Promoting Healthy Couples' Communication to Improve Reproductive Health Outcomes

"What is the proven high-impact practice in family planning? Implement interventions demonstrated to encourage couples to discuss family planning/reproductive health and make equitable, joint decisions to reach fertility intentions."



For decades, the family planning field has recognised the importance of couples' communication in the voluntary uptake of modern contraceptive methods. This form of interpersonal communication is influenced by the individual's immediate environment, attitudes, and values, as well as policies, culture, and social and gender norms. Since 2010, evidence has emerged on the importance of improving the quality of couples' conversations, with a focus on addressing gender inequalities. This High Impact Practice (HIP) brief examines successful social and behaviour change (SBC) efforts to improve healthy couples' communication that have resulted in uptake of modern contraception.



SBC for healthy couples' communication entails approaches such as creating an enabling environment (e.g., by creating spaces for couples to receive joint counseling) or addressing social change as much as individual behaviour change (e.g., by providing role models that practice healthy couples' communication). The brief begins by looking at why this practice is important, with Figure 1 illustrating a theory of change for promoting healthy couples' communication:



The brief then looks at the evidence that promoting healthy couples communication is high impact. Numerous studies have shown a correlation between couples' communication and uptake for modern contraception by both men (e.g., uptake of vasectomy) and women. Many of these evidence-informed interventions have simultaneously addressed issues of unequal gender norms. See Table 1 in the brief, which shows a range of SBC interventions with strong evidence and a diversity of countries represented. The Appendix includes additional evidence.



Tips for design and implementation of interventions to improve interpersonal communication are offered next, in recognition of the fact that behaviour is a function of the person and her or his environment. In brief, the tips include:

• Attend to gender and power dynamics, including gender-based violence (GBV).
• Ensure that interventions "do no harm" to undermine women's autonomy.
• Address norms of masculinity.
• Find creative and culturally appropriate ways to address women's and men's skills and perceived self-efficacy to communicate with their partners effectively.
• Consider and plan for the special requirements and challenges of couples counseling sessions.
• Search out existing platforms and spaces where boys and men can access information about sex, sexual relationships, reproductive health, and family planning information and services.
• Provide opportunities and job aids for those who offer health and family planning services.
• Identify and provide opportunities for respected couples in the community to model and talk about their healthy communication habits.
• Use social networks over time to spread the innovation of healthy couples' communication through training and other mechanisms.

The brief concludes with illustrative indicators based on the theory of change, a list of priority research questions, and links to tools, resources, and references.