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Culture

Two is Better than One

By Christine Grillo

Historically, family planning has been considered the woman's domain. And worldwide, family planning program leaders target women, believing them to be more motivated—and therefore more responsible—users of contraception than men.

More recently, the field of reproductive health began to recognize that men are key players—or can be—not only in use of contraception, but also in the prevention of sexually transmitted infections (STIs) such as HIV/AIDS, and even in perinatal care.

However, the potentially most effective reproductive health programs are those that approach the couple as a decision-making unit, says Stan Becker, PhD '78, professor of Population, Family and Reproductive Health (PFRH). In other words, it takes two to tango. Having written one of the key papers on couple studies in 1996, Becker firmly believes that when counseling women on how many children to have or what kind of contraception to use, or how to prevent disease, involving the man primes the couple for success. "If you educate both partners in the use of contraception," says Becker, "chances are the woman will be a better user."

Studies by Becker and by other School faculty bear out this idea. From the U.S. to Ethiopia and Bangladesh, programs that foster family planning, STI prevention and perinatal health have fared better when they've directed messages at wives and their husbands. In these studies, when husbands received counseling and education along with their wives, contraceptive use was higher (double in a study in Dhaka), the pregnancy and abortion rates were lower, and more infants survived (more than twice as many in a Bombay study).

In further research, Becker has found more evidence supporting the importance of taking the couple approach. As he has documented in several cross-national studies, some miscommunication in a marriage is inevitable, and it's the gaps in communication that may shed the most light on reproductive health. It seems that partners report on objective events with a high rate of agreement, or concordance—about 90 percent—for questions such as, How many years have you been married? and How many children do you have? But when it comes to more subjective questions of reproductive health—such as How many children do you want?—partners are in sync only about 60 or 70 percent of the time in the 10 studies he reviewed.

What this means, says Becker, is that couples aren't talking with each other about reproductive health issues—at least not enough. He notes also that the smallest gaps in husband-wife concordance occur in countries with the lowest fertility. More discussion leads to better family planning. "You have smaller families when couples talk," he says.

There are caveats, of course, to the couple approach—a partner could be abusive, or, in a very male-dominated culture, the man could be the main decision-maker of family size. But Becker hopes that clinicians and providers in the field will consider involving male partners: "Having a knowledgeable and supportive partner," he says, "can lead to better reproductive health outcomes for both men and women."

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