Abstract
Male partner resistance is identified as a key factor that influences women’s contraceptive use. Examination of the masculine norms that shape men’s resistance to contraception—and how to intervene on these norms—is needed. To assess a gender-transformative intervention in Kenya, we developed and evaluated a masculinity-informed instrument to measure men’s contraceptive acceptance—the Masculine Norms and Family Planning Acceptance (MNFPA) scale. We developed draft scale items based on qualitative research and administered them to partnered Kenyan men (n = 150). Item response theory-based methods were used to reduce and psychometrically evaluate final scale items. The MNFPA scale had a Cronbach’s α of 0.68 and loaded onto a single factor. MNFPA scores were associated with self-efficacy and intention to accept a female partner’s use of contraception; scores were not associated with current contraceptive use. The MNFPA scale is the first rigorously developed and psychometrically evaluated tool to assess men’s contraceptive acceptance as a function of male gender norms. Future work is needed to test the MNFPA measure in larger samples and across different contexts. The scale can be used to evaluate interventions that seek to shift gender norms to increase men’s positive engagement in pregnancy spacing and prevention.
Highlights
Male partners who resist contraceptive use undermine women’s reproductive autonomy and contribute to high undesired pregnancy rates in sub-Saharan Africa (SSA)
Scholars have increasingly called for the inclusion of men in efforts to improve the use of contraception and strengthen reproductive autonomy, given that spousal discussion and joint decisionmaking have been associated with women’s ability to initiate and continue using contraception when desired (Hartmann et al, 2012; Nketiah-Amponsah et al, 2012; Ntshebe, 2011; Ogunjuyigbe et al, 2009; Tumlinson et al, 2013)
We investigated gender power dynamics within couples related to contraceptive use and, relatedly, men’s perspectives on contraceptive use and male involvement in women’s health issues—areas underrepresented in the literature at the time
Summary
Male partners who resist contraceptive use undermine women’s reproductive autonomy and contribute to high undesired pregnancy rates in sub-Saharan Africa (SSA). Studies have shown that men are very concerned about contraception’s perceived potential to bolster women’s reproductive autonomy (Kabagenyi et al, 2014; Mosha et al, 2013) and to undermine their male-dominated decision making in relationships and households (Geleta, 2018; Withers et al, 2015b). This perceived conflict between contraceptive use and men’s ability to conform to their ideas of what an ideal man is consistent with research that has long emphasized the significance of gender norms in shaping health (Fleming & Agnew-Brune, 2015). A growing literature on masculinity in SSA (Dworkin et al, 2012, 2013a; Odimegwu et al, 2013; Shefer et al, 2008; Sideris, 2004; Silberschmidt, 2011; Stern & Buikema, 2013; Wyrod, 2008) and elsewhere (Fleming et al, 2013; James-Hawkins et al, 2019; Jordal et al, 2015; Maternowska et al, 2014; Wentzell & Inhorn, 2014) has illuminated how men’s adherence to masculine ideologies and their navigation of social expectations of manhood can influence their relationship dynamics and behaviors, with concomitant effects on health outcomes for both themselves and their female partners
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