FHI 360 study shows that couples communication is key factor in contraceptive uptake

May 22, 2012

RESEARCH TRIANGLE PARK, NC  — African couples who participated in the peer-outreach study, Male Motivators Project, were more likely to use contraception and also reported improved couples communication, according to a new study by FHI 360 published online in the Journal of Health Communication. This qualitative study, sponsored by the U.S. Agency for International Development (USAID), describes the impact that a couple's improved communication skills can have on increasing the use of family planning methods. Increased family planning efforts have been shown to positively affect the physical and economic health of all family members.

The study was designed to assess the impact of an intervention that increased men's knowledge about family planning and provided them with methods to initiate communication with their wives on the topic. Initial results showed that engaging men in the decisions increased the likelihood that the couple would choose to use one of several family planning methods.

"In the developing world, particularly in sub-Saharan Africa, men often are the primary decision makers about family size and use of family planning. This is true even though contraceptive methods and services are frequently geared toward women, and men may not be adequately informed," said Dominick Shattuck, a researcher with FHI 360 and a co-author of the study. "Previous studies have shown that when couples do not explicitly discuss family planning, the women often incorrectly assume that their partners are opposed to family planning. The women, then, either use contraception covertly or don't use it at all."

Because previous studies have shown that men tend to get reproductive health information from peers, the Malawi Male Motivator Project was developed to provide information through a trained male peer educator.

The initial study evaluation showed a dramatic increase in use of contraception when communication between couples increased. In interviews done a year after the study was completed, both men and women reported that increased use of effective family planning methods resulted from positive conversations about the topic and that they had richer and more frequent communication about a number of family and relationship issues.

For the study, researchers recruited 400 men from 257 villages in the Mangochi District of Malawi. All men in the study were 18 years or older and either married or living with a female sexual partner who was younger than 25 years old and not currently pregnant or breastfeeding. The couples and their wives had not used modern contraceptive methods in the past three months. They were randomly divided into a control group and an intervention group.

Several women also said improved communication brought them greater respect from their husbands. As one women said, "I have seen my husband consulting me in some issues, a thing I think he has learned from the study initiatives. This attitude gives me the impression that I am considered worthy and a trustworthy friend in the family."

Almost one-third of the women in the study said they had tried to talk to their husbands about family planning, but the men did not believe the information, did not trust the women or forbade them from using family planning.

Malawi was chosen for the study because it has a high fertility rate (6.34 children per woman) and only 7.6 percent of young people use contraception. (Both figures are from the Malawi Demographic and Health Survey, conducted in 2005 by the Malawi National Statistical Office.) Also, according to a previous study, more than a third of married women between 15 and 19 years old had never talked to their husbands about family planning.

Researchers report that both men and women perceive that having male peer motivators and a curriculum that focused on improving communication skills of husbands increased the use of family planning methods.

"Although men still largely started conversations about family planning, and often still made the final decisions, they increasingly thought of their wives as partners in the decision," said lead study author Miriam Hartmann, formerly a researcher at FHI 360 and now with RTI International. "While the ideal of equal decision making may not yet be a reality, our study results show a positive change in that direction."

In addition to Shattuck and Hartmann, researchers from FHI 360 included Greg Guest, who was principle investigator for the study, and Kate Gilles, (now with Population Reference Bureau). Brad Kerner of Save the Children in Westport, CT, also participated in the research.