How Husbands Influence Women in the Use of Contraceptives – Spousal Factors

9/7/12

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4.3cm x 5.5cm

Mak Wei LanMedical Social WorkerMedical Social Work Department

Medical Social Work Department (MSW)

KK Women’s and Children’s Hospital

Introduction

Unintended pregnancy – social, psychological and financial costs (Klima, 1998)

Consisting of mistimed and unwanted pregnancies (Moos, 2003)

A burden to a nation’s healthcare and resources, associated with late

bookings for prenatal care, lower birth weight and even child abuse (Moos,

2003; Schwartz, 2010)

The use of family planning is thus pivotal in giving individuals and couples

the freedom “to anticipate and attain their desired number of children and

the spacing and timing of their births.” (WHO, 2011)

Introduction

Lack of contraceptive use is one of the causes of unintended pregnancy

Contraception: ‘intentional prevention of pregnancy’ (Moos, 2003)

Barrier methods, steroid hormonal, intrauterine devices, male and female

sterilization and emergency contraception

Introduction

Patients seen in MSW Department for Abortion Counseling

Marital Status June’11-May’12 June’10-May’11

Married 165 140

Single 153 199

Divorced 27 23

Introduction

Personal Factors

Partner Relationship

Factors

Societal and Cultural Factors

Age

Income

Religion

Education & Working Status

Unreliable Use of Contraceptives

Lack of Information, Misinformation &

Fear of Side Effects

Pregnancy Motivations

Quality & Stage of Relationship

Domestic Violence

Partner Involvement & Communication

Self-Efficacy & Partner Involvement

Social Status of Men & Women

Accessibility

Determinants of Contraceptive Use

Introduction

Partner Influence is one of the determinants of contraceptives use (Kern et

al, 2003; Soler et al, 2000)

The study aimed to explore women’s experiences of how husbands

influence their decisions in the use of contraceptives within a Singapore

context, using a sample from KK Women’s and Children’s Hospital

Methods: Criteria

Female patients from KK Women’s and Children’s Hospital, Singapore

Married

21-30 years old

English speaking

Have experienced an unintended pregnancy

Methods

5 participants recruited from the Specialist Outpatient Clinic and Medical

Social Work (MSW) Department

Open-ended interviews with an interview guide

Interviews conducted over the phone or face-to-face

Methods: Interview Guide

24 questions

Themes: Relationship, decision-making, conflict resolution, communication,

influence, contraceptives and pregnancy

Methods: Interview Guide

Interview Guide

Methods: Participants and Procedures

Characteristics of Participants

Participant

Age/Occupation Husband’s Age/Occupation

Ethnicity Educational Level

Number of Children

A 31/Marketing Coordinator

38/Logistics Chinese Secondary School

N.A.

B 31/Childcare Teacher 37/Property Agent

Chinese Secondary School

3

C 30/Homemaker 29/Pest Controller

Malay Primary School 2

D 21/Nursing Student 25/Delivery Driver

Malay Secondary School

1

E 23/Homemaker 28/Lifting Supervisor

Indian Secondary School

4

Methods: Data Collection and Analysis

Interviews were taped with permission from participants and then transcribed

Transcripts were read several times to familiarize and gain an overall impression of

the data before a deeper analysis was carried out

Primary codes: Contraceptives, family planning, relationship with husband and

decision making

Subcategories and categories identified

Results (i)

Women’s Experiences of Husbands’ Influence in the Use of Contraceptives

Opinions on Using Contraceptives

Concerns about Family Planning and Pregnancy

Relationship with Husband

Decision Making

Purpose of Using Contraceptives

Concerns towards Use of

Contraceptives

Obtaining Information about Contraceptives

Regrets

Future Plans

Spousal Factors

Financial Considerations

Children’s Well-Being

Display of Concern

Communication

Relationship Satisfaction

Satisfaction

Compromise with Husband

Display of Support

Results (ii)

Spousal Factors

Consensus with Husband on which Contraceptive to

Use

Husband’s Limited Role in Decision

Making

Husband’s Fair Understanding of Contraceptives

“..so I asked [my husband], do you agree. Then he asked, are you

comfortable with the injection, the pain?”

“because for [my husband], he doesn’t actually do research first. For me I’m someone who will do research for this kind of thing. So I actually went to research on the different side effects of each and every one of them.. So that’s why after that, I was telling him. This will happen, this and this will happen. Cause pregnancy how many percent”

“I’m the one who gives [my husband] ideas you know. Then he says ok, its

up to you. So boring”

“for [my husband] I would say he has a fair understanding of it. We do have the mutual respect in the sense that he does understand the consequences if we do not use contraceptives and other things”

Results (iii)Relationship with Husband

Display of Concern Relationship Satisfaction

Communication

Husband shows concern

Mutual consultation

Discussion about contraceptive options

Discussion about family size

Frequent communication

B: “..[my husband] is quite, I would say, easy going. So long as [the contraceptive] doesn’t cause me any harm I would say he is still alright about it”

C: “.. he will call me about small things. He understands women’s emotions are hard to control”

B: “.. Usually if I decide to do something, I will talk to him.”

Satisfaction with relationship

Perceive husband’s satisfaction

C: “..so far so good. No problems.”

E: “..we are good, we are happy. There is trust between us.”

D: “[husband says that] I am the best wife”

Results (iv)

Decision Making

Satisfaction Compromise with Husband

Display of Support

C: “.. When it comes to decisions, we will discuss.. Whatever things, we will talk over.”

D: “..Sometimes I give in to some of the things that he really wants. We seldom fight about making decisions.”

A: “.. [when it comes to resolving] problems, he will give into me”

Advice Giving

Mutual communication

E: “..[husband will say] yeah its true, I need your advice before going into it.”

E: “.. Money problems.. He will ask me for advice..”

Discussion (i)

The study aimed to explore women’s subjective experience in contraceptive

use, including how husbands influence women in their decision to use

contraceptives.

There were significant issues that were raised from this qualitative study,

through a variety of experiences that these women shared during the

interview.

Findings are consistent with the general trend that birth control is often

regarded as the women’s responsibility, with men taking a limited degree of

ownership (Bongaarts & Bruce, 1995; Smith et al, 2011)

Discussion (ii)

Multi-level interventions & a combination of male and female

individual and couple interventions

There may be a need for programs to include support and training

for women when it comes to autonomous decision making in

contraceptive use.

Discussion (iii)

Highlights the need for contraceptive education to have an increased focus

on the personal responsibility of men when it comes to the use of

contraceptives, which would likely lead to increased involvement in decision-

making.

Gender-specific programmes such as through including male-female

negotiation concepts within schools, hospitals and family service centres

may be useful in achieving a more balanced role in contraceptive decision-

making. However, one needs to be cautious that efforts are made to

increase male involvement without male dominance (Bongaarts & Bruce,

1995).

Discussion (iv)

Most research may tend to focus on women and couples, few actually

focuses on healthcare providers.

Healthcare providers: advocates, gatekeepers and partners

Important for them to understand contraceptive users’ culture and social

context which they are from as it may affect how they relate to clients.

Explore healthcare providers’ views on contraceptives, the systems within

which they are from and work in as a means to meet the needs of

contraceptive users and improve service delivery.

Discussion (v)

However, with the creation of coitus-independent contraceptive

methods such as the pill, women gain more control of contraception

Hence, while more people are calling for increased involvement of

men in this area, methods such as the pill in fact allow women to

take more control over their reproductive decisions (Darroch, 2000).

To what extent then should men be involved in contraceptive

decision making?

Limitations

Small sample size

Female perspective

Timing of the interviews

Contributions

Exploratory study

However, findings contribute to the literature on gender imbalances

when it comes to contraceptive responsibility.

Increasing husbands’ involvement in the arena of family planning

seems to be essential in having more effective contraceptive use

and fewer unintended pregnancies, as studies have found (Kern et

al, 2003; Soler et al, 2000).

Conclusions

Limited male involvement in contraceptive decision making.

Male and female as well as couple interventions are recommended

On a macro level, information can be disseminated through various means

to educate and increase awareness in the area of contraceptive

responsibility and options.

However, given the availability of coitus-independent contraceptive

methods, is there really a need for men to play a greater role in this area?

And if so, what should the role be?

References

Berg, B.L. (1989) Qualitative Research Methods for the Social Sciences Allyn and Bacon Massachusetts, USA

Bongaart, J. & Bruce, J. (1995) The causes of unmet need for contraception and the social content of services Studies in Family Planning (26)(2)(57-75)

Darroch, J. (2000) The pill and men’s involvement in contraception Family Planning Perspectives (32)(2)(90-91)

Denzin, N.K. & Lincoln, Y.S. (2008) Strategies of Qualitative Inquiry Sage Publications Thousand Oaks, California

Fertility Regulation. In RHL The WHO Reproductive Health Library. Retrieved Feb 5 2011, from http://apps.who.int/rhl/fertility/en/

Kerns, J., Westhoff, C., Morroni, C., Murphy, P.A. (2003) Partner influence on early discontinuation of the pill in a predominantly Hispanic population Perspectives on Sexual and

Reproductive Health (35)(6)(256-260)

Klima, C.S. (1998). Unintended Pregnancy: Consequences and solutions for a worldwide problem Journal of Nurse-Midwifery (43)(6)(483-491)

Moos, Merry K. (2003) Unintended pregnancies: a call for nursing action The American Journal of Maternal/Child Nursing (28)(1)(24-30)

Rice, P.L. & Ezzy, D. (1999) Qualitative Research Methods: Health Focus Oxford University Press, Victoria, Australia

Rubin, A. & Babbie, E. (2005) Research Methods for Social Work (5th Ed) Thomson: Brooks/Cole, Belmont, Ca

Schwartz, A., Peacock, N., McRae, K., Seymour, R. & Gilliam, M. (2010) Defining new categories of pregnancy intention in African-American women Women’s Health Issues (20)

(6)371-379

Smith, J., Fenwick, J., Skinner, R., Merriman, G., & Hallett, J. (2011) Young males’ perspectives on pregnancy, fatherhood and condom use: Where does responsibility for birth control

lie? Sexual and Reproductive Healthcare (2)(1)(37-42)

Soler, H., Quadagno, D., Sly, D., Riehman, K. Eberstein, I. & Harrison, D. (2000) Relationship dynamics, ethnicity and condom use among low-income women Family Planning

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