Archive for the ‘Men's Roles in Family Planning’ Category
After two full days sharing research, ideas and knowledge, the question today at the ICFP is how to put the knowledge to action. Ward Cates, of Family Health International, opened today’s plenary by asking, “How do we do it?”
Cates spoke about the “pearls”—of knowledge, of wisdom—gathered over the last days. (Cates’s turn of phrase is more than appropriate: Uganda is known as the pearl of Africa.) Cates’s 10 points outline the areas of focus that he hopes will bring family planning renewed success and interest.
“Family planning is essential to achieving all of the Millennium Development Goals,” he said. Among the core issues discussed that deserve greatest attention are policies that address unmet contraceptive need; consistent and correct contraceptive use; contraceptive technology that makes adherence easy and cost-effective; and increased service delivery, so that all who wish to receive family planning have access to it.
Cates also tackled several of the newer issues that consistently surfaced at the conference. “I think we’ve reached a tipping point,” he said, in terms of getting countries on board with integrating family planning and HIV services. He also noted the growing acceptance of family planning as an effective HIV prevention strategy; the effectiveness of integrating family planning into other services such as postnatal and maternal and child health services; the need to get youth and men involved, particularly in reducing the taboos around vasectomy; reducing duplication among programs; and the importance of ownership of efforts by African leaders.
“Now, we can say that the state of family planning in Nigeria is having a brighter look. Now acceptance is increasing, both among men and women, and even religious leaders. It all depends on the language you use, how you call it. In traditional parts of the country, we call it ‘healthy timing,’ or ‘childbirth spacing.’ ‘Family planning’ is not a good way to call it in those places. It is very important to change your language to suit the culture. … We need to get men involved not only in family planning, but in total reproductive health for the couple. When men are involved, the whole family benefits, and the country benefits.”
Usman Gwarzo is a Family Health International, Nigeria program manager and country adviser for reproductive health and prevention of HIV transmission from mother to child. His organization is the largest PEPFAR-funded program in the world, and he is currently conducting research on a reproductive health and HIV integration project.
“Men are not the ones against vasectomy, but the myths are that vasectomy is castration. … When a man has more than one wife, he needs to have multiple negotiations about family planning. … The resistance to family planning is men, but vasectomy can be easily accepted so that the man does not have to worry about what happens to your children when you have more than you can support.”
Presenting findings from a study authored by Oladosu Ojengbede (University College Hospital, Ibadan, Nigeria), Stan Becker (Johns Hopkins Bloomberg School of Public Health), and others, Stella Okonkwo addressed the role of husbands during their wives’ delivery of their children.
According to Okonkwo, an obstetrician-gynecologist with University College Hospital, Ibadan, there is evidence that Nigerian women desire their husbands’ support during childbirth. The husband’s support and presence, data shows, are associated with better outcomes in the infant’s health.
In a study among Nigerian women and men, data showed that women whose husbands were present during childbirth were more likely to use contraceptives than those whose husbands were not present. Also, among the group whose husbands supported their wives during childbirth, the husbands were more likely to initiate the use of modern contraceptives among their wives.
Macellina Yinyinade Ijadunola, of the Department of Community Health, Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, presented findings from a recent study of male involvement. Among study participants in Ile-Ife, the data showed that 89 percent of men approved their wives use of family planning methods. But the question remained: Why do men themselves not participate in family planning?
Surveying family planning service providers in Ile-Ife, Ijadunola and colleagues found that the top three reasons—in the opinion of the providers—for men not participating were as follows: male participation in family planning goes against cultural norms; family planning is the women’s business; or religion dictates against it.
In conclusion, Ijadunola said, men in the study have the knowledge, but do not participate. “We need male service providers,” she said, “improved social marketing, and male-targeted information in the mass media.
“The two most cost-effective methods,” said Isaiah Ndong, of Engender Health, “are IUDs and vasectomy. And vasectomy is much cheaper than sterilizing women.” One of the advantages of vasectomy is that it can be offered in a variety of settings, which increases access.
“Despite what you all may have heard,” said Ndong, “African men want to be involved in family planning and are accepting of vasectomy.” The comment drew a few snickers from African women in the audience.
Citing Demographic and Health Surveys data, Ndong reported that in sub-Saharan Africa, only 20 percent of women report knowledge of vasectomy; likewise, only 33 percent of men report knowledge of it. “Vasectomy,” said Ndong, “is the modern family planning method that is least known.”
Ndong addressed some of the many misconceptions about vasectomy among Africans. One of the myths maintains that vasectomy is equal to castration. Another misconception is that vasectomy impairs sexual function. And still more misinformation includes the ideas that vasectomy will make the man fat, or weak, or less productive. But these are only myths, said Ndong.
Education is key, where vasectomy is concerned. Ndong recommended education strategies that include print, radio and hotlines. He also suggested that male champions of vasectomy be recruited. “Persistence yields results,” he said.
In more urban areas, the wife has more influence over family planning decisions. But in traditional, rural settings, it seems that the husbands have more influence than wives.
Erulkar outlined the “Addis Birhan” program, which explores how to best involve men in family planning. “Addis Birhan” used male mentors who mobilize husbands at the village level, and it adapted its message for rural Ethiopian settings. While addressing sexual and reproductive health, the program focused as well on non-violence and the responsibilities of men to care for their families. Aiding the program’s success were the pictures used as teaching aids—most of the beneficiaries of the program do not have adequate literacy to read.
“There is a significant demand for this program,” said Erulkar. In 18 months, 20,000 men were enrolled. “This program demonstrates that rural men in traditional settings can be reached with reproductive health and family planning initiatives.”