Geeta Nanda, DrPH , MHS Sidney Ruth Schuler, PhD Rachel Lenzi, MPH

1. Exploring Relationships between Gender Attitudes, Couple Concordance, and Family Planning in Tanzania Geeta Nanda, DrPH, MHS Sidney Ruth Schuler, PhD Rachel Lenzi, MPH

2. Background • Gender norms and power relations play an important role in reproductive decision-making • The role or views of one spouse cannot fully represent the views or actions of the couple • There is suggestive evidence on the role of communication and gender equitable attitudes in predicting contraceptive use

3. Study Objectives • To explore three measures of couple concordance as they relate to contraceptive use in peri-urban regions of Tanzania: • Relative scores on the Gender Equitable Men (GEM) Scale • Perceived spousal approval of family planning (FP) • Spousal communication about FP

4. Methods and Analysis

5. Research Hypotheses • Hypothesis 1: Couples in which both members endorse gender equitable attitudes will be more likely to use contraception than other couples • Hypothesis 2: When both members of a couple perceive that the other approves of family planning, the couple will be more likely to use contraception than other couples • Hypothesis 3: Couples in which both husband and wife state that discussions on family planning took place more than once in the past three months will be more likely to use contraception than other couples

6. Background Characteristics of Study Sample

7. Gender Equitable Men (GEM) Scale There are times a woman deserves to be beaten Men need sex more than women do A real man produces a male child A woman’s role is taking care of her home and family

8. Percent Distribution: Selected Variables of Interest

9. Couple Concordance on Gender Equitable Attitudes as a Predictor of Contraceptive Use ns = not significant; *p< .05, **p<.01, ***p<.001

10. Couple Concordance on Perceived Approval of FP as a Predictor of Contraceptive Use ns = not significant; *p< .05, **p<.01, ***p<.001

11. Couple Concordance on FP Communication as a Predictor of Contraceptive Use ns = not significant; *p< .05, **p<.01, ***p<.001

12. Summary of Results • Couples who express concordance in gender-equitable attitudes are more likely to use contraception than couples in which both members express less equitable attitudes (OR = 2.8, p < .05) • Couples who both state that the other approves of FP are more likely to use contraception than couples who disagree (or don’t know) about the other’s approval of FP, or couples who both perceive that their spouse does not approve of FP(OR = 2.5, p < .01)

13. Summary of Results (cont’d) • Couples who both report that they had discussions about FP more than once in the past three months are significantly more likely to use contraception than couples in which both members agree that they have discussed FP less than once in the past three months or disagree or don’t know (OR = 2.1; p < .05)

14. Study Limitations • Small sample size (n=400) • Respondents have high FP use • Cannot establish causal relationships due to cross-sectional survey design

15. Discussion • Improving gender equitable attitudes and encouraging couple communication will be conducive to FP • The views of both spouses matter, and concordance of views is a better predictor than one spouse alone

16. Acknowledgments • This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the C-Change program, managed by FHI360, and do not necessarily reflect the views of USAID or the United States Government.

17. THANK YOU For more information, contact: Rachel Lenzi rlenzi@fhi360.org http://www.c-changeprogram.org/