Enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda: a qualitative study

Abstract

Background Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda. Methods This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach. Results Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female’s issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement. Conclusion Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods.

What does your partner want? Using a gender equality lens to assess partner support and involvement in family planning in Uganda

“…Notable sex differences were seen in some specific ways that men and women operationalized partner support as more men preferred to jointly discuss with their partner while women preferred their partner to accompany them to health center. Our study findings corroborate the existing literature on the importance of partner support for contraceptive use [ 5 , 7 , 8 , 17 , 18 ].…”

“…Study findings improve the current understanding of partner support for family planning and offer insights on how social support can be leveraged in partnerships to improve health and well-being, particularly related to family planning. Understanding couple dynamics and preferences related to family planning in Uganda may inform the design of tailored gender-aware SBC interventions that improve male involvement and reproductive health outcomes [ 17 ].…”

“…Women’s perspectives of their partner’s support may not be an accurate reflection of the male partner’s actual position as stereotyping of men’s opinion of family planning has been noted [ 10 ]. For example, while women might view partner support as being escorted to the clinic, some men view escorting their partner as being controlled by the woman or being labelled as weak [ 17 ]. Nevertheless, analysis of matched female and male partner’s perceptions suggests that while women are poorly aware of their partners actual opinion, their perceived partner approval was a strong predictor of modern contraceptive use [ 10 ].…”

“…Limited studies in Uganda have explored partner support for family planning from the male partner’s perspective or provided an in-depth understanding of male and female differences in how partner support is defined and operationalized. In Uganda, men’s fertility preferences, attitudes towards family planning, and prevailing norms in their community influenced their support and involvement in family planning [ 17 ]. Other factors influencing male partner support in sub-Saharan Africa include religion, level of education and socioeconomic status [ 14 ].…”

“…Other factors influencing male partner support in sub-Saharan Africa include religion, level of education and socioeconomic status [ 14 ]. Qualitative studies suggest that men in Uganda preferred less involvement in family planning, citing excuses of work engagements, discomfort being seen escorting the woman to the clinic and feeling out of place while in the family planning clinic [ 17 ]. Understanding differences in male versus female preferences for partners support is crucial to improving male involvement in family planning resulting in subsequent uptake and continuity of contraception [ 18 ].…”