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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 88-92

Spousal communication on family planning, pregnancy, and delivery care among men in rural Northern Nigeria


Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria

Date of Web Publication6-Jul-2018

Correspondence Address:
Dr. Muhammed Sani Ibrahim
Department of Community Medicine, Ahmadu Bello University, Zaria
Nigeria
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DOI: 10.4103/smj.smj_66_16

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  Abstract 


Introduction: Communication between a husband and wife is necessary for joint decision-making on reproductive health issues. This study assessed the practice of spousal communication and reasons for not engaging in spousal communication among married men in two rural communities in Northern Nigeria. Materials and Methods: It was a cross-sectional study conducted among 411 married men selected through multistage sampling. Data were collected using a structured interviewer-administered questionnaire containing open- and close-ended questions and analyzed using SPSS Statistics version 17.0. Results: All of the men were Muslim and Hausa-Fulani, with mean age 37.3 ± 10.9 years. Overall, spousal communication was adequate in 204 (49.6%) of them. It was highest on whether or not wife should attend antenatal care (ANC) (68.3%), importance of ANC (66.3%), and services available at the health facility during ANC and delivery (55.6%). It was lowest on whether or not the couple should use family planning (22.4%), when to get pregnant (21.0%), husband's or wife's feeling about family planning (21.0%), and number of children to have (14.6%). The most common reason given for not engaging in spousal communication was that religion forbids the act and such discussion is not important. Conclusion and Recommendation: More effort should be put into improving spousal communication, especially in relation to family planning and birth preparedness. Such effort must address harmful cultural and religious beliefs, possibly by collaborating with religious leaders.

Keywords: Delivery, Nigeria, pregnancy, rural, spousal communication


How to cite this article:
Ibrahim MS, Sabitu K, Bashir SS, Olorukooba AA. Spousal communication on family planning, pregnancy, and delivery care among men in rural Northern Nigeria. Sahel Med J 2018;21:88-92

How to cite this URL:
Ibrahim MS, Sabitu K, Bashir SS, Olorukooba AA. Spousal communication on family planning, pregnancy, and delivery care among men in rural Northern Nigeria. Sahel Med J [serial online] 2018 [cited 2018 Nov 19];21:88-92. Available from: http://www.smjonline.org/text.asp?2018/21/2/88/236071




  Introduction Top


Communication between a husband and wife is necessary for joint decision-making.[1],[2] It varies from ordinary conversations between a husband and wife that are not meant to influence each other's views to a detailed discussion of issues that culminate in both partners being involved in decision-making. The amount of spousal communication that occurs between a husband and a wife affects their use of reproductive health services.[3],[4] For example, in the area of family planning, Lasee and Becker observed that couple engaging in spousal communication on family planning were about four times more likely to be current users of the service.[5]

Most research on spousal communication seemed to have been restricted to the area of family planning. In a community-based study done by Orji et al. to assess spousal communication on family planning in Ife, South-Western Nigeria, the findings buttress the fact that both parties are indispensable for responsible decision-making because they each have their key roles to play.[6] In another study done in Ondo state to examine the level of spousal communication and its impact on the use of contraceptives among Yoruba couples in South-Western, Nigeria, contraceptive prevalence was highest among couples who discussed and made joint decisions on contraception.[7] In addition, in Ethiopia couples who openly discussed family planning with each other were found to be more likely to be current users of contraception than their counterparts.[8]

Different researchers have attempted to document the level of spousal communication present among married couples. In Ondo State, Feyisetan reported that men were more likely to have reported that they alone took decisions.[7] On the other hand, for all reproductive health issues, most of the wives reported to have had more say than their husbands conceded to them. This could imply that the old situation where the man used to be in-charge was changing. In another research done in three South-Western states of Nigeria, only 24.5%, 30.9%, and 44.7% of couples had ever discussed family planning once, twice, or thrice, respectively. In the same South-Western Nigeria, the study carried out in Ife reported that only 50% of the respondents had discussed family planning with their partner.[6] In a similar study done in Pakistan, only 43% of the men had discussed family planning with their wives.[9]

There are many reasons why couples do or do not communicate with each other. Most couples who fail to communicate with each other say it is against their social norms or it simply did not occur to them.[9] A qualitative study done in South-Western Nigeria reported a woman as saying “He doesn't encourage discussion on sex; he might report me to his family and I don't want problems with my marriage,” and a male participant was reported to have said, “family planning is for the educated, and that is why they are promiscuous.”[6]

However, the men in qualitative study in Guatemala gave the following as reasons why men engage in spousal communication with their wives: the desire to know what the health-care provider said about the pregnancy and how it is progressing, concern about health of baby and wife, and lack of shame on the part of the husband.[10]

This study assessed the practice of spousal communication on family planning, pregnancy, and delivery care among married men in two rural communities in Northern Nigeria, and the reasons for not engaging in spousal communication, from the perspective of the men.


  Materials and Methods Top


Kaduna State is located in the North-Western region of Nigeria. Dinya and Garu are both rural communities with populations of 6206 and 4842,[11] located in Soba and Kudan Local Government Areas, respectively of Kaduna State and inhabited predominantly by Hausa-Fulani Muslims. Their level of education was generally low among the people of the communities, and the major occupation of the men was farming while the women were mostly petty traders. In addition, both the men and women were involved in handcrafting, sewing, and traditional embroidery. Health-care service is provided by separate primary health-care centers (PHCs) in each of the communities. The major maternal health services rendered by the facilities are antenatal care (ANC) and patient referral. In addition, they offer occasional normal delivery and family planning services, the latter on demand. There is no laboratory support for the services rendered, and data on service utilization and outcomes are poorly kept. Public electricity and water supplies to the PHCs are erratic with no alternative sources.

The study was cross-sectional in design, resulting from the baseline survey of an intervention study done in 2011. It was done among married men who were permanently resident in the communities in the 3 years preceding the survey, presently living in the same home with their wife and had a wife who was pregnant in the preceding 3 years. Multistage sampling technique was used to select the men that were interviewed. In the first stage, random number table was used to select 16 unguwa (unguwa meant a neighborhood with people living within it mostly having similar characteristics) from a list of all the unguwa in each of the two communities, making a total of 32 unguwa. Dinya had 23 unguwa while Garu had 18. The second stage involved the selection of houses and households within each selected unguwa. On arrival at a selected unguwa, a list of all the streets/paths in it was made, and one street was selected as the first to be visited using random number table. Then, all the dwelling houses on the selected street/path were counted and numbered using chalk, and the first house to be visited was also selected from among the houses on the street using the random number table. In the selected house, all households were identified. Where there was more than one eligible household in a house, one of them was selected for interview using balloting. In the third stage, the eligible man in each selected household was identified and interviewed. In the few instances where there was more than one eligible man, one of them was selected using balloting and interviewed. Where there was no eligible married man in a house, it was exited and the next one to its right visited. On completion of the interview in a house, the interviewer exited the house and entered the next house to the right of the one that he was exiting. And on reaching the end of a street or path, he turned into the street or path that was to the right, and entered its first house. This process continued until the required sample size of 13 for each of the 16 unguwa was reached, giving a total of 418 (208 in each community). Where the eligible man has more than one wife who was pregnant in the preceding 3 years, the questions were asked in relation to the wife with the most recent history of pregnancy.

Data were collected using a structured interviewer-administered questionnaire containing open and close-ended questions which were mostly adopted from a previous study.[2] All questions applied to respondents' practices in the last 1 year. The questions were data collection was done by a team of 10 trained research assistants; six junior resident doctors, and four community health officers. All research assistants were male who were fluent in the local language, Hausa. Before the survey, ethical approval was obtained from the Heath, Research Ethics Committee of Ahmadu Bello University Teaching Hospital on 26th January 2011. In addition, permission was obtained from both local government councils and from the leaders of both communities. The nature and objectives of the study were explained to each participant, assurance of confidentiality was given, and verbal consent was obtained before the interview. Any participant who did not consent to participate was exempted.

Data were entered into SPSS Statistics 17.0, (Released 2008. SPSS Inc., Chicago) cleaned, and analyzed. Variables were tabulated using frequencies and percentages, and mean and standard deviation were calculated for the variable age. Microsoft Office Excel 2007 was used to construct the bar chart. A man was regarded as having good spousal communication if he had discussed with his wife at least 5 out of the 10 listed items.


  Results Top


A total of 411 out of 416 men were successfully interviewed, giving a response rate of 98.8%. All of them were Muslim and Hausa-Fulani. Their mean age was 37.3 ± 10.9 years, and 253 (61.6%) had no formal education [Table 1]. The detailed description of their sociodemographic characteristics was included in an earlier publication.[12]
Table 1: Sociodemographic characteristics of the men studied (n=411)

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Overall, spousal communication was good in 204 (49.6%) of them. Spousal communication was highest on whether or not wife should attend ANC (68.3%), importance of ANC (66.3%) and services available at the health facility during ANC and delivery (55.6%). It was lowest on whether or not the couple should use family planning (22.4%) when to get pregnant (21.0%), husband's or wife's feeling about family planning (21.0%) and number of children to have (14.6%) [Figure 1]. The two most common reasons given for not engaging in spousal communication were that religion forbids the act and such discussion is not important [Table 2].
Figure 1: Levels of indices that were used to assess spousal communication among men who discussed with their wife

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Table 2: Major reasons for not discussing with wife among men who did not discuss with their wife

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  Discussion Top


This study reports good spousal communication in about half of the couples in the rural communities studied. Spousal communication was general high on issues related to ANC but particularly low on issues that were related to family planning. The most common reason for not engaging in spousal communication was related to ignorance and religion.

The previous studies that used indices of spousal communication that are purely related to particular aspects of reproductive health, mostly family planning, had also recorded similar levels of spousal communication.[13],[14],[15] Most of these studies recommended that further studies should be carried out using a combination of indices that are both, directly and indirectly, related to reproductive health. In this study, despite the inclusion of indices that are both directly and indirectly related to reproductive health, the level of spousal communication remains good in about half of the couples studied. This seems to imply that the dynamics of spousal communication between the participants, and their wives were the same for most issues, whether directly or indirectly related to reproductive health.

The individual indices that were used to compute spousal communication were also assessed separately in this study. It was observed that the levels of those indices of spousal communication that are directly related to child spacing were lower than the levels of the ones that are not directly related to child spacing. Furthermore, the indices of spousal communication that are directly related to child spacing recorded lower levels here than in other studies. For example, when compared with the findings of a study done in Ilorin,[15] the findings in this study on what husbands and their wives felt about family planning, when wife should get pregnant and whether or not the couple needed to do child spacing recorded levels that were lower than the study conducted in Ilorin. This is most likely due to the prevailing belief in the communities where this study was carried out that Islam does not support family planning.[16]

This study also looked at the reasons why some men did not discuss the individual issues with their wives, and the most common reasons that they mentioned here were related to religion. This agrees with an earlier study that identified religion as a determinant of spousal communication.[15] It also agrees with the findings of another study that observed misconception of Islam to be responsible for low acceptance of child spacing in Muslim communities in Northern Nigeria.[16] However, this finding contradicts that of a study in South-Western Nigeria where the major reason that men gave for not discussing issues on child spacing was that it was a sign of promiscuity while the women mostly said it could lead to rejection from the men.[16] Another common reason given for not engaging in spousal communication is that it is embarrassing. Such male embarrassment and shyness in discussing pregnancy and childbirth issues have been observed in the previous studies.[17] This observation could be a result of social stigma resulting from the perception of pregnancy and childbirth as exclusive affairs of women.[18],[19] The implication of variations in reasons for not engaging in spousal communication is that any approach to improving spousal communication must be tailored to fit the target population.

The study has a few limitations. Spousal communication varies from ordinary conversations between husband and wife not meant to influence each other's views to detailed discussions that culminates in decision-making. The study did not measure the depth or frequency of the communication occurring. In addition, the men could have considered some of the issues asked to be private between husband and wife, raising the possibility of wilful misstatement in some of their responses. However, the study is distinct in the fact it assessed spousal communication from a broader perspective, with indices related to family planning, ANC, and delivery.


  Conclusion Top


The level of spousal communication is generally average but low on issues that are related to family planning, mostly due to ignorance, religious beliefs, and culture. It is recommended that government and other stakeholders concerned with the health of women should work to improve spousal communication, especially in areas related to family planning and birth preparedness. Because the reasons for not engaging in spousal communication are mostly related to religious belief and culture, such effort must address religious misconception, possibly by collaborating with religious leaders so that they are trained and engaged to correct such misconceptions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mott FL, Mott SH. Household fertility decisions in West Africa: A comparison of male and female survey results. Stud Fam Plann 1985;16:88-99.  Back to cited text no. 1
    
2.
Ogunjuyigbe PO, Ojofeitimi EO, Liasu A. Spousal communication, changes in partner attitude, and contraceptive use among the yorubas of Southwest Nigeria. Indian J Community Med 2009;34:112-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kamal N. Inter-spousal communication on family planning as a determinant of the use of modern contraception in Bangladesh. J Fam Welfare 1999;45:31-43.  Back to cited text no. 3
    
4.
Raju S. Husband-wife communication and contraceptive behavior. J Fam Welfare 1987;33:44-8.  Back to cited text no. 4
    
5.
Lasee A, Becker S. Husband-wife communication about family planning and contraceptive use in Kenya. Int Fam Plan Perspect 1997;23:15-20, 33.  Back to cited text no. 5
    
6.
Orji EO, Adegbenro CA, Akinniranye BI, Ogunbayo GO, Oyebadejo AE. Spousal communication on family planning as a safe motherhood option in sub-Saharan African communities. J Chin Clin Med 2007;2:328-35.  Back to cited text no. 6
    
7.
Feyisetan BJ. Spousal communication and contraceptive use among the Yoruba of Nigeria. Popul Res Policy Rev 2000;19:29-45.  Back to cited text no. 7
    
8.
Haile A, Enqueselassie F. Influence of women's autonomy on couple's contraception use in Jimma town, Ethiopia. Ethiop J Health Dev 2006;20:145-51.  Back to cited text no. 8
    
9.
Ali M, Rizwan H, Ushijima H. Men and reproductive health in rural Pakistan: The case for increased male participation. Eur J Contracept Reprod Health Care 2004;9:260-6.  Back to cited text no. 9
    
10.
Carter MW. Because he loves me: Husbands' involvement in maternal health in Guatemala. Cult Health Sex 2002;4:259-79.  Back to cited text no. 10
    
11.
National Population Commission. 2006 Population Census of the Federal Republic of Nigeria. Abuja, Nigeria: National Population Commission; 2007.  Back to cited text no. 11
    
12.
Ibrahim MS, Idris SH, Abubakar AA, Gobir AA, Bashir SS, Sabitu K. Determinants of male involvement in birth preparedness among married men in two communities of rural Northern Nigeria. J Community Med Prim Health Care 2014;26:44-58.  Back to cited text no. 12
    
13.
Lundgren RI, Gribble JN, Greene ME, Emrick GE, de Monroy M. Cultivating men's interest in family planning in rural El Salvador. Stud Fam Plann 2005;36:173-88.  Back to cited text no. 13
    
14.
Abraham W, Adamu A, Deresse D. The involvement of men in family planning an application of transtheoretical model in Wolaita Soddo town, South Ethiopia. Asian J Med Sci 2010;2:44-50.  Back to cited text no. 14
    
15.
Araoye MO. Communication and decision making about reproductive health issues within couples in Kwara State, Nigeria. Trop J Obstet Gynaecol 2006;23:63-9.  Back to cited text no. 15
    
16.
Ibisomi L. Improving Contraceptive Use in Northern Nigeria: Could Male Involvement Make a Difference? Proceedings of the 26th IUSSP International Population Conference, Marrakech, Morocco; 2009. Available from: http://www.iussp2009.princeton.edu/download.aspx?submissionId=91613. [Last accessed on 2016 Dec 09].  Back to cited text no. 16
    
17.
Lewis S, Lee A, Simkhada P. The role of husbands in maternal health and safe childbirth in rural Nepal: A qualitative study. BMC Pregnancy Childbirth 2015;15:162.  Back to cited text no. 17
    
18.
Mullany BC. Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal. Soc Sci Med 2006;62:2798-809.  Back to cited text no. 18
    
19.
Nesane K, Maputle SM, Shilubane H. Male partners' views of involvement in maternal healthcare services at Makhado Municipality clinics, Limpopo Province, South Africa. Afr J Prim Health Care Fam Med 2016;8:e1-5.  Back to cited text no. 19
    


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