Association of Traditional Marital Practices with Contraceptive Decision-making, Couple Communication, and Method Use among Couples in Rural Maharashtra, India

"Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.

In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry, and purdah (female seclusion), are rooted in gender-based power structures of patrilineal (male-line descent) and patrilocal (couple residing with the husband's parents) norms, whereby in-laws have a strong influence over the couple's health and fertility behaviour. These marginalising social practices compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours among married women aged 18-29 years and their husbands in rural Maharashtra, India.

Study data come from a cross-sectional baseline sample from 1,201 couples enrolled in the CHARM2 [Counseling Husbands and wives to Achieve Reproductive Health and Marital Equity] study, a two-arm cluster randomised controlled trial (RCT) evaluating a gender-synchronised, gender-transformative family planning intervention in rural Maharashtra, India (see Related Summaries, below). Multivariable logistic regression was used to examine the association between marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders.

Among wives, 15.6% reported being the primary decision-maker on who to marry, and 9.4% reported they had been the primary decision-maker on when to marry. When asked about their age at marriage, 17.8% of wives said they were married before the age of 18. Purdah was practised by 9.7% of wives, and dowry was reported by 12.3% of wives. Modern contraception was used at some time by 58.1% of the couples, as reported by wives, while current (past 3 months) use of contraception was reported by 37.9% of wives. Contraceptive communication with husbands was reported by 72.9% of wives. The majority of wives (82.2%) reported they were involved in contraceptive decision-making, jointly with husbands or alone.

After adjusting for potential confounders, wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (adjusted odds ratio (AOR) 1.76, 95% confidence interval (CI) 1.16-2.68) and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Per the researchers, these findings indicate that "when women are the primary decision-makers on who to marry, this facilitates discussion between the couple on their fertility desires, such as the prevention of any unwanted pregnancy and using a modern method of contraception....Thus, ...lack of marital choice on who and when to marry may be harmful to women's fertility-related agency in the long term and may need to be considered for the prevention of unintended pregnancy among couples in rural India."

The researchers caution that the "findings should be viewed in the light of the rural Maharashtra context with respect to marriage formation, where marriage is usually arranged between two families by the elders of the family and community.....Families may take pride in forming marriages in a traditional manner as a way to preserving their culture and resisting modernisation or Westernisation. The local context further highlights the importance of understanding and working with local communities when undertaking this type of research to ensure an understanding of local social norms."

Based on the findings, the researchers suggest that interventions that aim to delay marriage and increase contraceptive access in India should be expanded to consider women's agency at the time of marriage and to include choice of partner to influence couples' communication around contraception. Given the complexity of women's agency as a construct, they also propose future research directions, such as exploring other mechanisms, such as access to resources, individual attitudes, and social norms, that can have a higher influence on traditional marital practices and their impact.

In conclusion: "future programmes in India need to target marital choice beyond just delay in marriage, to improve women's agency, thereby fostering enhanced couple communication and contraceptive use."