Barriers to male involvement in contraceptive uptake and reproductive health services: A qualitative study of men and women’s perceptions in two rural districts in Uganda

Reproductive Health, Volume 11, No. 1, Year 2014

Interprétation

Background: Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives. Methods. A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15-54 and women aged 15-49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Results: Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation. Conclusion: Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men’s negative beliefs regarding contraceptive services. © 2014 Kabagenyi et al.; licensee BioMed Central Ltd. A cross-sectional qualitative study was conducted using focus group discussions (FGDs) with women aged 15 – 49 and men aged 15 – 54 as well as 8 key informant interviews with government and community leaders in Bugiri and Mpigi Districts, Uganda. Uganda has an estimated population of 34 million people and is one of the youngest populations in the world [32]. Over 56% of the population is under 18 years of age, and the country has a growth rate of 3.2% per annum [32]. Recent national data has highlighted current reproductive health challenges. More than half of all pregnancies are unintended and roughly a quarter of maternal deaths are due to complications from unsafe abortions [33]. Uganda has one of the highest fertility rates in the region at an average of 6.7 children per woman, although the majority of Ugandan women would prefer fewer children [34]. Within the country, the contraceptive prevalence rates range from 19 to 30% [33,34], and the unmet need for family planning, referring to the estimate of women who desire to delay or prevent pregnancy but are not using contraception, is 36% [35]. Women and men’s access to modern contraceptive methods is also limited in some settings [34]. Traditional gender norms within Uganda elevate men as primary decision-makers in women’s use of family planning methods, although spousal communication and utilization of reproductive health services among men remains low [34,36]. All study participants were purposively selected. Comparable to standard reproductive age categories, men aged 15–54 and women aged 15–49 in current married or non-married partnerships who were living in Bugiri and Mpigi Districts at the time of the study and willing to participate were eligible to join. Bugiri and Mpigi Districts were selected to provide a range of contexts for contraceptive uptake. District health officers, members of village health teams, council leaders, and representatives from local women and men’s groups were recruited for key informant interviews. Participants were selected from both rural and urban settings within each of the two districts with the help of local field guides and community leaders. Data were collected in July and August 2012. Open-ended, semi-structured question guides were used to explore perceptions regarding barriers to men’s involvement in reproductive health. Discussions and interviews were conducted in the local languages, Lusoga and Luganda, in Bugiri and Mpigi Districts, respectively, until saturation was reached and no new findings emerged during study team debriefings. Interviews and focus group discussions were held in audibly private areas. Data were gathered by two trained research assistants with experience conducting qualitative research. The lead author of the study supervised all data collection to ensure quality control and assisted in taking notes. All study participants were encouraged to openly discuss their opinions. No personal information in the form of names or other identifying data was obtained. All discussions and interviews were recorded and transcribed verbatim in Lusoga and Luganda. After validating the transcription, the typed narratives were then translated into English and verified for accuracy. Analysis of the data was conducted by the primary author and included several iterative steps. Using thematic content analyses, the transcripts were reviewed several times, and a set of codes were developed to describe groups of words, or categories, with similar meanings. Transcripts were then coded and managed using ATLAS.ti (Version 7). The grouped categories were refined and used to generate themes emerging from the data. Direct quotations from men, women, and community key informants are presented in italics to highlight key findings. This study received ethics approval by the Makerere University School of Statistics and Planning Ethics Committee and the Uganda National Council of Science & Technology. Local leaders in each of the two districts were also invited to review and approve the study. Prior to data collection, informed consent was obtained for all potential study participants. Only the research team had access to the study data.

Résumé de l’IA

Study Justification:

This study aimed to explore the barriers to male involvement in contraceptive uptake and reproductive health services in two rural districts in Uganda. The justification for this study is based on the understanding that spousal communication can improve family planning use and continuation. However, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. By identifying the obstacles to men’s support and uptake of modern contraceptives, this study provides valuable insights for developing effective male-involvement family planning initiatives.

Highlights:

1. The study found five main barriers to men’s involvement in reproductive health:
– Perceived side effects of female contraceptive methods that disrupt sexual activity
– Limited choices of available male contraceptives, including fear and concerns relating to vasectomy
– Gender norms and traditional family planning communication geared towards women, leading to the perception that reproductive health is a woman’s domain
– Preference for large family sizes uninhibited by prolonged birth spacing
– Concerns that women’s use of contraceptives will lead to extramarital sexual relations
2. Despite high knowledge of effective contraceptive methods, lack of time and limited awareness regarding the specific role of men in reproductive health were identified as additional deterrents to men’s meaningful involvement.

Recommendations:

Based on the findings, the study recommends the following:

1. Develop and implement male-involvement family planning initiatives that address the identified barriers to men’s supportive participation in reproductive health.
2. Address men’s negative beliefs regarding contraceptive services through targeted education and awareness campaigns.
3. Promote spousal communication and shared decision-making on contraceptive use as a means to improve family planning outcomes.
4. Increase the availability and accessibility of male contraceptive options to provide men with more choices.

Key Role Players:

To address the recommendations, the following key role players are needed:

1. Government agencies responsible for reproductive health policies and programs
2. Community leaders and influencers
3. District health officers
4. Village health teams
5. Council leaders
6. Representatives from local women and men’s groups

Cost Items for Planning Recommendations:

While the actual cost is not provided, the following budget items should be considered in planning the recommendations:

1. Development and implementation of male-involvement family planning initiatives, including educational materials, training programs, and awareness campaigns
2. Research and evaluation to assess the effectiveness of interventions
3. Distribution and availability of male contraceptive options
4. Capacity-building for healthcare providers to ensure they are equipped to address men’s reproductive health needs
5. Coordination and collaboration among key role players to ensure effective implementation of initiatives.

Force de la preuve

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on a qualitative study using focus group discussions and key informant interviews. The study was conducted in two rural districts in Uganda, which provides a diverse sample. The themes identified in the study provide valuable insights into the barriers to men’s involvement in reproductive health. To improve the evidence, the abstract could include information about the sample size and demographic characteristics of the participants. Additionally, it would be helpful to mention the specific methods used for data analysis, such as the coding process in ATLAS.ti. This would provide more transparency and allow for better evaluation of the study’s findings.

Abstrait

A cross-sectional qualitative study was conducted using focus group discussions (FGDs) with women aged 15 – 49 and men aged 15 – 54 as well as 8 key informant interviews with government and community leaders in Bugiri and Mpigi Districts, Uganda. Uganda has an estimated population of 34 million people and is one of the youngest populations in the world [32]. Over 56% of the population is under 18 years of age, and the country has a growth rate of 3.2% per annum [32]. Recent national data has highlighted current reproductive health challenges. More than half of all pregnancies are unintended and roughly a quarter of maternal deaths are due to complications from unsafe abortions [33]. Uganda has one of the highest fertility rates in the region at an average of 6.7 children per woman, although the majority of Ugandan women would prefer fewer children [34]. Within the country, the contraceptive prevalence rates range from 19 to 30% [33,34], and the unmet need for family planning, referring to the estimate of women who desire to delay or prevent pregnancy but are not using contraception, is 36% [35]. Women and men’s access to modern contraceptive methods is also limited in some settings [34]. Traditional gender norms within Uganda elevate men as primary decision-makers in women’s use of family planning methods, although spousal communication and utilization of reproductive health services among men remains low [34,36]. All study participants were purposively selected. Comparable to standard reproductive age categories, men aged 15–54 and women aged 15–49 in current married or non-married partnerships who were living in Bugiri and Mpigi Districts at the time of the study and willing to participate were eligible to join. Bugiri and Mpigi Districts were selected to provide a range of contexts for contraceptive uptake. District health officers, members of village health teams, council leaders, and representatives from local women and men’s groups were recruited for key informant interviews. Participants were selected from both rural and urban settings within each of the two districts with the help of local field guides and community leaders. Data were collected in July and August 2012. Open-ended, semi-structured question guides were used to explore perceptions regarding barriers to men’s involvement in reproductive health. Discussions and interviews were conducted in the local languages, Lusoga and Luganda, in Bugiri and Mpigi Districts, respectively, until saturation was reached and no new findings emerged during study team debriefings. Interviews and focus group discussions were held in audibly private areas. Data were gathered by two trained research assistants with experience conducting qualitative research. The lead author of the study supervised all data collection to ensure quality control and assisted in taking notes. All study participants were encouraged to openly discuss their opinions. No personal information in the form of names or other identifying data was obtained. All discussions and interviews were recorded and transcribed verbatim in Lusoga and Luganda. After validating the transcription, the typed narratives were then translated into English and verified for accuracy. Analysis of the data was conducted by the primary author and included several iterative steps. Using thematic content analyses, the transcripts were reviewed several times, and a set of codes were developed to describe groups of words, or categories, with similar meanings. Transcripts were then coded and managed using ATLAS.ti (Version 7). The grouped categories were refined and used to generate themes emerging from the data. Direct quotations from men, women, and community key informants are presented in italics to highlight key findings. This study received ethics approval by the Makerere University School of Statistics and Planning Ethics Committee and the Uganda National Council of Science & Technology. Local leaders in each of the two districts were also invited to review and approve the study. Prior to data collection, informed consent was obtained for all potential study participants. Only the research team had access to the study data.

Matériaux

N/A

Innovations

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase male involvement: Develop and implement initiatives that promote male involvement in reproductive health. This can be done through targeted education and awareness campaigns that address men’s negative beliefs and misconceptions about contraceptive services.

2. Expand contraceptive choices for men: Address the limited choices of available male contraceptives, including addressing fears and concerns related to vasectomy. Research and development efforts should focus on creating more options for male contraception.

3. Challenge gender norms: Address the perception that reproductive health is solely a woman’s domain by challenging traditional gender norms. Promote gender equality and encourage open communication between couples about family planning decisions.

4. Improve knowledge and awareness: Increase awareness among both men and women about effective contraceptive methods and the specific role of men in reproductive health. This can be achieved through community-based education programs and targeted messaging.

5. Address concerns about family size: Address the preference for large family sizes by promoting the benefits of birth spacing and the importance of family planning for the health and well-being of both mothers and children.

6. Address concerns about extramarital relations: Address the misconception that women’s use of contraceptives will lead to extramarital sexual relations. Provide accurate information about the purpose and effectiveness of contraceptives to dispel these concerns.

7. Enhance healthcare provider training: Provide training to healthcare providers on how to effectively engage and involve men in reproductive health discussions. This can help create a supportive and inclusive environment for men seeking information and services.

8. Improve access to contraceptive methods: Address the limited access to modern contraceptive methods by improving the availability and affordability of contraceptives in both rural and urban settings.

9. Strengthen policy and advocacy: Advocate for policies that prioritize and support maternal health, including increased funding for reproductive health services and programs that promote male involvement.

10. Conduct further research: Continue conducting research to better understand the barriers and challenges to accessing maternal health services, particularly in rural areas. This will help inform the development of targeted interventions and strategies.

AI Innovations Description

The study mentioned is titled “Barriers to male involvement in contraceptive uptake and reproductive health services: A qualitative study of men and women’s perceptions in two rural districts in Uganda.” The study aimed to explore men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives in Bugiri and Mpigi Districts, Uganda.

The study used a qualitative research design, conducting 18 focus group discussions (FGDs) with men aged 15-54 and women aged 15-49, as well as eight key informant interviews (KIIs) with government and community leaders. The FGDs and KIIs were conducted in 2012 and were recorded, translated, and transcribed verbatim. Thematic analysis was used to identify five themes related to men’s limited involvement in reproductive health: perceived side effects of female contraceptive methods, limited choices of available male contraceptives, gender norms and traditional family planning communication, preference for large family sizes, and concerns about extramarital sexual relations.

The study found that while knowledge of effective contraceptive methods was high, men’s negative beliefs regarding contraceptive services and limited awareness of their specific role in reproductive health hindered their meaningful involvement. The study concluded that decision-making on contraceptive use should be a shared responsibility of men and women, and efforts to involve men in family planning initiatives should address these barriers and negative beliefs.

The study was conducted in Bugiri and Mpigi Districts, which were selected to provide a range of contexts for contraceptive uptake. The participants were purposively selected men and women in current married or non-married partnerships who were living in the districts at the time of the study and willing to participate. Key informant interviews were also conducted with district health officers, village health teams, council leaders, and representatives from local women and men’s groups.

Data collection took place in July and August 2012, and open-ended, semi-structured question guides were used to explore perceptions regarding barriers to men’s involvement in reproductive health. The discussions and interviews were conducted in the local languages, Lusoga and Luganda, and were held in audibly private areas. The data were collected by trained research assistants, and the lead author supervised the data collection process.

The data analysis involved several iterative steps, including reviewing the transcripts, developing codes to describe categories with similar meanings, and generating themes from the data. The analysis was conducted using ATLAS.ti software.

Ethics approval was obtained from the Makerere University School of Statistics and Planning Ethics Committee and the Uganda National Council of Science & Technology. Informed consent was obtained from all study participants, and their personal information was kept confidential. Only the research team had access to the study data.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase male involvement in reproductive health: Develop and implement initiatives that promote and encourage men’s participation in reproductive health, including family planning. This can be done through community awareness campaigns, educational programs, and targeted interventions that address men’s negative beliefs and perceptions regarding contraceptive services.

2. Expand contraceptive choices for men: Address the limited choices of available male contraceptives by investing in research and development of new and effective methods. This can include exploring options beyond condoms and vasectomy, such as male hormonal contraceptives or non-hormonal alternatives.

3. Promote gender equality and challenge traditional gender norms: Work towards changing societal norms and attitudes that view reproductive health as solely a woman’s responsibility. This can be achieved through comprehensive gender equality programs that promote shared decision-making and responsibility between men and women in matters of reproductive health.

4. Improve knowledge and awareness: Increase awareness among both men and women about effective contraceptive methods and the specific role of men in reproductive health. This can be done through targeted educational campaigns, community outreach programs, and integration of reproductive health education in schools and healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as contraceptive prevalence rates, unmet need for family planning, maternal mortality rates, and utilization of reproductive health services by men.

2. Collect baseline data: Gather data on the current status of the indicators in the target population or region. This can be done through surveys, interviews, and analysis of existing data sources.

3. Develop a simulation model: Create a mathematical or statistical model that simulates the impact of the recommendations on the identified indicators. This model should take into account the specific context and characteristics of the population being studied.

4. Input data and parameters: Input the baseline data and parameters related to the recommendations into the simulation model. This can include data on the current levels of male involvement, contraceptive choices for men, gender norms, and knowledge and awareness levels.

5. Run simulations: Run the simulation model using different scenarios that reflect the potential impact of the recommendations. This can involve adjusting the parameters related to male involvement, contraceptive choices, gender norms, and knowledge and awareness levels.

6. Analyze results: Analyze the results of the simulations to assess the potential impact of the recommendations on the identified indicators. This can involve comparing the simulated outcomes with the baseline data to determine the extent of improvement in access to maternal health.

7. Validate and refine the model: Validate the simulation model by comparing the simulated outcomes with real-world data, if available. Refine the model based on feedback and further analysis to improve its accuracy and reliability.

8. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community leaders. Use the findings to advocate for the implementation of the recommendations and inform decision-making processes related to improving access to maternal health.

Auteur

Dima Health

Statistics:

Citations: 161

Identifiers:

DOI: 10.1186/1742-4755-11-21

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations

Study Countries:

Uganda

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Qualitative

Participants Gender:

Male & Female

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