Covert use of reversible contraceptive methods and its association with husband’s egalitarian gender attitude in India

Abstract

Background In a patriarchal society, women often keep their use of contraceptives secret in order to meet their reproductive goals and satisfy their reproductive preferences. Nevertheless, to our knowledge, women’s covert contraceptive use and its association with husband’s gender attitude have not been studied in the Indian settings. The present study estimates the extent of covert modern contraceptive use (CCU) among women and its linkage with husbands’ gender attitudes in India. Methods The study is based on fecund and monogamous couples using modern, reversible contraceptive methods. The numbers of such couples were 4,825 and 7,824 in the national family health surveys 2005–06 and 2015–16 respectively. The outcome variable in the study was CCU, while the independent variables were husband’s gender attitude, women’s education, freedom of mobility, freedom to spend money independently, surviving number of children, concordance regarding additional children, couple-level information such as age and educational gap between spouses, and some socioeconomic status (SES) variables. We used latent class analysis to measure the gender attitude and used bivariate descriptive analysis and multivariate binary logistic regression to assess the linkages between husband’s gender attitude and CCU. Results This study found that the prevalence of CCU increased from 15% in 2005–06 to 27% in 2015–16. In both the time periods, contraceptive pills were the most preferred covert method, followed by intrauterine device (IUD). The results of the multivariate logistic regression show that women with husbands of moderate and low egalitarian gender attitudes were, respectively, 50% and 40% more likely to hide their contraceptive use than those with husbands of a high gender attitude. Women’s education, wealth index, number of living children, and region of residence were also found to be significantly associated with CCU. Conclusion The study reveals that husband’s low egalitarian gender attitude can be a potential barrier between spouses, preventing them from opening up about their fertility preferences and contraceptive needs to each other. A couple-oriented approach to family planning is needed so that both members of a couple can satisfy their fertility desires and preferences eventually.

More than Measurement Error: Discrepant Reporting of Contraceptive Use and the Role of Wives’ and Husbands’ Educational Attainment

“…This finding regarding wives' relatively greater education is especially interesting in conjunction with our finding that wives’ greater absolute level of education is associated with decreased odds of covert contraceptive use. A similar pattern was found in a recent study in India, though not reaching statistical significance in that study (Vishwakarma and Shekhar 2022). Overall, we can speculate from these results that wives’ absolute education may be associated with empowerment to openly use contraception, while having an educational advantage relative to husbands may be associated with greater incentive to implement preferences covertly.…”

“…More generally, the promotion of egalitarian gender ideals among women and men may contribute to greater concordance both by empowering women and by lowering the likelihood of relationship stress sometimes associated with women having an educational advantage. This approach is supported by Vishwakarma and Shekhar (2022) who found that there is less covert use of contraception in households where the husband holds more egalitarian gender attitudes.…”

Women’s ability to negotiate safer sex with partners by contraceptive status among a nationally representative sample of married women in Nigeria

“…There is a high likelihood that this group of women was using contraceptives without the knowledge of their partners. As evident in previous studies [36][37][38], women may decide to covertly use contraception due to the inability to have a fruitful discussion with partners or partners' disapproval of the method used. There are also cases where attempts to negotiate safer sex have led to incidences of spousal violence [6].…”

“…This is because the discovery of covert use of contraceptives by an unsupportive partner may lead to marital disharmony and sometimes violence which does not in any way promote the institution of marriage. Since male disapproval is reported to be one of the main causes of the covert use of contraceptives by women [36][37][38], it is thus important that family planning managers in the country should give more relevance to more couple-oriented approaches to improving access to family planning services for married men and women in the country.…”

“…However, it is not certain that all contraceptive users have the ability to negotiate safer sex with partners. For instance, most women who are using modern contraceptives covertly most probably do so due to their inability to negotiate with partners or inability to get partners' approval for the desired contraceptive method [36][37][38]. Likewise, there is no evidence that all non-users are not able to negotiate safer sex with partners since some women are non-users due to health concerns or other social reasons [39,40].…”