Perceived fertility desires of spouses and use of modern contraception among women in Rakai, Uganda

Most societies in Sub Saharan Africa are patriarchal with major decisions made by men. However studies on family planning mostly focus on women and ignore power dynamics within relationships. Here we use data collected between 2013 and 2015 from 2636 couples, part of a community based cohort, with the aim of assessing how women's perception of their spouse's fertility desires affects her use of modern contraception. We used mediation analysis for this. We also used Chisquare tests to assess how accurate women's perception of her spouse's fertility desires was by comparing it with her partner's reported fertility desires. We found that in 53.9% of the couples there was concordance between the female's perception of their male spouse's fertility desires and the reported fertility desires of the male spouse. However is 28.9% of couples females thought the man desired a child while the male did not desire a child. We also found that female's fertility desires were indirectly influenced by their perceptions of the male spouse's fertility desires which affected their use of modern contraception. This indirect effect was statistically significant (11%; p<0.001). There is a need to promote increased spousal communication which would help merge perceptions and actual desires within a couple in this setting. This would help reduce the high rates of unmet need for contraception observed in similar settings.