INTER-SPOUSE COMMUNICATION AND CONTRACEPTIVE BEHAVIOR IN CAMEROON: A COUPLE-BASED ANALYSIS MBELLA MBELLA Cédric Stéphane Ministry of Economy, Planning and Regional Development, (Cameroon) And YAKAM YEMTCHOUA Willy Adrien Demographic Research and Training Institute, (Care-Ifa/IFORD-Cameroon) Addis Ababa, 08 february

1. Background 2. Objective 3. Methods 4. Results 5. Conclusion

 While some progress are notable in terms of reducing maternal deaths, the number of deaths remains unacceptably high in developing countries.  Indeed, of the 830 daily maternal deaths registred in 2015, 550 occurred in sub-Saharan Africa and 180 in Southern Asia, compared to 5 in developed countries (WHO, 2015).  In addition, the risk of a woman in a developing country to die due to maternal-related causes during her lifetime is about 33 times more higher than a woman living in a developed country (WHO,2015)

 The situation is more worrying in Cameroon where maternal mortality is still increasing.  On the period, the number of maternal deaths significantly increased from 430 to 782 deaths per 100,000 living births (DHS-MICS, 2011).  In 2011, the risk of death from maternal causes was 1/25 throughout the procreation ages (DHS-MICS, 2011).

 Family planning (FP), a key component of reproductive healthcare, improves maternal health by reducing the number of unintended and high risk pregnancies and abortion-related deaths.  The Bill & Melinda Gates Foundation estimates in 2014 that approximately 1 woman out of 4 could be saved if they had global access to contraception.

 Despite its beneficial impact, FP remains unattainable by many people in developing world and contraceptive prevalence is still at low rate  Contraceptive use is especially low among women in union (married or cohabiting).  While contraceptive prevalence rate (CPR) among married women is 72 % in more developed countries, CPR is around 34 % and 26% in least developed and sub-Saharan countries respectively (PRB,2013).

 In Cameroon, CPR among women in union has increased between 1991 and 2004 from 16% to 26%, but there is a contrast in 2011, with a decrease to 23% (DHS-MICS, 2011).  In addition, 24 % of women in union had an unmet need for family planning in 2011 while this proportion was 22% 1991.

 Spousal communication concerning fertility and FP has emerged as a topic of interest in developing countries.  Inter-spouse communication on FP has been found to have a great influence in the decision making process of couples for adopting FP measures (Islam et al, 2010; Becker, 1996).  It is especially important in male dominated cultures, where, it is thought unnecessary for men to discuss family planning as child bearing and contraception are presumed to be female matters (Islam et al, 2010; Becker, 1996).

 Many studies have been led in Cameroon to find out the dynamic of family planning adoption but these studies mostly focused on the determinants of women’s contraceptive use.  Studies concerning husband’s influence in decision making regarding family size and family planning adoption are not well documented.

This study aims to estimate the effects of spouse communication about FP on current and future contraceptive use of couples in Cameroon

 Data used in this study derive from the 2011Cameroon Demographic and Health Survey combined with the Multiple Indicator Clusters Survey (DHS-MICS, 2011) carried out by the National Institute of Statistics of Cameroon.  The DHS-MICS data is a national representative two-stage sampling survey covering all the ten administrative regions in addition to the two main towns Yaoundé and Douala considered like regions.  The couple dataset was generated by linking two different data-sets. The first one is the male data-set constituted of a sample of 3000 men currently in union (married or cohabiting) and aged between years while the second one is female data-set which has a sample of 9805 ever married or cohabiting women aged between years

 The couple’s data base is obtained by matching within a household the man who is identified as the head of the household with the woman who is identified as his spouse; this resulted in a maximum of one couple per household.  Thus, our study focuses on 2973 couples of men aged between years and women aged between years old.  We made a step by step regression by creating four multivariate models: The first included only our main independent variable, in the second we added couple interaction variables, in the third we added individual- level characteristics and in the fourth we added community-level characteristics.

The specification used in this study is a binary logistic model.  The dependent variables: current use of any contraceptive method; intention to use contraceptive in the future. These variables take the value 1 if woman currently or intend to use contraceptive and 0 otherwise.  Spouse discussion on FP is the main independent variable. It has 3 modalities: 1 : Never; 2 : Once or Twice; 3 : Sometimes/Often;

Control variables: 1. Couple interactions variables : Woman’s autonomy, Couple’s desire for another child 2. Individual-level variables: Number of living children, Religion; Education level, Age groups 3. Community-level variables: Household wealth index, Place of residence.

1.Univariate Analysis Graph1: Distribution of couples by frequency of discussion on FP (n=2973)

2. Bivariate Analysis Graph 2: Current and future use of contraceptives of couples by frequency of discussion (n=2973)

3. Multivariate Analysis  There is a strong positive influence of husband-wife communication about family planning on current and future contraceptive use;  Couples which discussed on family planning once or twice are two times more likely to use contraceptives than couples which never discussed (OR = 2,38; 99%);  Couples which discussed on family planning sometimes/often are three times more likely to use contraceptives than couples which never discussed (OR= 3,18; 99%).  Concerning couples which do not currently using contraceptives, couples which discussed once or twice about FP are more likely to intend to use contraceptive in the future compared with those which never discussed about FP (OR= 2,17; 99%) and couples which discussed sometimes or often about FP were more likely to intend to use contraceptive in the future than those couples in which discussion does not exist (OR= 2,23; 99%).

Variables Current contraceptive useFuture contraceptive use Odds ratio Spouse discussion on Family Planning Never ref Once or Twice 2,38***2,17*** Sometimes/Often 3,18***2,23*** Woman’s autonomy Low autonomy ref Middle autonomy 1.52*** 1.07 High autonomy 1.29** 0.91 Couple’s desire for another child Both want another ref Neither wants another 1.66*** 0.76* Discordant responses *** Number of living children ref *** 1.31*** 4 and more 2.86*** 1.17 Religion Both Christian ref Both Muslim 0.31*** 0.80 Both Animist Both have Different religion Education level Both have None/Primary ref Husband>= Secondary; Wife<= Primary ** Husband = Secondary *** Both>= Secondary *** Age groups Same age or wife is older Husband is older by 1-5 years Husband is older by 5-10 years ref Husband is older by more than 10 years Place of residence Rural ref Urban 0.78* 0.92 Household wealth index Poor ref Internediate 3.37*** 1.88*** Rich 7.86*** 2.10***

Our study also revealed that 06 other factors have a significant influence on current and future contraceptive use of couples. Those factors are:  Woman’s autonomy;  Couple’s Education level differential  Couple’s desire for another child;  Number of living children;  Religion;  Household wealth index.

 This study reveals that spousal discussion about family planning has a strong and positive effect on current and future contraceptive use of couples in Cameroon, even controlling by other socio- economic factors.  Social and behavior change communication (SBCC) in reproductive health rights at all levels and through all traditional and modern communication channels can be an effective way to:  promote dialogue within the couples;  increase family planning use of couples;  and then improve maternal health in Cameroon and in developing countries.

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