Communication enables husbands and wives to know each other's attitudes toward family planning and contraceptive use. It allows them to voice their concerns about reproductive health issues, such as worries about undesired pregnancies or STDs. Communication also can encourage shared decision-making and more equitable gender roles.

Research over more than 40 years consistently demonstrates that men and women who discuss family planning are more likely to use contraception, to use it effectively, and to have fewer children (28, 65, 113, 122, 126, 141, 167, 239). In contrast, when men and women do not know their partners' fertility desires, attitudes about family planning, or contraceptive preferences, the consequences can include unintended pregnancies, transmission of STDs, and unsafe abortions (33, 106, 114, 161, 219).

Sometimes, however, communication between partners may not be desirable. For example, a woman may use contraception covertly because it would be unwise and even dangerous for her to inform or try to involve her partner. Counselors need to assess carefully the reasons for covert contraceptive use and the appropriateness of encouraging spousal communication (34).