Couple Relationships and Contraceptive Use in Peri-Urban Ethiopia
John, Neetu A.
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Background A strong association has been found between intimate partner relationships and individual health outcomes. Public health research and programs, however, continue to place emphasis mainly on individual cognitive and behavioral change. Studies of contextual influences also omit examining mutual influences and interdependence across individuals and their social relationships. Dyadic contextual influences are especially pertinent for decisions about contraceptive practice because they usually require the cooperation of two individuals in an intimate relationship. Studying the measurement and interdependence of partners’ assessment of the quality of their marital relationships can also help establish any associations they may have with a range of contraceptive use outcomes, such as current practice, type of method, and continuity of use. Methods This research utilizes partners’ assessments of their marital relationship quality collected from a probability sample of couples resident in a peri-urban community in Ethiopia. The Family Health and Wealth Study (FHWS) is an ongoing cohort study being conducted in several sub-Saharan African settings. This dissertation carries out an in-depth exploration of the psychometric properties of four marital quality scales, validated in the West, for the female and male partner samples. The re-specifed scales are then utilized to examine interdependence in spousal relationships by assessing if a spouse’s current marital quality report is affected by his or her previous marital quality report using two rounds of FHWS data. The Actor Partner Interdependence Model, a statistical technique designed to model interdependence in dyads, was adopted to examine these relationships. The associations between female and male partners’ marital quality measures and contraceptive use outcomes were then estimated with multivariate logistic and multinomial regression analysis. Results This study’s analyses did not support the original four-factor structure of the marital quality scales and instead a three-factor measure emerged specific for each gender and comprised of domains of trust, commitment and conflict. The measures were internally consistent and demonstrated good convergent, discriminant and concurrent validity. Our study also found linkages between wives’ and husbands’ marital quality scores, indicating the presence of spousal interdependence in this peri-urban Ethiopian setting. Surprisingly, our results found that females exerted a stronger influence on husbands’ marital quality reports than vice versa. Several marital quality measures were found to be significantly associated with contraceptive use outcomes. Male partners’ scores had a positive and stronger association with their own reported contraceptive behaviors and with their female counterparts’ continuity of use. Conclusions Understanding couple-level marital dynamics can help to improve the health and contraceptive use outcomes of individual spouses.