Male Method Choice in Bangladesh: Does It Matter Who Makes The Decision? Mohammad Amirul Islam Sabu S. Padmadas Peter W.F. Smith Division of Social Statistics University of Southampton, SO17 1BJ, UK British Society for Population Studies Conference, Southampton, UK, September 2006

Outline of the presentation Rationale Objectives of the research Data and methods Determinants of the decision-making process in FP Influence of the decision-making process in FP on male method use against female method use Conclusions

Objectives To explore the associated determinants of the decision-making process in FP (decision taken by mainly wife, mainly husband and jointly). To investigate the influence of the decision-making process in FP on male method use against female method use

Data The study uses the couple data set (N=2249) based on the Bangladesh Demographic and Health Survey. The couple data set is generated by linking spouses from the male data set constituting a sample of 2556 currently married men aged years and that from females which has a sample of 10,544 ever married women aged years. In the DHS women data set, the respondents who started using a contraceptive method after April, 1994 were asked the question, ‘Who is responsible for deciding to use FP?’ The predefined responses were, ‘mainly respondent’, ‘mainly husband’, ‘joint decision’, and ‘other’. Hence the sub-sample for the study was reduced to the size of 946.

Methods A multinomial logistic regression model will be fitted to identify the determinants of decision-making process in FP. A binary logistic regression model will be fitted to understand the influence of decision-making process in FP on couples’ method choice (male/female). Only the significant variables will be included in the final model

Determinants of FP decision-making Response variable: FP decision-making Categories: only by wife, only by husband, jointly The regression results are presented in terms of estimated probabilities corresponding to the estimated coefficients The estimated probabilities are calculated based on the reference couples’ characteristics The characteristics of the reference couple: Marital duration 5-10 years From Dhaka division From rural area Husband has primary level education Wife has primary level education Husband does not have access to newspaper Husband does not approve of FP Wife does not approve of FP

Influence of decision-making process in FP on couples’ FP method choice Study is restricted for couples where - both the spouses are currently using FP method both the spouses reported the same method use wife in the couple is fecund FP decision taken by either or both the spouses

Influence of decision-making process in FP on couples’ FP method choice A binary logistic regression model has been fitted Response variable is: Currently using male method v female method (reference category)

Coding of independent variables FP decision: Mainly wife, mainly husband, joint decision Husband’s Age: less than 25, 25-39, 40 and above Wife’s Age: less than 20, 20-34, 35 and above Number of living children: no children, 1-2, 3-4, 5 and more Division: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet Area of residence: urban, rural Husband’s education: no education, primary, secondary, higher Wife’s education: no education, primary, secondary, higher Wife approves of FP: yes, no Discuss FP with partner: yes, no Husband’s occupation: Unemployed, professional/managerial/technical, agriculture self- employed, agriculture employed, skilled manual, unskilled manual

Regression results If the FP decision is taken only by husband the couple is more likely to use male method, while the couple is more likely to use female method if wife alone takes the FP decision. Furthermore a couple is more likely to use male methods than female methods if - husbands aged 40 years and above, wives aged 35 years and above, husbands have education higher than secondary level, wives have education higher than secondary level, husbands are engaged in un-skilled manual jobs, wife does not approve of FP, and couple does not discuss FP.

Conclusion One third of the couples are taking FP decision without reaching to a consensus with their partners. This may lead to inconsistent and inefficient use of contraception and some time lead to drop out of methods. Couples should be encouraged towards joint FP decision. Sylhet division is not performing well in terms of joint FP decision compared to other divisions which requires administrative action. It is not well understood why urban couples are lagging behind in terms of motivation toward joint decision regarding FP. This needs further investigation. Sex of the spouse who takes decision regarding FP is found to be associated with the type of method in use (male/female). This indicates a serious state of unshared responsibility in contraception which is against the couple perspective of the FP programme. To increase the use of male FP methods among couples male should be more involved in the FP process. Shifting the target of the FP programme from a women only approach to a couple based approach may help improving the situation of FP decision-making process toward shared responsibility in the overall process which may finally lead to more uptake of male methods.