Decision-Making Patterns and Contraceptive Use: Evidence from Uganda

Literature on the effect of decision-making patterns on contraceptive use often does not (1) distinguish between women participating in decisions and controlling them, and (2) account for effects of common decision-making patterns within the community. In Uganda where high fertility persists, both of these factors may be relevant to adoption of contraception. We used data from the 1995/96 Negotiating Reproductive Outcomes (NRO) Study which surveyed 1,750 women in 78 communities located in two districts in Uganda. We assessed the effects of individual and community factors on the adoption of modern contraceptive methods using multilevel logistic regression. We included measures of decision-making patterns at both the individual and community levels that distinguished husband-dominated, joint, and wife-dominated decision-making patterns. Contraceptive use is 29% more likely in communities where women more commonly have unilateral control over household decisions. This strong effect of normative decision-making patterns within the community is net of individual education and community education, both of which had strong and significant effects. Less traditional gender roles as measured by normative decision-making patterns seem to support more innovative fertility behavior. Community decision-making patterns matter importantly for contraceptive use in this low contraceptive prevalence setting and need to be assessed elsewhere. Further, women’s influence is inadequately measured where joint decision-making and wife-dominated decision-making are considered together.