Power relations and negotiations in contraceptive decision-making when husbands oppose family planning: analysis of ethnographic vignette couple data in Southwest Nigeria

Abstract

Contraceptive use in Nigeria has remained low at less than 15% for over two decades. Although husbands' opposition is acknowledged as one of the factors impeding women's contraceptive use, little is known about how wives negotiate when their husbands oppose family planning. We address this research gap by conducting thematic analyses of qualitative data from 30 interviews of married couples. We employed thematic analysis to identify relevant themes from the transcribed data. The findings clearly demonstrate attitudes highlighting imbalance in power relations and contraceptive decision-making within marital relationships. By initially complying with the husband's wish as a 'sign of honour', and then making further attempts at convincing him about family planning use, a woman can achieve her contraceptive target; or through the involvement of a third party. Wives are less empowered to overtly use contraceptives when their husbands oppose family planning, however, there are accepted justifications for covert use. The findings underscore the need to strengthen family planning interventions to enable behavioural change among Nigerian men, promote gender and reproductive health rights, and empower women with better negotiation skills.

Addressing socio-cultural barriers to family planning and co-designing services to improve utilization: evidence from northern Nigeria

“…This conforms with known literature in the study areas and many other parts of Sub-saharan Africa [5][6][7][15][16][17][18]. Similarly, the influence of husbands as major decision makers on whether to use and not to use family planning services from this study also conform with known findings from other studies other parts of Africa [19,20]. While respondents affirmed that there had been increase in use of family planning in their communities, it was obvious that significant use of traditional methods still exist.…”

Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges

“…Most of the current literature on covert use of contraception falls in two categories: qualitative studies of women's reasons for and experiences of using contraception without their partner's knowledge [9,[15][16][17][18] or quantitative assessments of covert use from Demographic and Health Surveys (DHS) inferred from discordant reports of modern method use reported by the wife, but not the husband [19,20]. Two mixed-methods studies have begun to bridge the gap between qualitative and quantitative research by investigating levels of and reasons for discreet contraceptive use in facility-based or cohort populations [13,14].…”

“…Covert use of contraception reveals the tensions emerging from the dissociation between sexuality and procreation, and the repercussions of this division on gender power dynamics. Qualitative studies have documented women's reasons for concealing or wanting to conceal their use of contraception, including their discomfort or lack of confidence in initiating discussions of sexual issues, male opposition to contraception, and strong pronatalist culture that values high fertility [8,9,15,[21][22][23]. Further, studies exploring women's acceptability of new contraceptive methods, such as patches and injectables, have highlighted women's preferences for discreet forms of contraception [24][25][26].…”

From non-use to covert and overt use of contraception: Identifying community and individual factors informing Nigerian women’s degree of contraceptive empowerment

“…Such suspicions, and the tension they cause may lead to disclosure by some women, ultimately bringing about improvement in communication between partners [10]. On the other hand, it has been reported that if a male partner discovers on his own that a woman is using a method without his approval, he may feel betrayed [5,10] and could report her to her parents, accuse her of infidelity, stop having sex with her, start an extramarital affair, physically abuse her, marry another wife, withdraw economic support, or even divorce her, all in a bid to "punish" and "disgrace" her for her actions [5,[8][9][10]12,13].…”

“…This may be a reflection of couple conversations on fertility desires and family planning, and these have been shown to improve overt use of contraception [21]. On the other hand, qualitative research from Ethiopia, Nigeria, and Uganda suggests that the absence of financial support from her male partner may propel a woman to use a family planning (FP) method covertly [10,13]. The woman may perceive this lack of financial support as an indication of an unstable relationship, and her choice to use a contraceptive covertly may be her own way of self-preservation as she thus avoids another birth that could potentially make her even more dependent on her partner [10,13].…”