Kenyan men’s fears about family planning

Despite increases in recent years in the number of women wanting to avoid pregnancy, the use of modern contraceptives in sub-Saharan Africa remains low. For example, in Kenya about three-quarters of married women aged 15–49 want to stop childbearing or delay it for at least two years, yet only 39 percent report using a modern contraceptive method. About 43 percent of pregnancies in Kenya are unplanned2. Increased contraceptive use could result in fewer unplanned pregnancies, decreased mother-to-child HIV transmission, fewer illegal abortions and maternal and infant deaths.

WithersTab;e1Men’s disapproval of family is a major barrier to increasing women’s contraceptive use in sub-Saharan Africa. To design and evaluate effective family planning programs, we need to understand why male approval of contraception is low and to determine what strategies to encourage male participation would be acceptable to both women and men in sub-Saharan African contexts.  We explored Kenyan men’s perspectives on these issues through 12 focus group discussions with a total of 106 married men between the ages of 20–66 in Nyanza Province, Kenya.

When asked whether men should be involved in family planning, men in our study almost universally believed that men wanted to be, and should be, involved. In fact, only four out of 106 felt that men should not be involved. Numerous benefits of male involvement were discussed, including better relationships with their wives and informed, joint decision-making around appropriate contraceptive methods. However, while the majority of men reported overwhelming family planning approval, in reality many were reluctant to publicly acknowledge this. Traditional gender roles in Kenya dictate that men should be powerful, dominant and have many children. Men in our study were concerned that community members would criticize them for accepting family planning, think that they were being controlled or “herded” by their wives, or that they had given their wives permission to be unfaithful, since contraceptive use was associated with promiscuity and infidelity. While men in our study stressed their desire to learn more about family planning, they distrusted the family planning information provided by their wives because they suspected their motive to use family planning might be to have extramarital affairs. Men preferred to receive family planning information from health care providers. At the same time, however, they were reluctant to go to family planning clinics because they feared that providers might pressure them into having vasectomies or into disclosing extramarital sexual activity or HIV diagnoses to their wives.

Our results show that while encouraging clinic visits by couples may be useful, it is also important to allow men and women to meet individually with providers and to em­phasize that they will have privacy.  Community-based strategies involving male outreach workers and village leaders, such as pro­viding family planning education to men at community events and via home visits, were suggested. It is important to note that involving men in family planning could reduce a woman’s power and her ability to choose for herself whether to use contraception, as well as lead to conflict and violence against women. Programs seeking to increase men’s involvement in family planning should care­fully consider potential negative consequences for women.  Finally, approaches that challenge traditional male gender roles and address men’s fears regarding family planning could increase male family planning involvement. Increased awareness of the positive gender-related benefits that family planning holds, such as the ability to be provide financially to fewer children, could help encourage more male acceptance of and comfort with family planning.

 

Publication

Men’s Perspectives on Their Role in Family Planning in Nyanza Province, Kenya.
Withers M, Dworkin SL, Onono M, Oyier B, Cohen CR, Bukusi EA, Newmann SJ.
Stud Fam Plann. 2015 Jun

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