Background to the Study
Recognition is growing on a global scale that the involvement of men in family planning practices (FPPs) offers both men and women important benefits. Such benefits include a decreased maternal mortality rate and an increased contraceptive prevalence rate (CPR). According to Cleland, Bernstein, Ezeh, Faundes, Glasier and Innis (2006), an estimated ninety per cent (90%) of abortion-related and twenty per cent (20%) of pregnancy-related morbidity and mortality, along with thirty-two (32%) per cent of maternal deaths could be prevented by use of effective contraception. Hubacher, Mavranezouli and McGinn (2008) also noted that in Sub-Saharan Africa, an estimated fourteen million unintended pregnancies occur every year. These unintended pregnancies and subsequent abortions could have been avoided if the male partners had applied family planning (FP) methods.
In the past, men were considered to be beyond the scope of FP programmes; the reasons, according to Dahal, Padmadas and Hinde (2008), included the notions that reproduction was primarily a woman’s issue and that men usually did not take responsibility for reproductive health and FP. However, it has been widely acknowledged that men in developing countries, such as Nigeria, make most of the decisions regarding family formation (Bankole & Singh, 1998); and according to Morgan and Niraula (1995), despite women’s increasing influence on household decision making, their preferences regarding contraceptive choices and family size may not translate into practice unless they conform to their husbands’ wishes. Thus, without the husband’s approval and support, the wife may not be able to practise FP.
Studies in Sub-Saharan Africa, including Nigeria, revealed a high level of knowledge of FP methods and a strong positive attitude towards FP by men but the actual use of these FP methods remains uncommon (Mustapha & Mumford, 1984; Gallen & Kak, 1986; Obionu, 1998). This apparent refusal or reluctance by men to use male FP methods presents a source of concern, especially regarding the need for couples to share the responsibilities of reproduction. According to the Alan Guttmacher Institute- AGI (2003), studies conducted in Africa and Latin America had revealed that more than a quarter of men who wanted to limit or postpone their wives’ childbearing did not use any method to prevent unwanted pregnancy. Hence, the burden of contraception was borne by the women only. This confirmed the assertion by Lasee and Becker (1997) that in most developing countries, like Nigeria, women carry the burden of responsibility for contraceptive use often with little or no support and sometimes, with great resistance from their male partners. This may be the reason why in spite of an increased emphasis on FP programmes in Nigeria, the impact on fertility is still very low with a population growth rate of two point nine per cent per annum (Uzuegbunam, 2005). In line with this, Duze and Mohammed (2006) opined that one factor that might have contributed to the lack of success of the population control programmes may be that they tend to be directed toward women only, ignoring the role of men in FP decisions.
FP, according to Arkutu (1995), refers to the actions couples take to have the desired number of children, when they are wanted. He added that using a method of FP meant allowing choice, not chance to determine the number and spacing of children. This implied that people, especially couples, had a responsibility of deciding the number of children they wanted and the timing of their births, hence the birth of children need not be by accident. Similarly, FP was defined by Planned Parenthood Federation-PPF (2002) as the kind of services which help people to plan their families in such a way that they can have children when they want and help individuals to enjoy normal sexual relations without fear of unwanted pregnancy. This definition views FP as a range of services which enabled people to plan their families and avoid unnecessary anxiety brought about by fear of unwanted pregnancies. Similarly, FP was defined as the planning of when to have children and the use of birth control and other techniques to implement such plans (Family Health International – FHI, 2009). This highlights the importance of employing birth control techniques or FP methods to determine when or not to have children. These different FP methods or techniques are classified into natural and artificial; temporary and permanent; and male and female (Jones, 1982).
Natural FP methods, according to Kippley and Kippley (1996), refer to any use of fertility awareness methods which involve a woman’s observation and charting of her body’s fertility signs to determine the fertile and infertile phases of her cycle. Artificial FP methods, according to PPF (2002), refer to those methods that work in various ways to: physically prevent sperm from entering the female reproductive tract (for example, male condom and female condom); hormonally prevent ovulation from occurring (for example, oral contraceptives, injectables, implants and Intra Uterine Devices-IUCDs); or surgically altering the female or male reproductive tract to induce sterility (for example, tubal ligation and vasectomy).
Temporary FP methods refer to those that can be reversed if and when the individual or couple want to have children while the permanent FP methods are those that cannot be easily reversed such as tubal ligation and vasectomy (Jones, 1982). Condom, withdrawal and vasectomy (FHI, 2009) are the only FP methods available for men. The rest are for females or require female participation. According to FHI (2009), the development of hormonal methods for women and subsequent development of IUCDs and modern surgical sterilization led to the development of a FP services focused on women often to the exclusion of men. There is, therefore, the need to reintegrate men into the FP programme, not just in supporting spouses’ use of FP methods but in practicing FP themselves.
Practice, according to Hornby (2001), is a way of doing something that is the usual or expected way in a particular organization or situation. In the same vein, Cornog, Vranken and West (2008) defined practice as the actual performance or application. In the above definitions practice implies one taking action concerning a particular thing. Therefore, in this study, FPPs refer to all the activities undertaken by individuals, especially males, to prevent unwanted pregnancies, determine the number of children they want and the interval between their births. It is one thing to get involved in these FP activities but it is the extent of such involvement that can determine their success or failure.
Extent is defined as the space or degree to which a thing is extended (Macdonald, 1980). He further referred to extent as bulk, scope or amount. Cornog, Vranken and West (2008) defined extent as the point or degree to which something extends. They also stated that extent refers to dimension, magnitude or measure of something. These definitions indicate that extent has to do with the degree or magnitude of something in relation to others. In the present study, extent is regarded as the degree of males’ involvement in FPPs. The extent of males’ involvement in FPPs is determined by certain factors which are referred to as determinants in this study.
Determinant, according to Hornby (2001) is a thing that decides whether or how something happens. Cornog, Vranken and West (2008) also defined it as an element that identifies or determines the nature of something or that fixes or conditions an outcome. Macdonald (1980) defined determinant as that which serves to determine or decide how something happens. Determinant, according to these definitions, can be regarded as something that decides the outcomes of a thing. In this study, therefore, determinants refer to socio-demographic factors such as level of education, occupation, religious affiliation, age and geographical location. These factors decide or determine the extent of males’ involvement in FPPs.
To involve, according to Macdonald (1980), means to envelop or concern somebody with something. Similarly, Cornog, Vranken and West (2008) stated that involvement means to draw in as a participant, to oblige, to take part, to require as a necessary accompaniment and to include. Involvement, according to the above definitions, means concerning oneself with something or participating in it. Involvement, in this study, refers to the participation or inclusion of males in FPPs. It has also been asserted that male involvement in FPPs means, not only, increasing the number of men using condoms and having vasectomies but also includes the number of males who encourage and support their partners and their peers to use FP (Toure,1996).
Male is a state of being a man or a boy. It refers to the masculine gender or an individual that produces motile gametes (spermatozoa) which fertilize the eggs of a female (Cornog, Vranken & West, 2008). Males, as used in the present study, refer to currently married men. In developing countries such as Nigeria, males play significant roles as household heads, custodians of their lineage and providers for their family. Due to these roles, decision-making power within the family and society largely lies with males and is extended to decisions involving FPPs (Duze & Mohammed, 2006). Furthermore, males make most of the decisions regarding family formation (Bankole & Singh, 1998) and their reproductive preferences and motivation influence their wives reproductive outcome (Lasee & Becker, 1997). The need for males’ involvement in FPPs cannot be over-emphasized and the extent of such involvement can be determined by demographic and socioeconomic factors (Hossain, 1999).
There are several socio-demographic factors capable of influencing the extent of males’ involvement in FPPs. This study is concerned with such factors as level of education, occupation, religious affiliation, age and geographical location.
Level of education has been identified as a strong factor influencing males involvement in FPPs. Studies have indicated that men who are educated are more knowledgeable about FPPs. Obionu (1998) confirmed, in a study, that there was a significant association between the practice of FP by males and their level of education. The educational background of males, according to Akafua and Sossou (2008) determined their willingness to use a FP method. This may be because exposure to FP information through the mass media differed considerably by level of education (Bangladesh Demographic and Health Survey-BDHS, 2000). The more educated men were, the more they were exposed to information about FP and thus had a better chance of choosing to use or support their spouses’ use of FP methods.
Reports from researchers indicate that occupation, hence level of income, can determine the extent of males’ involvement in FPPs. According to Dahal (2005), a large proportion of women whose husbands were manual workers favoured female sterilization because of their fear that vasectomies would render men weak and too ill to work and hence potentially impair their ability to support the family. In the same vein, Dahal, Padmadas and Hinde (2008) stated that FP method choice differed by occupation. Thus men working in the professional sector reported the highest rates of male sterilization and condom use, while men who had manual or agricultural jobs were the most likely to use no contraceptives. Gaverick (2004) posited that the FPPs of men is shaped in part by the inherent cost of accepting the FP method including the cost of purchasing the contraceptive or service; cost of acquiring the information; cost of travel and time; cost associated with side effects; and the psychological cost of using a method that may be accompanied by social disapproval.