“It’s her pain. it’s her body”: perceived low reproductive control among participants in the men's fertility attitudes and behaviors study

Abstract

Objectives: Unintended pregnancy is common and disproportionately occurs among low-income populations. Family planning advocates call for engaging men in contraceptive decision making, yet little is known about men's contraceptive and pregnancy attitudes and behaviors. Methods: Semistructured telephone interviews were conducted with 58 low-income, Black and White men aged 18–45 to explore the spectrum of men's contraceptive attitudes and behaviors. Narratives were analyzed using content analysis. Results: Preliminary analysis identified emerging themes centering on men's perceived lack of reproductive control. First, men commonly reported that contraceptive and abortion decisions are (and should be) largely in the control of their female sexual partners because women bear the burden of pregnancy and because most methods are female controlled. Thus, men did not often initiate contraceptive conversations because they felt doing so would be inappropriate or poorly received. Second, men expressed frustration about the limited options for male-controlled methods for pregnancy prevention, viewing condoms primarily as agents to prevent STI infection in casual or new relationships. Third, several men reported experiencing pregnancy-promoting behaviors by women, such as lying about contraceptive use, improperly using a method, poking holes in condoms or physically preventing them from withdrawing during ejaculation. Last, many men believed that risk of pregnancy was low, thereby diminishing their perceived need to ensure effective contraceptive use in the first place. Conclusions: In our sample of low-income, racially diverse men, we found that men feel they have little agency in preventing unwanted pregnancy. Finding ways to help men respectfully discuss pregnancy risk and contraception with their partners is needed.