Rising contraceptive use, falling couple concordance: A mixed-methods analysis of the concordance paradox in Nigeria
- 1Research and Development Department, Fescosof Data Solutions, Ogun State, Nigeria.
Abstract
Couple agreement on contraception is widely treated as a marker of programme success, yet whether such agreement has kept pace with rising contraceptive use in sub-Saharan Africa is largely unknown. We analysed three rounds of the Nigeria Demographic and Health Survey Couples’ Recode (2013, 2018, 2024; 23,547 couples) using design-weighted descriptive, trend, and multivariable logistic analyses. We defined practice concordance from partners’ independently reported current method status and decomposed it into five mutually exclusive categories. A qualitative study of 42 Ogun State couples illustrated the mechanism behind the pattern. National practice concordance fell from 81.6% to 73.5% (and from 70.0% to 46.4% in Ogun State) even as women's modern use (9.7% to 16.1%), spousal communication (33.0% to 42.1%), and Unmet need (16.1% to 21.3%) rose. Concordance was overwhelmingly shared non-use (69.5% in 2024); genuine mutual active use remained near 4%; and wife-only discordance nearly doubled (7.5% to 14.0%), which supplied most of the offsetting rise in discordance as shared non-use contracted. An inverse socioeconomic gradient and a north-south gradient persisted after adjustment, and spousal communication was negatively associated with concordance (odds ratio 0.83, 95% CI 0.76–0.91). Rising, increasingly female-led contraceptive practice is associated at the population level with falling couple concordance, a pattern consistent with an incomplete gender transition rather than programme failure.
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BibTeX
@article{sanni2026rising,
title = {{Rising contraceptive use, falling couple concordance: A mixed-methods analysis of the concordance paradox in Nigeria}},
author = {Olaniyi Felix Sanni and Abike Elizabeth Sanni and Collins Isioma Onyeagwaibe},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0007450},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007450},
note = {CC BY},
}
RIS
TY - JOUR
TI - Rising contraceptive use, falling couple concordance: A mixed-methods analysis of the concordance paradox in Nigeria
AU - Olaniyi Felix Sanni
AU - Abike Elizabeth Sanni
AU - Collins Isioma Onyeagwaibe
PY - 2026
DA - 2026/10/30
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007450
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007450
AB - Couple agreement on contraception is widely treated as a marker of programme success, yet whether such agreement has kept pace with rising contraceptive use in sub-Saharan Africa is largely unknown. We analysed three rounds of the Nigeria Demographic and Health Survey Couples’ Recode (2013, 2018, 2024; 23,547 couples) using design-weighted descriptive, trend, and multivariable logistic analyses. We defined practice concordance from partners’ independently reported current method status and decomposed it into five mutually exclusive categories. A qualitative study of 42 Ogun State couples illustrated the mechanism behind the pattern. National practice concordance fell from 81.6% to 73.5% (and from 70.0% to 46.4% in Ogun State) even as women's modern use (9.7% to 16.1%), spousal communication (33.0% to 42.1%), and Unmet need (16.1% to 21.3%) rose. Concordance was overwhelmingly shared non-use (69.5% in 2024); genuine mutual active use remained near 4%; and wife-only discordance nearly doubled (7.5% to 14.0%), which supplied most of the offsetting rise in discordance as shared non-use contracted. An inverse socioeconomic gradient and a north-south gradient persisted after adjustment, and spousal communication was negatively associated with concordance (odds ratio 0.83, 95% CI 0.76–0.91). Rising, increasingly female-led contraceptive practice is associated at the population level with falling couple concordance, a pattern consistent with an incomplete gender transition rather than programme failure.
SN - 2767-3375
ER -