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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.
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