The DHS and other studies that have interviewed husbands and wives about fertility and family planning offer insight into the extent of their communication on these topics (36, 54, 72, 76). Using surveys to assess spousal communication is difficult, however (28, 33, 103). Communication is an ongoing process, but surveys capture information from only a single point in time. They do not chart the progression of a couple's discussion or decision-making. Further, surveys alone cannot determine to what extent communication between partners promotes contraceptive use and to what extent the use of contraception leads to spousal communication (28, 141, 183, 219).

The DHS report two aspects of couple communication about family planning, occurrence and frequency. First, the DHS ask husbands and wives whether or not they discussed family planning with their partner in the preceding year (76). Of husbands and wives who report discussing family planning at all, the DHS then ask how often they did so—once or twice, or more often (76).

In West African countries only a minority of married men surveyed reported discussing family planning with their wives in the past year from 23% in Niger and Senegal to 43% in Mali (see Figure 3). In East African countries surveyed men were more likely to have discussed family planning—from 49% in Burundi to 68% in Kenya.

In Egypt, Morocco, and Bangladesh, couples were even more likely to have discussed family planning in the past year (76). In Pakistan, however, just 25% of men reported doing so (151).

Among couples who discussed family planning, husbands and wives reported similar frequencies of discussion. Most said that they discussed it more than twice within the past year. Couples in East Africa were most likely to report frequent discussions, with men reporting more frequent discussions than women. Couples in Mali, Niger, and Pakistan reported the lowest frequencies of discussion (76).

Studies in other regions also find that spousal communication about family planning is uncommon (78, 161, 188). For example, qualitative studies in the Central Asian Republics of Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan reveal that married couples rarely discuss matters related to sex or reproductive health. In focus-group discussions men and women said they were too embarrassed to talk about these subjects. Most men said that they leave family planning decisions to their wives, but they expect their wives to ask for approval to use contraception. Rarely, however, do they reject the wife's choice of method (238).

Similarly, in urban Peru women said in focus-group discussions that husbands and wives rarely talk about the number of children they want to have. Women said that they must have children soon after marriage to please their husbands (85). A study of Bolivian couples found that most men and women have positive attitudes toward family planning, but only half said that they discussed with their partner the number of children they desired (298).

In Uganda researchers found that fewer than half of respondents had ever discussed family size with their spouses. On average, only about one-third of men or women reported ever talking with their partners about the number of children they would like to have. Couples in urban areas were more likely to talk about childbearing than rural couples (36).

Partners may communicate their reproductive desires or concerns through nonverbal or indirect means, if they do so at all (36, 85, 117). In Uganda, for example, most communication between men and women regarding reproductive issues took the form of suggestions, hints, and talking to friends or relatives in the hope that they would convey the information to the sex partner (36).