Couples' fertility and contraceptive decision-making in developing countries: Hearing the man's voice

Context: Family planning research, policy and programs in developing countries have traditionally given little attention to men's role in reproductive decision-making. Men's exclusion from family planning efforts may have ramifications for their preferred family size and attitudes toward contraceptive use. Methods: Demographic and Health Survey data collected in 18 developing countries between 1990 and 1996 were used to directly compare husbands' and wives' attitudes toward fertility and contraception. Logistic regression analyses were conducted to examine how these attitudes affect couples' contraceptive behavior. Results: Men and women in these countries desire fairly large families; however, husbands tend to want more children than their wives and to want the next child sooner. The proportion of couples in which partners' ideal family size differs by two children or more ranges from 30% (in Bangladesh) to 72% (in Niger). In most couples, either both spouses want more children or both want no more, but in 10-26%, their desires differ. Modern method use is low in most of these countries, but husbands are more likely than their wives to report such use. Combining each spouse's fertility intentions into a couple analysis, while controlling for their demographic characteristics, significantly predicts modern method use in nine of 14 countries for which data are available; in six of these countries the wife's fertility preference has a greater impact than the husband's Conclusions: Spouses may have disparate reproductive goals, and data from both partners are necessary to ascertain these differences. Fertility and family planning programs and research must continue to expand their focus on men's attitudes and behavior.