Covert contraceptive use: Prevalence, motivations, and consequences

This paper examines women’s covert use of contraceptives, that is, use without the knowledge of their husbands. Covert use may highlight conflict between husbands and wives about family planning, or it may reflect behaviors that spouses find difficult to discuss together. This study addresses three questions: 1) How is covert use measured in different settings? 2) How prevalent is it? and 3) What are the factors underlying covert use? We examine these questions by drawing on existing studies and detailed survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and a subsample of their husbands. The prevalence of women’s covert use of contraceptives is estimated to account for between 6 and 20 percent of all current contraceptive use and is more widespread in settings where contraceptive prevalence is low. A multivariate analysis of women’s covert use based on the Zambia survey data indicates that difficult spousal communication about contraception is the strongest determinant of covert use. The positive effect of husbands’ disapproval of contraception on covert use works through spousal communication rather than as a direct influence. Husbands’ pronatalism had no significant effect on covert use. The paper concludes with a discussion of the implications of covert use for policies and programs addressing reproductive health issues and gender relations, especially the extent and nature of partner involvement that should be encouraged.