Contraceptive method choice and spousal communication: examining the effect of family planning method using an instrumental variable approach

Objectives - Spousal communication is an important factor in reproductive health outcomes, including family size, contraceptive use and conflict. A purported advantage of traditional contraception is that it increases communication about family planning, since both partners need to be involved in contraceptive practice. However, there is likely to be some degree of endogeneity due to selection: couples who communicate better are more likely to select methods requiring higher degrees of communication.

Method - This paper uses an instrumental variable approach to assess the causal effect of method choice on spousal communication in 7 countries in Sub-Saharan Africa. Religion is used as an instrument since this is correlated with method but not communication.

Results - Results indicate that both traditional and modern methods are associated with greater discussion of family planning, and this is robust to the introduction of controls. However, when using the instrumental variable to account for selection effect, many of the significant results for traditional methods disappear although they persist for modern methods.

Conclusions - These findings indicate that the effect of traditional methods in improving communication is due to selection, rather than causation. While traditional methods still have a role to play in the contraceptive method mix, enthusiasm for side benefits such as family planning communication should be tempered.