The Influence of Family Dynamics on Contraceptive Use in Madagascar and the Ensuing Impact on Family Well-Being

Author(s): Hajason JZ, Piña K, Raveloharimisy JL

Year: 2013

Abstract:

While studies have shown a relationship between family dynamics and contraceptive use and between contraceptive use and family well-being, no empirical study has been conducted to test whether a relationship exists between family influence on contraceptive use and family well-being. The objective of this study is to explore whether there is such a relationship between family influence on contraceptive use and family well-being.

Methods

A survey was administered in the Vatovavy Fitovinany region of Madagascar, which has one of the lowest contraceptive prevalence rates in the country.  The survey collected data on demographics, access to social services, socio-economic status, family dynamics, and knowledge and practice of family planning. Data were retained for 768 Malagasy couples in a binding relationship, such as marriage and civil union. Multiple regression was used to determine (1) the relationships between contraceptive use and two levels of family dynamics: spousal dynamics (communication and agreement within a couple) and extended family influence (communication and agreement between a couple and their parents) and (2) whether the two levels of family dynamics and contraceptive use were associated with four types of well-being: psychological, physical, intellectual, and economic.

Results

Fifty-seven percent of couples talk to, discuss with, and agree with each other on family planning decisions; 20.8% of couples talk to, discuss with, and agree with extended family on family planning decisions. Fifty-one percent of women use at least one method of contraception.  About 96% of couples who have discussions do so with their spouse before others. There is evidence that while both spousal dynamics and extended family influence were associated with contraceptive use, spousal dynamics showed a stronger relationship. Analyses regarding well-being were inconclusive overall but suggest that spousal dynamics may also have a greater association with well-being than extended family influence.

Conclusion

We recommend increased support for family planning promotion and training that includes couples as a unit rather than women only.  Also, family planning can be promoted during community outreach in order to increase understanding and acceptance within the community, which includes extended family members.