Contraceptive Decision-making in North-Central Nigeria

Globally, contraceptive technologies have been critical to improving the reproductive lives of women. This thesis examined the decision-making processes among couples in Kwara State, Nigeria. It began with the premise that contraceptive decision-making is a complex process that involves an array of actors and structural forces that operate and intersect at different levels to influence decision-making. Using a mixed method qualitative approach, this thesis used interviews (semi-structured and Key informant), Focus Group Discussions and participant observation as research tools to provide a nuanced exploration of contraceptive decision-making. The promotion of smaller families by the State served as a precondition for contraceptive discussions collectively within the population and individually within the household. Contraceptive knowledge proved insufficient in guaranteeing use, as the decision to use contraception is not a rational process. Decision-making is gendered and this thesis argued that spousal communication is critical to the use of contraception and involved a series of non-linear conversations that occur at different stages in the reproductive life course of a couple. These conversations stressed the role of external influences and highlights the effect friends and family have on the decision making process. Economic and sexual triggers were identified as life events necessary to move spousal communication from the household to the public domain of service provision. Making informed choices on the method of contraception used highlighted some of the challenges faced in providing quality contraceptive services and how women’s bodies are differentiated and ‘modernised’ based on location. This thesis suggests that in order to make improvements to women’s reproductive lives, bodies need to be understood more broadly in relation to the gender dynamics between couples, the community (family/friends and service providers) and service provision (the State, service providers and the international community).