Rising contraceptive use, falling couple concordance: A mixed-methods analysis of the concordance paradox in Nigeria

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.