Traditionally, fertility and family planning research and programs have focused on women. With the expansion of the field to include reproductive health following the 1994 International Conference on Population in Cairo, the more appropriate focus for most reproductive health components appears to be the sexually active couple. This review of studies of couples and reproductive health outcomes examines reports of objective reproductive events, of attitudes and reproductive intentions, of the effect of each partner's attitudes and intentions, of reproductive outcomes, and of the effectiveness of interventions that target couples compared with those that target one partner or the other. For couples' statements about reproductive events, studies throughout the world typically show identical reports less than 90 percent of the time. Concordance between partners on subjective matters is in the range of 60 to 70 percent. Data based on reports of reproductive intentions from both partners have been shown to lead to better predictions of behavior than have data from only one partner. Finally, reproductive health interventions that target couples are found to be more effective than those directed to only one sex. The evidence clearly justifies a focus on couples.
PIP: The shift proposed at the 1994 International Conference on Population from a family planning to a broader reproductive health approach implies a focus on the sexually active couple rather than on women only. Reviewed in this article are studies that collected and matched data from both partners on objective reproductive events, attitudes, and intentions, as well as studies that assessed the effectiveness of interventions that targeted couples. For actual reproductive events (e.g., number of live births, ever-use of contraception, years married, abortions), identical responses to the same question occurred less than 90% of the time. With respect to fertility and family planning attitudes and intentions, partner concordance was in the range of 60-70%. Background and attitudinal variables from both spouses produced a significantly better fit in logistic regression models predicting contraceptive use than the set of variables from either spouse alone. Finally, reproductive health interventions targeted at both partners have resulted, in most cases, in higher rates of contraceptive use and are especially important to reducing transmission of sexually transmitted diseases, including acquired immunodeficiency syndrome (AIDS). Although the sexually active couple is clearly the most appropriate focus for reproductive health programs, the costs of program expansion, complexities inherent in dual data collection and matched analysis, and the relative superiority of addressing partners together versus simultaneous dual interventions must be addressed.