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.