Opposition from husbands. Many women do not use contraception because their husbands are opposed (37, 47, 165, 184, 188, 204). In seven sub-Saharan countries contraceptive use among women whose husbands disapprove of family planning averages only one-third as much as among women whose husbands approve of it (25).

From the limited evidence available, only a minority of all wives and husbands appear to disagree about using contraception. Nevertheless, these couples probably make up a substantial share of couples with unmet need (20, 37). In Kenya, among women who had stopped using contraception for reasons other than having another child, 12% had stopped because their husbands wanted another child or had forced them to discontinue for another reason (63). In the Philippines researchers found that the husbands of women with unmet need are much more pronatalist than the husbands of contraceptive users (37). When husbands want to have more children than their wives, the preference of the husband usually prevails (114, 121, 137).

Men's reasons for opposing family planning vary. Some want more children. Others oppose contraception, even if they do not want to have more children, because they worry that their wives might be unfaithful if protected from pregnancy (10, 40, 188). Others are jealous that male physicians would examine their wives (139). Still others want to control their wives' behavior, have religious objections, or fear the side effects of contraception (10, 37, 54, 184, 188). Husbands' attitudes may affect not only whether or not wives use contraception but also the choice of a method and how long it is used (99).

Husbands' opposition can have serious consequences. For example, in Guatemala one woman told researchers that she had been using oral contraceptives without her husband's knowledge, but when her husband discovered them, "he told me that I was using them because I had a lover. But I was doing it because I wanted to avoid suffering. But his beatings were greater than that" (10). In Tamil Nadu, India, T.K. Ravindran reported that women whose husbands oppose contraceptive use "may resort to abstinence under one pretext or another and, if pregnant, resort to a back-street abortion rather than face disapproval and discredit" (165).

According to DHS data, women with unmet need are much less likely than contraceptive users to believe that their husbands approve of family planning. For example, in Botswana only 47% of women with an unmet need think that their husbands approve of family planning compared with 82% of contraceptive users. In Pakistan the difference is even more striking—32% compared with 83% (see Figure 5).

Also, women with unmet need are much less likely than contraceptive users to have talked with their husbands about family planning. For example, in Ghana only 44% of women with unmet need had discussed family planning with their husbands in the preceding year compared with 72% of contraceptive users (see Figure 6). In India the level of unmet need for limiting births was significantly lower among couples who had discussed family planning than among those who had not, but discussion made little difference to unmet need for spacing (163)—possibly because temporary methods were not readily available. Such findings do not indicate whether discussion leads to contraceptive use or vice versa. It may be that, when woman use contraception, they are more likely to discuss family planning with their husbands. It could also be, however, that discussion makes it more likely that women can use family planning with their husbands' cooperation.

Opposition from families and communities. Although less important than husband's opposition, lack of support by extended families and community leaders also prevents some women from using contraception. In the Philippines, for example, women with unmet need are less likely than contraceptive users to consider contraception socially acceptable (37). In Kenya mothers-in-law prevent some women from using contraception because they think that it would weaken the control of the husband's family or that their daughters-in-law should not expect anything different from their own experience (184).

In most countries religious opposition is not an important reason for unmet need (237). In a few surveyed countries, however—including Bangladesh, Nigeria, Pakistan, and Senegal—religious opposition is one of the main reasons that women give in the DHS. In each of these four countries more than 10% of women with unmet need who do not intend to use contraception cite religious objections (237). In the study of Trishal, Bangladesh, only about half of women with unmet need thought that their religion approved of family planning compared with nearly three-quarters of contraceptive users (see Table 4).