Spousal Communication, Fertility Preference and Contraceptive Uptake Among Couples in Oyo State: A Rural-Urban Comparison

  • Maternal and child health
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Increasing global population and its consequences constitutes a preeminent public health challenge. A key cost- effective intervention is the use of contraceptives whose uptake is still low especially in developing countries. Spousal communication (SC) and fertility preference (FP), known to be key determinants of contraceptive uptake (CU) have been studied mainly in isolation among women. We therefore examined the influence of these factors simultaneously amongst couples in rural and urban areas of Oyo state, Nigeria.
We conducted a comparative cross-sectional study among reproductive age women and their partners using a two- stage cluster sampling technique in one rural and one urban area of Oyo State. We collected data using semi- structured, interviewer-administered questionnaires. Key variables were CU, SC (measured using the SC index), and FP. Levels of agreement were determined using Cohen’s kappa statistic. We identified predictors of CU by estimating adjusted odds ratios (aOR) and confidence intervals (CI) with multivariable logistic regression.
Overall, 66.3% of the couples in the rural compared to 77.3% in the urban setting had good SC about family plan- ning (p=0.003). A higher proportion of couples in rural (56.7%) compared to those in urban (43.3) desired more children (p<0.001). CU was similar in both areas (p= 0.541) (34.1% rural: 31.7 urban). Women with tertiary edu- cation (aOR=2.31; 95%CI=1.30-4.10), in the richer and richest wealth quintiles (aOR=1.82, 95%CI= 1.02-3.25) or with good SC (aOR= 2.86; 95%CI= 1.83-4.47) were more likely to use contraceptives. However, couples where both part- ners desire more children were less likely to use contraceptives (aOR=0.50; 95%CI= 0.27-0.95).
Our findings demonstrate low levels of CU and poor SC and desire for larger families were associated with this. We, therefore, recommend incorporating spousal communication in FP programs as well as focusing on couples, especially those with primary education and in the lower socioeconomic classes as previous attention had been solely on women to increase uptake of contraceptive use.

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