Communicator: Journal of Indian Institute of Mass Communication,New Delhi Vol. XLII No.1 Jan-Dec 2007

INTER-SPOUSAL COMMUNICATION IN REPRODUCTIVE HEALTH

Dr. Y.L. Tekhre*, Mrs. Vandana Bhattacharya**, Nishith***

ABSTRACT

RATIONALE: Inter-spousal communication has been recognized widely for sustainable family well-being. Such communication especially has immense significance in seeking overall health care and reproductive health care in general and family planning services in particular. Yet demographic studies have tended to focus on women alone which shouldn’t be confined to women only. The utility of RCH and success of services depend upon certain aspects of inter-spousal communication in the different communities. Therefore, with regard to decision making, data required are to be collected from both the spouses who can answer questions about couple communication, negotiation and the degree of men’s influence on fertility or contraceptive usage. Family size, conception, pregnancy, spacing and choice of contraception are directly linked with the spousal communication. International Conference on Population and Development held in Cairo in 1994 and the Fourth World Conference on Women held in Beijing in 1995 emphasized the importance of reproductive rights and reproductive health for both men and women and greater involvement of men in reproductive health.

It is recognized that there is a dire need of equity in gender relation, responsible sexual behaviour and active involvement of men in reproductive health programmes in order to meet the women’s reproductive health needs as well as their own. In order to know the level of male participation in reproductive health services, a need for expanding the appropriate spousal interaction/communication is felt. If the male partners are not included in reproductive channels, the end result will remain doubtful. It is estimated that approximately 19 million unsafe abortions take place around the globe of which over 50 percent (10.5 million) occurred in Asia (Ahmad and Shah).

OBJECTIVE

The aims of this paper are:

(i) To examine the nature and extent of inter-spousal communication on various aspects of Reproductive and Child Health;

(ii) To find out the attitude and decisions about contraceptive method and family size among spouses.

(iii) To explore the variation among the diverse segment of population/state on the subject of inter-spousal communication and reproductive health issues.

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________________________________________________________________________* Dr. Y.L. Tekhre, Director (Research), National Human Rights Commission, Faridkot

House, New Delhi 110003, (Former Professor of Social Sciences, National Institute of Health and Family Welfare, Munirka, New Delhi) E-mail: yade_lal@yahoo.co.in

** Mrs. Vandana Bhattacharya, Research Officer, Department of Social Sciences, National Institute of Health and Family Welfare, Munirka, New Delhi-110 067. Email: vandanabhattacharya@rediffmail.com

*** Nishith, National Human Rights Commission, Faridkot House, New Delhi 110001

INTRODUCTION

Although both men and women make important contributions to the production of children, demographic studies of fertility and family planning have focused on women or have looked at men from a narrow range of approaches. Now in recent years, it is widely recognized that communication between spouses/partners and shared decisions are at the core of sustainable family well-being. Such communication proves especially important in seeking overall health care and reproductive health care and family planning services in particular. A study in India found that husbands were the principal decision-makers and initiators of discussions about family planning use. As one group of researchers has noted, power imbalances in marriages favour men, and the husband's opposition to contraception may be sufficient to block use in many cases, but the reverse--the wife's opposition preventing use if the husband is favourably inclined--will occur less often. The researchers conclude, "This asymmetry means that when spouses disagree, women's family planning aspirations will more often be frustrated than men's."

Current literature supports the view that couples' joint decision-making forms the beginning of family planning use. "Programs aimed exclusively either at men or at women may fail in their purpose, since most sexual, family planning, and childbearing decisions are made or may potentially (and perhaps ideally) be made by both partners of a couple." It is informative to distinguish between contraceptive use resulting from a joint planning process and use by either spouse alone without consultation. A study in the Philippines, however, failed to show that joint decision-making was more strongly associated with contraceptive use than individual decision-making--presumably, as the researchers pointed out, because the index of decision-making used could have been faulty, and husbands' tendency to consider family planning women's concern may have muted the differences. It remains to be conclusively shown, therefore, whether couples' joint decision-making is more strongly associated with family planning use than is decision-making by either spouse alone. Of particular interest are the dynamic of the decision-making process and whether and how spousal communication affects this dynamic. Spousal communication about family planning should be encouraged in rural areas of Nigeria. Since men as well as women play key roles in safe motherhood, communication is necessary for making responsible decisions (Orji Ek.O. et al 2007).

1. STATEMENT OF PROBLEM

The right to reproductive health is a key component of women’s and men’s reproductive and sexual rights. Moreover, the achievement of reproductive health is inextricably linked to women’s and men’s ability to exercise reproductive and sexual rights i.e. I) reproductive decision making 2) equality and equity for men and women and 3) sexual and reproductive security. The catalyst to active these rights, to which we generally ignore is inter-spousal

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communication which is important for sustainable family well-being. Such communication especially has immense significance in seeking overall health case and reproductive health care in general and family planning services in particular. The present study reveals that with regard to decision making, data required are to be collected from both the spouses about couple communication, negotiation and the degree of men’s influence on fertility or contraceptive usage. Further more family size, conception, pregnancy, spacing and choice of contraception are directly linked with the inter-spousal communication

2. METHODOLOGY

Study Area

Two states were taken for study namely, Tamilnadu & Orissa on the basis of a well performing state and comparatively a poor performing state respectively in a large reproductive health issues respectively.

Sampling Design and Sample Size

Four different purposive samples were selected representing urban, rural, slum and tribal populations from each state. Tamilnadu was selected since it was a well performing state in various parameters of reproductive health. Orissa was selected since it was a backward state in several aspects of reproductive health scenario.

For each group of sample 300 male respondents were randomly selected with specific criteria that the respondent should be married, whose wife was in the reproductive age group (i.e., 15-45 years of age), had spent at least one year of married life and had at least one child

Data Collection Tools and Techniques

The data were collected through personal interview with the help of a semi-structured and pre-tested interview schedule specially designed for this study. To supplement the survey at different points of investigation some qualitative techniques were used such as Focus Group Discussion (FGD) and in-depth interview among males.

3. SUMMARY OF THE RESULTS/FINDINGS

Table 1: Distribution of Male Respondents on ‘Spousal Discussion’ about Number of Children, the Couple Want to Have in the Family

N=2398

Discussion within couple

Urban Rural Slum Tribal Total

TN Orissa TN Orissa TN Orissa TN Orissa TN Orissa

Yes 220 295 198 150 244 273 201 84 863 802

% 73 98 66 50 82 91 67 28 72 67No 80 5 102 150 54 27 90 216 335 398

% 27 2 34 50 18 9 30 72 28 33

Total 300 300 300 300 298 300 300 300 1198 1200

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The table shows that respondents discussed with their wives about the number of children, the couple want to have. In all 72% in TN and 67% in Orissa, said yes, whereas 28% in TN and 33% in Orissa said they never discussed the matter with their spouse. The tribal of TN and urban respondents from Orissa were found more advance. Similarly, rural from Tamilnadu and slum from Orissa were found more in percentage towards discussion with couple about size of the family.

FIRST INTERSPOUSAL DISCUSSION REGARDING FAMILY SIZE

0%

10%

20%

30%

40%

50%

60%

Urb

an

Ru

ral

Slu

m

Tri

bal

Urb

an

Ru

ral

Slu

m

Tri

bal

T amilnadu Orissa

AREAWISE RESPONSE

Immediately after marriage After firstChild After Second Child After third Child

Table 2: Stages of ‘first time spousal discussion’ about number of children, the couple wanted in the family

N=2398

Stages of discussion

with spouse about family

size

Segment of population and stateTotal

Urban Rural Slum Tribal

TN Orissa TN Orissa TN Orissa TN Orissa TN Orissa

Immediately after marriage

65 172 84 84 155 80 38 5 342 341

% 22 57 28 28 52 27 13 2 29 28After first child

38 119 39 27 52 138 18 18 147 302

% 13 40 13 9 17 46 6 6 12 25After two or more

117 4 75 39 37 55 145 61 374 159

% 39 1 25 13 12 18 48 20 31 13

Never 80 5 102 150 54 27 99 216 335 398% 27 2 34 50 18 9 33 72 28 33

Total 300 300 300 300 298 300 300 300 1198 1200

The table clearly shows that the discussion regarding the number of children, the couple wanted in the family, for the first time took place quite later. Only 29% out of 72% in TN and 28% in Orissa out of 67% discussed immediately after marriage; 12% in TN & 25% in Orissa were such who discussed after first child was born; ironically i.e. 31% in TN and

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13% in Orissa discussed after the birth of second or even third child regardless of their segment/group.

Table 3: Distribution of Respondents about Initiative towards Inter-Spousal Communication on Number of Children in the Family According to Their Category and State

N=2398

Initiative taken by

Category/stateTotal

Urban Rural Slum TribalTN Orissa TN Orissa TN Orissa TN Orissa TN Orissa

Husband 63 103 62 36 82 97 65 34 272 320% 21 34 21 12 27 32 22 11 23 27

Wife 16 8 10 11 10 11 31 1 67 31% 5 3 3 4 3 4 10 0 6 3

Both 141 184 126 53 152 165 105 49 524 451% 47 61 42 18 51 55 35 16 44 38

None 80 5 102 150 54 27 99 216 335 398% 27 2 34 50 18 9 33 72 28 33

Total 300 300 300 300 298 300 300 300 1198 1200

It was found that 23% in TN and 27% in Orissa respondents took the initiative to discuss the number of children the couple wanted in the family. Only 6% in TN and 3% in Orissa wives were able to take initiative; 44% in TN and 38% in Orissa respondents said the couple took the discussion together. The gist of the discussion indicates that most of the communications are reciprocal in both the states. Quite a high (28 percent) in TN and 33 percent in Orissa respondents never initiated any communication or discussion towards number of children in the family.

Table 4: Distribution of respondents based on number of Children, when the couple adopted any family planning methods for the first time according to their category and state.

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N=2398

Number of children

in the family

Category/stateTotal

Urban Rural Slum Tribal

Tamil Nadu

OrissaTamil Nadu

OrissaTamil Nadu

OrissaTamil Nadu

OrissaTamil Nadu

Orissa

No child 5 4 3 5 5 5 0 0 13 14

% 2 1 1 2 2 2 0 0 1 1

One child 69 52 44 26 108 49 9 2 230 129

% 23 17 15 9 36 16 3 1 19 11

Two children 93 80 57 39 66 54 58 0 274 173

% 31 27 19 13 22 18 19 0 23 14

Three and more 49 95 49 49 39 50 83 4 220 198

% 16 32 16 16 13 17 28 1 18 17

Never used any method

84 69 147 181 80 142 150 294 461 686

% 28 23 49 60 27 47 50 98 38 57

Total 300 300 300 300 298 300 300 300 1198 1200

Mean no of children

2.36 3.5 2.5 1.44 2.1 1.1 2.97 2.3 2.5 1.34

The above table shows that total mean number of children at the time of adoption of the first method in Tamilnadu is 2.5 whereas Orissa shows 1.34 mean no of children. At the same time total respondents 38% in Tamilnadu and 57% in Orissa never used any contraceptive method. One can derived that the TN respondents (19 percent) adopted any family planning methods first time after one child, whereas only 11 percent in Orissa.

0%

20%

40%

60%

80%

100%

INTERSPOUSAL COMMUNICATION REGARDING NUMBER OF CHILDREN IN THE FAMILY

Tamilnadu 73% 66% 81% 67%

Orissa 98% 50% 91% 28%

Urban Rural Slum Tribal

Table 5: Distribution of respondents on initiatives taken by them to adopt family planning methods according to their category (Segment of population) and state.

N=2398

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InitiativesSegment of population and state

TotalUrban Rural Slum Tribal

TN Orissa TN Orissa TN Orissa TN Orissa TN OrissaOwn 68 14 35 25 38 7 40 1 181 47% 23 5 12 8 13 2 13 0 15 4Wife 17 65 4 41 18 48 28 0 67 154% 6 22 1 14 6 16 9 0 6 13Both 120 146 98 52 142 99 55 4 415 301% 40 49 33 17 48 33 18 1 35 25Others 11 6 16 1 20 4 27 1 74 12% 4 2 5 0 7 1 9 0 6 1NA (No method used ever) 84 69 147 181 80 142 150 294 461 686% 28 23 49 60 27 47 50 98 38 57Total 300 300 300 300 298 300 300 300 1198 1200

The above table gives the descriptive statistics of the total 62% of TN and 43% of Orissa respondents, who adopted the family planning methods. The initiative in majority was taken together by the couple i.e. 35% in Tamilnadu and 25% in Orissa. The respondents who took the initiative themselves were 15% TN and 4% in Orissa surprisingly 13% wives took initiatives in Orissa and 6% in TN.

Table 6: Distribution of respondents who had adopted family planning methods according to their category and state

N=2398

Types of familyPlanningmethods

Segment of population and stateTotal

Urban Rural Slum Tribal

TN Orissa TN Orissa TN Orissa TN Orissa TN Orissa

Female sterilization 126 121 82 69 73 88 143 2 424 280

% 42 40 27 23 24 29 48 1 35 23

Oral Pills 19 41 5 18 11 27 0 2 35 88

% 6 14 2 6 4 9 0 1 3 7

IUD/CuT 23 23 24 2 45 4 4 0 96 29

% 8 8 8 1 15 1 1 0 8 2

Conventional method of vasectomy 2 13 0 5 1 3 1 1 4 22

% 1 4 0 2 0 1 0 0 0 2

Condoms 20 21 18 14 30 8 1 0 69 43

% 7 7 6 5 10 3 0 0 6 4

2-3 non permanent methods(variety of spacing methods)

26 12 21 11 58 28 1 1 106 52

% 9 4 7 4 19 9 0 0 9 4

Non scalpel vasectomy 0 0 3 0 0 0 0 0 3 0

% 0 0 1 0 0 0 0 0 0 0

Not using any method (disinterested) 84 69 147 181 80 142 150 294 461 686

% 28 23 49 60 27 47 50 98 38 57

Total 300 300 300 300 298 300 300 300 1198 1200

Table No.6 shows the descriptive statistics of the respondents 62% in TN & 43% in Orissa in relation to the method they adopted at first time. Very high majority i.e. 35% in TN and 23% in Orissa opted for female sterilizations. The data reveals that, women alone are

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carrying the burden of family planning (46% in TN out of 62% and 32% in Orissa out of 43%) as compared to the men. Male sterilizations were found negligible, condom user were also very less 6 percent in TN and 4 percent in Orissa). The table clearly shows the differential practices of contraceptive methods between spouses.

Table 7: Distribution of respondents regarding decision on various family planning methods according to their category and state

N=2398

Decisionmakers

Category of respondents and stateTotal

Urban Rural Slum Tribal

TN Orissa TN Orissa TN Orissa TN Orissa TN Orissa

Husband 60 54 24 42 33 44 43 2 160 142

% 20 18 8 14 11 15 14 1 13 12

Wife 18 8 10 10 62 14 27 2 117 34

% 6 3 3 3 21 5 9 1 10 3

Both 136 167 116 66 115 100 80 2 447 335

% 45 56 39 22 39 33 27 1 37 28

Others 2 2 3 1 8 0 0 0 13 3

% 1 1 1 0 3 0 0 0 1 0

N.A (Not adaptors) 84 69 147 181 80 142 150 294 461 686

% 28 23 49 60 27 47 50 98 38 57

Total 300 300 300 300 298 300 300 300 1198 1200

The above table clearly shows the statistically representation of the decision-maker, to adopt the contraceptive method out of 62% in TN and 43% in Orissa, the couple who took the decision together were 37% in TN and 28% in Orissa. Husbands who took the decisions were 13% in TN and 12% in Orissa. There were courageous females (10% in TN and 3% in Orissa) also who took the decision themselves. The above table obviously highlights that most of the families were having joint decisions on family planning methods; this trend was more in the state of Tamilnadu, as compared to Orissa. In case of Tribal respondents in Orissa the mutual decisions, decision by husband and wife were almost negligible (only one percent). Contrast to this, the Urban segment was prompt (56 percent), families took decisions jointly on the family planning methods.

0%

20%

40%

60%

80%

100%

INTERSPOUSAL COMMUNICATION REGARDING NUMBER OF CHILDREN IN THE FAMILY

Tamilnadu 73% 66% 81% 67%

Orissa 98% 50% 91% 28%

Urban Rural Slum Tribal

Table: 8 Distribution of respondents regarding history of last pregnancy

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N=2398

Was pregnancy planned?

Tamilnadu

History/record of last pregnancy

Planned Unplanned

Urban Rural Slum Tribal Total Urban Rural Slum Tribal Total

82 118 157 60 417 218 182 143 238 78

% 35% 65%In case planned, who planned

Husband 11 9 29 18 67

     

% 13 9 19 30 16

Wife 2 4 30 2 38

% 3 4 19 3 9.5

Both (Husband and Wife) 69 105 98 40 312

% 84 88 62 67 74.5

Total 82 118 157 60 417If not planned, reasons of failure

Contraceptive failure 2 7 19 6 34

% 1 4 13 2 4

No use of contraceptive 216 175 124 232 747

% 99 96 87 98 96

Total 218 182 143 238 782

Orissa

Planned Unplanned

Was pregnancy planned? 261 82 209 130 682 39 218 91 170 518

% 56.8% 43%

In case of planned, who planned

Husband 3 8 5 3 18          

% 1 10 3 2.3 2      

Wife 2 4 30 2 38      

% .5 17 14 2 5      

Both (Husband and Wife) 256 60 174 125 644      

% 98.5 73 84 96 94.4          

Total 261 82 209 130 682          

If pregnancy was not planned, reasons of failure

Contraceptive failure 1 15 3 13 32

% 1 7 3 66 62

No use of contraceptive 38 203 88 157 486

% 99 93 97 94 93.8

Total 39 218 91 170 518

The distribution of data shows that 35% of TN respondents said the pregnancy was planned whereas 65% said it was unplanned. In Orissa 56.8% respondents aid it was planned and only 43% said no this gives quite a different picture.

The respondents who said the last pregnancy was planned (35% in TN) the decision of wives; in this regard was minimum (9.5%), husbands (6%) but the decision of both, the couple was at large (74.5) as said by respondents. The picture is somewhat different in Orissa (56.8%) said yes it was planned. Out of this only 2% husbands planned; whereas 5% wives and 94.4%. The couples planned for the pregnancy.

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The major reason behind the unplanned pregnancy was no use of contraceptives among the two states. In the state of Tamilnadu, it was 96% whereas in Orissa it was 93.8% out of total unplanned pregnancies.

CONCLUSION

Table 9: Demographic characteristics of spouses N=2398

VariablesUrban Rural Slum Tribal Total

TN Orissa TN Orissa TN Orissa TN Orissa TNOrissa

Mean age of wife at marriage (yrs)

20 20 18 20 17 19 17 15 18.26

17.83

Mean duration of marriage (yrs) 14 9.9 12 10.3 12 9.4 15 10.7 13 10Mean Age of wife at first pregnancy (yrs)

20 22.2 19 20 21 20 19 19.5 19.7

20.4

Illiterate (%) 17 52 36 35 40 37 68 75 40 50Mean No. of Children when the couple adopted FPM at first time

2.36 3.5 2.5 1.44 2.1 1.1 2.97 2.3 2.5 1.34

A. Three too’s (too early marriage; too early pregnancy; too many pregnancies): The results shows that mean age of marriage (women) is low in Orissa (17.83 %) as compared to TN (18.26) stretching the span of reproductive years. This early marriages are associated with the early pregnancies. 32% in TN and 25% in Orissa had first pregnancy upto the 18 years of age. Another noticeable thing is that tribals of Orissa had first pregnancy upto the Age of 13 yrs. The data also reveals that (40% in TN and 50% Orissa) majority of women are illiterate more so in Orissa.

Tribal data of Orissa, of early marriage and early child birth as early as 13 yrs of age with 75% of illiteracy among women reflects one of the major reasons, why there was high maternal mortality and infant mortality in the State. Various studies have shown that child mortality found to decline with higher levels of maternal education [1,2,3]. The women who are illiterate and housewives (29.% in TN and 36% in Orissa) have association within side, the home and courtyard, where the family cared for. This is in context to males, who belong to outside. Since education, health care and labour force participation all involve interaction with the outside girls and women face special barriers in these areas [4,5,6].

As we can see the women mainly in Orissa, getting married at earlier age, the opportunity for their education minimizes only 30% in TN and 46% in Orissa had gone upto the primary level. There is consistent evidence from various studies that decrease in the number of years of schooling for girls is almost always associated with early age of marriage. To the extent that marriage is associated with initiation of sexual activity, later marriage would have prevented early initiation of sexual activity and early child bearing, the health risk of which are well known [7].

B. Inter-spousal Communication – Inter-spousal communication is a measure of couple’s personal, social, emotional interpersonal interaction, which helps to understand the dynamics of power relations and adjustments in the day to day life. The data from this study revealed that irrespective of place of residence, a significant percentage of respondents (50% to 98%) reported that they discussed with their wives regarding the number children they would like to have in the family. However, only 28% of tribal

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respondents of Orissa discussed with their wives regarding number of children they would like to have in the family. It was also important to note that about one third of the respondents in Tamilnadu did not discuss with their wives regarding number of children. More than one fourth of respondents in both the states irrespective of their place of residence except tribals discussed immediately after marriage and rest respondents after first child, second or third child was born. While more than fifty percent of urban respondents of Orissa and slum respondents of Tamilnadu discussed immediately after marriage, a few tribal respondents of Orissa ever discussed with their wives.

Reproductive decision making is another aspect of the Inter spousal communication. The respondents of TN as a progressive State reported that 65% of the last pregnancies were unplanned; whereas, in Orissa, which is comparatively backward State, 43% of the last pregnancies were unplanned. The major reason in both the states (96% in TN and 93.8 in Orissa) what respondents reported was no use of any contraceptive methods. The last pregnancy in majority of cases was planned by the couple in both the states.

The results of the FGDs also reported that unplanned pregnancies could have been avoided; communications among the couple were scanty on this issue, whose consequences were born by the respective women.

As far as adoption of family planning methods are concerned, mean number of children after which the couple adopted the Family Planning Method is 2.5 in TN and 1.34 in Orissa. In this TN is showing a different picture. There were also respondents (38% in TN & 57% in Orissa) who never used any method of contraception. The initiative to adopt the Family Planning method was taken together by the couple (35% TN & 25% or), as reported by respondents. Only 6 % in TN & 13% in Orissa, Women took initiative to adopt the FP method. 10% TN and 3% in Orissa females were able to take their decision which shows Orissa has social taboos, associated with family planning and women and minimum inter-spousal communication. The respondents who were not using any contraceptive method is less in TN as compared to Orissa which shows awareness level of importance of family planning is been created among masses in TN which resulted in fairly in fairly good communication exposure among the couple.

The FGD’s conducted showed that there was a huge gap between the knowledge and awareness regarding different contraceptive methods and their actual use or practice among the respondents of both the states irrespective of their place of residence. Awareness about the contraceptive methods was also very low among tribals of Orissa only 3 NSV, cases were found, out of 2400 respondents in both the states.

Out of total, very high majority, i.e. 35% in TN and 23% in Orissa decided for female sterilization. The study also reveals that only women (75% in TN & 77% in Orissa) carries the responsibility of family planning which very clearly emphasis on the fact that yet recent national policy statement emphasis on the importance of choice, this change in approach has not occurred at the programme level. And since clients have limited knowledge of reversible methods, female sterilization remains the dominant method in the programme. This fact can be supported by the data related to the reasons of not using any contraceptive method by the respondents.

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The data clearly reveals male dominance and inferior status occupied by majority of women in the family leads to lesser or no inter-spousal communication. All decisions related to reproductive health issues were likely to be influenced by dominant males.

Recommendations

The study revealed lack of inter-spousal communication on various aspects of reproductive health. Special efforts should be made to emphasize men’s shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning. Special emphasis should also be given on family counseling, IEC activities, community mobilization and active involvement/participation of males in the entire process of RCH programme. Counseling on various aspects of reproductive health, has to be organized by health personnel on regular basis in the community.

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