An analysis by researchers at the Johns Hopkins Bloomberg School of Public Health of data collected from married couples in 23 developing countries has found many discrepancies between spouses' statements about their use of contraception.
In all populations surveyed, husbands reported higher contraceptive use than did wives. The study appears in the June 2001 issue of Studies in Family Planning.
The analysis also revealed that if a couple had discussed family planning or if the wife had a higher-than-average level of education, the chances were better that the two spouses would concur on the contraceptive method. Conversely, concurrence was lower if one or both spouses reported other sex partners.
Lead author Stan Becker, PhD, professor of population and family health sciences at the Johns Hopkins Bloomberg School of Public Health, said, "Large differences in spouses' reporting persisted even when we analyzed data only on monogamous couples who reported no other sex partners."
Becker noted why these inconsistencies are cause for concern -- increases in the use of modern contraceptives are the major reason for fertility declines around the world, making accurate estimates of contraceptive use crucial for estimating the needs of family planning programs, for evaluating the impact of such programs and for predicting fertility levels and population change.
The researchers analyzed data collected through a USAID-funded program called the Demographic and Health Surveys (DHS), which in 1987 began collecting data in selected countries from both men and women in households about their reproductive health.
The DHS surveys studied were conducted in 23 countries: 17 in Africa, two in Asia, and four in Latin America and the Caribbean.
Higher levels of concurrence were found for Bangladesh, Brazil, Dominican Republic and Pakistan than for Haiti or anywhere in Sub-Saharan Africa.
Husbands reported current contraceptive use about twice as often as did their wives in Benin, Burkina Faso, the Central African Republic and Mali.
The condom and periodic abstinence were the main methods reported by men whose wives reported no contraceptive use. In cases where a direct comparison was possible, the likelihood that the man would report use when the woman did not was everywhere greater than the probability that the woman would report use when the man did not.
Lack of concurrence was greater among polygamous couples than among monogamous couples, as well as among those couples in which one or both spouses reported extramarital sexual partners.
The authors suggested a number of reasons why husbands and wives might not concur on their method of contraception.
Women's secret practice of female contraceptive methods could account for a sizable proportion of women's sole reports, but husbands had many more sole reports.
The possibility also exists that respondents give what they consider to be a socially desirable response rather than a valid one. Women, for example, may sometimes be embarrassed to report the use of coitus-dependent methods such as condoms.
On the other hand, husbands might tend to overreport contraceptive use if they want to project a modern image to interviewers, who typically are urban residents and more educated than the respondents.
In eight of eighteen countries, among wives reporting they practiced periodic abstinence, fewer than 50 percent could give an accurate answer about the time of ovulation. Validity was high, however, for wives who reported using the pill. In 17 of 21 countries, among women who reported using oral contraceptives, three-fourths or more were able to produce the pill packet.
The authors state that they lean toward putting more credence into what a woman says about birth control than what her husband says. As Becker notes, "Biologically, women have more at stake in terms of the risks of pregnancy and so they are more likely to know whether they are protected or not from becoming pregnant."
Nevertheless, the authors also recommend men's reports of contraceptive method continue to be collected and analyzed since, according to Becker, "interviewing and analyzing responses from both partners is an important step toward determining the extent of male involvement in contraceptive method choice and use."
The research was supported by a grant from the U.S. National Institutes of Health.
[Contact: Tim Parsons]