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ABSTRACTBackgroundThe use of contraception in Lao PDR remains inadequate. In 2017, unmet contraception needs among married women aged 15–49 were 14.3% in Lao PDR overall and 18.6% in the province of Savannakhet. Although the government has a goal to reduce gender inequalities, they still persist in many areas.ObjectiveThe aim of this research was to understand the extent to which couples’ dynamics and gender attitudes affect contraception use in Savannakhet, Lao PDR.MethodsTo conduct this research, mixed methods were used. Quantitative methods took the form of a survey filled out by 200 married couples in the province of Savannakhet. Afterwards, focus group discussions were carried out to give meaning to the quantitative data and to obtain a deeper understanding of gender roles and contraceptive use.ResultsFindings showed that most couples rely on female-dependent contraceptives and that while women hold most of the family planning responsibility, men’s opinions have more weight on the final decision. Additionally, women’s financial autonomy and spousal communication regarding birth control were associated with contraceptive use within the couple. However, this communication usually began after the birth of the third child. Lastly, the hypothesis that egalitarian gender attitudes were associated with contraceptive use could not be confirmed.ConclusionThis study clearly demonstrates that contraception use is influenced by couples’ dynamics, more specifically spousal communication, in Lao PDR. The findings have highlighted the need to involve men in all stages of family planning, and to foster both spousal communication and financial autonomy for women. If the findings are implemented, this may foster shared decision making within couples.