Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests

Abstract

The World Health Organization (WHO) estimated in 2012 that 287,000 maternal deaths occurred in 2010; sub-Saharan Africa (56%) and Southern Asia (29%) accounted for the global burden of maternal deaths. Men are also recognized to be responsible for the large proportion of ill reproductive health suffered by their female partners. Male involvement helps not only in accepting a contraceptive but also in its effective use and continuation. The objectives were to assess men's knowledge, attitude, and practice of modern contraceptive methods; determine the level of spousal communication about family planning decision making; and investigate the correlates of men's opinion about their roles in family planning decision making. We searched the following electronic databases from January 1995 to December 2013: Medline, Embase, CINAHL, LILAS, International Bibliography of Social Sciences, Social Services Abstracts, and Sociological Abstracts. Along with MeSH terms and relevant keywords, we used the Cochrane Highly Sensitive Search Strategy for identifying reports of articles in PubMed. There were no restrictions to language or publication status. Of 137 hits, 7 papers met the inclusion criteria. The concept of family planning was well known to men. In the Nigerian study, almost (99%) men were aware of the existence of modern contraceptives, and most of them were aware of at least two modern methods. Awareness of the condom was highest (98%). In the Malawi study, all of the participants reported that they were not using contraception before the intervention. In Ethiopia, above 90% of male respondents have supported and approved using and choosing family planning methods, but none of them practiced terminal methods. Generally, more male respondents disagreed than agreed that men should make decisions about selected family planning issues in the family. Decision-making dynamics around method choice followed a slightly different pattern. According to female participants, decisions regarding method choice were equally made by women or jointly, with male-dominated decisions falling last. There are many challenges to increase male involvement in family planning services. So far very few interventions addressing these challenges have been evaluated scientifically. Health education campaigns to improve beliefs and attitudes of men are absolutely needed. Additionally, improving accessibility, affordability, availability, accommodation and acceptability of family planning service venues will make them more attractive for male partners.

Partner Support for Family Planning and Modern Contraceptive Use in Luanda, Angola

“…Male approval of family planning has been associated with increased male involvement 32 . Male involvement has been promoted in many quarters as a key to increasing contraceptive prevalence and has been called into question by others 1,[33][34][35] . Our study had some limitations.…”

Barriers to Males Involvement in Family Planning Services in Arba Minch Town, Southern Ethiopia: Qualitative Case Study

“…However, family planning services traditionally targeted women regardless of the fact that men's involvement is equally important and childbearing has an impact on men's life too. A review of male involvement in decision making in family planning in Sub-Saharan Africa reflected low involvement of men in family planning programs [5]. A research report from Muslim communities in Ghana suggested further low male involvement in family planning uptake and higher non- Tamiso) 47 approval of for spouses contrary to perfect knowledge and awareness to contraceptive options [6].…”

Multivariate Analysis of Household Decision Making, Contraceptive Use and Fertility Behaviour among Ever-Married Men in Nigeria

“…A similar finding has been reported in developing countries particularly in Sub-Saharan African. Vouking (2014);Okigbo et al (2013);Odu et al (2005) reported in their studies that men who solely take a decision on household earnings were more likely to want more children than men whose wives solely take a decision on household earnings. This finding may be due to dominating of men in reproductive decision making.…”

“…Yet, limited studies have delved into men's decision-making role in affecting contraceptive use, as a means of controlling fertility in Nigeria. Studies in sub-Saharan Africa have shown that male partners have absolute decision-making power that brings about the compliance and submission of their wives (Vouking, 2014). For instance, a study carried out among Mozambique women showed that husband influenced a woman's intention to use contraceptives (Mboane and Bhatta, 2015).…”