As part of the implementation of the World Contraception Day Ambassadors project and 120 Under 40 award grants, my organization, Lighthouse Global Health Initiative (LGHI), is pleased to undertake the second phase of our Rural Contraceptive Access Campaign (RCAC). In Phase I of the project, we learned about the important role of male involvement in family planning and reproductive health in rural areas in Nigeria. In Phase II, we want to do more to promote male involvement and support for family planning uptake through targeted advocacy and data-capturing activities related to knowledge, attitudes, perceptions, and practices of rural boys and men.
Our team conducted a mixed-method study in the Moro community, part of the Ife North Local Government in Osun State, Nigeria. We administered a total of 304 questionnaires and held six focus group discussions (FGDs) with men and women of reproductive age. When asked if family planning “is entirely a female affair,” more than half of the respondents felt strongly that family planning is an issue for women alone. However, men in the community reported the use of male condoms as their most preferred contraceptive method.
The fact that many men we surveyed were indifferent or completely opposed to family planning has negative consequences on increasing the contraceptive prevalence rate (CPR) from the 20.4% reported by World Bank in 2016 to 36% by 2018, and achieving 27% modern CPR by 2020 (Nigeria’s FP2020 commitment). We must rewrite the bad narratives of high maternal and infant mortality. A highly patriarchal community like ours must do more to achieve behavioral change among men. This is especially important in rural communities, where people are usually less educated and may be unfamiliar with modern family planning methods. According to NDHS 2013, the prevalence of contraceptive use varies significantly when urban areas (>25%) are compared with rural areas (9%).
This is why LGHI, through the RCAC project, embarked on strategic advocacy to the Moro community’s traditional council to enlighten them about the importance of family planning and why boys and men should support it. We also incorporated sport (football competition) into the project implementation. With the football competition, we were able to reach hundreds of young boys and men with information on family planning. IEC materials on facts about family planning were printed in English and Yoruba and distributed to spectators.
One common answer men gave for not supporting their wives’ use of family planning, especially long-acting reversible contraceptives (LARCs), is fear of promiscuity. According to one FGD participant, “Family planning causes some women to misbehave in the society. Some women are interested in adopting it; some even—without informing their husbands—begin to practice it because it gives them [the] opportunity to misbehave sexually, making them misuse it. Family planning for married women helps them not to give birth to more [children] than they can afford, but…it causes some women to misbehave sexually.” This and other myths associated with family planning were addressed through the trainings and advocacy campaigns organized through RCAC.
Despite prevalent myths, the economic burden of caring for multiple children compels some men to open up to considering family planning options. During the FGDs, both men and women spoke about the challenge of raising more children than their resources can accommodate. According to one FGD participant, “If we consider the economic situation in Nigeria nowadays, food, education, and…other essential things are now very expensive compared to the olden days. [T]his is the reason some men also support family planning.” This is a factor that can be leveraged to promote male involvement in family planning.
Family planning is everyone’s concern and not just a woman’s issue, especially in a patrichial society where a woman’s decisions are subject to her husband’s approval. Advocacy and behavior change campaigns must target both men and woman in order to be truly effective. In many communities, women feel the impact of uncontrolled childbearing much more than men do, since they are the ones carrying the pregnancies.
One thing is certain: Male resistance to family planning uptake would not be this high if men were the ones carrying pregnancies.