Level of contraceptive use is one of the primary proximate determinants of fertility level. Among Arab countries, Iraq experiences high fertility rates, especially among adolescents. According to the 2018 Iraq Multiple Indicator Cluster Survey (IMICS 2018), 52.8% of currently married Iraqi women used a contraceptive method (36.1% used modern methods, and 16.7% used traditional methods). A multiple multinomial logistic regression model was adopted to investigate the demographic, socioeconomic, fertility, and cultural determinants of contraceptive use among currently married, nonpregnant Iraqi women based on the 2018 Iraq Multiple Indicator Cluster Survey data. The main findings indicated that women using modern contraceptive methods had more children, did not experience the death of a child, and had no desire for more children. Moreover, they were married before age 21, had at least an upper secondary education, had access to mass media, used the internet, belonged to a low or middle wealth category, and lived in urban Kurdistan. Kurdish women prefer to use traditional methods. The results suggest that family planning programmes should target women who live in southern/central areas of Iraq, as they were the least likely to use contraceptives, and motivate Kurdish women to use modern contraceptives rather than traditional contraceptives.

Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992–93 (3.5%) to 2015–16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43–1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44–9.38), north-eastern (aOR: 11.37, 95% CI: 10.62–12.18), eastern (aOR: 6.96, 95% CI: 6.60–7.34), western (aOR: 4.65, 95% CI: 4.40–4.92) and central (aOR: 10.89, 95% CI: 10.35–11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.

From 1989 to 2014, Iran was known as a country with a successful family planning programme, and has experienced a sharp decline in fertility over recent decades. This led to the introduction of pronatalist policies in 2014 and the restriction of family planning services. The aim of this study was to explore men’s views on their access to contraceptive information and services and the socio-cultural barriers to such access in Tehran. The qualitative study was conducted in 2014 using in-depth interviews with 60 married men of varying ages and socioeconomic status from across Tehran. The data were analysed with a basic interpretive approach using MAXQDA10. Although the majority of the men acknowledged the importance of family planning and contraceptive use, they reported that their access to contraceptive information and services was limited. Discussion of sexual matters and contraception among men was identified as being somewhat embarrassing. Three main issues were identified: (1) men’s poor awareness of contraceptive use; (2) men’s poor access to high-quality health care services; and (3) cultural taboos and gender norms as barriers to contraception use by men. Socio-cultural and gender norms were found to significantly affect the men’s contraceptive use. The study results support the growing call for gender-transformative approaches to family planning and reproductive health service delivery in Iran, to involve men and facilitate their greater participation.

Couple-level reports of contraceptive use are important as wives and husbands may report their use differently. Using matched couple data (N = 63,060) from India’s NFHS-4 (2015–16), this study examined concordance in spousal reports of current contraceptive use and its differentials. Reporting of contraceptive use was higher among wives (59.0%) than husbands (25.2%). Concordance was low; 16.5% of couples reported the current use of the same method, while 20.4% reported the current use of any method. Many husbands did not report female sterilization as a means of contraception being used by their wives. Reconstruction of contraceptive use among men, based on the ‘ever-use of sterilization’ question asked to men, increased concordance by 10%. Multivariate analyses showed that concordance was low in urban and southern India, among younger women and among women with a lower wealth index. Men’s control over household decision-making and negative attitudes towards contraception were associated with lower concordance. The findings highlight the importance of using couple-level data to estimate contraceptive prevalence, and the role of education programmes to inculcate positive attitudes towards contraception, fostering gender equality and involving men in family planning efforts. The results also raise the issue of data quality as the survey questions were asked differently to men and women, which might have contributed to the wide observed discordance.

This study sought to investigate the determinants of current use of modern contraceptives beyond the individual level in Eswatini (formerly Swaziland). Previous studies have overlooked the role of community characteristics such as socioeconomic development, women’s empowerment and fertility norms in shaping contraceptive use. Hierarchical structured subsample data of 4112 sexually experienced women from the 2007 Eswatini Demographic Health Survey were analysed using multilevel logistic regression to identify factors contributing to community/cluster variations in women’s current use of modern contraceptives. Less than half (44.2%) of the sexually active women were using modern contraceptive methods in 2007. At the community level, the odds of contraceptive use decreased for rural women (AOR = 0.82, 95% CI: 0.68–0.98) and among women residing in communities with high-fertility norms (AOR = 0.77, 95% CI: 0.66–0.89). After adjusting for both individual- and community-level factors, no community-level variables considered for the study were significantly associated with contraceptive use. The findings highlight in all four models, from the empty to full model, that there is a small and decreasing significant variation in women’s contraceptive use across communities (MOR, 1.37–1.17). In 2007, the findings suggest individual rather than community factors account for some contextual variability in contraceptive use. The study proposes the use of ethnographic techniques to unravel community factors that promote modern contraceptive use in Eswatini.

This paper presents an analysis of trends in sexual activity by marital status and age, and their associations with contraceptive use. Understanding levels of, and trends in, sexual activity is important for assessing the needs for family planning services and for analysing commonly used family planning indicators. Data were taken from 220 Demographic and Health Surveys (DHSs) and 62 Multiple Indicator Cluster Surveys (MICSs) to provide insights into sexual activity by marital status and age in a total of 94 countries in different regions of the world. The results show the sensitivity of the indicator with respect to the definition of currently sexually active, based on the timing of last sexual intercourse (during the last 4 weeks, 3 months, or 1 year). Substantial diversity in sexual activity by marital status and age was demonstrated across countries. The proportion of married women reporting recent sexual activity (sexual intercourse during the last 4 weeks) ranged from 50% to 90%. The proportion of unmarried women reporting recent sexual activity did not exceed 50% in any of the 94 countries with available data, but showed substantial regional differences: it appeared to be rare in Asia and extremely varied within Africa, Europe and Latin America and the Caribbean. Among married women, sexual activity did not vary much by age group, while for unmarried women, there was an inverted U-pattern by age, with the youngest age group (15–19 years old) having the lowest proportion sexually active. The proportion of women who reported currently using contraception and reported not being sexually active varied by the contraceptive method used and was overall much greater among unmarried women. The evidence presented in this paper can be used to improve family planning policies and programmes to serve the diverse needs, for example regarding method choice and service provision, of unmarried women.

The positive effect of women’s empowerment on the use of contraceptives is well established. However, the reverse effect, i.e. the potential effect of use of contraceptives on women’s empowerment, is relatively unexplored. This study examined the direct impact of contraceptive use on women’s empowerment in currently married women aged 15–49 years in India using data from the National Family Health Survey-4 conducted in 2015–16. A two-stage least squares (2SLS) regression model was used to account for the issue of endogeneity that appears in a general logit model. The use of contraceptives by the sample women was found to be associated with greater women’s empowerment in terms of both their mobility and decision-making power. The pathways to greater women’s empowerment are often presumed to be factors such as changing perception of their domestic role and sense of control over their own body. While these are integral, this paper highlights how the possible control over family size and birth interval through use of contraception may also be critical pathways to increasing women’s empowerment.

This study examines the postmarriage bargaining power of women—specifically, their decision-making power with regard to fertility—vis-à-vis imbalances in matching in the marriage market. Applying a multinomial logit model to data on rural Bangladesh for 1998/99, the study gauges women's relative empowerment: (i) at the time of marriage (measured by the bride price as a share of total marriage payments) and (ii) postmarriage (measured by women's use of the contraceptive pill). The empirical findings reveal that a higher bride price (as a share of total household marriage payments) has three main outcomes: it increases the predicted probability of women (i) using the contraceptive pill, (ii) spacing births further apart, and (iii) choosing to have fewer children.

This paper explores the impact of gender differences in the desire for sex and the distribution of power in the household on the onset of the demographic transition and the take-off to growth. Depending on the price and efficacy of modern contraceptives, the gender wage gap, and female bargaining power, the economy assumes one of two possible equilibria. At the traditional equilibrium, contraceptives are not used, fertility is high and education and growth are low. At the modern equilibrium, contraceptives are used, fertility is low and further declining with increasing income, and education and growth are high. The theory motivates a “wanted fertility reversal”: At the traditional equilibrium, men prefer more children than women, whereas at the modern equilibrium, men prefer fewer children than women. Female empowerment causes households to provide more education for their children and leads to an earlier uptake of modern contraceptives and an earlier onset of the demographic transition and the take-off to modern growth.