The Influence of Wives' and Husbands' Education Levels On Contraceptive Method Choice in Nepal, 1996-2006

CONTEXT: The association between education level and fertility, contraceptive behavior and method choice has been extensively researched, but little is known about how the education differential between husbands and wives in Nepal may influence the choice of specific methods. METHODS: Data collected from currently married, nonpregnant women aged 15-49 in the Nepal Demographic and Health Surveys of 1996, 2001 and 2006 were analyzed to identify shifts in the education levels of husbands and wives and the influence of those shifts on couples' current contraceptive method use over the past decade. Multinomial logistic regression models assessed associations between method choice and each partner's education level, the education differential between partners and a combined education measure. RESULTS: Although the wife's education level was associated with the type of method used by the couple, the husband's education level had more influence on the use of male sterilization and condoms. For example, men with any secondary or higher education were more likely than those with none to rely on either of these methods (relative risk ratios, 1.6-2.1). Furthermore, couples in which the husband had at least six more years of education than the wife also showed increased reliance on male sterilization or condoms (1.6-1.8). Differences in the use of any method of family planning by education level have narrowed considerably in the past decade, although differentials remain in the use of some methods. CONCLUSION: A better understanding of how wives' and husbands' relative educational attainment affects decisions on their contraceptive choices is needed, particularly when both education levels and contraceptive use are increasing.