ABSTRACT

The literature suggests an important linkage between inter-spousal decision making and contraceptive use. Decision making in a spousal relationship helps to support spousal growth as compromises can be reached on sensitive topics, especially those regarding fertility preference, the type of contraceptive method to adopt, and other reproductive health issues that affect the woman’s overall health and well-being. However, the effect of decision making on contraceptive method choice has received little attention. Therefore, the main objective of the study was to examine the effects of spousal decision making in Ghana and its association with the type of contraceptive method used among women in Ghana.

The dataset used for the study was the 2014 Ghana Demographic and Health Survey (GDHS) women’s file and the weighted sample consisted of 1,408 married or cohabiting women who were currently using a method of contraception. Spousal decision making and the type of contraceptive method used was investigated by using cross tabulations and binary logistic regression techniques to assess their associations. At the multivariate level, the relationship between decision making and the type of contraceptive method used was analyzed while controlling for socio-economic and demographic characteristics using binary logistic regression. Decision making was found to be a significant predictor of the type of contraceptive method used as those making joint decisions were more likely to use modern methods. A woman’s age, region of residence, educational attainment and number of living children showed significant associations with the type of contraceptive method used.

Findings from the study inform recommendations to improve joint decision making which can result in use of modern methods of contraception. There is also need for further qualitative research to explore the details of spousal decision making and how it influences the type of contraceptive

method used.

CHAPTER ONE

INTRODUCTION

  Background of the study

A 2015 trend report by the United Nations (UN) indicates that globally 64 percent of married or in-union women of reproductive age used a method of contraception (UN, 2015). The majority of women in almost all regions of the world use some form of contraception to help control births and prevent unintended pregnancies. However, contraceptive use in least developed countries is still low being 40 percent, and is particularly low in Africa with 33 percent (Ahmed et al., 2012; UN, 2015).

Contraceptive methods can be split into two groups, modern and non-modern (usually referred to as traditional). The most recent literature on the classification of contraceptive methods explains that modern methods should “have a sound basis in reproductive biology, a precise protocol for correct use” and there should be data to indicate that the efficacy of the method has been tested under “various conditions” (Festin et al., 2016; p.292). Traditional or non-modern methods, on the other hand, are all other methods that do not fit into the modern method criteria.

Modern methods include an array of products and procedures, and thus, the majority (57%) of married and in-union women worldwide used modern contraception in 2015, this comprised 90 percent of contraceptive users (UN, 2015). Nevertheless, modern contraceptive use in least developed countries, including Ghana, is low.

In Ghana, the modern contraceptive prevalence rate currently stands at 22.2 percent (GSS, GHS and ICF International, 2015). Similarly, the use of traditional contraceptive methods has been

fluctuating since 1998 in Ghana and has decreased somewhat over the past six years from 7 to 5 percent (GSS, GHS and ICF International, 2015). The use of traditional methods is seen to be higher in societies where family planning prevalence is low and the use of contraception is weak (UN, 2015).

Studies have noted that inter-spousal contraceptive decision making has been recognized as a key factor for adoption and sustained use of family planning because it allows couples to discuss what might appear unclear and exchange information that may change strongly held beliefs (Bawah, 2002; Feyisetan, 2000). In addition to this, not only contraceptive use but also the decision of choosing an appropriate contraceptive method are also largely influenced by inter-spousal communication and decision making (Ogunjuyigbe et al., 2009). The literature has indicated that there is a pathway of influence between spousal communication and decision making on the type of contraceptive method used globally (Islam et al., 2014).

Ideally, it has been made evident that couples spending a substantial portion of their adult lives together are often bound to make decisions together. However, contraceptive use is a taboo subject in some parts of the Ghanaian society (Bawah et al., 1999) and is rarely discussed with men even though studies have shown the importance of men’s perception in matters of contraceptive use (Avogo et al., 2008). Various dynamics play out when discussing the male role in decision making, especially about reproductive issues, including contraceptive use. The types of relationships and women’s levels of autonomy in the relationship influence whether decision making takes place or not. Young women and especially those in arranged marriages have less decision making opportunities within marriage (Haberland et al, 2003). Studies also suggest that in sub-Saharan African culture, couples largely come from a patriarchal society where men in general have most authority over their wives’ next birth, the number of children and when to stop childbearing. In

this situation, there is little or no communication among spouses about women and their reproductive health related issues (Kamal et al., 2012). Being a mostly patriarchal society, Ghana has not been an exception to this problem.

Most women have been deprived of their ability to control their own fertility as one of their basic and important rights because of lack of communication and decision making with their partners. Communicating and making decisions about contraception will bring to light that a better regulated sexuality and productive life affects positively the status of both men and women socially and economically. Additionally, lack of communication and decision making among couples on modern contraceptive use has been identified as one of the main reasons for the lower rate of contraceptive use among women in under developed countries (Bawah, 2002).

It is evident that spousal communication and decision making, in fact, is an explanatory factor in modern contraceptive use (Bawah, 2002; Islam et al., 2014). Many reviews have been directed on family planning reception by women and there has been little male involvement in modern contraception adoption especially in developing countries. Effective spousal communication and decision making promote collective contribution by couples in embracing preventative contraception measures, its practices and continuing usage. Few studies have assessed this role of inter spousal decision making on the choice of either traditional or modern methods. Bearing all this in mind, this study seeks to examine the relationship between inter-spousal decision making and the type contraceptive method used among married women in Ghana.