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Perceptions of husband’s fertility preferences and covert contraceptive use in 8 Sub-Saharan African countries

Dana Sarnak, Johns Hopkins University, Bloomberg School of Public Health
Alison Gemmill, Johns Hopkins Bloomberg School of Public Health

Covert use of contraception is a common but underreported and understudied phenomenon where one partner uses contraception without the other’s knowledge. This paper uses an indirect estimate of female covert use in eight sub-Saharan African countries to test the association between covert use among female users and perceptions of husband’s fertility preferences. We used DHS couple data to examine the relationship between wives’ perceptions of husbands’ fertility preferences and type of contraceptive use (overt versus covert) in Benin, Ethiopia, Kenya, Mali, Nigeria, Sierra Leone, Uganda and Zambia using logistic regression. Perceptions that husbands wanted more children were associated with increased odds of using covertly compared to perceiving that husbands wanted the same number in all countries except Benin and the strength of the relationships ranged from aOR 2.97 in Zambia to aOR 4.31 in Sierra Leone. Not knowing husbands’ fertility preferences was also associated with increased odds of using covertly compared to perceiving that husbands wanted the same number in all countries except Zambia, ranging from aOR 1.99 in Ethiopia to aOR 3.88 in Kenya. Understanding the factors associated with covert use has critical programmatic and policy implications for reproductive health and autonomy.

Keywords: Family planning and contraception, Sexual and Reproductive Health and Rights

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  Presented in Session 71. Barriers to Contraceptive Use