Analysis

Manoj from Haryana talks about his views on family planning.

Video credit: Vishal Srivastava, Swasti

Yesterday was Father’s Day, and as we acknowledge the important role fathers play in the life of every child, it also offers us an opportunity to reflect on one particular part of that role: The role men play in deciding whether and when to have children. In Mohammadpur slum just outside Gurgaon, where I was visiting Swasti’s i4We primary healthcare intervention, when men are asked about the role they play in family planning, they often respond like Manoj does in the video above: That the decision is left to their wife, and is no business of theirs. The data from NFHS-4 corroborates this: 35% of urban and 38% of rural men agreed with the statement that ‘Contraception is women’s business and a man should not have to worry about it’. While India has had a successful family planning program in place since 1952, male participation remains an important gap. Why is there so little involvement in family planning among men in India?

There are various possible reasons, including ignorance or misconceptions concerning the multiple contraceptive methods available, misconceptions around male sterilization, as well as a lack of incentives. However, norms around gender equality are perhaps the most crucial factor underlying the disinterest: An interesting study conducted in Uttar Pradesh in 2014 revealed a correlation between men’s attitudes regarding gender equality and their use of contraception. In urban settings, men with ‘moderate to high-level’ gender-equal attitudes were likely to be the users of modern methods of family planning, whereas, in rural areas, the same group was more likely to be involved in traditional family planning methods than not to be involved at all. Men’s attitudes to gender can affect a couple’s contraceptive use through reduced communication between couples, domestic violence, restrictive access to information and decision-making power for women, and mediating the effects of family/community pressure and social norms, among others. Especially among younger and adolescent couples, where women may face greater stigma in accessing contraception, their partner’s support is invaluable. And this importance of men’s involvement is seen not just in India: Studies conducted in Kenya and Ethiopia have shown that women’s fertility preferences and their adoption of contraceptive methods are not only influenced by their own attitudes regarding gender but their husbands’ attitudes as well. Addressing unfavorable attitudes towards gender equality - in both men and women - is clearly key to positive reproductive health outcomes, especially within households where men are the primary decision-makers. So what can we do about it? Incorporating gender-transformative approaches into health and family planning programs is the need of the hour. One important part of this is reaching out to men and boys with information about why and how to use family planning, both through interpersonal communication as well as mass media. This needs to be combined with innovative behavior change solutions, like C3 India’s Do Kadam Barabari Ki Ore, that specifically address the gaps and misconceptions in men’s knowledge of gender issues in Indian contexts, and create sensitivity and interest in family planning issues. Some of these can be found at the K4Health website here. For India’s family planning program, this renewed focus needs to be supported by stronger evidence around the extent and nature of male involvement. A recent report by MEASURE Evaluation brings together a list of critical indicators to measure male involvement, sourced from a month-long online conversation among high-level experts from around the world. The report can be found here. Effective family planning has a substantial effect on reproductive, maternal and child health, women’s empowerment, and gender relations within the household. That’s why USAID has turned a spotlight onto the issue, leveraging $15.6 million in the last six months alone, to prevent maternal and child deaths and promote family planning — and successfully averted 3.4 million pregnancies at that time.

The importance of having mothers and fathers take these decisions together cannot be overstated. We’ll leave the last word to a father-of-one from Haryana, Pankaj: