Abstract
BackgroundSpousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives.MethodsA qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti.ResultsFive themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation.ConclusionDecision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.
Highlights
Research suggests that male involvement can increase uptake and continuation of family planning methods by improving spousal communication through pathways of increased knowledge or decreased male opposition [1,2,3,4,5]
Despite growing evidence on the benefits of engaging men in reproductive health decision-making, fertility rates and unmet need for family planning remain high in many sub-Saharan African countries
In many sub-Saharan African settings, few men are involved in issues relating to reproductive health, and there is a dearth of evidence on barriers to men’s constructive engagement
Summary
Research suggests that male involvement can increase uptake and continuation of family planning methods by improving spousal communication through pathways of increased knowledge or decreased male opposition [1,2,3,4,5]. Despite growing evidence on the benefits of engaging men in reproductive health decision-making, fertility rates and unmet need for family planning remain high in many sub-Saharan African countries. At the same time, men dominate decision-making regarding family size and their partner’s use of contraceptive methods in many traditionally patriarchal settings [10,11]. Fear of spousal retaliation due to disagreements about whether to use contraception has been shown to be a significant barrier among women [14] This seemingly contradictory role among men of being both key decisionmakers regarding fertility desires and remaining detached from reproductive health issues has posed considerable challenges in African contexts to involve men to address low contraceptive prevalence rates [15,16]. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives
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