It’s time to talk: exploring the role of couples' communication in improving health behaviors in Kebbi, Nigeria

Abstract

In societies with strong patrilineal traditions, such as in northern Nigeria, husbands play the primary role in many household decisions, including for the reproductive health of their wives and the health of other family members. While previous research has shown that couples who engage in health-related discussions are more likely to utilize health services, these discussions may be inhibited in northern Nigeria by entrenched gender norms and roles, as well as unfavorable attitudes towards certain health behaviors. Focusing on married couples in Kebbi state in northwestern Nigeria, this study investigates the prevalence of health-related discussions between spouses, focusing on which factors seem most likely to influence the probability of discussions. Data for this analysis comes from a 2021 household survey of 1,043 couple dyads involving husbands and wives with a child under the age of two. We focus on couples’ discussions of breastfeeding, contraception for birth spacing, and reproductive and child health services (e.g., antenatal care, delivery care, childhood vaccinations). Multivariate logistic models are used to estimate the magnitude of relationships between couples’ engagement in discussions and concordance and discordance in attitudes, norms, decision-making authority, social influences, and sociodemographic characteristics. Average marginal effects are used to present effect sizes (in percentage points) for each discussion topic. We find that the prevalence of discussions varies by health topic. Discussions of family planning are the least common; nearly 10% of couples say that they have discussed fertility goals, and only one quarter of couples agree that they have discussed using contraception for birth spacing. Discussions of antenatal care and child health are more common, though still less than half of couples reported discussions. Husbands are considerably more likely to report discussions than wives. Husbands and wives who score higher on an index of gender equality attitudes are more likely to discuss health topics, perhaps reflecting a greater value placed on shared responsibilities. Other factors include holding positive norms and lower levels of stigma towards priority health behaviors and having more accurate knowledge/risk perceptions about health behaviors. Higher levels of education (for both husbands and wives) and household wealth also appear to contribute, perhaps indirectly. Couples report that health-related discussions focus foremost on the benefits of engaging in a particular behavior, followed by logistical considerations such as where and when to go. These content measures reflect a rational decision-making process comparing the advantages of adopting a healthy behavior against its explicit and implicit costs. Numerous studies have identified a link between couples’ communication and greater likelihood of engaging in behaviors benefiting maternal and child health. In northwestern Nigeria, discussions are rare. Programs that can promote the social acceptance and discussion of sensitive topics such as fertility and family planning, particularly among husbands, as well as those that improve communication skills, are likely to be increasingly important for improving women’s and children’s health and overall family wellbeing.