Husband-wife dynamics predicting modern contraceptive use among couples attending the child health clinic at Webuye County Hospital, Western Kenya

Abstract

Background: Despite the pledge by the international community through the United Nations to make Reproductive health services accessible to all by 2015, use of modern contraceptive methods is still low globally. In Kenya, this is exemplified by the health facility assessments which show that commodities for Family Planning (FP) in health facilities either expire or are redistributed because the utilization rates are low. Although studies elsewhere have shown that couple dynamics play an important role in FP use, there is lack of local studies on the same. This study sought to fill this gap. Objective: To examine couple dynamics that predict modern contraceptive use among couples attending the Child Health Clinic (CHC) at Webuye County Hospital (WCH), western Kenya. Methods: A hospital-based cross-sectional study employing quantitative methods was used. The study was conducted at the CHC of WCH, western Kenya between February and September 2021 on 272 couples who met the eligibility criteria. A pretested interviewer-administered questionnaire was used for data collection. A systematic sampling method was used to select study participants. Clients who came without their spouse were requested to come with them at a later agreed date and place of their convenience for the interview. The questionnaires were checked daily for completeness. The data was cleaned, entered and analyzed using Statistical Package for Social Sciences (SPSS) version 23. Descriptive statistics (frequencies and proportions) were used to summarize data from the categorical variables including background characteristics of the respondents. Pearson's Chi-square statistic was used both in the bivariate and multivariate models to test for the association between predictor variables and outcome variables. Results: When the husband did not want additional children the odds of using FP was 2.7 (95% CI: 1.59-4.61; p<0.001). When the husband wanted spacing of longer duration than the wife the odds of using FP was 1.9 (95% CI: 1.12-3.21; p<0.001). More than 90% of the couples with concordance made the decision regarding FP use, desired family size, and spacing of children jointly; while in 32.9% of the couples with concordance, the decision regarding choice of a contraceptive method was made by the wife only. There was a positive association between spousal concordance on making FP decisions, and modern contraceptive use (AOR: 2.2; 95% CI: 1.29-4.56; p<0.001). 64% of the couples reported having communicated about FP. The odds of couples using a contraceptive method after having communicated about FP was 12.6 (95% CI: 6.81-24.4; p<0.001). There was a positive association between spousal communication about FP, and spousal concordance on making decision regarding FP use (AOR: 8.18; 95% CI: 4.58-15.1; p<0.001). Conclusion: Despite majority of the couples having made the decision regarding FP jointly, there was increased odds of contraceptive use whenever the husband did not want additional children and whenever the husband wanted to space children for longer duration than wife; suggesting that husbands play a more influential role in family planning. Recommendations: We should enhance male spouse involvement in FP by operationalizing ministry of health’s guidelines on ways of engaging men in family planning.