Influence of Spousal Communication and Women's Gender Attitudes on Contraceptive Use

Despite the common belief that inequitable gender norms can function as barriers to contraceptive use by constraining spousal communication and family planning (FP) decision-making, there is little published evidence linking FP with gender attitudes. This study examines the influence of spousal communication and gender attitudes on contraceptive use, using survey data from an operations research project in Tanzania. A baseline household survey was conducted in 2009 with 200 couples of reproductive age to explore gender attitudes as measured by the Gender Equitable Men (GEM) Scale, and their relationship to FP. Logistic regression analyses were carried out separately for husbands and wives. The dependent variable was current use of contraception. Independent variables were spousal communication and GEM Scale score, controlling for age, education, number of living children, and geographic region. Spousal communication (reported by the wife) was a significant predictor of contraceptive use, after adjusting for covariates. In a second model, the wife's GEM score was a significant predictor of contraceptive use, and spousal communication remained significant. In comparable models, using data from husbands, neither spousal communication nor husband's GEM score were significant in predicting women's contraceptive use. The effect of women's gender attitudes was largely independent of couple communication, suggesting that gender attitudes may influence women's propensity to take initiative in FP. While influencing men to be more gender egalitarian may be worthwhile for many reasons, it is women's gender attitudes that influence contraceptive use in this setting.