Perceptions of Partners' Fertility Preferences and Women's Covert Contraceptive Use in Eight Sub-Saharan African Countries

Abstract

Covert use of contraception is a common but underreported and understudied phenomenon where one partner uses contraception without the other's knowledge. We used Demographic and Health Survey couple data to examine the relationship between wives' perceptions of husbands' fertility preferences and type of contraceptive use (overt vs. covert) in Benin, Ethiopia, Kenya, Mali, Nigeria, Sierra Leone, Uganda, and Zambia using logistic regression. Wives who perceived that their husbands wanted more children than them had increased odds of using covertly, compared to those who perceived that husbands wanted the same number of children in all countries except Benin, and the strength of the relationships ranged from adjusted odds ratio (aOR) 2.89 (95 percent confidence interval (CI) 1.75-4.76) in Zambia to aOR 4.01 (95 percent CI 1.68-9.58) in Mali. Wives who reported not knowing their husbands' fertility preferences had increased odds of using covertly compared to wives who perceived that their husbands wanted the same number of children in all countries except Zambia, ranging from aOR 2.02 (95 percent CI 1.11-3.69) in Ethiopia to aOR 3.82 (95 percent CI 2.29-6.37) in Kenya. Our findings indicate that efforts to increase partner engagement to align couple's fertility preferences may encourage overt use.

Keywords: couples; covert contraceptive use; fertility preferences.

FIGURE 1

Weighted percentages showing relationships between wives’ perceptions of husbands’ fertility preferences and type of contraceptive use (overt vs. covert) in eight sub‐Saharan African (SSA) countries

FIGURE 2

Unadjusted and adjusted odds ratios for perceptions associated with covert use, compared to overt use among couples in eight SSA countries NOTE: Reference category is perception that husband wants the same or less number of children. Adjusted models include household wealth quintile, residence, wife's age, wife's parity, wife's highest education completed, wife's employment status, husband and wife age differential, and husband and wife schooling difference.