How Attitudes Toward Family Planning and Discussion Between Wives and Husbands Affect

Contraceptive Use in Ghana

Author(s): Sarah Salway
Source: International Family Planning Perspectives, Vol. 20, No. 2 (Jun., 1994), pp. 44-47+74
Published by: Guttmacher Institute
Stable URL: http://www.jstor.org/stable/2133433
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ARTICLES

How AttitudesTowardFamilyPlanning
And Discussion BetweenWivesand Husbands
AffectContraceptiveUse in Ghana
BySarahSalway

A study usingdatafrom the1988GhanaDemographic andHealthSurvey revealsthat77%of childrearing are notdistributedequally

betweenmenand women.-2 Thus,neither
cohabiting maritalpartners heldsimilar attitudestoward familyplanning
andthat73%ofthecon- sex can be ignoredin attemptsto under-
cordant couplesapproved ofcontraceptive use. However, only61% ofthewivescorrectly re- standfertilitybehavior,and communica-
portedtheir husband's attitude. Although 76%ofthecouplesagreedon whether theywanted tionbetween partners maybe vitaltosuc-
cessfulfamilyplanning.
morechildren, just44%gaveconcordant responsesonidealfamily size.Among respondents Despitetheinterest intherolemenplay
whoreported knowing a contraceptive method, 35% ofwivesand39% ofhusbandssaidthey in familyplanning,relatively littleinfor-
haddiscussedfamily planning with their spouseduring thepreviousyear.Regression analysis mation on thesubject is available,and few
studieshave exploredtherelativeinflu-
showsthaturbanresidence, thewife's attitude towardfamilyplanninganddiscussion offamily enceofthesexeson couples'reproductive
planning between spouses.havesignificant independent effectsoncurrent contraceptive use. behavior.An investigation ofthissortis
(International
Family
Planning
Perspectives,
20: 44-47 & 74,1994)
particularlypertinent for a country such
as Ghana, where contraceptiveuse re-
mainslow (13%) despiterelativelyhigh
Some authorshave recentlysuggest- thatwomen'sreportscannotbe takenas levels ofbothcontraceptiveknowledge
ed thatAfricanfamilyplanningpro- representing thecouple. and expresseddesireto limitchildbear-
grams are severelyhamperedby Researchhas rarelyexploredtheroles ing.13Ghana is hometo a varietyofma-
theirneglectofmen.1Theseprogramsare ofhusbandsand wivesinfertility-related and patrilineal
trilineal ethnicgroups,and
also hindered bytherelativescarcity ofin- decisions.Someauthorshavearguedthat sexual relationshipsfollowdiversepat-
formation about men's knowledge,atti- inAfrica, menoftenmakethecouple'sde- terns.14 Couples in Ghana oftenpursue
tudesandpractices regarding family plan- cisionsaboutfertility limitation.5 Others separateinterests withinsingle-sex groups,
ning.2Most investigationsin this area have suggestedthatwomenthemselves and interactions betweenhusbandsand
focusonlyonwomen,ignoring theirpart- take theinitiativeto limittheirfertility wives are limited.15 Couples rarelypool
ner'sroleand theinteraction betweenthe withouttheinvolvement, and sometimes theireconomicresources;accordingto
sexesin fertility behavior. withouttheknowledge, oftheirhusband.6 WolfBleek,thispractice"reflects thedom-
Thisapproachassumeseitherthatthe AlexandreMuhawenimchasuggested inantviewofmarriage, namelythata hus-
characteristics ofthewomancan serveas thata lack of communicationbetween band and wifearenotone,buttwo.116 In
a proxyforthoseofthecoupleorthatthe spousesregarding familysize was an im- thissetting, itis particularly important to
womanplaysthemostimportant rolein portantfactorin thelow levelsofcontra- explorethe attitudesof both men and
determining the couple's behavior.Re- ceptiveuse.7GbolahanOniandJamesMc- womenand tounderstand theroleofeach
searchin variouspartsoftheworldchal- Carthyfoundthatin Nigeria,discussion in decisionsaboutfamilyplanning.
lengesbothoftheseassumptions. Several betweenspouseswas positively associat- We use data fromthe1988Ghana De-
studieshavefoundsignificant divergences ed withcontraceptive use.8Francinevan mographicand HealthSurvey(GDHS) to
inmen'sand women'sreportsaboutcon- de Walleand MariamMaiga drewsimi- investigate thesimilarity ofGhanaianmar-
traceptiveuse, attitudestowardfamily larconclusionsfroma studyinMali,9and ital partners'attitudesand preferences
planning, and fertility preferences and in- Therese McGinn and colleagues con- aboutfamily sizeandfamily the
limitation;
tentions.3 Althoughotherstudies have cluded thatmenand womenin Burkina degreeofcommunication and discussion
found smallerdifferences between the Fasowerepoorlyinformed ofeachother's betweenhusbandsand wivesaboutfam-
sexes,4theevidenceas a whole suggests attitudes,oftenbelievingthattheirpart- ilyplanning; andtheroleofhusbands'and
nerwas ignorantabout and opposed to wives'attitudes and preferences, and that
Sarah Salway is a researchfellowat theCentreforPop- family planning.10 of discussion in the
ulation Studies,London School of Hygiene and Tropi-
between partners,
cal Medicine. This articleis based on her master's the- Giventhesefindings, a modelthatas- adoptionofcontraception.
sis. The authoris gratefulto GregFegan forcomputing sumesjointdecision-making is probably
assistance,to Oona Campbell and JohnCleland fortheir notsuitable
valuable supervision,and toSushilaZeitlyn,Sandra Las-
for Africa.Family relations in- Methods and Materials
tonand MatthewKigginsfortheirhelpfulcommentson volvebothcongruence and conflict,"' and In the1988GDHS, interviewswerecon-
earlierdrafts. thebenefits and costsofchildbearing and ductedwitha representative sample of

44 InternationalFamilyPlanningPerspectives

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4,488womenaged 15-49selectedfrom150 tween variablesof interestand contra-
ofthe200clusters used fortheGhanaLiv- ceptiveuse,we examinedmultivariate re- Table 2. Percentage ofwives reportingcurrent
method use, by various attitudes of the cou-
ingStandards Survey. In half of these clus- lations usingmultiplelogistic regression. ple toward familyplanning issues
ters,theGDHS also interviewed a sample
ofhusbands;eachofthesemenwas mar- Results Attitude N
(661)
% current
users
riedtoand livingwitha womanwho had In 77% ofthecouples,thehusbandand
beensuccessfully interviewed.17 wifehad similarattitudestowardfamily ApprovalBoth
of familyplanning
369 29.8
We limitedour analysisto couples in planning(Table1). Ofthesecouples,73% Wifeonly 61 15.1
whichbothpartnersreporteda monoga- approvedoffamily planning(notshown). Husband only 91 2.2
140 0.7
mousrelationship. Thisrestriction ensured The kappa statisticsuggestsfairto good Neither
thatthe men's and women's responses agreementbeyondchanceon thisques- Ideal familysize 0-3 children
Both 11 36.4
wouldrelatetothesamemarital union.Be- tion.However,whenwe comparedwives' Wife only 40 30.0
cause thestudyfocusedon exploringthe reports oftheirhusband'sattitude toward Husband only 33 23.5
determinants ofcurrent contraceptive use, familyplanningwiththeanswersgiven Neither 577 12.4

we excludedcoupleswho reportedrely- by the men themselves, an pat-

interesting Accuracy of wife's perceptlon
ingon sterilization.* Thisgave a sample ternemerged.Althoughinmanycouples, Correctly believes
husband approves 284 26.0
of661 couplesforwhomdata was avail- thehusbandand wifeappeared to hold Incorrectly believes
able on all variablesofinterest. similarattitudes towardfamilyplanning, husband approves 36 11.1
Doesn't know 142 6.3
In oursample,75%ofthecoupleslived 39%ofthewomen in thesample did
either Correctlybelieves
in a ruralarea.Themenweremorelikely notknowormisreported theirhusband's husband disapproves 121 3.3
thanthewomento have had some edu- attitude.As thetableindicates,only48% Incorrectly believes
78 5.1
husband disapproves
cation(66%vs.49%).Agriculture was the of thewives thoughttheirhusband ap-
most commonoccupationforthe men provedoffamily planning, butabout70% ing
Note:Trendwithin
to X2test.
eachcategoryissignificant
atp<.O01accord-
(63%),followedby manual labor (19%), ofthehusbandssaid theyapprovedofit.
clericalor sales work (9%) and profes- Thekappastatistic suggeststhattheagree-
sionalortechnicalwork(9%).Mostofthe mentbetweenthewives' reportsoftheir band and wifegiveresponsesinthesame
women(44%)were25-34yearsold, 35% husband's attitudeand the husbands' category. Thekappavalueof0.14suggests
wereaged 35 orolder,and 21%wereaged own reportswas poor. verypooragreement beyondchance.
15-24.Forty-six percenthad had threeor Womenand menwho reportedknow- Theseresultsshowthatdiscordance be-
fewerchildren, 30% had had sixormore, ingat leastone methodofcontraception tweenGhanaianhusbandsand wiveson
and 24%had had fourorfive.Fifty-eightwereasked whethertheyhad discussed attitudesand preferences relatedto fer-
percentworkedoutsidethehome. familyplanningwiththeirpartnerin the tilityis notuncommonand thatcommu-
First,we exploredthedegreeof-con- past year.Levels ofreporteddiscussion nicationbetweenpartnerson mattersre-
cordancebetweenhusbands'and wives' werelow: Just35%ofwomenand 39% of latingto familyplanningis limited.
responsesto a seriesofquestionsregard- mensaid theyhad discussedfamilyplan- Wetheninvestigated howa couple'sat-
ingattitudes towardfamily planning, dis- ningwiththeirspouse in thepast year. titudesand preferences onmatters related
cussionoffamilyplanning,and fertility Thekappa statistic suggeststhatthelevel to fertility, and theirdiscussionoffamily
preferences.We used two measuresof of agreementbetween husbands and planning,influencetheadoptionofcon-
concordance-the simple percentage wiveson thisvariablewas high. traception. Toidentify important variables
agreement and thekappa statistic, which The level ofdiscordanceon desirefor forinclusion inthelogistic regression mod-
adjustsfortheextentof-chance agreement anotherchildwas low,althoughthewives els,we exploredbivariate relationships be-
expected.t were somewhatmore likelythan their
We thenexaminedhow adoption of husbandstowantto avoid a futurebirth *No informationwas available on when a woman had
contraceptionwas influencedby hus- (27% vs. 20%). Anotherquestion-"Do adopted hercurrentcontraceptive method.Eithera tem-
porarymethodora permanentmethodcould have been
bands' and wives' attitudesand prefer- you intendto use familyplanningin the adopted long beforetheGDHS. However,women who
ences,and by discussionbetweenpart- next12 months?"-produceda largede- had adopted a temporarymethodlong beforethesur-
ners.Thedependentvariablewas current greeofdiscordant responsesfrompartners vey had theoptionofchangingmethodsor discontinu-
use ofa traditional ormoderncontracep- (notshown). ing contraceptiveuse-a choicenotavailable to women
tivemethodas reported bywomen.After We foundsubstantialdiscordanceon who had adopted a permanentmethod.For thisreason,
we believed thatthe informationon currentattitudes,
determining thebivariate relationships be- idealfamily size(notshown).Eightpercent preferencesand discussionreportedby women using a
ofthewives and 7% of temporarymethodat thetimeof thesurveywas more
Table 1. Among 661 Ghanaian couples, percentage of wives and the husbands wanted likelyto reflecttheirsituationat thetimetheyadopted
husbands holdingvarious fertility-related attitudes;percentage of threeorfewerchildren, their method than was the informationreported by
using a permanentmethod.Thus,we restricted
couples In which husband and wifeagree (and kappa value), 1988 and 33% of the wives women
theanalysisto couples who did notreportsterilization.
Attitude Wife Husband % in
and 30% of the hus-
agreementt bands wanted4-5 chil- tKappa is defined as the ratio of the observed excess
Approvesoffamilyplanning 65 70 77 (.47)
dren,while 59% of the agreementbeyondchanceto themaximumpossibleex-
Husband approves offamilyplanning 48 70 61 (.20) wives and 63% of the cess (see J.Fleiss,StatisticalMethodsforRatesandPropor-
Has discussed familyplanning husbandswantedsixor tions,JohnWileyand Sons,New York,1981).In thecur-
withspouse inpast year 35 39 77 (.50) rentcontext, agreement willalmostalwaysbe greaterthan
Wants no morechildren 27 20 76 (.46)
moreor gave a nonnu- thatexpectedon thebasis ofchancealone. However,sta-
merical response. In tisticalsignificancein thiscase may notbe meaningful,
tTheresponse"don't
know" is treated Kappavalueslowerthan.40 indicate only 44% of couples,
as discordant.
pooragreementbeyondchance. because itsays nothingabout theimportanceofthedif-
however,did the hus- ferencebetweenhusbands' and wives' responses.

Volume 20,Number 2, June1994 45

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All use subject to JSTOR Terms and Conditions
Attitudes
Toward
Family
Planning
inGhana

tweenselectedvariablesandcontraceptive *Desireforno morechildren. Couples in variableswere added. Thus, it appears

use.Table2 (page45)showsthatincouples whichthewifewantedno morechildren thatthewife'sperception ofherhusband's
inwhichbothpartners approvedoffami- weremorelikelytobe practicing contra- attitudemayhave itsimpacton contra-
lyplanning, thewifewas morelikelytore- ceptionthanwerethoseinwhichthewife ceptiveuse throughincreaseddiscussion
portcontraceptive use thanin couplesin wantedmorechildrenorwas uncertain. offamilyplanning.
whicheither thewifeorthehusbandalone Thisassociationremainedaftertheeffects Therelativerisksforthefinalmodelare
reported approval.Thetableshowsa sim- ofconfounding variableswerecontrolled. also shownin Table4. Womenwho said
ilarrelationship forsmallidealfamily size The husband's desire to have no more theyapprovedoffamily planningwereal-
(0-3children)and contraceptive use. childrendid nothave a significant effect. mostninetimesas likelytobe practicing
Thehypothesis thatbothpartners play *Discussion offamilyplanning inpastyear. contraception as werewomenwho said
a rolein theadoptionofcontraception is Bothdiscussionreportedbythewifeand theydisapproved.Theprobability ofcon-
reinforcedby the associationbetween discussionreportedbythehusbandwere traceptiveuse doubled when eitherthe
wives' reportedcontraceptiveuse and stronglyassociatedwithcurrentcontra- husbandor thewifereporteddiscussion
theirperceptionsoftheirhusband'satti- ceptiveuse,evenwhenconfounding vari- of familyplanning.Womenwho had a
tude towarduse of familyplanning.In ables werecontrolled. smallidealfamily size (0-3children) were
couplesin whichthehusbandapproved *Wife's perceptionofhusband'sattitude to- twiceas likelytobe practicing contracep-
of familyplanning,the proportionof wardfamily planning.Wiveswhobelieved tionas werewomenwhoseideal was six
womencurrently usinga methodwas 26% thattheirhusband approved of family ormorechildren, althoughthedifference
amongthosewhobelievedtheirhusband planningweresignificantly morelikelyto was onlymarginally significant (p<.10).Of
approved, compared with 5% among be practicingcontraceptionthan were thethreeconfounding backgroundvari-
thosewho believedtheirhusbanddisap- thosewhofelttheirhusbanddisapproved ables, onlyurbanresidencehad a more
proved.In couplesinwhichthehusband orthosewho saidtheydid notknowtheir thanmarginally significant effect.
disapproved,the proportionwas 11% husband'sattitude.As theresultsin the Overall,thewife'sattitudesand pref-
amongwomenwho believed theirhus- second column show,this relationship erences appeared to be more strongly
bandapproved,and 3%amongthosewho persistedeven whenconfounding back- associatedthanherhusband'swithherre-
believedtheirhusbanddisapproved. groundfactorswerecontrolled. port of currentcontraceptiveuse. The
Weusedlogistic regression tofurther ex- After estimatingthese preliminary resultsneverthelesssuggest that both
ploretheroleofhusbandsandwivesinthe models, which controlledonly forthe partnersplay a role in the adoption of
adoptionofcontraception. Table3 shows threesignificant background variables,we contraception.t
twosetsofmodelsthatexamineeachofthe redidtheanalysisto examinetheeffects
fertility-related variables.The modelsin of each of thefertility-related variables Discussionand Conclusion
thefirst columnincludeonlythevariable while controlling fortheothers.The lo- The findingsfromourstudy,whichuses
ofinterest; thoseinthesecondcolumnin- gisticregression modelingprocedurepro- data fromthe1988GDHS toexaminethe
cludethreebackgroundvariablesthatwe vides a numberofinsightsintotherela- rolethathusbands'and wives' attitudes
identifiedas confoundingfactors-the tionships betweenthevariablesofinterest. and preferences play in theadoptionof
wife'seducation, whether sheworkedand The beta coefficients fortherelation-
whethershelivedin an urbanarea. shipsthatwerestillsignificant areshown Table3. Relativeriskofcurrentcontraceptive
*Approval offamily planning. Whenno con- in Table4. The wife'sapprovaloffamily use, byselectedfertility-related variables,ac-
trolsforconfoundingvariableswerein- planningand her ideal familysize re- cordingto whetheranalysisis controlledfor
cluded,thewife'sapprovaloffamily plan- mainedsignificantly associatedwithher backgroundfactors
ning was significantly associated with reportofcontraceptive use aftertheother Attitude Uncon- Con-
current contraceptive use; thehusband's fertility-related variablesand theback- trolled trolledt
approvalwas onlymarginally significant groundvariableswere included.How- Attitude toward
(p<.10).*Afterwe introduced controlsfor ever,herdesiretohave no morechildren family planning
confoundingfactors, onlythewife'sap- was no longersignificantly associated Wifeapproves 15.67** 11.75***
provalwas associatedwithcontraceptive withcontraceptive use oncethemodelin- Husbandapproves 2.07* 1.81
use (p<.Ol). cludeddiscussionoffamilyplanning,the Idealfamilysize
*Idealfamily size.The wife'sideal family wife'sapproval offamilyplanningand Wife
sizewas significantly associatedwithcur- herideal familysize. 0-3 children 3.32*** 2.13**
4-5 children 1.63** 1.09
rentcontraceptiveuse even when con- Bothdiscussionvariablesretainedtheir Husband
founding factors werecontrolled. Thehus- significance evenwhendesireforadditional 0-3 children 1.83 1.57
band's ideal familysize had no effect. children andidealfamily sizewereentered 4-5 children 1.05 0.75
intothemodel.Thissuggeststhat,rather Desirefornomorechildren
*Although the p-value for the coefficientassociated thanbeingmerelyan indicator ofdesireto Wifewantsnomore 1.99*** 1.88**
with the husband's approval of familyplanning was Husbandwantsnomore 1.06 1.05
controlfertility,discussionhas an inde-
significantonly at the 10% level, the likelihood ratio
pendentassociation withcontraceptive use. Discussion of familyplanning
statisticforthe addition of this variable to the model 3.34*** 2.79***
showed significanceat the5% level. A wife'sperception ofherhusband'sat- Wife reportsdiscussion
Husbandreports discussion 3.10*** 2.54***
titudetowardfamilyplanningcontinued
tThe resultsoftheregressionmighthave been different
tobe a significantexplanatory factoreven Wife's report ofhusband's
ifthedependentvariablehad been men's reportsofcon- attitude
toward contraception
traceptiveuse. However,theresultsofthebivariateanal-
when boththewife'sapproval and the Wifesayshusbandapproves 6.25** 4.75**
ysisusingmen'sreportsweresimilartothoseoftheanal- husband's approval were controlled.
ysis using women's reports.There was no evidence of However,theeffect ofthisvariablewas no tControlledforeffects
ofwife's
education,
wife working
andurban

interactionsbetweenthemain variablesofinterest. longersignificant oncethetwodiscussion

46 InternationalFamilyPlanningPerspectives

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 toadopta contraceptive methodwithout Ghana.However,we cannotconcludethat
Table 4. Final logistic regression model show- consultingtheirpartner;policymakers eithermenorwomenplayno rolein fer-
ing significant beta coefficients and relative
risks(RR) of currentcontraceptiveuse among and familyplanningprogrammanagers tility decisions.Thereis a needforgreater
couples in Ghana, by variable shouldbe awareofthispracticeand make understanding ofmale-female exchanges
servicesaccessibleto thesewomen. about familyplanning,includinginfor-
Variable ,B RR
The findingthatdiscussionbetween mationonwhotakestheinitiative tolimit
Wifeapproves ofcontraception 2.181 8.85 partners was an important explanatory fertility, who acquires the method, what
Wifereportsdiscussion 0.765*** 2.15
Husband reportsdiscussion 0.776*** 2.17 factorin current contraceptive use shows circumstances enable women to adopt
Wife'sideal familysize 0-3 0.709* 2.03 that husbands,too, have a role in the contraception independently, and whose
Urbanresidence 0.426*** 1.53
Wifeworks 0.490* 1.63 adoptionofcontraception. Bothmen'sand preferences arebeingfulfilled mosteffec-
Wifereceivedsome education 0.517* 1.68 women'sreportsofdiscussioncontribut- tively.Such information, importantfor
*p<.1 ; **p<.05;***p<.0
1. ed independentlyto thefinalmodel ex- bothresearchand programplanning, will
plaininguse ofcontraception. The find- onlybe acquiredthrough research designs
ingthatdiscussionretaineda significant thatincludebothmenand women.
contraceptives inGhana,haveimportant associationwithcurrentuse of contra-
implications bothforfuture investigations ceptionevenwhenthedesiretostopchild- References
intofertility-related attitudesand behav- bearingwas controlled suggeststhatdis- 1. M. T. Mbizvo and D. J.Adamchak,"FamilyPlanning
Knowledge,Attitudesand PracticesofMen in Zimbab-
ior,and fortheeffective provisionoffam- cussionis morethanjustan indicatorof we," StudiesinFamilyPlanning, T. McGinn,
22:31-38,1991;
ilyplanningservicesin Ghana. desireforfertility control. A. Bamba and M. Balma,"Male Knowledge,Use and At-
The studyrevealedinconsistencies- Giventheavailablecross-sectional data, titudesRegardingFamilyPlanningin BurkinaFaso," In-
some of which were considerable-be- we couldnotclarify thetimingofdiscus- ternational FamilyPlanningPerspectives, 15:84-871989;C.
tweenhusbands' and wives' reportson sion offamilyplanningand adoptionof Oppong, "ResponsibleFatherhoodand BirthPlanning,"
in C. Oppong, ed., Marriage,Fertility and Parenthood in
severalfertility-related variables.Thesein- a method.Thisissue maynotbe impor- WestAfrica,AustralianNational Press,Canberra,1987;
consistencies mayreflect truedivergences tant,however,because a two-wayrela- and P. T. Piotrow et al., "Changing Attitudesand Be-
inattitudes and preferences. Discordance tionshipis likely.Formanycouples,dis- havior:The Zimbabwe Male MotivationProject,"Stud-
may,however,be partlya productofthe cussionoffamily planningwillcontribute iesinFamilyPlanning,23:365-375,1992.
questioningprocedure:Husbands and toeffective and continued use.Inaddition, 2. L. C. Coombs and D. Fernandez, "Husband-Wife
wivesmaydiffer intheiraccuracyofrecall, we could not considerthe topics,fre- AgreementAbout ReproductiveGoals," Demography,
15:57-73,1978.
interpretation ofquestions, desiretoplease quencyornatureofdiscussion becausethe
theinterviewer and opennessin answer- information on discussionavailableinthe 3. L. C. Coombs and M. C. Chang, "Do Husbands and
Wives Agree? FertilityAttitudesand Later Behavior,"
ingquestionson sensitivetopics. GDHS was extremely limited. PopulationandEnvironment, 4:109-1271981;M. A. Koenig,
The findingof significant divergence Inconsistency betweenhusbands'and G. B. Simmonsand B. D. Misra,"Husband and WifeIn-
betweenhusbands'and wives'reports on wives' reportson discussionof family consistenciesin ContraceptiveResponses,"in Population
the husbands' attitudestowardfamily planningsuggeststhat,insomecases,such Studies,38:281-298,1984; and S. N. Mitra et al., "Mea-
ContraceptivePrevalence:Responses fromHus-
planningsupportstheresultsofresearch discussionmay notbe intenseand may suringand Wivesin Bangladesh,"paper presentedat the
bands
elsewherein Africa.18 Althoughthisdi- havelittleimpacton behavior.Forexam- annual meetingofthePopulationAssociationofAmer-
vergencemayto some extentbe an arti- ple,amongcouplesin whichthewifere- ica, Boston,1985.
factof the questioningprocedure,the porteddiscussion,28% of husbandsre- 4. K. 0. Mason and A. M. Taj, "DifferencesBetween
smallproportion ofspouseswhohad dis- portednodiscussion. Thecurrent lowlevel Women'sand Men's ReproductiveGoals in Developing
cussed familyplanning suggests that ofcontraceptive use and apparently high Countries," Population and Development Review,
manywomen may notknow theirhus- levelsofunmetneedinGhana19mayalso 13:611-638,1987
band's attitude.Thislack ofknowledge arisepartlyfromdistantspousalrelation- 5. T. Djedouboum,"Le r6lede l'hommedans le bien-etre
mayhaveimportant implications forcon- ships*and poorcommunication between familial,"in L. L. Brandon,Rapportfinalde la conference
sur thebien-etre familialdu Tchad,Ministerede la sante,
traceptive use. partners. Efforts toimprovemale-female N'Djamena, Chad, 1988;T. Dow et al., "Characteristics
The precisereasonsfordiscrepancies communication mayimprovethechances ofNew ContraceptiveAcceptorsin Zimbabwe," Studies
betweenresponsesgivenby wives and ofeffective familyplanning. inFamilyPlanning,17:107-113,1986;M. A. Khalifa,"At-
husbandsaredifficult toelucidate.What- An important limitationofourstudyis titudesof Urban Sudanese Men Toward Family Plan-
ning,"Studiesin FamilyPlanning,19:236-243,1988;P. T.
everthosereasonsmaybe,however,our thattheanalysisfocusedon monogamous Piotrow et al., 1992,op. cit.(see reference1).
findings implythatanyconclusions about couples. Moreover,theGDHS included
0. Akinkugbeetal., "Does theResponsibility forFam-
current orlikelyfuture behaviorbased on onlythehusbandsofcohabiting couples. 6.
ilyPlanningRestPrimarilywiththeWoman?"Planners
single-sexdata willbe subjectto impor- In a settingsuchas Ghana,wheresexual ForumMagazine,1:12-13,1983.
tantbiases.To improveourunderstand- relationships takea varietyofforms, itis
7. A. Muhawenimcha,"L'hommedans les programmes
ing offamilyplanningdecision-making clearlyimportantto considerunions of de planificationfamiliale,"Famille,Sante,Developpement,
inGhana,researchers mustinterview both different types. Dec. 13,1988,pp. 35-38.
menand women. Althoughmanyfactors contributing to 8. G. A. Oni and J.McCarthy,"FamilyPlanningKnowl-
Our resultssuggestthattheattitudes theuse ofcontraception werenotconsid- edge,Attitudesand PracticesofMales in Ilorin,Nigeria,"
and preferences ofthewifearemoreim- eredin thisstudytheanalysisdoes shed International FamilyPlanningPerspectives, 17:50-55,1991.
portant in determiningwhether she lighton some factorsthatare important 9. F. van de Walle and M. Maiga, "FamilyPlanningin
adoptscontraception thanarethoseofher intheadoptionofcontraception. A model Bamako,Mali,"International FamilyPlanningPerspectives,
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jointlymake decisions,openly discuss 10. T.McGinn,A. Bambaand M. Balma,1989,op. cit.(see
*Ofallwomeninterviewed inthe1988GDHS,34%were views and shareinformation on family reference1).
notlivingwiththeirhusband. planningis clearlynot appropriatefor (continued on page74)

Volume 20,Number 2,June1994 47

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FieldBriefings

is and thatitis notharmful.Atthebegin- Sixty-eight percentthoughtthe course said thatsex educationand familyedu-
ningofthecourse,67%offemalestudents should be required,and 20% thought cationshould be taughtbeginningwith
and 58%ofmalestudentscouldnotname parentalapprovalshouldbe necessary be- firstgrade.
evenonecontraceptive method;attheend forea studentcouldtakethecourse. A uniform sexeducationcoursehasstill
of the course, these percentageshad In October1991,theNationalUnionof notbeeninstitutionalized intheMexican
droppedto25%and 18%,respectively. Stu- Parentspublishednewspaperadvertise- schools,althoughmanycoursesarebeing
dentsalso showedimprovements inareas mentsdemandingthatthe teachingof taughtusingelementsoftheIMIFAPcur-
suchas decision-making and self-esteem. "Adolescence and Development" be ricula.IMIFAPrecently completedtrain-
In theopinionsurveyof1,795students stoppedbecauseitwas encouragingsex- ingofteachersand schooladministrators
who had takenthecourse,75%said they ual promiscuity, butIMIFAPhadgarnered inHonduras,Bolivia,Colombia,Chileand
likedthecourse"a lot."Sixty-four percent sufficientsupportand approval of the Uruguayon the"PlanningYourLife"cur-
had talkedwiththeirparentsabout the coursefromparents, teachersandstudents riculumand ondealingwithgovernments
contentsofthecourse;80% thoughttheir thattheSecretary ofEducationdeclaredthe and oppositiongroups.
parentsapprovedofsexualitybeingdis- trialcoursewould continueunchanged. Aretherelessonsforothercountriesin
cussed at school;and 18% did notknow Whena new Secretary ofEducationwas the Mexican experience?Accordingto
what theirparentsthoughtabout the appointed,theend-of-project resultswere Pickde Weiss,"Inthestates,sexeducation
course.Fifty-seven percentsaid theyhad presentedto his administration; on the becamea politicalissue.InMexico,itis de-
notfeltshyduringdiscussionsofsexual- basis ofthese,IMIFAP was asked to de- bated,and we have had to negotiateex-
itytopics;40%feltshybutlikedthecourse velopmoreeducationalprograms. tensively,but always at a privaterather
anyway, and only1%had feltshyand had Finally,in July 1993, the Mexican thanpubliclevel.Whenall theseclippings
notlikedthecourse. Congresspassed theGeneralEducation came out in the newspapers,we first
Studentsgiventheopinionsurveywere Law, encouragingthe "creationof con- thoughtmaybewe shouldanswerback."
alsogivena questionnaire fortheirparents; sciousnessregardingthepreservation of Theydecidednotto,because "thenthey
a totalof1,406parentscompletedit.Moth- health,familyplanningand responsible answerback,thenwe answerback,and
ers were morelikelyto have spoken to parenthood."'RicardoVernon,a Popula- everyone gets involved." In contrast,
theirchildrenaboutthecourse,especial- tionCouncilassociatewhoworkedon the whenIMIFAP metwithMexicaneduca-
lytotheirdaughters.Themoreeducation project,feelsthattheIMIFAPwork"un- toestablishthatthesexedu-
tionofficials
parentshad,themorelikelytheywereto doubtedly"helped get the law passed. cationprogramwould continue,it "was
talkwiththeirchildren.The vastmajori- "Theimportant pointinallthisis howyou quietlydone at breakfast meetings."
ty(87%) werein favorofteaching"Ado- use researchtocreatepolicychanges,"he
lescenceand Development" intheschools. claims.IMIFAP also arrangedfora na- Reference
A smallpercentage (2.4%)wereagainstit, tionwideGallup poll of2,595Mexicans. 1. Ley General de Educaci6n, Volume 478, No. 9,
and 10% wereneitherfornoragainstit. Of thosepolled who wereparents,90% ArticleVII, ItemsI and X, DiarioOficial,July13,1995.

AttitudesToward FamilyPlanning... erence9); and T. McGinn,A. Bamba and M. Balma,1989, efectos sobre
e independientes
significativos
op. cit.(see reference1). el usoactualdeanticonceptivos.
(continued
frompage47)
19. GSS and IRD, 1989,op. cit.(see reference13).
Resume
11. A. Sen, "Cooperation,Inequality,and theFamily," Resumen Uneetudebase'esurlesdonne'es del'Enquete
and
in G. McNicoll and M. Cain, eds., RuralDevelopment Unestudiorealizado enbasea losdatosdela de'mographique etdesante'effectue'e en 1988
and Policy,supplementto Popu-
Population:Institutions Encuesta Demogrdfica ydeSaludrealizada en au Ghanare'veleque77%despartenaires con-
lationand Development Review,Vol. 15,1989. Ghana,en1988,revela queel77%delaspare- jugauxvivantsousle memetoitavaientdes
12. N. Kabir,"Do WomenGain fromHigh Fertility?" in jas que cohabitan demuestran actitudessi- attitudessimilaires concernant la planifica-
H. Afshar,
ed., Women,WorkandIdeology
intheThirdWorld, milaresconrespecto a la planificacio'n etque73%descouples
fami- tionfamiliale, dumeme
TavistockPublications,London and New York,1985. liaryqueel73% delasparejasqueestaban de avisapprouvaient l'utilisationdecontracep-
13. Ghana StatisticalService(GSS) and InstituteforRe- acuerdo aprobaban elusodeanticonceptivos.tifs.Cependant, seulement 61% dese'pouses
sourceDevelopment/MacroSystems,Inc. (IRD), Ghana Sinembargo, solamente el61% delasesposas ontfaitcorrectement etatdel'attitude deleur
DemographicandHealthSurvey,1988,Accra,Ghana, and informaron enforma correcta sobrela actitud mari.Bienque76% descouples aientleme^me
Columbia, Md., Sept. 1989. desusco'nyuges. Si bienel76% delasparejas avisquanta'l'agrandissement deleurfamille,
andBirth
14. W Bleek,SexualRelationships ControlinGhana: estuvieron deacuerdo conrespecto al deseode seulement 44% ontdonne' desre'ponses con-
A CaseStudyofa RuralTown,UniversityofAmsterdam, Vit- tenerma's hijos, solamenteel 44% res- cordantes sur la tailleidealede la famille.
gave,Netherlands,1976;S. K. Gaisie,DynamicsofPopula- pondieron de la mismaforma conrelacio'n al Parmilespersonnes interroge'es ayantaffir-
tionGrowthinGhana,University ofGhana,Accra,1969;and 35%
tamafno idealdelafamilia. Entrelaspersonas mesconnaftre unemethode contraceptive,
M. Verdon,TheAbutiaEweofWestAfrica: A ChiefdomThat
NeverWas,MoultonPublishers,Berlin,Germany,1983.
quedijeron queconocifan unmetodo anticon- dese'pouseset39% desmarisontdeclare'avoir
ceptivo,el35% delasmujeres yel39% delos discute deplanificationfamilialeavecleurcon-
15. W. Bleek,"Familyand FamilyPlanningin Southern Uneanal-
hombres indicaron quehabifan discutido con jointau coursdel'anne'eprecedente.
Ghana," in C. Oppong, ed., Sex Roles,Populationand
Developmentin WestAfrica,Heinemann, Portsmouth,
su parejasobreel temadela planificacio'n fa- ysedere'gressionmontre quela re'sidence ur-
N. H., 1987 miliarduranteel afloprevio.Medianteun baine,I'attitude de l1e'pousea' le'gardde la
analisisderegresio'n se indicaquela residen- planification familiale,etla discussion dela
16. W. Bleek,1976,op. cit.(see reference14), p. 143.
cia urbana,la actituddela mujerrespecto de planification
familiale entre conjoints ontdes
17. GSS and IRD, 1989,op. cit.(see reference13). la planificacio'n
familiar y el intercambio de effetsindependants significatifssurl'utilisa-
18. F.van de Walle and M. Maiga, 1991,op. cit.(see ref- opinio'nentrela parejasobreestetemasurten tioncourante decontraceptifs.

74 InternationalFamilyPlanningPerspectives

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