Choosing to Involve Men in Family Planning.
The abundance of interventions and Behavior Change Communication campaigns that all primarily target women for family planning seemingly relieves men of the responsibility. Advances in contraceptive technology, such as the introduction of female condoms, injectable contraceptives and progestin only pills, imply a void in research and development of contraceptives that focus on male anatomy and physiology. This apparent irrelevance of men in turn creates even less space for the involvement of men in family planning.
Men often dominate the decision-making process whereby couples seek information about, or adopt any traditional or modern method of contraception. Further studies from India indicate that men overwhelmingly initiate discussions with their partners about contraceptives, and may “respond adversely” should the female partner do so. Research repeatedly exposes the links between male support and continuation of a variety of female-oriented contraceptives. (IPPF, 1984; Wambui, 1994)
Synovate India, a research firm, conducted a campaign tracking study in 2005-2006 in north Indian cities involving 1645 males aged 20-29. Theirs and other studies show that men who act responsibly in one way are likely to carry this attitude over to other areas of their lives. For example, men who accept the contraceptive usage are less likely to abuse their wives; increasing the pool of men in either regard positively influences the other. (IFPP, 2000) Men are stakeholders in family planning.
Many women in urban India find condoms unprocurable due to harassment at distribution points, or even greater embarrassment directly associated with female sexuality. In addition to Synovate’s study mentioned here, an array of quantitative studies suggest that male embarrassment hinders the procurement by men of condoms, the only contraceptive that offers dual protection against both unwanted pregnancy and the transmission of sexually transmitted infections and HIV/AIDS. Taken together, both women and men face social hurdles to procuring condoms, creating a barrier for reproductive justice.
These and similar studies in urban and per-urban India reveal widespread misconceptions about contraceptives among males who are often primarily in charge of decisions concerning family planning. (Khan, 1997) Such environments are non-conducive to dialogue between spouses or partners regarding the reproductive health of either partner; consensus building with spouses or partners regarding their reproductive goals does not exist.
Initial family planning efforts focused on risk reduction associated with pregnancy. These risks have included maternal mortality, excessive child-bearing, unwanted pregnancy, socially enforced pregnancy, emotional sexual abuse, lack of birth spacing, mother-to-child transmission of HIV/AIDS, female feticide and infanticide. Moreover, each risk carries its own set of psychosocial traumas, which largely remain unacknowledged and treated.
Family planning must target men alongside women to take greater responsibility for care towards their partners to conquer mutually undesirable gender-skewed reproductive outcomes such as abuse, sexually transmitted infection, unwanted pregnancies as well as maternal and child mortality.
Men as family planning stakeholders
Despite the fact that men are often the decision-makers in family planning matters, many studies suggest that men lack sufficient knowledge about family planning, spacing, and the variety of available contraceptives to make life-affirming, informed choices. Advancement and adoption of contraceptive technology demands male support. Women should expect support from partners and kin in her environment to understanding and coping with the responsibility and changes in menstrual cycle accompanying a variety of methods of contraception.
There are a variety of broader implications surrounding male responsibility and involvement in family planning. A study published in the Journal of the American Medical Association of 6,695 husbands aged 15-65 in the state of Uttar Pradesh revealed that men with less than five years of formal education, had more than one child, or were classified as extremely poor were factors that were all independently associated with elevated odds of (self-reported) incidence and frequency of abuse.
Both pre- and extra-marital sex, symptoms of STIs and unplanned pregnancies account for elevated odds of physical and sexual spousal abuse, even when controlling for social and demographic factors. In fact, “Abuse was more common among men who did not practice contraception than among those who did (49% vs. 42%), and was reported more frequently by men who had experienced an unplanned pregnancy than by those who had not (52% vs. 44%).” The study indicated that each variable was most strongly associated with nonconsensual sex without physical force.
Respond.
There are a plethora of policy, advocacy and intervention responses that readily emerge from these findings. First, rejecting violence as a means of conflict resolution and expressing power, particularly in family dynamics, is a worthy, long-term aim that must underscore any effort thereafter. Next, expanding access to contraceptive knowledge and technology synergistically increases life-choices for both men and women; this is a step towards raising standards of education and reducing poverty- both of which positively correlate with reduced spousal abuse and increased contraception acceptance and use. Then, alleviating the mal-effects of poverty lessens the unnecessary burden carried by women and allows men to assume greater responsibility for their lives.
Unwanted pregnancy and sexually transmitted infections decrease the overall quality of life of both partners. Behavior Change Communication efforts to thwart these factors must target both men and women accordingly. The eventual outcome enhances the lives of women and families overall. Expanding the basket, knowledge, availability and usage of contraceptives must consider both women and men, and the synergy in focusing on the empowerment of all genders. Behavior Change Communication can address both the immediate symptoms and eventual outcomes towards reproductive justice, exploiting the links between male responsibility, various forms of abuse and contraceptive acceptance.
References
Digest.
• India Men with Higher Socioeconomic Status are more likely to be knowledgeable about Reproductive Health. Volume 26, No.3, September 2000.
International Family Planning Perspectives.
• In India, Poverty and Lack of Education Are Associated with Men’s Physical and Sexual Abuse of their Wives. Volume 26, No.1, March 2000.
International Planned Parenthood Federation.
• Male Involvement in Family Planning. 73–76, 79–80. 1984.
Khan, M.E. and Patel, Bella C.
• Male Involvement in Family Planning: A KABP study of Agra District. Final report. The Population Council, India. June 1997.
Martin S.L et al.
• Sexual behaviors and reproductive health outcomes: Associations with wife abuse in India, Journal of the American Medical Association, 1999, 282(20): 1967-1972.
Population Council.
• Maternal and Child health. Mixed Success Involving Men in Maternal Care Worldwide. Population Briefs- reports on Population Council research. Volume 11, No.1, January 2005.
Touré, Lalla MD, MPH.
• Male Involvement in Family Planning: A Review of the Literature and Selected Program Initiatives in Africa
Wambui, Catherine.
• Male Only Centers: A New Concept in Family Planning. Published in Conveying Concerns: Women Write on Male Participation in the Family, Population Reference Bureau, Inc.: 18–19. 1994.
Zavier, Francis and Padmadas, Sabu S.
• Use of a Spacing Method before Sterilization Among Couples in Kerala, India. Volumbe 26, No.1, March 2000.
Men often dominate the decision-making process whereby couples seek information about, or adopt any traditional or modern method of contraception. Further studies from India indicate that men overwhelmingly initiate discussions with their partners about contraceptives, and may “respond adversely” should the female partner do so. Research repeatedly exposes the links between male support and continuation of a variety of female-oriented contraceptives. (IPPF, 1984; Wambui, 1994)
Synovate India, a research firm, conducted a campaign tracking study in 2005-2006 in north Indian cities involving 1645 males aged 20-29. Theirs and other studies show that men who act responsibly in one way are likely to carry this attitude over to other areas of their lives. For example, men who accept the contraceptive usage are less likely to abuse their wives; increasing the pool of men in either regard positively influences the other. (IFPP, 2000) Men are stakeholders in family planning.
Many women in urban India find condoms unprocurable due to harassment at distribution points, or even greater embarrassment directly associated with female sexuality. In addition to Synovate’s study mentioned here, an array of quantitative studies suggest that male embarrassment hinders the procurement by men of condoms, the only contraceptive that offers dual protection against both unwanted pregnancy and the transmission of sexually transmitted infections and HIV/AIDS. Taken together, both women and men face social hurdles to procuring condoms, creating a barrier for reproductive justice.
These and similar studies in urban and per-urban India reveal widespread misconceptions about contraceptives among males who are often primarily in charge of decisions concerning family planning. (Khan, 1997) Such environments are non-conducive to dialogue between spouses or partners regarding the reproductive health of either partner; consensus building with spouses or partners regarding their reproductive goals does not exist.
Initial family planning efforts focused on risk reduction associated with pregnancy. These risks have included maternal mortality, excessive child-bearing, unwanted pregnancy, socially enforced pregnancy, emotional sexual abuse, lack of birth spacing, mother-to-child transmission of HIV/AIDS, female feticide and infanticide. Moreover, each risk carries its own set of psychosocial traumas, which largely remain unacknowledged and treated.
Family planning must target men alongside women to take greater responsibility for care towards their partners to conquer mutually undesirable gender-skewed reproductive outcomes such as abuse, sexually transmitted infection, unwanted pregnancies as well as maternal and child mortality.
Men as family planning stakeholders
Despite the fact that men are often the decision-makers in family planning matters, many studies suggest that men lack sufficient knowledge about family planning, spacing, and the variety of available contraceptives to make life-affirming, informed choices. Advancement and adoption of contraceptive technology demands male support. Women should expect support from partners and kin in her environment to understanding and coping with the responsibility and changes in menstrual cycle accompanying a variety of methods of contraception.
There are a variety of broader implications surrounding male responsibility and involvement in family planning. A study published in the Journal of the American Medical Association of 6,695 husbands aged 15-65 in the state of Uttar Pradesh revealed that men with less than five years of formal education, had more than one child, or were classified as extremely poor were factors that were all independently associated with elevated odds of (self-reported) incidence and frequency of abuse.
Both pre- and extra-marital sex, symptoms of STIs and unplanned pregnancies account for elevated odds of physical and sexual spousal abuse, even when controlling for social and demographic factors. In fact, “Abuse was more common among men who did not practice contraception than among those who did (49% vs. 42%), and was reported more frequently by men who had experienced an unplanned pregnancy than by those who had not (52% vs. 44%).” The study indicated that each variable was most strongly associated with nonconsensual sex without physical force.
Respond.
There are a plethora of policy, advocacy and intervention responses that readily emerge from these findings. First, rejecting violence as a means of conflict resolution and expressing power, particularly in family dynamics, is a worthy, long-term aim that must underscore any effort thereafter. Next, expanding access to contraceptive knowledge and technology synergistically increases life-choices for both men and women; this is a step towards raising standards of education and reducing poverty- both of which positively correlate with reduced spousal abuse and increased contraception acceptance and use. Then, alleviating the mal-effects of poverty lessens the unnecessary burden carried by women and allows men to assume greater responsibility for their lives.
Unwanted pregnancy and sexually transmitted infections decrease the overall quality of life of both partners. Behavior Change Communication efforts to thwart these factors must target both men and women accordingly. The eventual outcome enhances the lives of women and families overall. Expanding the basket, knowledge, availability and usage of contraceptives must consider both women and men, and the synergy in focusing on the empowerment of all genders. Behavior Change Communication can address both the immediate symptoms and eventual outcomes towards reproductive justice, exploiting the links between male responsibility, various forms of abuse and contraceptive acceptance.
References
Digest.
• India Men with Higher Socioeconomic Status are more likely to be knowledgeable about Reproductive Health. Volume 26, No.3, September 2000.
International Family Planning Perspectives.
• In India, Poverty and Lack of Education Are Associated with Men’s Physical and Sexual Abuse of their Wives. Volume 26, No.1, March 2000.
International Planned Parenthood Federation.
• Male Involvement in Family Planning. 73–76, 79–80. 1984.
Khan, M.E. and Patel, Bella C.
• Male Involvement in Family Planning: A KABP study of Agra District. Final report. The Population Council, India. June 1997.
Martin S.L et al.
• Sexual behaviors and reproductive health outcomes: Associations with wife abuse in India, Journal of the American Medical Association, 1999, 282(20): 1967-1972.
Population Council.
• Maternal and Child health. Mixed Success Involving Men in Maternal Care Worldwide. Population Briefs- reports on Population Council research. Volume 11, No.1, January 2005.
Touré, Lalla MD, MPH.
• Male Involvement in Family Planning: A Review of the Literature and Selected Program Initiatives in Africa
Wambui, Catherine.
• Male Only Centers: A New Concept in Family Planning. Published in Conveying Concerns: Women Write on Male Participation in the Family, Population Reference Bureau, Inc.: 18–19. 1994.
Zavier, Francis and Padmadas, Sabu S.
• Use of a Spacing Method before Sterilization Among Couples in Kerala, India. Volumbe 26, No.1, March 2000.
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