Exploring Relationships between Gender Attitudes, Couple Concordance, and Family Planning in Tanzania Geeta Nanda, DrPH, MHS Sidney Ruth Schuler, PhD Rachel Lenzi, MPH

Background Gender norms and power relations play an important role in reproductive decision- making The role or views of one spouse cannot fully represent the views or actions of the couple There is suggestive evidence on the role of communication and gender equitable attitudes in predicting contraceptive use 2

Study Objectives To explore three measures of couple concordance as they relate to contraceptive use in peri-urban regions of Tanzania: 1.Relative scores on the Gender Equitable Men (GEM) Scale 2.Perceived spousal approval of family planning (FP) 3.Spousal communication about FP 3

Methods and Analysis Source of Data: baseline household survey of 200 couples in Dodoma and Mwanza regions, Tanzania (from a larger OR study testing the effectiveness of radio programming addressing gender norms in support of a CBD program) Dependent variable: current contraceptive use (as reported by women) Independent variables: couple concordance on GEM Scale; couple concordance on FP approval ; couple concordance on FP communication Control variables: age, education, number of living children, region Analyses: multivariate logistic regression 4

Research Hypotheses Hypothesis 1: Couples in which both members endorse gender equitable attitudes will be more likely to use contraception than other couples Hypothesis 2: When both members of a couple perceive that the other approves of family planning, the couple will be more likely to use contraception than other couples Hypothesis 3: Couples in which both husband and wife state that discussions on family planning took place more than once in the past three months will be more likely to use contraception than other couples 5

Background Characteristics of Study Sample VariableWives (n=200)Husbands (n=200) Age years years 66.0% 34.0% 31.5% 68.5% Education No education or some primary Complete primary or higher 26.5% 73.5% 16.0% 84.0% Number of living children None or one Two Three or more 29.0% 26.5% 44.5% 28.0% 24.5% 47.5% Region Mwanza Dodoma 50.0% 50.0% Religion Christian Muslim Other 74.5% 25.0% 0.5% 69.5% 29.5% 1.0% 6

Gender Equitable Men (GEM) Scale There are times a woman deserves to be beaten Purpose: To measure attitudes towards gender norms in intimate relationships Scale Domains: Violence Sexual Relationships Reproductive Health and Disease Prevention Domestic Chores and Daily Life Scoring: 3-point scale Men need sex more than women do A real man produces a male child A woman’s role is taking care of her home and family 7

Percent Distribution: Selected Variables of Interest Variable% Distribution (n=200 couples) Couple concordance on GEM Scale Both H and W have low equity H low equity and W high equity H high equity and W low equity Both H and W have high equity 29.0% 20.5% 28.5% 22.0% Couple concordance on perceived spousal approval of FP Both H and W do not perceive spousal approval of FP, disagree, or DK Both H and W perceive spousal approval of FP 34.0% 66.0% Couple concordance on FP communication (in past 3 months) Both H and W agree on FP communication less than once, disagree, or DK Both H and W agree on FP communication more than once 64.0% 36.0% Current contraceptive use No Yes 54.5% 45.5%

Couple Concordance on Gender Equitable Attitudes as a Predictor of Contraceptive Use 9 VariableAdjusted Odds Ratio Agens Educationns Number of living children 0-1 (R) 2 3 or more 4.17 ** 5.65 *** Region of residence Mwanza (R) Dodoma7.23 *** Couple concordance on GEM Scale Both H and W have low equity (R) H low equity and W high equity H high equity and W low equity Both H and W have high equity ns 2.77 * ns = not significant; *p<.05, **p<.01, ***p<.001

Couple Concordance on Perceived Approval of FP as a Predictor of Contraceptive Use 10 VariableAdjusted Odds Ratio Agens Educationns Number of living children 0-1 (R) 2 3 or more 3.85 ** 5.29 ** Region of residence Mwanza (R) Dodoma4.98 *** Couple concordance on perceived spousal approval of FP Both H and W do not perceive spousal approval of FP, disagree, or don’t know (R) Both H and W perceive spousal approval of FP 2.54 ** ns = not significant; *p<.05, **p<.01, ***p<.001

Couple Concordance on FP Communication as a Predictor of Contraceptive Use 11 VariableAdjusted Odds Ratio Agens Educationns Number of living children 0-1 (R) 2 3 or more 3.40 ** 4.79 ** Region of residence Mwanza (R) Dodoma6.09 *** Couple concordance on FP communication Both H and W agree on FP communication less than once in past 3 months, disagree, or don’t know (R) Both H and W agree on FP communication more than once in past 3 months 2.08 * ns = not significant; *p<.05, **p<.01, ***p<.001

Summary of Results Couples who express concordance in gender- equitable attitudes are more likely to use contraception than couples in which both members express less equitable attitudes (OR = 2.8, p <.05) Couples who both state that the other approves of FP are more likely to use contraception than couples who disagree (or don’t know) about the other’s approval of FP, or couples who both perceive that their spouse does not approve of FP(OR = 2.5, p <.01) 12

Summary of Results (cont’d) Couples who both report that they had discussions about FP more than once in the past three months are significantly more likely to use contraception than couples in which both members agree that they have discussed FP less than once in the past three months or disagree or don’t know (OR = 2.1; p <.05) 13

Study Limitations Small sample size (n=400) Respondents have high FP use Cannot establish causal relationships due to cross-sectional survey design 14

Discussion Improving gender equitable attitudes and encouraging couple communication will be conducive to FP The views of both spouses matter, and concordance of views is a better predictor than one spouse alone 15

Acknowledgments This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. GPO-A The contents are the responsibility of the C-Change program, managed by FHI360, and do not necessarily reflect the views of USAID or the United States Government. 16

For more information, contact: Rachel Lenzi THANK YOU