Men’s Attitude Towards Contraception and Sexuality, Women’s Empowerment, and Demand Satisfied for Family Planning in India

Abstract

Whilst the prevalence of unmet need and contraceptive use remained unchanged for 10 years (between 2005–2015) in India, gender restrictive norms and power imbalances also have persisted, preventing married women from meeting their family planning desires. Data for this study are from the 2015–6 National Family Household Survey, which contains information on fertility preferences and family planning for women in reproductive age. As a proxy for men’s attitudinal norms, we aggregated men’s perceptions regarding contraception (contraception is women’s business, women who use contraception may become promiscuous) and control over their wife (if his wife refuses to have sex, men have the right to deny financial support, have sex with another woman, or beat wife) at district level. Using a three-level random intercepts model, we assessed individual and contextual-level associations of men’s attitudinal norms and met need for contraception among sexually active women (aged 15–49) with any demand for family planning, while adjusting for women’s empowerment indicators [education, job status, and adult marriage] and individual demographic factors. Our results indicate that men’s attitudinal norms are negatively associated with women’s contraceptive use; for instance, a 1 standard deviation increase in the proportion of men who believe that contraception is women’s business was associated with a 12% reduced likelihood of contraceptive use (OR = 0.88, 95% CI 0.82–0.95). Similar associations remained or were stronger after considering only modern methods, or when excluding female sterilization. Furthermore, our contextual effects analysis revealed that women’s higher education or wealth did not improve contraceptive uptake in communities with strong attitudinal norms, but working women or women married as children were more likely to use contraception in those communities. Our results suggest that men’s attitudinal norms may be dominating over women’s empowerment regarding family planning choices among reproductive age women. However, employment appeared to play a strong protective role associated with women’s contraceptive use. It is important for programs seeking to transform gender equality and empower women in making contraceptive choices to consider women’s employment opportunities and to also address male attitudinal norms in the context of the ecosystem in which men and women coexist and interact.

Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?

“…The current study showed that males who were divorced or separated had increased odds of involvement in FP decisions in Malawi, while males who were widowed were found to have increased odds of participation in FP decisions in Tanzania. A study carried out in Ethiopia [ 79 ] backed up this conclusion. This could be because joint decision-making between male and female partners to use contraception is a predisposing factor for male involvement in FP decisions among respondents who are married, cohabiting, widowed or divorced/separated.…”

“…To achieve universal access to reproductive health care services, as part of the 2030 Agenda for Sustainable Development, it is crucial to increase access to contraception and ensure that the demand for FP is satisfied when utilizing effective contraceptive methods. Despite numerous coordinated efforts and success in increasing access to contraception, there are still significant obstacles to overcome [ 79 , 80 ]. Women’s empowerment, health, and gender equality are some of the related 17 SDGs goals/targets and the 2030 Agenda.…”

“…In poor nations, the role of male involvement in family planning (FP) and their participation enhances women’s adoption of FP techniques, strengthens spousal coordination, helps the achievement of FP programs, and provides their partners with reproductive health rights [ 84 ]. Thus, the emphasis of men’s shared responsibility and the promotion of their active involvement in the prevention of sexually transmitted diseases, responsible parenthood, sexual and reproductive behaviour, including FP, and prevention of unwanted and high-risk pregnancies has become a major agenda in SDG 3 [ 79 , 85 ]. Involving men in FP services implies that there will be great improvement of health service utilization and this will ensure universal access to sexual and reproductive healthcare services, which include FP, education and information, and the integration of reproductive health into national strategies and programs.…”

Women’s Empowerment, Income, and Nutrition in a Food Processing Value Chain Development Project in Touba, Senegal

“…The lack of women’s empowerment in the use of contraception should also be a concern for nutrition-sensitive value chains if the prevention of malnourishment is viewed from a more nuanced gendered lens rather than a simple sex disaggregation across nutritional outcomes. The inclusion of men and community leaders in gender-sensitive VCD projects must also be considered, as men’s and community leaders’ attitudes toward women’s empowerment and women’s reproductive choices impact women’s use of contraception and women’s agency in other areas of public health importance [ 78 , 79 , 80 , 81 ].…”

Barriers to contraceptive use in humanitarian settings: Experiences of South Sudan refugee women living in Adjumani district, Uganda; An exploratory design using qualitative method

“…In most patriarchal societies, men have dominated all decisions that pertains to family matters [27]. This male dominance has further exacerbated the vulnerability of women and girls affecting their access to health services.…”