Couple fertility-preference concordance and decision-making regarding contraceptive non-use among women in union in Somalia: A cross-sectional study

Abstract Background Contraceptive research in Somalia has largely focused on contraceptive use, primarily from an individual woman-level perspective. Less attention has been given to how partners’ fertility preferences and decision-making interact in shaping contraceptive non-use. This study examined the association between couple fertility-preference concordance and discordance and decision-making regarding contraceptive non-use among women in union in Somalia. Methods The study used the cross-sectional data of the 2020 Somali Health and Demographic Survey and included 7,481 women aged 15–49 years who were currently in union, not pregnant, not using contraception, and had valid information on decision-making regarding contraceptive non-use. The 2020 SHDS used a stratified, multistage probability cluster sampling design and data were collected using face-to-face interviews. Couple fertility-preference status was categorized as concordant, discordant, or uncertain/unknown based on women's reported fertility preferences and those of their husbands. The outcome distinguished respondent-led, husband-led, and joint decision-making. Multinomial logistic regression was used to estimate adjusted relative risk ratios (RRRs) and 95% confidence intervals, accounting for the complex survey design and adjusting for sociodemographic and couple characteristics. Adjusted predicted probabilities were also estimated. Results Among women not using contraception, 34.7% reported joint decision-making, 31.5% husband-led decision-making, and 27.1% respondent-led decision-making. Compared with concordant couples, women in couples with uncertain or unknown fertility preferences had lower relative risks of respondent-led (adjusted RRR = 0.67, 95% CI 0.54–0.97) and husband-led (adjusted RRR = 0.61, 95% CI 0.51–0.74) rather than joint decision-making. Fertility-preference discordance was not significantly associated with respondent-led (adjusted RRR = 1.21, 95% CI 0.71–2.06) or husband-led decision-making (adjusted RRR = 1.14, 95% CI 0.66–1.97). Adjusted predicted probabilities of joint decision-making were 32.1% among concordant, 28.7% among discordant, and 42.3% among uncertain/unknown couples. Conclusion Contraceptive non-use decisions commonly involved either the husband or both partners. While fertility-preference discordance was not independently associated with unilateral decision-making, uncertainty about partners' fertility preferences was associated with greater joint decision-making. These findings highlight the value of considering couple-level fertility preferences and reproductive decision-making alongside individual characteristics.