Introduction
Family planning is a way of thinking and living that is adopted voluntarily on the bases of knowledge, attitude and responsible decision making by individuals and couples in order to promote health and welfare of the family group and thus contribute effectively to the social economic development of the country (WHO, 2011). It involves practices that will enable couples or individuals to determine the number of children they would like to have, when to have them, that is both the timing and spacing and most importantly, those they have the capacity or the means to cater for (Fumilayo and Kolawole, 2008).
Men are pivotal decision maker’s at all household level within the rural communities. The duties of men in the society seems supreme, especially in rural communities, they are in charge of the family, they run the world governments, they control religious organizations and they co-ordinate all social system (Okeke, 2011). Furthermore, they play vital in pregnancy and delivery and transmission of sexually transmitted infections. Onuoha (2009) stated that African men are mainly responsible for deciding whether their wives will practice family planning and the method to be adopted. He further stated that the true position is that in traditional African societies, including Nigeria, men are conferred with authority to determine who gets what, how and when in the family. The authority implies that they have the final say on the number of children the family should have, the spacing, maternal health and general level of reproductive health in the family. Thus, any family planning programme that excludes men is meant to have minimal impact on the targeted population.
Male involvement in family planning would increase its recognition, acceptance and practice by the people especially within the rural communities men are still the gate keepers in the families who control power and decision making. Their involvement will help to achieve huge success in the numerous campaigns aimed at reducing, population explosion in Africa, arrest the increasing surge of sexually transmitted infections and reduce maternal and infant morbidity and mortality (Onuoha,2009).
Despite global recognition of the importance of male involvement in family planning, Nigeria has not developed programs in family planning that fully involves men. Most family planning programs in our environment seems to focus on women only. The non-inclusion of men in various family planning programs by program planners has make men not to know much about family planning and the benefits to their spouses and family especially in the rural communities. Yet men can participate in family planning either as user of male methods or as supportive partners of users (Fumilayo and Kolawole, 2008).
With the above scenario, one wonders what then will be the situation in rural community where traditions is still highly upheld. Rural communities have typical characteristics such as: they share common interest, bound or tied to tradition and culture, resist change among others. These make men exercise undue authority or control over their wives in family matters such as issues of child bearing and contraceptive use. All these seem to make the acceptance of family planning more difficult in these rural communities (Onuoha, 2009).
Therefore, it is very important to get men involved in family planning in order to achieve better success. This will improve health of both themselves and their spouses.
Concept of family planning
Family planning, according to World Health Organization, is a way of thinking and living that is adopted voluntarily upon the basis of knowledge, attitudes and responsible decision by individuals and couples, in order to promote health and welfare of the family, groups, and thus, contribute effectively to the social development of the country, (WHO, 2011]..
An expert committee on health described family planning as, practices that help individuals or couples to attain certain objectives to avoid unwanted birth, to bring about wanted births, to regulate the intervals between pregnancies, to control the time at which birth occurs in relation to the ages of the parents and to determine the number of children in the family, most importantly that they have the capability or the means with which to do so (Parks, 2007).
This also implies that people have the ability to reproduce, to regulate their fertility and to practice and enjoy sexual relationships. They also have right to be informed and to have access to safe, effective, affordable, acceptable methods of family planning services of their choice (Onuoha, 2009).
History of family planning
Historical development of man’s desire to control his reproduction is as old as humanity. Thus family planning is as old as history itself (FMOH, 2007).
The history of family planning was traced to 1912, when Margaret Sanger was called out with a doctor to a truck driver’s wife in New York who had just committed an abortion. The woman was nursed back to health and warned that another abortion would kill her.
In 1914, Margaret Sanger was called out again to the same woman who had committed abortion again. But before Sanger could arrive she died. The incident gave Sanger concern about the suffering of women with unwanted pregnancies and abandoned children.
In 1916 Margaret Sanger opened the first family planning clinic which was closed down nine days later by the authorities which were against family planning. Sanger and her sister were imprisoned. She went on hunger strike for 103 hours. This made the United States women to demonstrate and make an appeal to the government. She was eventually released and allowed to carry on with her pioneering work in family planning. In 1920 Margaret Sanger alone founded the first family planning clinic in U.S.A. (Fumilayo & Kolawole, 2008).
In 1921, the first birth control clinic was opened in England by Marie Stopes and the society for constructive birth control was founded. In 1952 the International Planned Parenthood Federation (IPPF) comprising 32 countries was founded. In Nigeria, Pathfinder fund sponsored the survey of the country’s need for Family Planning. In 1960, the IPPF and Pathfinder fund aided in the formation of Family Planning Council of Nigeria which was formally launched at Napo Hall Ibadan and thereafter family planning clinics were established at other places. (FMOH, 2007).
Simultaneously late Professor Ojo started the programme in U.C.H. Ibadan in 1964. He later got Mrs. Adeyemi on as part time, then Mrs. Delano who later became the programme co-coordinator of Fertility Research Clinic. The College of Medicine University of Ibadan took over the unit in 1975 and since then it has been under the Department of Obstetrics and Gynecology and is currently known as Fertility Research Unit, College of Medicine U.C.H., U. I. Ibadan (Fumilayo and Kolawole, 2008; FMOH, 2007).
Family planning methods
According to Fumilayo and Kolawole (2008), the natural family planning method is said to be the monitoring of the natural physiological signs and symptoms in a female reproductive system within the reproductive life to determine the fertile periods for the approach to the timing of pregnancy. It can be called fertility awareness methods (FAM) These include the Basal body temperature method, the cervical mucus method (CMM) or Billings Ovulation methods, symptothermal method (STM). Others are withdrawal method, prolonged lactation and abstinence.
Parks (2007), opined that contraceptive methods are preventive methods to help women avoid unwanted pregnancies. They include all temporary and permanent measures to prevent pregnancy resulting from coitus. Contraceptive methods maybe broadly divided into two classes, Spacing methods and terminal or permanent methods. The spacing methods include:- Barrier methods, intra uterine devices, hormonal methods, post conceptual methods.
Terminal or permanent methods: includes. Male sterilization and female sterilization. Barrier methods aim to prevent live sperm from meeting the ovum. However in the rural communities of this study we are focusing on condom use among men and their support for their wives contraceptive usage. Parks, (2007) stated that condom is the most widely known and used barrier devices by males around the world. He also noted that its non-contraceptive advantages has some Protection from sexually transmitted infections, a reduction in the incidence of pelvic inflammatory diseases and possibly some protection from the risk of cervical cancer. Condoms can be a highly effective method of contraception, if they are used correctly and consistently.
Health benefits of family planning
The health benefits of family planning are numerous as it has impact on the mother, infant/children, father and the community in general.
Maternal
To the mother according to Parks (2007), family planning helps couples or individuals to control the number, interval and timing of pregnancies and births. This affords time to recuperate or recover well after each pregnancy, thereby, reducing material mortality. Furthermore it offers mothers opportunity for smaller family size for better provision of adequate nutrition for her.
KOM (2010) opined that family planning is an important factor in the prevention of unwanted pregnancies with its potential complications, which may result from unsafe induced abortion. About 150,000 unwanted pregnancies are terminated every day, out of which one-third is unsafe abortion resulting in about 500 deaths every day. In the African sub-region, abortion is in the first three highest causes of maternal mortality. Hatcher, Rinehart, Blackburn and Gella, (2000), further stated that every day, 1,600 women and more than 10,000 newborns die from preventable complication during pregnancy and child birth.
Almost 99% of these maternal and 90% of neonatal deaths occur in the developing countries. Family planning as a pillar of safe motherhood plays a major role in reducing maternal and newborn morbidity and mortality.
To the father:
Family planning gives the father ability to provide financially for the family and spend more time with the family.
Infant/children’s health
Parks, (2007) noted that child’s proper growth, development and nutrition can be achieved with family planning as birth spacing and smaller family size enhances child survival.
To the community
Family planning helps the community to plan her needs. It shows the rate of population growth which offers more opportunity for education and employment to the community. Family planning also improves the quality of life for the people within the rural community, for example, it helps the government to provide adequate food supply, housing, health care services, portable water supply, good road network system to her members. It reduces or prevent the spread of sexually transmitted infections, for instance, condom offers some degree of protection to sexually transmitted infection. Thus reducing mortality indices for the community (FMOH, 2007).
Factors that affect men’s involvement in family planning
Lack of many contraceptive options for men:
One of the greatest deterrents to greater men’s involvement in family planning is the lack of contraceptive options for men. Apart from withdrawal, only vasectomy and condom are available to men but while male condom provides effective protection against pregnancy and sexually transmitted infection, there is often reluctance to use them (Khannc and Van 2009).
Poor information, education and communication (IEC):
Some men are unaware of the concept and the importance of their involvement in family planning. Poor IEC causes non motivation and communication of males to the programme, for instance the introduction of programmes on radios andtelevision on male involvement in family planning and the advantages that are associated to the responsibilities and participation will go a long way in increasing the number of males that get involved in family planning (Onuoha, 2009).
Inadequate knowledge:
Even though procreation is the co-operate responsibilities of both males and females, in most cultures in African sub regions, pregnancy and child birth are often perceived as a woman’s problem alone. Consequently, most men assume that women should bear the entire burdens of preventing unwanted pregnancies, sexually transmitted infections, using of contraceptives alone (Kom, 2010). Also levy, (2013) opined that women who want to discuss family planning with their spouses may be perceived as promiscuous or unworthy of trust.
Religious beliefs:
Some religious beliefs of people are against male participation in family planning. Artificial family planning is a crime to some religions example Roman Catholic denomination in Christian religion does not believe inartificial family planning of any type such as the practice of vasectomy and condom are prohibited by males. Also the Muslims believe in a man marrying multiple wives as many as four. This encourages gender inequality and deprivation of women’s right and empowerment (Grillo, 2009).
Culture:
According to Kom (2010), in the African sub-region, there is a belief that expression of wealth of a man is in the number of children or wives he has. Thus polygamy and extra marital relationships are common practices in many rural communities. Also in the literate communities, having concubines is an acceptable norm. Consequently men may tend to believe that they need not to be involved in family planning.
Also, Grillo (2009), observed that it is also believed in some cultures that man reincarnates after the life on earth. The cultural belief has gone a long way in preventing men to get involved in family planning, example vasectomy, with the notice on that if they are rendered sterile in this life, they will come again in their next world as impotent human beings and will not be able to reproduce. Then some others believe that vasectomy is equal to castration which impairs sexual functions. And still more misinformation include the ideas that vasectomy will make the man fat or weak or less productive.
Economic concern:
According to a study by Bunce, Guest, Searing, Frajzyngier, Riwa, Kanama and Achawal (2007), in Tanzania, economic hardship was the most frequently mentioned reason for vasectomy acceptance among men. The respondents commented on the general economic benefits of a smaller family and anticipated problems covering the basic needs of many children, including adequate foods, healthcare and education. Similarly, a study in Jordan on men’s knowledge of and attitude towards birth spacing and contraceptive use revealed that economic considerations were the main reason that they used or intended to use family planning. Also, some of the respondents cited ability to provide a good quality of life for their children as the most pressing reason for wanting to limit their family size (Nustas, 2014).
Spousal influence:
A wife’s approval was seen as key to many vasectomy decisions that was seen in a study in Tanzania by Bunce et al., (2008), where most of the men (vasectomy clients) reported discussing the decision with their spouses and more than 50% mentioned wife’s approval as a factor in the decision. Concern for one’s wife was also mentioned by many of them, as it encompassed a desire to stop the cycle of problems of pregnancies and births, to free her from family planning methods perceived to be potentially harmful.
Provider availability and reputation:
Providers are seen as often unavailable or inaccessible and there was confusion as to when providers would be seen in the area to answer questions or to provide services or to assist the clients. The family planning providers should be permanently stationed in the communities or at the very least, have regular scheduled days in the area to provide services. These were observed in a study in Tanzania by Bunce et al., (2008), the men simply described the difficulty involved in obtaining the family planning services due to lack of provider availability.
Overview of men that practice family planning, the methods and services available to men
Men’s involvement in family planning can be either as user of male methods or as supportive partner of female users (Fumilayo and Kolawole, 2008). The vision to involve men in family planning is to increase men’s awareness and support of their spouses in family planning services. It is also expected to raise men’s awareness of the need to safeguard their spouses and their own reproductive health, especially by preventing sexually transmitted infections. And to enhance couples access to male methods of family planning (Onuoha, 2009).
Family planning methods and services available to men
Condom
The family planning method include withdrawal, condom and vasectomy are available to men. Male latex condom offer very effective prevention from unplanned pregnancy and HIV/AIDS infection. They are therefore considered a “dual” protection method. When used correctly and consistently for each sex act, condom is 97% effective in preventing pregnancy (Vogelsong, 2010).
Condom preference
According to a cross – sectional study done in inhabitants of Chandigar, India, men prefer condom usage 36.1% to vasectomy 1%. Their reasons were:-
Easy availability: This was the most common perceived reason in favour of condom usage. As condom can easily be procured from chemist shops, health centers and family planning clinics.
Knowledge and awareness: More than 75% of men were aware of its usage. (Puri, Walia, Mangat and Sehgal, 2010). Kom, (2010) observed that in Iran the use of oral contraceptive pills increased from 12% to 90% when the pills was distributed by husbands. Studies conducted in rural areas of Agra district New Delhi India by Khan and Patel, (2009) to access the involvement of men in family planning revealed that among 517 males, 52% take all decisions regarding to family planning alone while 10% of them felt that women alone could take such decisions. The report further showed that about 42% of family planning users prefer non terminal methods, largely condoms over vasectomy. The study further revealed that 89% of men had correct knowledge of condom and how to use it correctly.
In Northern Chandigarh India Puri et al., (2010) found that contraceptive use rate among men was more than 50% and out of these almost half were condom users. Another study done in the same population by them showed that condom usage to be 31% that increased to 70% after intervention. In Tanzania among men in Mbeya region plan revealed that though the awareness about condom was high the usage rate was low (Plann, 2011).
Vasectomy or male sterilization
Vasectomy or male sterilization is the most effective of male methods of Contraceptive currently available worldwide. More than 40 million couples use Vasectomy as their method of fertility regulation. However, this method is opular in only a few countries. Expanding the use of vasectomy requires overcoming several obstacles or factors viz: Social cultural and political barriers Provider bias inadequate information regarding its safety and efficiency of the procedures. Dispelling myths and misconceptions (Lohiya, Manivanna, Mishra & Patha, 2011).
Other factors include the need for a surgical intervention that is the surgical nature of the procedure put many men off using the methods.
Again the fact that the procedure needs to be considered permanent as the success rate of reversal is low (Vogelson, 2010). According to Bunce et al., (2008) vasectomy make up of only 7% of all modern contraceptive used worldwide. And although vasectomy prevalence is low in most developing regions, it is especially low in Africa where it rarely exceeds 0.1%.
Nature of men’s involvement in family planning decision making on contraceptive use within the family
Men are the dominate decision makers regarding family affairs in developing countries. Men have the final say in decision making about family size and use of contraceptives especially in the rural communities (Puri et al, 2010).
In Bangladesh, decision about family size and of contraceptives by wives and their continuation depends largely on the decision of their husbands (Hossain, 2013). The study by this author (2013) revealed that decisions about adoption of family planning are mainly taken by males. The study further stated that the males had the highest influence in deciding about the acceptance of sterilization.
Onuoha (2009), observed that importance of African men in decision making about family size, giving their wives permission to use contraceptives and obtaining traditional methods of family planning to be supreme.
Onuoha (2009), stated that the true position is that in traditional African societies, men are conferred with authority to determine who gets what, how and when in the family. This authority also implies that the men have the final say on the number of children the family should have, the spacing, maternal health and general level of reproductive health in the family. Thus, any family planning programme that isolates men is bound to have minimal impact.
Clark, (2013) noted that the decision making process within a cultural group are indicative of its activities towards authority. Traditional Asia or Latino family identifies the husband/father as the primary decision maker in all family issues. Many decisions are jointly made by husbands and wives particularity in those families where the women are employed.
In Agra district a rural community in India, men dominate in decision making in the family in all reproductive processes – number of children, choice of contraceptive method and abortion of unwanted pregnancies. The women have no right of independent decisions other than to abide by their husbands decisions (Khan & Patel, 2009).
Spousal communication
Spousal communication is positively associated with contraceptive use. Demographic health survey data from seven African countries (Botswana, Brundi, Ghana, Kenya, Senegal and Togo), showed that the percentage of women using modern contraceptive is consistently higher in the group that had discussed family planning with their husbands in the year before the interview than in the Group that had not (Toure, 2011). A similar study by Eze, Seroussi and Roggers in 2008 revealed that because of lack of communication, many women do not know what their husband think about family planning. Many women think that their husbands disapprove, when in fact their husbands approve. In West Africa, about three quarters of the men and women had not discussed family planning with their spouses in the year preceding the survey. Decision about using family planning and fertility control measures are not entirely individual decision. Spousal communication between a husband and wife has been found to be a prime indication of the extent of knowledge and acceptance of family planning practices that couples will be willing to adopt and use (Share and Valente, 2002 in Akafua and Sessou, (2008) Lack of desired communication between spouses about family planning, may also be a serious barrier to contraceptive use. In recent years, over half (52%) of currently married women said they had not discussed with their husbands about family planning in Bangladesh (Hossain, 2013).
According to Jordanian National Population Commission, men play a principal role in reproductive decision making in their country as in other countries. Jordanian men expect to take the initiative in family matters. Women are reluctant to discuss family planning with their husbands unless their husbands introduce the subject. With good spousal communication, their women can possibly discuss family planning and practice them (Nustas, 2014). Approval of a contraceptive method, men’s approval or opposition to their wives’ practice of family planning has a strong impact on contraceptive use in many parts of the world including Africa (Toure, 2011).
Grillo, (2009) in a recent study in Ile – Ife observed that 89% of men approved their wives use of family planning methods and this increased their wives contraceptive usage.
A study by Kamal, (2012) in Bangladesh on influence of husbands on contraceptive use by the women, revealed that husbands’ approval of family planning led to the increase of any family planning method used by females. He further observed that women in Bangladesh have a tendency to use contraceptive only when they perceive that their husbands do not object. In other countries for example Sri Lanka women whose husbands disapproved of contraceptive use had a four times higher risk of unwanted pregnancy compared with those whose husbands approved. The husband’s approval is found to be a good predictor of future practice and continued contraceptive use. There are studies done in Philippines which indicated that the continuation rate among women whose husbands approved their contraceptive practice is much higher than chose whose husbands do not give approval to their wives. In South Korea researchers found that 71% of women whose husbands approved of family planning had used contraception at some time compared with 23% of women whose husbands did not approve (Toure, 2011).
According to a survey in Jordan it was observed that among couples women who had never used contraceptives reported that their wives main reason was their husband’s opposition. Also 40% of men said that they should continue having children until they have a son. (Nustas, 2014).
Caring for their spouses.
According to Puri et al. (2010), men being dominate decision makers regarding family affairs in developing countries can directly or indirectly affect women’s contraceptive use thereby affecting women’ reproductive health. Men can promote safe motherhood by participating in family planning as well as occupying their wives to meet health provides where they can learn about the available contraceptive methods correctly. And men can also encourage their wives to seek help from healthcare providers if side effects occur and also provide emotional support to them. According to Insterinbey and Hubly (2009) in Mali a programme was conducted to encourage men to accompany their spouses to family planning and gynecological services, for such will actually encourage the women to practice family planning.
According to Grillo, (2009) the findings from a study among Nigerian men and women on family planning in Ibadan showed that women whose husbands were present during their child birth were more likely to use contraceptives than those whose husbands were not present. The study further revealed that also among the group whose husbands supported their wives during child birth, the husbands were more likely to initiate the use of contraceptives among their wives. Khan and Patel, (2009) observed that in Agra district in India, a rural community, men dominate in decision make in all matters related to timing of pregnancy, number of children and contraceptive use. They also dominate in decision make as regards to health care, who decides when or which doctor to be consulted when sick. So women have no right of independent decision about timing of medical consultation or source of treatment. It also implies that when men adequately care for their wives when sick, such women are likely to use contraceptives.
Financial or economic involvement
KOM, (2010) observed that women are fully dependent on their spouses for economic support and decision making especially in the rural communities. She further observed that women believed that any decision from men cannot be rejected even though it may not favour them.
Hence, exclusion of men from family planning means couples would be unable to use modern contraceptive. She noted that in Iran the use of oral pills (Contraceptive) increased from 12% to 90% when pills was distributed by husbands. Akafua et al., (2008) observed that there is however a growing recognition in Ghana that men play significant and influential role in reproductive decision making and family planning practices. They also revealed that lack of economic resources and power differentials have prevented many women from effectively negotiating use of contraceptives with their male partners. This implies that when men provide financial resources to their wives, they will be encouraged to use family planning services.
Theoretical framework review
The Health Belief Model (HBM). Theory related to behaviour was used as framework for this study. The Health Belief Model is a psychological model that attempts to explain and predict health behaviours. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the United States Public Health Services (Murph, 2009).
The model was developed in response to the failure of a free tuberculosis (TB) health screening programme. Since then the HBM has been adapted to explore a variety of long and short term health behaviours including the transmission of HIV/AIDS. Core assumptions and statements of health belief model as identified by Murphy (2009):
The HBM is based on the understanding that a person will take a health related action. (a man can get involved in family planning) if that person: Feels negative conditions such as getting the number of children they could not cater for, increases chances of unwanted pregnancies and increases maternal and infant morbidity and mortality can be avoided.
Has a positive expectation that by taking a recommended action such as (actively participating in family planning) he will avoid a negative health condition and believes that he has successfully taken a recommended health action, such as, determining number of children to have, that is timing and spacing, adopting male method of contraception or supporting wives` usage of contraception with Confidence.
The HBM was spelt out in terms of four constructs representing the perceived threat and net benefits, perceived susceptibility, perceived barriers. These concepts were proposed as accounting for peoples: readiness to act”. An added concept Cues to action would activate the readiness and stimulate overt behaviour. A recent addition to the HBM is the concept of self-efficacy, or ones Confidence in the ability to successfully perform the action. This concept was added by Rosenstock stretcher and Becker in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behavior such as smoking, poor hand hygiene etc. (Glanz, Rimmer & Lewis, 2012).The Health Belief Model is used by health education specialist to analyses factors that contribute to clients perceived state of health or risk of diseases and to client probability of taking appropriate health plans of actions.
Application of health belief model to male involvement in family planning in rural communities
Men in the rural communities will actively participate in family planning programme if they: Believe there is a danger of having greater number of children one cannot cater for, increased chances of unwanted pregnancy and increase incidences of maternal and infant morbidity and mortality associated with male noninvolvement.(Perceived susceptibility).Believe that male involvement in family planning is effective at eliminating the dangers such as, wanted pregnancies, having more children than one can cater for and increased incidence of maternal and infant mortality and morbidity etc.(Perceived benefits). Trust that the method (actively participating in family planning) is safe and has an acceptable level of risk (possibly through education and mass media). Has the means to actively participating in family planning such as adopting male methods of contraception, supporting wives’ usage of contraceptives, attending clinics for the treatment of sexually transmitted infection etc. (no barriers to behavior change).
Males in the rural communities receive reminder cues as appreciation for being involved in family planning from government and non-governmental bodies. Also it can be inform of receiving message, through use of town criers etc., reminding them of how to be actively involved in family planning. Men become confident in actively participating in family planning such as adopting a contraceptive method and supporting the wives’ usage of contraception etc. This is achieved through regular and repeated education and guidance by health workers and programme planners using different men’s forum such as Igwe’s cabinet, men church group etc.
Empirical review
Studies done in male involvement in family planning by Hossain, (2003) in Bangladesh with other selected countries in Asia and Middle East with regards to current use of male methods of contraception revealed that there is great variation across countries in the percentage of men that practice family planning. In Bangladesh 54% of the eligible couples currently practicing family planning, only 40% use the male methods current rate of marital condom use in Bangladesh is very low 4%. In Turkey, with high level of contraceptive prevalence rate 62.6% withdrawal is the most popular method 26.2% and condom use 7% of all current users. The study further revealed that in Philippines, with 40% of couples using contraceptives, withdrawal is 7%.
In Bangladesh the rate of male participation in family planning is low. With even half of the eligible couples (54%) currently practicing contraception only 14% use the male methods. The low level use of male methods use indicates the increase contraceptive prevalence rate in the country can only be achieved by promotion of active male involvement in family planning (Hossain, 2003).
In Indonesia – there is low use of all male methods 3.2% out of contraceptive Prevalence rate of 50%. In India, contraceptive prevalence rate 41%, participation Of male methods is 9.8% and current use rate of vasectomy is 3.4%. In Pakistan, half of total contraceptive use is 9.8% and is shared by male methods (Hossain, 2013). Also in a study done in Cameroon on Men’s attitude towards family planning by Leke, (2010) revealed that 64% of men in the rural areas of Akonoling and 63% of men in the rural areas of Obala practice family planning. In a survey in Jordan couples who are currently practicing contraception 86%, among couples who had never used contraception, only 40% had discussed family planning. Also 20% of women who had never practiced family planning reported that the main reason was their husbands’ opposition. (Nustas, 2014).
Studies done among men in slum inhabitants of Chandigarh India on prevalence of various contraceptive methods found out that 65.9% of the respondents were practicing family planning and condom use among them 58.9% Another study done in same population showed that condom usage to be 31% that increased to 70% after intervention in Chandigarh (Puri et. al., 2010).
Studies done on sex preference and contraceptive behavior among men in Mbeya region in Tanzania revealed that though the awareness of condom was high the usage rate was low (Plann, 2009). Studies done on male involvement in family planning: women’s perception in Port Harcourt Nigeria by Nte, Odu and Enyindah, (2009) revealed that about 15.8% would depend on their husbands for choice of contraceptive methods and 52.7% would discontinue family planning if their husbands objected. Studies conducted on men’s knowledge of and attitudes towards birth spacing and contraceptive use in Jordan by Nustas (2014) revealed that communication between partners is significantly associated with contraceptive use. And men who are currently practicing family planning are twice as those who likely have never discussed contraception with their wives. Studies one on men’s attitudes, acceptability and participation towards family planning in Ilorin Nigeria showed that vasectomy and withdrawal are among the least known methods among men while the use of condom being the widely recognized. The study further revealed that 62% of men have used a method at one time or the other and this approved the use of family planning techniques by themselves and their spouses. While 58% of men are currently practicing family planning (Olawepo and Okedare, 2010).
Again studies conducted in Ghana to examine knowledge, attitude and use of family planning among Ghanaian men revealed that spousal communication is a key factor in the adoption and sustained use of family planning because such discussions allow couples to exchange new ideals and clarify information, which might change some wrong beliefs about the use of some family planning devices. They further observed that open communication between couples about family planning also provides couple with an opportunity to discuss family size preferences and the means to achieving them (Akafuah & Sossou, 2008).
Similarly Sharen and Valente, (2008) in a study in Nepal on spousal communication and family planning adoption observed that spousal communication between a husband and wife has been found to be a prime indicator of the extent of knowledge and acceptance of family planning practices that couples will be willing to adopt and use. Also a study in Kenya on discussion on family planning among couples revealed that a desired family size by men positively co-relates with their women to practice a contraceptive methods (Kimune & Adachak, 2010). According to Sabir, Rahamanda and Islam (2009), a study in Bangladesh revealed that decision about family size and the use of contraceptives by wives and their continuation depends largely on the decisions of their husbands. In another study in Bangladesh by Sabir et al. (2007) revealed that the males had the highest influence in deciding about the acceptance of sterilization. They further observed that decisions about adoption of family planning are mainly taken by the males.
Also studies done in Zimbabwe according to Zimbabwe Reproductive health survey revealed that 42% of married women stated that it was the husband’s responsibility to decide whether his wife should use family planning methods. The studies further revealed that men are the ultimate decision makers on family size and all family planning matters. They also observed that men need more information about family planning to make better decisions (Onuoha, 2009).
Studies conducted by Puri et al. (2010) in slum population in Chandigarh India on current scenario of contraception and Indian men revealed that men are the dominate decision makers regarding family affairs in developing countries can directly or indirectly affect women’s reproductive health. They can promote safe motherhood by practicing family planning as well as accompanying their wives to meet health provides where they can learn about the available contraceptives methods. They can also help their wives use contraceptive methods correctly, can encourage them to seek help from health providers if side effects occur and also they themselves can operate for male contraceptive methods.
Studies conducted on differentials in current use of male methods in Bangladesh further revealed that the level of current contraceptive use is higher in urban area 60% than in rural area 52% among couples. There is a considerable difference in urban 10% and rural areas 3% probably indicating easier availability of the method in urban areas (Hossain, 2013). Another study done in Bangladesh on the influence of husband on contraceptive use by the women revealed that husbands approval of family planning had to the increase of any family planning method used by the wives. Also women in Bangladesh have a tendency to use contraceptives only when they perceive that their husbands do not object. He further observed that in other countries for example Sri Lanka women whose husbands disapproved contraception had a four times higher risk of unwanted pregnancy compared with those whose husbands approved (Kamal, 2012).Studies done in Philippines also revealed that the contraceptive continuation rate among women whose husbands support contraceptive practice is much higher than those whose husbands do not give support to their wives. This study further observed that husbands support has been found to be a good predictor of future practice and continued use (Toure, 2011).
Studies carried out in South Korea according to Population Reports 1994 also revealed that 71% of women whose husbands approved family planning had used contraception at some time, compared with 23% of women whose husbands did not approve. While in Madagascar, nor plant continuation rates were higher after one year among couples in which the husbands has being involved in the decision making process, and among these couples both wives and among these couples both wives and husbands were more satisfied with Nor plant than those in which only the wife was counseled (Toure, 2011).
According to studies done in Tanzania to find out factors affecting vasectomy acceptability among men revealed that economic hardship was the most frequently mentioned reason for vasectomy acceptance among men. The respondents enumerated the general economic benefits of a smaller family and anticipated problems covering the basic needs of many children including adequate food, health care and education (Bouce et. al. 2008).
Similarly, in study in Jordan on men’s knowledge of and attitudes towards birth spacing and contraceptive use revealed that economic considerations were the main reason that they used or intended to use family planning. Also some of the respondents cited ability to provide a good quality of life for their children as the most pressing reason for wanting to limit their family size. Studies in Tanzania also revealed that attitudes towards contraceptive use vary by religious denominations. The respondents reported that in Tanzania, the seventh day Adventist church is a strong advocate of contraception. For example vasectomy services are provided at Heri Seventh Day Adventist hospital and contraception is discussed and promoted in sermons. Furthermore, the denomination organizes educational seminars and advertises the availability of family planning providers. Also, the respondents further revealed that the Roman Catholic Church in Tanzania actively discourages the use of modern methods. And most other denominations, including Islam, Anglicanism, Lutheranism and Pentecostalism were seen as falling somewhere between the stances of the Seventh Day Adventist Church and the Roman Catholic Church (Bounce et al., 2008).
Studies done by Isaac Ndong of the Engender Health on Men’s Roles in family Planning in sub – Saharan Africa observed many misconceptions about vasectomy among Africans. One of the myths maintains that vasectomy is equal to castration. Another says vasectomy impairs sexual functions and that is will make man fat or weak or less productive (Grillo, 2009). Similarly, studies in Tanzania on factors affecting vasectomy acceptability revealed man misconceptions about vasectomy these include rumors of decreased sexual desire or performance. Additional rumours include equating vasectomy with castration, believing it causes cancer, believing that sperm will accumulate in the body and have negative effects and fear that vasectomy causes weight gain and physical weakness. These misunderstanding and rumors about the vasectomy process contributed to many people’s reluctance to choose the method. (Bounce et al., 2008).Also studies conducted on male involvement in family planning by KOM, (2010) observed various misconceptions across African sub-region that even though procreation is the co-operate responsibility of both males and females but in most cultures in the African sub-region, pregnancy and child birth are often perceived as a woman’s problem alone. Consequently most men assume that women should bear the entire burdens of preventing unwanted pregnancy and using contraceptives alone. According to studies done by Khanna and Van (1998) Reproductive health research revealed that one of the greatest deterrent to greater male involvement in family planning is lack of contraceptive options for men. Apart from withdrawal, only vasectomy and the condoms are available to men.
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