Shakya Holly B, Dasgupta Anindita, Ghule Mohan, Battala Madhusudana, Saggurti Niranjan, Donta Balaiah, Nair Saritha, Silverman Jay, Raj Anita
Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA.
Center on Gender Equity and Health (GEH), University of California, San Diego, CA, USA.
BMC Womens Health. 2018 Sep 4;18(1):147. doi: 10.1186/s12905-018-0636-7.
Persistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting.
Using data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men's and women's reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women's empowerment (household and fertility decision-making, women's education, and women's knowledge of contraception).
When individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women's empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband's education, husband's familiarity with contraception, and number of children.
Overall there were clear patterns to differential reporting. Associations with women's empowerment and contraceptive communication and use suggest a strategy of women's empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences.
Clinical Trials Number: NCT01593943 , registered May 4, 2012 at clinicaltrials.gov.
印度农村年轻妻子长效避孕措施使用率持续较低，这与该国持续出现的不良孕产妇、婴儿及儿童健康结局有关。研究发现，性别不平等一直是避孕措施低使用率的预测因素。然而，关于避孕措施报告存在一个问题，即在报告避孕措施使用情况时，印度农村的夫妻双方报告往往不一致。虽然避孕措施使用情况的不一致报告可能会阻碍避孕措施的推广，但很少有研究调查不一致报告的预测因素。
我们使用从印度马哈拉施特拉邦农村地区的867对夫妇收集的数据，这些数据是一项以男性为重点的计划生育随机对照试验的一部分。我们根据夫妻双方关于当前避孕措施使用情况的报告不一致、与配偶就避孕措施进行的沟通以及理想家庭规模对夫妇进行分类，并评估每个类别的不一致程度。然后，我们进行多项回归分析，以确定不一致类别（重点关注妇女赋权，包括家庭和生育决策、妇女教育以及妇女的避孕知识）的预测因素。
当个人报告就避孕措施进行了沟通而其配偶未报告时，这些人在配偶未报告使用避孕措施的情况下，也更有可能报告自己使用了避孕措施。在夫妻双方都报告了避孕措施沟通或使用情况的夫妇中，以及仅妻子报告了避孕措施沟通或使用情况的夫妇中，妇女赋权程度更高。存在一些夫妻层面的特征，可预测在妻子未报告使用避孕措施或未进行避孕措施沟通的情况下，丈夫会报告使用避孕措施或进行避孕措施沟通：丈夫的教育程度、丈夫对避孕措施的熟悉程度以及子女数量。
总体而言，不同报告存在明显模式。与妇女赋权以及避孕措施沟通和使用之间的关联表明，妇女赋权策略可改善生殖健康。仅妇女报告不一致表明，即使项目与赋权妇女互动，纳入丈夫也至关重要。仅丈夫报告不一致突出了那些可能比妻子更容易接受计划生育信息的男性的特征。计划生育项目在与夫妇而非仅与妇女合作时可能最有效，应专注于改善夫妻之间的沟通，并支持他们在生育偏好上达成一致。
临床试验编号：NCT01593943，于2012年5月4日在clinicaltrials.gov注册。
