries, the wife's fertility preference has a greater impact than the husband's. Conclusions: Spouses may have disparate reproductive goals, and data from both partners are necessary to ascertain these differences. Fertility and family planning programs and research must continue to expand their focus on men's attitudes and behavior.
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15
number of a couple’s births. In some coun-
tries or among some social groups, the
male partner has greater influence than his
spouse.4In Ghana, the wife’s attitude to-
ward contraception is strongly influenced
by her husband’s attitudes and back-
ground characteristics, especially educa-
tion, but the husband’s views are not sim-
ilarly influenced by his wife.5
On the other hand, the perception that
men will necessarily have more influence
on reproductive decisions because they
typically control the family’s assets, are ac-
cepted as the household head and are older
may be an exaggeration. The actual situa-
tion is likely to depend on other factors and
to vary over time and by location. For in-
stance, among the Yoruba of Nigeria, the
fertility desires of both marriage partners
are important predictors of the couple’s fer-
tility. However, whereas the husband’s de-
sire is dominant in predicting the couple’s
behavior when the number of living chil-
dren is small, the wife’s desire becomes
more important as the number of children
grows.6In Taiwan, when spouses disagree
over whether to have another child, the
wife tends to prevail.7
Efforts to promote family planning in
developing countries have often been crit-
Akinrinola Bankole is senior research associate and
Susheela Singh is director of research, The Alan
Guttmacher Institute, New York. The authors thank Thu
Vu, Yvette Cuca, Taylor Haas and Linda Appel for re-
search assistance and Jacob Adetunji, Jacqueline E. Dar-
roch, Bolaji Fapohunda, Charles F. Westoff and Deirdre
Wulf for commenting on drafts of this article. This re-
search was supported by a grant from the Pew Charita-
ble Trusts/Global Stewardship Initiative.
Couples’ Fertility and Contraceptive Decision-Making
In Developing Countries: Hearing the Man’s Voice
By Akinrinola Bankole and Susheela Singh
Until recently, fertility and family
planning research in developing
countries, as well as policy and pro-
gram formulation, has generally relied on
data collected from women. Increasingly,
however, attention is being paid to includ-
ing men. The reasons for the new interest in
men are not hard to find: First, information
that has become available from surveys con-
ducted over the past decade suggests that
men and women do not necessarily have
similar fertility attitudes and goals.1Second,
the scope of fertility and family planning re-
search has expanded to include such broad-
er reproductive health issues as sexually
transmitted diseases, on which data from
both men and women are needed.2
Although women bear children and
most modern contraceptives are female
methods, childrearing has an impact on
men’s lives too. This impact may be felt
financially, if men accept the responsibil-
ity of supporting their children, and in a
range of other ways, including through
the health and well-being of their wives
and children. Often, a man’s social status
is also affected when he becomes a father.3
The male partner may play an impor-
tant role in decision-making regarding
contraceptive use and the timing and
icized for their exclusion of men. The con-
sequence of the female-only approach has
been that some men view family planning
with suspicion, regarding it as being aimed
at undermining their authority in the fam-
ily. For instance, men in Nigeria typically
believe that contraception makes it easy for
their wives to engage in extramarital sex-
ual relationships.8While men’s attitudes
toward family planning are generally pos-
itive, some studies show that men believe
that they should be in control of whether
and when a couple uses contraceptives.9
Failure to involve men in family plan-
ning programs can have serious implica-
tions. Even when women are educated
and motivated to practice contraception,
they may not do so because of opposition
from their husbands. Individuals inter-
viewed in urban Sudan believed that the
male partner decides if a couple will use
contraceptives and, if they do, supplies the
method.10 In light of these findings, some
researchers question the validity of the es-
timates of unmet need derived from in-
formation collected only from women.11
This article examines the reproductive
preferences and behavior of married men
and their wives in 18 developing coun-
tries. The main objective is to understand
the role of husbands in reproductive de-
cision-making by focusing on their pref-
erences concerning family size and hav-
ing additional children, whether they are
aware of family planning and what role
they play in contraceptive use. We exam-
ine these phenomena by comparing the re-
sponses of husbands with those of their
wives in order to bring out the similarities
and differences. For instance, it is impor-
tant to know whether husbands and
wives are equally knowledgeable about
contraceptive methods, and how their
family-size goals compare. In the case of
disagreement about fertility desires, we
attempt to identify whose view carries the
Volume 24, Number 1, March 1998
Context: Family planning research, policy and programs in developing countries have tradi-
tionally given little attention to men’s role in reproductive decision-making. Men’s exclusion from
family planning efforts may have ramifications for their preferred family size and attitudes toward
contraceptive use.
Methods: Demographic and Health Survey data collected in 18 developing countries between
1990 and 1996 were used to directly compare husbands’ and wives’ attitudes toward fertility
and contraception. Logistic regression analyses were conducted to examine how these atti-
tudes affect couples’ contraceptive behavior.
Results: Men and women in these countries desire fairly large families; however, husbands tend
to want more children than their wives and to want the next child sooner. The proportion of cou-
ples in which partners’ ideal family size differs by two children or more ranges from 30% (in
Bangladesh) to 72% (in Niger). In most couples, either both spouses want more children or both
want no more, but in 10–26%, their desires differ. Modern method use is low in most of these
countries, but husbands are more likely than their wives to report such use. Combining each spouse’s
fertility intentions into a couple analysis, while controlling for their demographic characteristics,
significantly predicts modern method use in nine of 14 countries for which data are available; in
six of these countries, the wife’s fertility preference has a greater impact than the husband’s.
Conclusions: Spouses may have disparate reproductive goals, and data from both partners
are necessary to ascertain these differences. Fertility and family planning programs and re-
search must continue to expand their focus on men’s attitudes and behavior.
International Family Planning Perspectives, 1998, 24(1):15–24
however, is that it does
not cover the prefer-
ences and behavior of
men and women who
are not in a legal or co-
habiting union.
Methodology
Data
Data in this analysis are
from national surveys
conducted as part of
the Demographic and
Health Survey (DHS)
program between 1990
and 1996 in 18 develop-
ing countries—13 in
Sub-Saharan Africa, two
each in North Africa and
Asia, and one in Latin
America. The DHS is the
only major series of
cross-national surveys of
reproductive behavior in
developing countries
that cover both men and women; our analy-
ses include all but two countries for which
data on men and women were available.*
The dominance of Sub-Saharan African
countries among those in which men have
been surveyed probably reflects a focus on
HIV and AIDS, and the need to incorporate
men in any analysis of this topic; in other
countries, the motivation for including men
was to explain husband-wife agreement
and communication in matters related to
fertility decision-making.
The female data for the Sub-Saharan
African countries, Brazil and Morocco are
based on samples of all women aged
15–49, while the data for Bangladesh,
Egypt and Pakistan are for ever-married
women of the same age range. The male
samples are less uniform (Table 1). All
men, regardless of marital status, were
surveyed in 13 countries, but only the hus-
bands of interviewed women were in-
cluded in the remaining five. The age
range of the male samples also varies, with
some countries having no age limits, some
having a lower limit and others having
both lower and upper limits. To obtain the
couple data used in this study, we com-
bined data from the separate interviews
of husbands and wives in all 18 surveys.
The male questionnaire is similar in
structure to the female questionnaire, but
is shorter. Men are asked about their back-
ground characteristics, fertility experi-
ences, contraceptive knowledge and use,
marriage, sexual behavior and reproduc-
tive preferences. In recent DHS question-
naires, the fertility section includes de-
greater weight in terms of contraceptive
use. Although relatives and friends may
play important roles in couples’ repro-
ductive decision-making, we do not ex-
amine their contributions.
Many studies that have examined dif-
ferences in reproductive preferences by
sex take the aggregate-level approach and
compare men as a group with women as
a group.12 This approach tends to under-
state the extent and role of disagreement
in fertility preferences, particularly in pop-
ulations where the norm is to have many
children. When small numbers of indi-
viduals begin to prefer and actually have
smaller families, the impact of these in-
novations is often submerged, since the
overall average is likely to reflect the pre-
vailing norm of the society.
On the other hand, comparing the indi-
viduals who make up a couple, and treat-
ing couples as the unit of analysis, adds a
different perspective and enhances our un-
derstanding of reproductive preferences
and decision-making. The couple-level ap-
proach involves direct comparison of the
preferences of the two individuals who
matter most in reproductive decision-mak-
ing. Furthermore, such differences are
more real in terms of their impact on re-
productive outcome (e.g., contraceptive
use or subsequent fertility). An important
limitation of the couple-level approach,
tailed questions on the number of children
ever born and the number surviving and
deceased by sex. (In some of the earlier
surveys, men were asked only to report
their total number of children or their
number of living children by sex.)
In the section on contraception, the re-
spondent is asked to name all the methods
that he knows. After he has done so, the
interviewer reads a description of each
modern and traditional method that was
not mentioned and asks the respondent
whether he knows any of these and
whether he has ever used each of the meth-
ods that he has heard of. Also, detailed
questions are asked about current method
use and, among nonusers, intention to use.
The section on fertility preferences in-
cludes questions about respondents’ ideal
number of children (in some cases by sex);
whether they intend to have any more
children and, if so, the preferred timing of
the births; and their own and their part-
ners’ attitudes toward family planning. As
much as possible, the questions in the
male questionnaire are worded the same
way as in the female questionnaire.
The data are limited to the extent that
the DHS, like other large-scale national
surveys, uses structured interviews that
do not probe deeply into most topics and
usually do not include open-ended ques-
tions. In some countries, even standard
questions were not included because of
cultural preferences or concerns. These
limitations prevent deeper coverage of
some of the issues examined here. Fur-
thermore, the lack of uniformity in the
ages of male respondents leads to some
bias in overall comparisons. Nevertheless,
by allowing comparison across 18 coun-
tries, the DHS data may help our under-
standing of reproductive preferences and
decision-making among couples.
Analytic Methods
We adopted the DHS definition of a cou-
ple as consisting of a man and a woman
who are legally married or who are living
together in a consensual union. In countries
where polygyny is widely practiced (most
of which are in Sub-Saharan Africa), this
implies that the sample includes some men
who have more than one wife. (We cate-
gorize a union as polygynous or monoga-
mous on the basis of the husband’s report
of his number of wives.) For our analysis,
the number of couples in a polygynous
household is the same as the number of
wives, and the information for the male
partner is the same for each couple. How-
ever, since most of the questions asked of
husbands that relate to their wives did not
16 International Family Planning Perspectives
Couples’ Fertility and Contraceptive Decision-Making
*The 1987 Burundi survey and the 1992 Rwanda survey
were excluded because we believe that results based on
these data will not reflect the current reality. Because of civil
war, drastic changes have taken place, and are still taking
place, in the demographic situation of both countries.
Table 1. Selected characteristics of samples of men in 18 Demo-
graphic and Health Surveys, by country
Country and Men Age No. of No. of
survey year sampled limit men couples
Sub-Saharan Africa
Burkina Faso, 1992–1993 All 18 1,845 1,269
Cameroon, 1991 Husbands None 814 909
Central African Republic,
1994–1995 All 15–59 1,729 933
Côte d'Ivoire, 1994 All 15–59 2,552 1,030
Ghana, 1993 All 15–59 1,302 550
Kenya, 1993 All 20–54 2,336 1,266
Malawi, 1992 All 20–54 1,151 772
Mali, 1995–1996 All 15–59 2,474 1,630
Niger, 1992 Husbands None 1,570 1,731
Senegal, 1992–1993 All 20 1,436 789
Tanzania, 1991–1992 All 15–60 2,114 938
Uganda, 1995 All 15–59 1,996 1,109
Zimbabwe, 1994 All 15–54 2,141 711
Other regions
Bangladesh, 1993–1994 Husbands None 3,284 3,323
Brazil, 1996 All 15–59 2,949 1,311
Egypt, 1992 Husbands None 2,466 2,406†
Morocco, 1992 All 20–70 1,336 748
Pakistan, 1990–1991 Husbands None 1,354 1,366
†Data for 60 husbands could not be matched with data for their wives. Notes:Couples include
those who are legally married and those in a cohabiting union. Surveys based on husbands
interviewed only the male partners of female respondents.
17Volume 24, Number 1, March 1998
variations exist within the region: Polyg-
yny is most prevalent in West African
countries, which are predominantly Mus-
lim.The relatively high prevalence of
polygyny may account for the larger age
gap between spouses in these countries,
since women in societies where polygy-
ny is common tend to marry at younger
ages than their counterparts in societies
where the practice is less prevalent.15
In every country, at least 80% of husbands
are currently working. A substantial pro-
portion of wives work, although wide vari-
ations exist between countries. More than
50% of wives are currently working in 10
countries, but in North Africa and Asia, the
proportions are only 15–22%.
The literacy level among men varies
from 10% in Senegal to 77% in Zimbabwe.
In every country except Brazil, wives are
considerably less likely than their hus-
bands to be literate. The proportion of
wives who can read without difficulty
ranges from 3% in Niger to 76% in Brazil.
In nine countries, the proportion literate
among husbands is at least two times that
for wives.
The number of years of schooling that
men and women receive remains very low
in many developing countries. The pro-
portion of husbands with seven or more
years of schooling ranges from 5% in
Burkina Faso to 67% in Zimbabwe; it is
greater than 20% in 13 countries. Wives
tend to spend fewer years in school than
their husbands in most of these countries;
the proportion of wives with seven or
more years of education exceeds 20% in
only six countries.
require a polygynous man to be wife-spe-
cific in his answer, we do not know to
which wife or wives the responses refer.
Unfortunately, nothing can be done to cor-
rect this problem. Thus, in cases where this
ambiguity may affect the results, we either
carry out the analysis by type of marriage
or include monogamous couples only.
To examine couples’ ideal number of
children, contraceptive knowledge and
modern method use, we constructed mea-
sures of these variables combining hus-
bands’ and wives’ reporting. For instance,
the measure of modern method use is a
three-category variable showing the pro-
portions of couples in which only the hus-
band reports use, both spouses report use
and only the wife reports use. This measure
allows us both to show the level of agree-
ment between spouses and to measure use
separately for husbands and wives.
The analysis of the effects of fertility in-
tentions on couples’ contraceptive behav-
ior is restricted to fecund monogamous
couples in which the wife was not preg-
nant at the time of the survey. (Couples are
considered fecund if neither spouse reports
that either partner is infecund.) Polygy-
nous couples are excluded because men’s
answers to the question about fertility in-
tentions are not wife-specific.
A couple is defined as using a modern
method of family planning if the wife re-
ports current use of any method or (be-
cause women may underreport use of
male methods, especially condoms) if the
husband reports condom use. We used lo-
gistic regression analysis to examine the
effects of fertility intentions on couples’ use
of modern contraceptives; the results are
presented as predicted proportions, to fa-
cilitate a comparison of the effects before
and after controlling for other variables.*13
Results
Characteristics of Husbands and Wives
In some settings, the difference in the ages
of husband and wife is a determinant of
whether the spouses have similar repro-
ductive preferences.14 In all 18 countries,
husbands are typically older than their
wives; the median age difference ranges
from 2.7 years in Brazil to 12.2 years in
Senegal (Table 2). Generally, the gap is
widest in Sub-Saharan Africa.
Polygyny is evident in the 16 countries
for which data are available on type of
marriage. However, while polygyny is
very common in Sub-Saharan Africa, its
prevalence is negligible in other regions.
On average, 23% of husbands and 29% of
wives are in polygynous unions in Sub-
Saharan Africa (not shown), but wide
Childbearing Goals
Although conventional wisdom suggests
that men desire more children than
women in developing countries, data that
permit empirical, cross-cultural studies to
verify this claim have only recently be-
come available. A review of earlier stud-
ies, however, does not support this no-
tion.16 And a recent study that examined
male and female preferences using DHS
data showed that except in some countries
*The procedure involves adding the constant to the para-
meter estimate for each category of joint fertility intentions
and computing the antilog. For example, to calculate the
unadjusted proportion shown in Table 6 for Burkina Faso
under “Husband only wants no more,” we first ran a lo-
gistic regression examining the relationship between mod-
ern method use and joint fertility intentions with no con-
trols. Then we obtained the predicted logit for the category
by adding the constant value (–2.39001) to the parameter
estimate (1.38299); the result was –1.00702. Dividing by
one plus the antilog of this number (0.3653), and multi-
plying by 100 produced the reported proportion (26.8%).
The weighted average of these predicted proportions, com-
puted using the proportions shown in the first column of
the table (11.9% for Burkina Faso), is the same as the over-
all proportion using modern methods obtained from a sim-
ple cross-tabulation of joint fertility intentions by use of
modern methods. Similarly, the adjusted proportions are
obtained from the results of a logistic regression includ-
ing the control variables. But these proportions have been
constrained to reproduce the proportion of women in the
sample who were using contraceptives so that the over-
all proportions of couples using contraceptives are the
same for the unadjusted and adjusted numbers. This in-
volves changing only the regression constant and is done
by solving for a constant value that will produce the de-
sired overall proportion.
†Of the African countries included in our study, seven
(Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Mali,
Niger and Senegal) are in West Africa, four (Kenya,
Malawi, Tanzania and Uganda) are in East Africa, and
one each is in Central and Southern Africa (Central
African Republic and Zimbabwe, respectively).
Table 2. Selected characteristics of married men and women, by country
Country Husband’s % in polygynous % employed % literate % with 7 years
age minus union of schooling
wife’s age Men Women Men Women Men Women Men Women
(median)
Sub-Saharan Africa
Burkina Faso 10.1 40.2 53.7 98.9 62.2 u 4.4 5.1 3.0
Cameroon 9.3 55.6 57.7 80.4 70.0 66.9 24.1 34.6 15.8
Central African Rep. 4.3 13.3 22.7 93.2 85.5 41.5 10.3 25.7 5.9
Côte d'Ivoire 7.7 20.2 29.1 95.6 80.5 u 16.1 25.4 7.1
Ghana 5.9 16.3 21.8 99.4 85.5 44.2 15.6 57.0 37.5
Kenya 5.9 12.5 13.9 99.3 53.1 74.9 53.7 61.8 47.6
Malawi 5.2 10.2 11.6 91.4 25.2 47.8 22.2 32.4 12.9
Mali 9.5 29.3 39.7 90.2 46.1 14.1 5.2 10.6 4.1
Niger 9.6 15.2 32.3 98.6 45.3 10.6 2.5 u 1.5
Senegal 12.2 40.7 51.2 96.4 54.8 10.4 7.6 11.0 4.2
Tanzania 6.5 15.9 19.5 100.0 49.0 68.1 43.0 46.9 40.2
Uganda 4.8 15.8 18.1 u 62.8 58.9 29.4 36.7 17.6
Zimbabwe 5.2 9.4 11.3 81.8 54.4 77.4 66.0 66.8 58.3
Other regions
Bangladesh 8.3 u u 98.5 14.7 36.1 22.4 24.2 10.6
Brazil 2.7 u u 89.6 52.9 71.0 75.5 37.8 40.2
Egypt 6.2 2.5 2.6 87.6 22.0 56.0 32.7 39.2 26.3
Morocco 5.9 4.2 4.6 95.5 21.2 31.5 14.3 19.2 7.1
Pakistan 5.0 2.6 3.4 79.8 17.1 42.2 17.1 28.3 10.4
Notes: Includes those who are legally married and those in a cohabiting union. For the number of couples, see Table 1; data for men in
polygynous unions are counted only once. u=unavailable.
number she or he would prefer to have).
Nonetheless, the question is still asked
in fertility surveys because it is simple and
allows comparison with earlier survey
data. Although the measure may be un-
stable over time at the individual level, it
is remarkably consistent at the aggregate
level.19 Therefore, some researchers con-
sider it a good indicator of societal norms
about family size, and believe that changes
in this indicator over time reflect changes
in attitudes that may affect behavior.20
Husbands tend to want a larger family
than their wives in many countries, espe-
cially in Sub-Saharan Africa (Table 3).* The
proportion of couples in which the hus-
band desires at least two children more
than his wife ranges from 17% in Pakistan
to 49% in Niger. By contrast, the corre-
sponding estimate for wives ranges from
11% in Bangladesh and Egypt to 23% in
Malawi and Niger. The gender differen-
tial is more pronounced in Sub-Saharan
Africa than in other regions and is larger
in West Africa than in East Africa.
If we define agreement to mean that a
husband and wife reported either the
same desired number of children or a one-
child difference,the proportion of cou-
ples in which spouses agree ranges from
27% in Niger to 70% in Bangladesh.
Agreement is higher among couples in
countries outside Sub-Saharan Africa than
in that region. While more than 60% of
couples in the five North African, Asian
and Latin American countries included
here are in agreement, fewer than half
in West Africa, the family-size preferences
of men and women are quite similar.17
However, this conclusion was based on
aggregate-level results, which may con-
ceal disagreements at the couple level.
Desired number of children. One com-
monly used measure of reproductive pref-
erences is the number of children that a re-
spondent would like to have if he or she
could choose. The meaning and utility of
this measure have been debated since the
1960s, when researchers argued that re-
sponses may be no more than polite an-
swers to meaningless inquiries.18 The
problems usually identified with the mea-
sure include inconsistency (which de-
pends on how stable reproductive pref-
erences are, as well as on whether
questions are meaningful to the respon-
dent) and rationalization (whereby the re-
spondent simply gives a number that is
equal to or greater than the number of chil-
dren she or he already has, rather than the
agree in eight of the 13 Sub-Saharan
African countries; in five of these eight
countries, only 30–40% of husbands and
wives desire the same number of children.
(The 68% shown for Pakistan is probably
too high, because 64% of men and 60% of
women gave nonnumeric responses,
which are assigned a value of six children
and thus may lead to false agreement. The
actual level of agreement probably re-
sembles levels in Sub-Saharan Africa.)
On average, married men want a large
number of children in many of these coun-
tries. The mean number of children de-
sired by husbands ranges from 2.9 in
Brazil to 11.5 in Niger; it exceeds five in 11
of the Sub-Saharan African countries.
Husband’s desired family size tends to be
higher in West Africa than in East Africa.
On average, husbands in all of the other
countries except Pakistan want fewer than
five children. Wife’s average preferred
family size shows a similar range across
countries and similar regional patterns.
The difference in spouses’ mean desired
family size is substantial—one child or
more—in seven Sub-Saharan African
countries, five of which are in West Africa.
No gender difference in mean desired
number of children is discernible in coun-
tries from other regions.
Fertility intentions. Another prominent
measure of reproductive preferences is
whether or not the respondent intends to
have another child. This measure is a ro-
bust predictor of contraceptive and fer-
tility behavior at both the aggregate and
the couple levels;21 it also has become an
indispensable ingredient in the estimation
of unmet need for family planning.22
Using DHS data to compare husbands’
and wives’ responses on this issue among
all couples is somewhat problematic: Since
the surveys do not ask polygynous hus-
bands whether they intend to have more
children with each wife, the results prob-
ably understate the extent of agreement
between spouses in polygynous unions.
For example, if a man with two wives says
he wants more children, he may want
them with both wives or only with one. If
he wants them only with one, a compar-
ison of his survey response and that wife’s
will accurately show whether they agree.
However, if the wife with whom he wants
no more children also wants no more (i.e.,
their intentions agree), the couple will
nevertheless be counted as disagreeing
because his response did not reflect his in-
tention with this wife.
Despite the possibility of bias in the di-
rection of disagreement, husbands and
wives show a high degree of agreement
18 International Family Planning Perspectives
Couples’ Fertility and Contraceptive Decision-Making
Table 3. Percentage distribution of married couples, by spouses’ comparative family-size de-
sires, and men’s and women’s mean desired family size, according to country
Country Difference in desired number Mean desired family size
2 children, 2 children 1 Total Hus- Wives Differ-
husband wife wants child bands ence
wants more more
Sub-Saharan Africa
Burkina Faso 32.2 16.1 51.7 100.0 7.2 5.8 1.4
Cameroon 47.3 19.5 33.2 100.0 10.3 7.4 2.9
Central African Republic 43.1 19.5 37.4 100.0 8.6 6.8 1.8
Côte d'Ivoire 35.5 21.4 43.1 100.0 7.0 6.1 0.8
Ghana 27.8 16.4 55.8 100.0 5.6 5.0 0.6
Kenya 23.5 20.6 55.9 100.0 4.3 4.1 0.2
Malawi 25.6 23.2 51.2 100.0 5.5 5.3 0.2
Mali 44.8 20.7 34.5 100.0 8.8 6.8 2.0
Niger 49.3 23.3 27.4 100.0 11.5 7.8 3.7
Senegal 47.2 15.0 37.9 100.0 9.9 6.3 3.6
Tanzania 31.6 20.3 48.2 100.0 7.6 6.4 1.2
Uganda 32.7 21.2 46.1 100.0 6.3 5.5 0.9
Zimbabwe 25.0 16.6 58.4 100.0 5.0 4.6 0.4
Other regions
Bangladesh 19.1 11.4 69.5 100.0 3.2 2.9 0.3
Brazil 20.7 13.0 66.3 100.0 2.9 2.6 0.2
Egypt 26.1 11.1 62.9 100.0 4.1 3.4 0.7
Morocco 21.3 16.4 62.3 100.0 4.1 4.1 0.0
Pakistan 17.0 14.8 68.3 100.0 5.5 5.3 0.2
Notes: Includes those who are legally married and those in a cohabiting union. For the number of couples, see Table 1. Nonnumeric re-
sponses to the question on desired family size are classified as six children.
*The DHS question from which the measure was derived
asks respondents with no children: “If you could choose
exactly the number of children you have in your whole
life, how many would that be?” For those who already
have at least one child, the question begins: “If you could
go back to the time you did not have any children.…”
Nonnumeric responses (e.g., up to God or as many as
Allah sends) are assigned the value of six children.
†We adopted this extended definition of agreement be-
cause we consider the “perfect agreement” definition too
strict for high-fertility countries. The disagreement
caused, for example, when one spouse in such a popu-
lation wants six children while the other wants five will
be less important to the couple than that caused when a
spouse in a low-fertility country wants two children and
the other wants only one.
19Volume 24, Number 1, March 1998
ther to have another child soon or to wait.
Among those in disagreement, there is
some evidence of a gender difference con-
cerning which partner wants the child soon-
er than the other. In six of the nine Sub-Sa-
haran African countries for which data are
available, husbands want the next child
sooner than their wives; this difference is
five or more percentage points in four of
these countries. Therefore, at least in Sub-
Saharan Africa, husbands not only want a
larger family than their wives, but also want
the next child sooner than their spouses.
Type of Marriage and Reproductive Goals
Although the causal path is unclear, polyg-
yny may be associated with men’s repro-
ductive preferences: Men may either have
more than one wife because they want
many children or want many children be-
cause they have more than one wife.23 The
fertility preferences of wives in polygy-
nous unions are less clear: On the one
hand, wives may want many children in
order to compete favorably with co-wives
in terms of childbearing and status in the
household. On the other hand, this desire
may be curtailed by the fact that women
in polygynous unions shoulder greater re-
sponsibilities in rearing their children than
do those in monogamous marriages.24
Some differences exist in the desired
family size of marital partners by type of
union. In almost all countries for which we
can classify couples by type of union, the
proportion in which the husband’s fami-
about their fertility intentions (Table 4).*
The proportion of couples in which both
spouses agree on this measure (i.e., either
both want more or both want no more)
ranges from 74% in Kenya to 90% in Niger.
Couples’ type of agreement—whether
both want no more children or both want
more—differs by region. Throughout Sub-
Saharan Africa, husbands and wives
whose fertility intentions agree general-
ly want more children. Of all couples in
agreement, the proportion who want
more children ranges from 53% in Kenya
to 99% in Niger. This supports the finding
that a high proportion of both husbands
and wives want a large family in Sub-
Saharan Africa.
Outside Sub-Saharan Africa, spouses
whose intentions agree typically want no
more children. The only exception is Pa-
kistan, where findings resemble those for
Sub-Saharan Africa. Of all couples in
agreement in the remaining four coun-
tries, the proportion who want to stop
childbearing ranges from 51% in Moroc-
co to 79% in Brazil. This regional differ-
ential is not surprising, since desired fam-
ily size and actual fertility are lower and
declining in most developing countries
outside Sub-Saharan Africa.
In all settings, though, some couples
have disparate fertility intentions. Overall,
the lowest level of disagreement is in Niger
(10%), and the highest is in Kenya (26%).
In most countries, when couples disagree
about future childbearing, the wife wants
no more children but the husband wants
more. (The exceptions are Bangladesh and
Malawi, where both types of disagreement
are about equally likely.) Among all cou-
ples experiencing disagreement, the pro-
portion in which the wife wants no more
children but the husband wants more is
60% or greater in 13 countries.
One important implication of dis-
agreement about desired family size and
fertility intentions relates to how it affects
contraceptive use. However, even when
spouses agree, potential areas of conflict
remain. For instance, in many countries,
the DHS asks men and women who say
they intend to have another child how
long they would like to wait before doing
so; responses indicate that husbands and
wives may disagree as to whether they
want to have the next birth soon (within
two years) or they want to postpone it.
Among couples in which both spouses
want more children, the proportion who
disagree as to the timing of the next birth
ranges from 21% in Brazil to 40% in Burkina
Faso and Uganda. This implies that in the
majority of couples, the spouses agree ei-
ly-size preference exceeds the wife’s by
two or more children is higher for polyg-
ynous than for monogamous unions. In
Sub-Saharan Africa, the proportion ranges
from 21% in Kenya and Zimbabwe to 48%
in Niger among monogamous couples,
and from 33% in Malawi to 57% in Mali
among polygynous couples.
For Sub-Saharan Africa overall, the pro-
portion in which the husband’s family-
size preference exceeds the wife’s by two
or more children averages 32% for monog-
amous couples and 47% for polygynous
couples. By contrast, 47% of couples in
monogamous unions and 36% in polyg-
ynous unions in Sub-Saharan Africa agree
about family size. The differences are
probably associated with factors that are
believed to be more prevalent in monog-
amous unions, such as conjugal closeness
and spousal communication.25
We found only a small difference in the
joint distribution of fertility intentions of
monogamous and polygynous couples.
First, the proportion who agree either to
have more children or to stop childbear-
ing is slightly higher among monogamous
couples (83% in Sub-Saharan Africa over-
all) than among their polygynous coun-
terparts (75%). Second, the implied high-
*The DHS questionnaire asks: “Now, I have some ques-
tions about the future. Would you like to have a/another
child or would you prefer not to have any (more) children?”
We excluded all couples who declared themselves infecund
and classified all respondents who were not certain about
their fertility intentions as wanting to have more children.
Table 4. Percentage distribution of married couples, by fertility intentions, and among those
who want more children, percentage in which only one partner wants the next child soon, ac-
cording to country
Country Fertiliity intentions Want more children
N Both Both Husband Wife Total No. of Husband Wife
want want no only only couples only only
more more wants wants wants wants
no more no more soon soon
Sub-Saharan Africa
Burkina Faso 1,158 74.3 6.3 5.7 13.7 100.0 860 24.9 15.3
Cameroon 803 79.0 7.3 3.8 9.9 100.0 u u u
Central African Rep. 861 81.6 4.8 4.0 9.7 100.0 702 20.9 16.9
Côte d'Ivoire 984 74.7 6.9 3.8 14.6 100.0 u u u
Ghana 532 58.5 24.1 7.0 10.5 100.0 311 13.8 12.9
Kenya 1,219 39.1 34.7 9.6 16.6 100.0 477 19.9 11.6
Malawi 700 61.9 13.4 13.5 11.2 100.0 423 16.5 17.0
Mali 1,581 79.7 3.5 3.5 13.3 100.0 1,260 23.5 8.2
Niger 1,638 88.6 1.2 1.1 9.1 100.0 u u u
Senegal 570 73.7 4.4 3.1 18.8 100.0 u u u
Tanzania 895 70.8 8.0 4.5 16.8 100.0 626 11.4 24.0
Uganda 1,072 60.6 15.0 7.6 16.7 100.0 650 31.5 8.5
Zimbabwe 682 52.6 23.6 11.2 12.6 100.0 359 13.4 14.4
Other regions
Bangladesh 3,134 29.8 55.2 7.2 7.9 100.0 934 13.3 13.3
Brazil 1,230 18.7 69.2 3.8 8.4 100.0 230 14.0 6.6
Egypt 2,359 25.0 55.1 5.4 14.5 100.0 u u u
Morocco 671 37.9 38.8 9.4 13.9 100.0 u u u
Pakistan 1,295 49.8 26.7 7.0 16.5 100.0 u u u
Notes: Includes those who are legally married and those in a cohabiting union. Infecund couples and those who gave no response are
excluded. u=unavailable.
with his wife a week before the survey
may report that he and his wife currently
use condoms, while if his wife has for-
gotten about that incident or recalls sev-
eral acts of unprotected intercourse they
have had since then, she may report that
they use no method.28 The DHS data per-
mit us to examine the contraceptive
knowledge and practice of husbands and
their wives across countries.
Knowledge of modern methods of fam-
ily planning is generally high among both
husbands and wives, but variations by
country are substantial. The proportion of
husbands who know at least one modern
method ranges from 57% in Burkina Faso
to 100% in Brazil (Table 5). Knowledge of
modern methods is lower among hus-
bands in West Africa than elsewhere. Sim-
ilarly, wives exhibit a high level of knowl-
edge of modern methods: from 57% in
Cameroon to 100% in Bangladesh, Brazil
and Egypt. The difference between the pro-
portion of husbands and wives who know
a modern method is generally small with-
in a country. It is less than five percentage
points in 12 countries, 6–8 points in five
countries and 16 points in one country.
Every respondent who reports know-
ing at least one method of family planning
and who is not currently pregnant (or
whose spouse is not pregnant) is asked if
she or he is “doing something now or
using any method with any partner to
delay or avoid pregnancy.” If the respon-
dent reports using more than one method,
the interviewer is instructed to record the
most effective of the methods mentioned.
er disagreement among polygynous cou-
ples is manifested in both types of dis-
agreement (i.e., the husband wants to stop
childbearing while the wife wants more
children and vice versa). Among monog-
amous couples, on average, 5% of hus-
bands and 12% of wives want to stop
childbearing while the other spouse wants
more children. Similarly, among polygy-
nous couples, on average, 8% of husbands
and 17% of wives want to stop childbear-
ing, disagreeing with their spouse. As-
suming that agreement is understated
among polygynous couples because of a
lack of appropriate data, monogamous
and polygynous couples appear to differ
very little in levels of spousal agreement
on fertility preferences.
Contraceptive Knowledge and Behavior
A substantial proportion of married men
know of at least one method of family
planning, but in some countries, only a
small proportion of those who know of a
method are practicing contraception.
However, husbands often report greater
method use than their wives.26 This dis-
parity may stem from several factors: mul-
tiple sexual partners, differential report-
ing of condom use by husbands and
wives, differences in perception of rhythm
among marital partners, and underre-
porting of method use because of the pres-
ence of other adults during wives’ inter-
views.27 The difference may also be related
to the type of method used, the frequen-
cy of use or the reference period: For ex-
ample, a man who used the condom once
Responses vary considerably across coun-
tries for both husbands and wives. The
proportions of men and women reporting
modern method use are lowest in Niger
and Central African Republic, and are
highest in Brazil. Except in Kenya and
Zimbabwe, fewer than 20% of husbands
and 13% of wives in Sub-Saharan Africa
reportedly use modern methods. On the
other hand, use is substantial outside Sub-
Saharan Africa, except in Pakistan.
In most of the countries included here, a
higher proportion of husbands than wives
report using a modern method. The esti-
mated level of modern contraceptive use
varies, sometimes substantially, depending
on whose reporting is taken into account.
For instance, in Ghana, the level of use ac-
cording to husbands’ reports (i.e., whether
only he reported use or both he and his
spouse reported use) is 18%; according to
wives’ reports, it is 13%. However, if the pro-
portion is based on couples in which both
spouses report use, the level is 10%, and if
it is based on those in which either spouse
reports use (i.e., combining the data for hus-
bands only, wives only and both), it is 21%.
Similarly, in Bangladesh, the level of
modern method use is 44% according to
husbands’ reports, 39% according to wives’
responses, 36% as measured by both spous-
es’ replies and 47% if at least one partner
reports use. In Central African Republic,
the use of modern methods among couples
when either spouse reports use (5%) is
roughly five times the level when both
spouses report use (1%) and more than
double when wives only report use (2%).
While differences between husbands
and wives in the reporting of current use
of modern contraceptives can be sub-
stantial, particularly in Sub-Saharan
Africa, it is not clear why these differences
exist. Polygyny is not likely to explain
much of the discrepancy. First, we see the
difference even in countries where polyg-
yny does not exist or is uncommon. Sec-
ond, an analysis of men’s and women’s re-
porting of contraceptive use by type of
union reveals little or no difference be-
tween monogamous and polygynous cou-
ples (not shown). For instance, in Sub-Sa-
haran Africa, on average, only husbands
reported modern contraceptive use in 5%
of monogamous and 6% of polygynous
couples. Similarly, the proportion of cou-
ples in which only the wife reported use
of modern methods was 2% for monoga-
mous and 3% for polygynous couples.
Is condom use the source of the differ-
ences in husbands’ and wives’ reporting of
modern contraceptive use? If this were the
case, we would expect substantially larger
20 International Family Planning Perspectives
Couples’ Fertility and Contraceptive Decision-Making
Table 5. Percentage of spouses who know of and who report use of a modern contraceptive
method, and percentage of couples in which the husband only reported condom use, all ac-
cording to country
Country Know 1 modern methods Repor t modern method use Husband only
Husband Both Wife Husband Both Wife reported
only only only only condom use
Sub-Saharan Africa
Burkina Faso 0.0 57.3 4.5 4.8 2.1 1.6 3.3
Cameroon 16.8 47.7 8.8 2.1 3.2 1.3 1.0
Central African Republic 0.0 63.8 3.1 2.7 1.0 1.1 2.2
Côte d'Ivoire 0.0 65.4 5.6 3.6 2.4 1.9 2.0
Ghana 0.0 84.2 4.7 8.0 10.0 2.9 4.9
Kenya 2.3 94.9 1.5 10.4 21.2 5.7 5.9
Malawi 6.0 89.1 3.4 6.4 5.8 2.9 5.4
Mali 0.0 58.2 5.9 4.9 2.1 2.2 2.1
Niger 27.0 47.0 11.4 1.9 1.2 0.8 0.6
Senegal 20.2 57.2 12.3 3.2 4.2 1.1 1.0
Tanzania 16.6 67.9 8.6 4.3 6.2 1.3 2.8
Uganda 0.0 89.1 2.3 4.7 5.5 1.4 1.8
Zimbabwe 0.0 99.2 0.1 12.1 42.5 5.0 3.6
Other regions
Bangladesh 0.0 99.5 0.4 8.2 36.0 3.0 1.7
Brazil 0.0 100.0 0.0 4.2 68.3 1.7 2.0
Egypt 0.2 96.5 3.2 2.8 44.3 2.2 0.5
Morocco 1.5 96.1 2.2 5.1 33.7 4.2 0.4
Pakistan 14.3 63.4 13.2 2.1 7.9 2.5 1.3
Notes: Includes those who are legally married and those in a cohabiting union. For the number of couples, see Table 1.
21Volume 24, Number 1, March 1998
proportions of husbands than wives to re-
port condom use. When we examine the
proportion of couples in which only the hus-
band reports condom use, we find that this
may be an important explanation for the dis-
crepancy. The proportion ranges from less
than 1% in Egypt, Morocco and Niger to 6%
in Kenya (Table 5); the average is 3% for Sub-
Saharan Africa. The results are also very sim-
ilar for monogamous and polygynous cou-
ples in most countries (not shown).
Furthermore, among couples in which
only the husband reports use of a modern
method, the proportion of use that is due
to husbands’ reporting of condom use
ranges from 8% in Morocco to 84% in
Malawi. This proportion is more than one-
half in eight countries and close to one-half
in three others. The only countries where
this proportion is low (21% or less) are
Bangladesh, Egypt and Morocco. Thus, al-
though other factors may contribute to the
observed differences between husbands’
and wives’ reporting of modern method
use, the role of differential reporting of con-
dom use seems to be very important. What-
ever the explanation, these discrepancies
also emphasize the importance of obtain-
ing information from both men and women
when measuring contraceptive prevalence.
Fertility Intentions and Contraceptive Use
Assuming that individuals who want no
more children or wish to postpone child-
bearing practice contraception, it is easy
to see why contraceptive use will be high
when both spouses want to stop or post-
pone childbearing and low when both
want to have another child. However,
whether and to what extent contraceptives
are used in situations where spouses dis-
agree about their intentions is the ques-
tion. Do couples use contraceptives more
when the husband wants more children
and the wife does not or when the wife
wants more and the husband does not?
Where men are favored in terms of access
to household and community resources
and recognition, do they also have a
greater influence on contraceptive use?
The data largely confirm the predicted
direction of method use among couples
who are in agreement. Except in Côte
d’Ivoire, use of modern methods is high-
est when spouses agree to stop child-
bearing (Table 6). The proportion of cou-
ples in this category who are using
modern methods ranges from 14% in Côte
d’Ivoire to 87% in Brazil; it exceeds 20%
in 16 countries. On the other hand, in most
countries, modern method use is lowest
among couples who agree to have more
children. The level of use for this group of
Table 6. Unadjusted and adjusted percentages of married couples using modern contracep-
tives, by fertility preferences, according to country
Country All Wants no more children Both χ2df
Husband Both Wife want or F
only only more
SUB-SAHARAN AFRICA
Burkina Faso (N=462)
Unadjusted 11.9 26.8 31.1 16.8 8.4 18.6** 3
Adjusted 11.9 22.5 26.0 17.6 9.1 5.3 3
Cameroon (N=284)
Unadjusted 5.2 0.0 44.2 5.6 1.7 72.9** 3
Adjusted u u u u u u u
Central African Republic (N=453)
Unadjusted 6.1 0.0 23.4 6.1 5.2 17.4** 3
Adjusted u u u u u u u
Côte d'Ivoire (N=585)
Unadjusted 8.8 23.6 13.5 7.3 7.8 7.1 3
Adjusted 8.8 15.5 9.0 6.3 8.8 2.1 3
Ghana (N=355)
Unadjusted 20.6 24.0 27.7 25.7 15.9 6.2 3
Adjusted 20.6 15.8 30.5 31.8 14.6 7.2 3
Kenya (N=909)
Unadjusted 38.3 36.8 54.6 29.7 23.6 76.6** 3
Adjusted 38.3 25.4 58.7 42.7 18.2 66.8** 3
Malawi (N=498)
Unadjusted 16.0 24.8 39.0 16.0 9.1 36.7** 3
Adjusted 16.0 26.8 40.6 18.3 8.0 19.4** 3
Mali (N=770)
Unadjusted 9.1 15.9 23.3 16.5 7.1 15.8** 3
Adjusted 9.1 11.1 30.3 22.1 6.0 11.3** 3
Niger (N=925)
Unadjusted 3.3 4.7 6.3 6.7 2.9 3.2 3
Adjusted u u u u u u u
Senegal (N=326)
Unadjusted 9.5 28.6 57.1 12.2 5.9 26.7** 3
Adjusted u u u u u u u
Tanzania (N=592)
Unadjusted 12.5 7.5 25.1 19.1 9.5 14.4** 3
Adjusted 12.5 5.8 37.0 17.7 8.3 6.6 3
Uganda, 1995 (N=704)
Unadjusted 11.5 10.6 28.4 11.8 6.9 33.8** 3
Adjusted 11.5 8.7 28.5 17.3 5.8 24.6** 3
Zimbabwe, 1994 (N=532)
Unadjusted 60.8 68.4 68.8 72.3 53.0 15.6** 3
Adjusted 60.8 66.9 76.2 73.7 49.6 1.5 3
OTHER REGIONS
Bangladesh (N=2,855)
Unadjusted 46.8 37.8 58.4 35.9 28.9 216.0** 3
Adjusted 46.8 33.9 61.5 32.2 24.5 114.2** 3
Brazil (N=1,159)
Unadjusted 79.5 52.1 87.1 54.4 66.3 97.4** 3
Adjusted 79.5 51.3 89.8 49.6 58.1 53.8** 3
Egypt (N=2,059)
Unadjusted 53.8 35.1 64.8 56.9 28.5 202.5** 3
Adjusted 53.8 34.1 65.2 50.8 31.1 51.5** 3
Morocco (N=548)
Unadjusted 45.8 40.9 59.6 47.1 30.6 37.1** 3
Adjusted 45.8 35.0 62.1 45.5 29.7 8.5* 3
Pakistan (N=1,049)
Unadjusted 14.0 10.4 31.6 13.2 3.8 120.1** 3
Adjusted 14.0 7.5 32.5 12.4 3.9 60.8** 3
*p=.05. **p=.01. Notes: Adjusted proportions were estimated by controlling for both spouses’ age and education, residence and num-
ber of living children. u=unavailable because at least one category of the joint fertility preference variable has fewer than 20 cases.
Discussion
In many countries covered in this study,
both husbands and wives want a large fam-
ily. While this is especially true in Sub-Sa-
haran Africa, evidence from Ghana, Kenya
and Zimbabwe suggests that the norms that
support the large family are not uniform
even within that region. At the aggregate
level, husbands in Sub-Saharan Africa are
more likely than their wives to want a large
family; no difference is discernible between
the number of children desired by hus-
bands and wives in other regions.
At the couple level, though, differences
between the family-size preferences of hus-
bands and wives may be larger than sug-
gested by the aggregate-level measure. In
all 18 countries, there is a substantial dis-
crepancy between the preferences of spous-
es: In about two-thirds of couples, hus-
bands and wives differ by one child or
more in the family size they consider ideal.
Even when disagreement is defined as a
difference of two or more children between
partners’ reported ideal family size, it re-
mains high: between 30% of couples (in
Bangladesh) and 73% (in Niger). Our find-
ings also show that in most countries, hus-
bands want a larger family than their
wives. Thus, husbands and wives differ in
their fertility goals, although the magnitude
of the difference and its importance for be-
havior vary across countries and regions.
Spouses for the most part agree about
whether they want more children. More
than 70% of couples are in agreement on
this subject, with little variation by coun-
try. However, in 10–26% of couples, part-
ners disagree; usually, the husband wants
more children but the wife does not. Fur-
thermore, when marital partners agree to
have another child, they may differ about
whether they want the child within two
years or later. This type of disagreement
occurs in 21–40% of these couples, and
more often husbands want to have the
next child sooner than their wives do.
The findings from these two indicators
of reproductive preferences have impli-
cations for fertility and family planning be-
havior. First, they show that decline in fam-
ily-size preferences, which is a necessary
precursor of decline in actual fertility, tends
to occur first among wives. Furthermore,
the results indicate that married women
probably have a better understanding of
the benefit of spacing their children and the
danger associated with having births in
quick succession than their husbands have.
Therefore, contraceptive use either to space
births or to limit family size is likely to be
initiated by wives rather than their hus-
bands. But success in achieving a smaller
couples ranges from 2% in Cameroon to
66% in Brazil; it is less than 10% in 11 coun-
tries and above 20% in only six. Appar-
ently, these couples are using contracep-
tives to postpone the next birth.
When spouses’ fertility intentions dis-
agree, there is no clear pattern with respect
to the direction of contraceptive use. In 10
countries, modern contraceptive use is
higher when only the husband wants to
stop childbearing. In the other eight coun-
tries, however, it is higher when only the
wife wants to stop having children. The dif-
ference in use according to which spouse
wants no more children is generally triv-
ial—less than eight percentage points in 12
countries. For the remaining countries, the
difference ranges from nine percentage
points in Malawi to 22 percentage points
in Egypt, and the level of use is higher
when only the husband wants no more
children in five of these countries, all in
Sub-Saharan Africa (Burkina Faso, Côte
d’Ivoire, Kenya, Malawi and Senegal).
These findings suggest that although
there is no systematic difference, hus-
bands’ preferences have a greater influence
than wives’ preferences have on contra-
ceptive use in Sub-Saharan Africa. Is this
conclusion valid after the effects of other
variables are taken into account? Data for
14 countries allow us to conduct a logistic
regression analysis controlling for the ef-
fects of both spouses’ age and education,
residence and the number of living chil-
dren. The results indicate that in nine coun-
tries, couples’ joint fertility intentions are
a significant predictor of current use of
modern methods, and the pattern and the
direction of the relationship remain large-
ly similar to the unadjusted results.
Use of modern methods is highest when
both spouses want to stop childbearing
and lowest when they want to have more
children. Only in Malawi are couples more
likely to be using modern methods when
the husband wants no more children and
the wife wants more. On the other hand,
use of modern contraceptives seems to be
higher among couples in Egypt, Kenya,
Mali, Morocco, Pakistan and Uganda
when the wife wants no more children and
the husband wants more. In Bangladesh
and Brazil, levels of use in the two groups
of couples are very similar. Thus, in the
majority of these countries, when the ef-
fects of other variables are taken into ac-
count, the wife’s preference appears to be
dominant in determining whether or not
the couple use modern contraceptives.
However, this conclusion should be in-
terpreted with caution, since the analysis
is based on only 14 countries.
family will depend on how responsive
husbands’ fertility preferences are to the
changes in their spouses’ preferences and
on the influence of husbands’ preferences
on couples’ reproductive behavior.
Contraceptive knowledge is high among
husbands and wives in the 18 countries,
and only small differences are observed be-
tween the reporting of marital partners. On
the other hand, husbands are more likely
than wives to report modern method use.
While differential reporting of condom use
between marital partners is an important
source of this discrepancy, it does not ap-
pear to be the sole cause. This finding high-
lights a potential problem associated with
the conventional measure of contraceptive
prevalence based only on women’s reports.
Estimates of contraceptive use may vary
widely depending on whether the re-
searcher relies solely on data obtained from
women or takes into account husbands’ re-
porting of use. For instance, in Ghana, 18%
of husbands report modern method use,
compared with 13% of wives, a difference
of 28%. Studies of fertility and family plan-
ning will benefit from adopting measures
of contraceptive use that are based on the
reporting of both partners.
Our findings support the claim that re-
productive intentions are important pre-
dictors of contraceptive behavior. Before
controlling for other variables, the joint fer-
tility intentions of the spouses significantly
determine whether the couple will use
modern methods of family planning in 15
of the 18 countries for which we have in-
formation. After controlling for the effects
of spouses’ characteristics, joint fertility in-
tentions remain a significant predictor of
use in nine of the 14 countries for which
information exists. As expected, contra-
ceptive use is more likely when couples
want to stop childbearing and less likely
when they intend to have more children,
even in countries where overall use is low.
The level of contraceptive use when one
spouse wants more children but the other
does not is not as easy to predict. Overall,
the results of the multivariate analysis
show that the wife’s preference exerts a
stronger influence on the couple’s con-
traceptive behavior in six of the nine coun-
tries where the variable significantly pre-
dicts contraceptive behavior.
Although this study included only a
few countries outside Sub-Saharan Africa,
the results show that Sub-Saharan Africa
and the rest of the developing world may
differ in important ways. Among the
countries covered, there is more agree-
ment between spouses on the ideal num-
ber of children in Asia, Latin America and
22 International Family Planning Perspectives
Couples’ Fertility and Contraceptive Decision-Making
23Volume 24, Number 1, March 1998
in the Philippines, Studies in Family Planning, 1997,
28(3):173–191.
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6. Bankole A, 1995, op. cit. (see reference 1).
7. Coombs LC and Chang M, Do husbands and wives
agree? fertility attitudes and later behavior, Population
and Environment, 1981, 4(2):109–127.
8. Bankole A, The Role of Mass Media in Family Planning
Promotion in Nigeria, DHS Working Papers, Calverton,
MD, USA: Macro International, 1994, No. 11.
9. Mbizvo MT and Adamchak DJ, Family planning
knowledge, attitudes, and practices of men in Zimbab-
we, Studies in Family Planning, 1991, 22(1):31–38; and
Mustafa MA and Mumford SD, Male attitudes towards
family planning in Khartoum, Journal of Biosocial Science,
1984, 16(4):437–450.
10. Khalifa, MA, Attitudes of urban Sudanese men to-
ward family planning, Studies in Family Planning, 1988,
19(4):236–243.
11. Dodoo FN-A, A couple analysis of micro level sup-
ply/demand factors in fertility regulation, Population Re-
search and Policy Review, 1993, 12(2):93–101; and Bankole A
and Ezeh AC, Unmet need for couples: a conceptual frame-
work and evaluation with DHS data, paper presented at
the annual meeting of the Population Association of Amer-
ica, Washington, DC, Mar. 26–29, 1996.
12. Mason KO and Taj AM, Differences between
women’s and men’s reproductive goals in developing
countries, Population and Development Review, 1987,
13(4):611–638.
13. Westoff CF and Rodríguez G, The Mass Media and
Family Planning in Kenya, DHS Working Papers, Colum-
bia, MD, USA: Macro International, 1994, No. 4.
14. Bankole A and Olaleye DO, Do marital partners have
different reproductive preferences in Sub-Saharan Africa?
in: Makinwa P and Jensen A, eds., Women’s Position and
Demographic Change in Sub-Saharan Africa, Liège, Belgium:
International Union for the Scientific Study of Popula-
tion (IUSSP), 1995, pp. 147–167.
15. Westoff CF, Blanc AK and Nyblade L, Marriage and
Entry into Parenthood, DHS Comparative Studies, Calver-
ton, MD, USA: Macro International, 1994, No. 10.
16. Mason KO and Taj AM, 1987, op. cit. (see reference
12).
17. Ezeh AC, Seroussi M and Raggers H, Men’s Fertili-
ty, Contraceptive Use, and Reproductive Preferences, DHS
Comparative Studies, Calverton, MD, USA: Macro In-
ternational, 1996, No. 18.
18. Hauser PM, Family planning and population pro-
grams: a book review article, Demography, 1967,
4(4):397–401; and Demeny P, Social science and popula-
tion policy, Population and Development Review, 1988,
14(3):451–479, 535 & 537.
19. Bankole A and Westoff CF, The consistency and pre-
dictive validity of reproductive attitudes, Journal of Bioso-
cial Science, 1998 (forthcoming).
20. Ezeh AC, Seroussi M and Raggers H, 1996, op. cit.
(see reference 17); and Westoff CF, Reproductive inten-
tions and fertility rates, International Family Planning Per-
spectives, 1990, 16(3):84–89.
21. Bongaarts J, Do Reproductive Intentions Matter? Work-
ing Papers, New York: Population Council, 1991, No. 30;
Thomson E, McDonald E and Bumpass LL, Fertility de-
sires and fertilit:. hers, his and theirs, Demography, 1993,
27(4):579–588; and Westoff CF, 1990, op. cit. (see refer-
ence 20).
22. Westoff CF and Ochoa LH, Unmet Need and the De-
mand for Family Planning, DHS Comparative Studies, Co-
North Africa than in Sub-Saharan Africa.
And although levels of agreement as to
fertility intentions are similar across all re-
gions, couples in Asia, Latin America and
North Africa are more likely to agree to
stop childbearing than to have another
child, whereas the reverse is the case for
couples in Sub-Saharan Africa.
In terms of contraceptive use, inconsis-
tency in spousal reporting is evident in all
18 countries studied; the proportions of
couples in which only husbands or only
wives report use are very similar across
countries. However, because use of mod-
ern methods is lower in most of the Sub-
Saharan African countries, these differ-
ences imply a greater relative bias in
measurement of contraceptive prevalence
there than in other regions.
Our findings suggest that more work is
needed on gender differences in repro-
ductive preferences and behavior. The in-
vestigation should be extended to un-
married men and women, particularly
never-married men and their sexual part-
ners, and to more countries, especially in
regions other than Sub-Saharan Africa. In
addition, survey questions should be
more specific, especially on matters that
involve respondents and one or more of
their partners. Attempts to examine such
issues as why marital partners report con-
traceptive use differently will benefit from
information gathered in in-depth surveys
of men’s and women’s attitudes, prefer-
ences and behavior regarding contracep-
tive use and childbearing. Longitudinal
data are required if we are to gain a bet-
ter understanding of the effects of repro-
ductive attitudes and preferences on con-
traceptive use and fertility.
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Resumen
Contexto: Las investigaciones, las políticas
y los programas de planificación familiar en
los países en desarrollo tradicionalmente han
prestado poca atención al papel del hombre en
el proceso de adopción de decisiones en cues-
tiones de reproducción. La exclusión del hom-
bre de los empeños y gestiones que se realizan
en materia de planificación familiar puede afec-
tar sus preferencias con respecto al número de
hijos y el uso de anticonceptivos.
Métodos: Los datos recopilados por las En-
cuestas Demográficas y de Salud realizadas en
18 países en desarrollo, entre 1990 y 1996, fue-
ron utilizados para comparar directamente las
actitudes de los hombres y sus parejas con res-
pecto a la fecundidad y la anticoncepción. Se
realizaron análisis de regresión logística para
examinar la forma en que esas actitudes afec-
tan la conducta de la pareja con respecto a la
anticoncepción.
Resultados: Hombres y mujeres de estos paí-
ses desean tener familias bastante numerosas;
sin embargo, los hombres tienden a preferir más
hijos que sus cónyuges y a desear que el próxi-
mo hijo nazca más pronto que lo desea la mujer.
La proporción de parejas que difieren con res-
pecto al número ideal de hijos en dos niños o más
varía entre el 30% (en Bangladesh) y el 72% (en
Níger). En la mayoría de las parejas, ambos cón-
yuges desean o tener más hijos o acuerdan en no
tener más, aunque en el 10–26% de los casos se
difieren de opinión. El uso de métodos moder-
nos es bajo en la mayoría de estos países, aun-
que los hombres son más proclives que sus cón-
yuges a notificar el uso de dichos métodos. Al
combinar las preferencias de fecundidad de
ambos cónyuges en un análisis a nivel de pare-
ja, y controlando las características demográfi-
tudes à l’égard de la contraception.
Méthodes: Les données d’Enquête démo-
graphique et de santé recueillies dans 18 pays
en voie de développement entre les années 1990
et 1996 ont servi à une comparaison directe
des attitudes des conjoints, hommes et femmes,
vis-à-vis des questions de fécondité et de con-
traception. Différentes analyses de régression
logistique ont été menées pour évaluer la
mesure dans laquelle ces attitudes affectent le
comportement contraceptif des couples.
Résultats: Les hommes et les femmes des pays
considérés désirent des familles nombreuses. Les
maris ont cependant tendance à désirer un plus
grand nombre d’enfants, et à intervalles plus rap-
prochés, que leurs épouses. La proportion des
couples dans lesquels le nombre d’enfants idéal
exprimé par les deux partenaires diffère d’au
moins deux enfants varie entre 30% (au
Bangladesh) et 72% (au Niger). Dans la plu-
part des couples, les conjoints désirent soit tous
deux encore des enfants, ou ils n’en désirent plus
cas, se puede prever el uso de métodos moder-
nos en nueve de los 14 países de los cuales hay
datos disponibles; en seis de estos países, la pre-
ferencia de la mujer con respecto a la fecundi-
dad tiene un mayor impacto que la del hombre.
Conclusiones: Los cónyuges podrían tener di-
ferentes metas reproductivas y los datos de
ambos son necesarios para cerciorarse de cuá-
les son las diferencias. Los programas e inves-
tigación sobre la fecundidad y la planificación
familiar deben continuar ampliando su enfo-
que sobre las actitudes y conductas del hombre.
Résumé
Contexte: La recherche, les politiques et les
programmes de planning familial des pays en
voie de développement n’ont jamais accordé
que peu d’attention au rôle des hommes dans
les décisions relatives à la procréation. Leur
exclusion des efforts de planning familial pour-
rait bien se faire ressentir dans le nombre d’en-
fants préféré des hommes et dans leurs atti-
ni l’un ni l’autre. Dans 10% à 26% des couples,
les désirs de l’un diffèrent cependant de ceux de
l’autre. La pratique de la contraception moderne
est faible dans la plupart des pays soumis à
l’étude, mais les maris sont plus susceptibles de
la signaler que leurs épouses. La combinaison
des intentions de fécondité de chaque conjoint
en une analyse des couples, compte tenu de leurs
caractéristiques démographiques, laisse nette-
ment entrevoir la pratique de méthodes modernes
dans neuf des 14 pays pour lesquels on dispose
de données. Dans six de ces pays, la préférence
de la femme, en matière de fécondité, a plus d’in-
cidence que celle du mari.
Conclusions: Les époux poursuivent parfois
des buts de procréation différents, et les don-
nées relatives aux deux partenaires sont néces-
saires à l’évaluation de ces différences. La
recherche sur la fécondité et les programmes
de planning familiale doivent continuer à éten-
dre leur portée aux attitudes et aux com-
portements des hommes.
24 International Family Planning Perspectives
Couples’ Fertility and Contraceptive Decision-Making
Correction
In “Couples’ Fertility and Contracep-
tive Decision-Making in Developing
Countries: Hearing the Man’s Voice,” by
Akinrinola Bankole and Susheela Singh
[1998, 24(1):15–24], the first paragraph of
page 22 should read as follows:
“When spouses’ fertility intentions dis-
agree, there is no clear pattern with respect
to the direction of contraceptive use. The
difference in use according to which
spouse wants no more children is gener-
ally trivial—less than eight percentage
points in 12 countries. For the remaining
six countries, however, the differences are
more substantial: In four countries (Burk-
ina Faso, Côte d’Ivoire, Malawi and Sene-
gal), the proportion using a method is at
least nine points higher when only the
husband wants to stop having children,
while in two countries (Egypt and Tan-
zania), it is at least 12 points higher when
only the wife wants no more children.
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Resumen El volumen Planeamiento Familiar y Programas de Poblacion es un libro indispensable tanto para demógrafos como para otras personas interesadas en el control de población. Tiene sus limitaciones dodo su caracter heterogéneo, su falta de autocrítica, el no tratar sobre la validez y confiabilidad de las encuestas de conocimientos, attitudes y prácticas (KAP), su injustificado tono optimista, y su fracaso al no explorar y considerar alternativas para las presunciones y premisas sobre las cuales se basan los actuates programas de planeamiento familiar. Es sin embargo un importante hito que resume las contribuciones de las ciencias sociales y biomédicas al campo de la demografía.
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Data from 18 countries with Demographic and Health Surveys show that the average fertility rate of married women who want no more children is 43% below the rate observed among women who have not yet completed their desired childbearing. These two groups of women also differ in their average level of contraceptive use--49% among the former and 24% among the latter. A systematic pattern of differences in these variables exists among countries at different stages of the fertility preference transition: In societies where relatively few women want to limit childbearing, reproductive intentions have only a modest impact on contraceptive use and fertility; in countries where large proportions of married women want no more births, most of these women practice contraception to control their fertility. The strength of a country's family planning program is also an important determinant of levels of contraceptive prevalence and of fertility among women who want to stop childbearing.
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A review of fertility determination theories indicates there are plausible reasons for expecting similar fertility desires among women and men, greater desires among women, and greater desires among men in pretransition settings. Most theories agree, however, that social, economic, or demographic modernization should reduce any pre-existing differences. Statistics from more than three dozen published studies show, on average, only small differences between women's and men's family size desires, with women wanting more children than men in some studies and wanting fewer in others. Thus, claims that women consistently want fewer or more children than men appear to be incorrect. In high-fertility settings, however, there is some tendency for women to express the desire to cease childbearing more frequently than men do. Differences in the preference for sons are common (men typically prefer sons more strongly than do women) and may help to explain differences between the sexes in the desire for additional children.
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This article presents arguments that call for a rethinking and redesign of institutional arrangements that now relegate policy-oriented social science work related to population issues in the developing world to the performance of technical functions servicing existing population programs. To the extent that programs do need such technical services, they can, and obviously will and should, continue to purchase them along with other program inputs. But monitoring and analyzing the process that more than doubled the world population since mid-century, assessing and understanding its causes and consequences, and not the least, observing and evaluating actual and potential policy approaches aimed at influencing demographic change, call for systematic, rigorous, and independent social science research efforts that cannot be conducted as activities ancillary to existing population programs.
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A new, health-based concept of unmet need for contraception identifies women for whom pregnancy would raise the mortality risk for themselves, their expected child or their previous child because of maternal age, short birth interval or high birth order. When applied to Demographic and Health Survey data for Sri Lanka, the method classifies 4-23% of currently married women as being in need of contraception, depending on whether women who are pregnant, abstaining or using traditional methods are considered as potentially in need. The usual concept of unmet need, based on women's stated fertility preferences, classifies 6-31% as in need. The preference-based approach identifies 50-90% of the women with health-based unmet need, performing better when women using traditional methods and those abstaining from sex are included as potentially in need and when pregnant women are not. The health-based approach identifies 43-65% of those with preference-based unmet need, performing better when pregnant women are included and women using traditional methods are not.
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According to couple data from the 1989 Kenya Demographic and Health Survey both knowledge and approval of family planning are virtually universal in Kenya: Among 98% of couples, one or both partners know of at least one modern method, and among 85% of couples both partners approve of family planning. Discussion with the partner about family planning was reported in 82% of couples. However, only 67% of wives and 75% of husbands correctly predicted their spouse's approval of family planning. Knowledge and approval of family planning, husband-wife communication, desire for more children and ideal family size are all significantly associated with current use. Multiple logistic regression analyses show that husband-wife communication, particularly the wife's perception of her husband's approval of family planning, is highly associated with current contraceptive use (odds ratio of 4.2). Dialogue appears to increase the effectiveness of communication: Specifically one spouse's perception of the other spouse's approval is more likely to be correct if they have discussed family planning than ii they have not, and this relationship significantly affects contraceptive use.
Article
26 have been posed about a wide range of be- havior, including the effects of television on violence, on children's education, on consumers' choices of products and on vot- ing behavior, among others. The evidence on the effectiveness of such communica- tions is mixed, 1 but the belief that there is some effect has persisted and is reflected in the emergence of a whole industry de- voted to such activities. The application of mass communica- tions to influence fertility is a natural ex- tension of the basic idea that the media can both inform and motivate people, even about such complex subjects as their re- productive means and goals. Communi- cations efforts have become increasingly widespread in the developing world as part of international technical assistance and government programs designed to re- duce fertility. A 1986 summary 2 of radio coverage alone cited nearly 250 sources describing Analyses of data from the 1989 Kenya Demographic and Health Survey demonstrate a strong statistical association between women's reports of having heard or seen messages about fam- ily planning through various media outlets and their use of contraceptives and their reproduc- tive preferences. While 15% of women who say they have neither seen nor heard media mes- sages on family planning are currently using a contraceptive method, this proportion rises to 25% among those who have heard radio messages, to 40% among those exposed to both radio and print messages and to 50% among those exposed to radio, print and television messages. These associations persist even when a variety of life-cycle, residential and socioeconomic con- trols are imposed, so that women exposed to no messages report an average of 5.5 children as their ideal family size, while those exposed to three types of messages report 4.7 children as ideal. Given the persistence of these strong relationships, the results suggest that the mass media can have an important effect on reproductive behavior.