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Husbands’ Involvement in the Family Planning of Couples in
Selected Communities
Anacleto D. Pedrozo, Ed.D.
Jefferson M. Sadera, MPM
Wilma D. Billman, Ph.D.
David Cababaro Bueno, MPM, Ed.D.
==============================================
Abstract - The main aim of the study is to investigate the knowledge, attitudes, practices and
involvement of men in family planning in the selected communities in Olongapo City. The researchers
used the survey-questionnaire, focus group interview and observation, and the analysis of data utilized
descriptive Statistics such as Percentage and Mean towards. Only those first ten barangays with the
highest number of population based on the National Statistics Office (Olongapo) Census 2012 were
included as communities surveyed under purposive sampling. These barangays were Santa Rita,
Gordon Heights, New Cabalan, Old Cabalan, Barreto, East Bajac Bajac, Kalaklan, Mabayuan,
East Tapinac, and New Kalalake. The majority of the respondents were Roman Catholics, very few
were Iglesia Ni Cristo, Born Again, Muslim and Protestant; with at least college and technical
vocational education; and currently employed as service workers; and the majority has 1-3 children.
The knowledge about family planning was relatively high among respondents, with a proportion of
ninety-eight percent having heard of family planning, which gave them the opportunity to plan the
number of their children (limiting family size) as well as proper spacing of childbirth. The respondents
were familiar with family planning methods like pills, condoms, injectables; vasectomy, tubal ligation
and abstinence. Other methods like intrauterine device, norplant, spermicidal, and prolonged
breastfeeding were also noted by them. Thus, the majority of them wanted to use safer FP methods such
as pills and condoms in the future. Fewer numbers of children and proper spacing of childbirth were
due to lack of money for rearing many children, mothers and child health. The respondents had ever
used contraceptives by using condoms, pills, and injectables. Some possible reasons for stopping them
from using such were fear of side effects, and desire to have more children, and for some were a religion
and source of contraceptive. The majority of the respondents has ever convinced others, including their
partners to use family planning methods. Thus, the decision on the utilization of family planning
methods was done jointly by the husband and wife through spousal discussion. A condom still ranked
number 1 among male users. They have radio/ tv at home; and ever heard of information about family
planning through various media and health professionals. Health institutions (Barangay Health
Centers and Hospitals), pharmacy, and friends were their sources of contraceptives. Moreover, the
majority of the respondents has gone to health care institutions for advice or service and the service
providers were friendly regardless of gender. Some supporters of the use of contraceptives such as partner
and society were reported, but they don’t know whether their religion is against the use of contraceptives.
The level of male involvement in family planning programs has been good among communities in the
City of Olongapo. The male support in FP practice was encouraging. Thus, an educational module
was developed in support to the FP advocacy.
Keywords – Public management, family planning, husband, communities, descriptive-survey design,
Olongapo City
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INTRODUCTION
It is widely acknowledged that the Philippine family planning (FP)
program has focused almost exclusively on women and may have missed
opportunities to effectively involve men to address these challenges.
Research findings from the Philippines show that men are influential
gatekeepers for FP acceptance in the household and are an important client
group for FP program efforts (Perez, 2000). Due in part to the lack of progress
in the Philippine FP program, USAID programs have intensified efforts to
include men in FP advocacy and services (Management Sciences for Health,
2003).
For more than a decade, there have been increased efforts to include
men in FP programs. This is the result of many factors, including the 1994
International Conference on Population and Development (ICPD) Plan of
Action, the global HIV/AIDS pandemic, and high quality quantitative data on
men from the Demographic and Health Surveys (Ezeh, Seroussi, & Raggers,
1996). There is evidence that working with men in FP and related reproductive
health (RH) areas can result in improved health outcomes (Becker, 1996).
USAID’s Interagency Gender Working Group (IGWG) has developed
resources that document health program justifications for including men in FP
as well as compelling program. Studies show that involving men can have
significant benefits to FP programs of contraceptive acceptance, continuation,
client satisfaction and efficacy (Wang, 1998). Given these encouraging findings,
the Philippine FP program may benefit from the implementation of practical
and culturally rooted strategies to involve men in FP.
Three important caveats should be considered in including men in FP
(Clark, Brunborg, Rye, Svanemyr, & Austveg, 1999). First, men’s participation
in FP should be constructive; that is, it should always protect women’s interests
and not reinforce the traditions of male dominance. Second, involving men
may require added expense and may mean competition for scarce resources.
Programs include men in FP need to add rather than subtract resources from
existing programs for women (AVSC, 1998). Third, efforts to involve men
must be cost-efficient in terms of better outcomes in order to justify additional
funds.
Building on previous male involvement approaches (Cohen & Burger,
2000), this framework views man as equal partners of women but
acknowledges that gender inequities influence fertility behavior. (Badiane,
2005). The framework emphasizes a partnership between men and women in
decision making, and encourages human rights for both men and women. It
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also proposes an educational approach to sensitize men about male and female
gender roles and their consequences (Badiane, 2005).
Approaches to FP activities to involve men can be allocated into three
categories: gender exploitative, gender accommodating, and gender
transformative. Efforts to involve men should avoid the first two and attempts
to use a gender transformative approach. Work with the Population Council
Horizons program has shown that programs that help young men reflect on
their gender identity and change gender norms can improve knowledge,
attitudes and behaviors related to FP and sexually transmitted infections (STIs)
(Pulerwitz, Barker, & Segundo, 2004).
For a long time, international family planning and reproductive health
programs focused exclusively on women (Greene, 1998). As a consequence,
population policies were implemented almost exclusively through basic family
planning programs serving women. If men were involved, it was in a limited
way, often to ensure contraceptive continuation and acceptability or to
promote the diagnosis and treatment of sexually transmitted infections
(Mbizvo et al. 1996).
Although both men and women have responsibilities and interest in
reproductive health and family planning, demographic studies on fertility and
family planning have overwhelmingly focused on women. (Greene and
Biddlecom 2000).
In practice, the effect that men have on their own and on women’s
reproductive lives may be more varied. To exclude men from information,
counseling, and services is to ignore the important role men’s behavior and
attitudes may play in the couples’ reproductive health choices (Bloom, 2000).
For example, in some countries, societal norms, religious practices, and even
legal requirements provide men greater influence over decisions that affect
their family’s reproductive health. Perhaps most importantly, around the world,
many women and their partners would like to participate more fully in
reproductive health counseling and services (Ringheim, 2002). In response to
these factors, programs are increasingly seeking ways to develop strategies that
allow men’s constructive involvement in family planning and other
reproductive health services. Studying male involvement, therefore, is
important to understand the multiplicity of forces shaping reproductive
decisions among women and men (Clark, 2008).
Men are more interested in family planning than often assumed, but
need communication and services directed specifically at them. Most studies
report that men have responded positively to being involved in interventions
and that they do in fact care about the welfare of their families (Singh and
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Arora, 2008). Critics of male involvement have argued that persuading men to
view sexual and reproductive health as important and not just women’s
responsibility will be very difficult (Narayan, 2000). Some fear that resources
earmarked for projects targeting women will be reallocated into projects that
target men, and that the issue of addressing men will possibly reduce female
reproductive autonomy as an unintended consequence (Berer, 1996).
However, it is also pointed out that couples who talk to each other
about family planning and reproductive health can reach better, healthier
decisions (Drennan, 1998). Also, involving men in reproductive health is
crucial to promote gender equality in all spheres of life and encourage and
enable men to take responsibility for their sexual and reproductive behavior
and their social and family roles (Bernstein and Hansen, 2006).
Successful male involvement is critically dependent on addressing the
social and cultural norms that impede health. It is very difficult for men to
access accurate, timely and good quality reproductive and sexual health
information and services (Pande, 2006).
More recently, however, male involvement in reproductive health has
become a popular area among reproductive health program designers, policy
makers, and population researchers. Still, the meaning of “male involvement”
has divergent interpretations. In the patriarchal culture predominantly
prevalent in most of India, husbands have the authority to make legitimate
decisions on behalf of their wives, and reviews have suggested that they are
also involved in making decisions about their wives’ reproductive health,
including contraceptive usage, visit to the health facility and family
composition and size (Edmeades, 2011).
The program to involve men in reproductive health uses many terms,
including men’s participation, men’s responsibility, male motivation, male
involvement, men as partners, and men and reproductive health (Finger, 1998).
However, there is no consensus about which term best describes this
perspective on men, what these terms mean, and how men can best be
involved in reproductive health activities. Whatever the term used, the purpose
is to describe a complex process of social and behavioral change that is needed
for men to play more responsible roles in reproductive health. “Men’s
participation can be seen as a means to an end, rather than as a goal in itself”
(Greene, 2006).
It expounds what male involvement entails at the community level,
and how it has been interpreted in program and research efforts, specifically
focusing on access to family planning information, services and practices in the
selected communities in Olongapo City.
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OBJECTIVES OF THE STUDY
The main aim of the study is to investigate the knowledge, attitudes,
practices and involvement of men in family planning in the selected
communities in Olongapo City. Specifically, the study aims to: (1) determine
the socio-demographic characteristics of husbands; (2) analyze the knowledge
and attitudes towards family planning; (3) explain the family planning practices;
(4) assess the involvement of the husband in family planning; (5) analyze the
effects of socio-cultural factors in family planning utilization; and (6) propose
an educational module to improve family planning practices.
METHODOLOGY
This study used both quantitative and qualitative methods to offer
different, but complimentary data about the involvement of men in the family
planning practices. Using mixed methods, this study is designed as a
“concurrent triangulation design. Qualitative and quantitative data were
collected at the same time, but separately. The data analysis was also conducted
at the same time. Surveys were conducted as the preferred method of
quantitative data collection while interviews and focus groups were made to
collect qualitative data. The rationale for using mixed methods is to make
inferences about the population based upon the sample taken from the selected
international school (Creswell, 2003). The researchers considered the four
hundred (400) randomly selected men from various communities within the
City of Olongapo to answer the instruments regardless of the actual number of
couples in the selected community. Forty (40) respondents were taken from
each selected community. This is to gather both quantitative and qualitative
data through the survey-instruments, interview and focus group discussions.
The research questions were answered by using the researcher- made surveyquestionnaire. This was constructed based from the readings of the researcher
on the available literature related to the problem. Interviews were conducted
with conveniently selected husbands in order to add a greater depth of
understanding than surveys alone. According to Yin (2003), “One of the most
important sources of case study information is the interview.” The researcher
developed interview questions to provide in depth responses. All questions
were open ended in nature. One-on-one in-person interviews were conducted
by the researcher. Interview questions elicited more in-depth responses than
the survey questions. Focus groups were conducted at the community health
center. The goal of a focus group was to collect data that are of interest to the
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researcher-typically to find the range of opinions of people across several
groups. The focus group presents a more natural environment than that of an
individual interview, because participants are influencing and influenced by
others just as they are in life. The researcher served several functions in the
focus group: moderator, listener, observer, and eventually analyst using an
inductive process. The validation of the instrument was done with the adviser
and selected midwives available at the local community health centers and
selected couples among the communities not included in the study. After the
validation, the draft was shown to the dissertation adviser for the final revision
of the instrument. The researcher sought permission from the city health
administrator through the community health centers’ administrative officers or
officer-in-charge to be endorsed by the dean of the graduate school. After the
letter of request was approved, the researcher prepared separate letters for the
possible respondents. All quantitative data gathered through the instruments
were tallied, tabulated, analyzed and interpreted accordingly using descriptive
statistical tools.
RESULT AND DISCUSSIONS
1. Socio-demographic Characteristics of Respondents
Ninety percent (90%) are Roman Catholics; five percent are Iglesia Ni
Cristo; three percent are Born Again; and the rest are Muslim and Protestant.
The data further show that the majority of the respondents are Roman
Catholics.
Thirty one percent (31%) are college levels; thirty three percent (33%)
are with secondary level of education; twenty three (23%) are technical
vocational graduates; ten percent are elementary graduates; and three percent
have no formal education.
The occupation of respondents varies from professionals to laborers.
As reflected, there are 35.5% who are service workers; thirteen percent (13%)
professional workers; and very fewer are clerks, government officials, farmers
and laborers. Thus, the majority of the respondents are service workers.
Seventy four percent (74%) of the respondents have 1-3 children in
the family; twenty five percent have 4-6 children and the rests still do not have
a sibling. Having children had a significant meaning for all of the participants.
They often said having children was “the medicine against death” and children
were representatives of their parents.
Almost all of the participants from mentioned that the level of respect
parents received did not depend on the number of children they had. However,
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they said there were many merits of having many children, such as the parents
being able to get various types of support from their children, and a family with
many children has less risk of being physically attacked by another family than
a family with a small number of children. Many also said that if a family was
wealthy enough to have many children, it was considered good to have many
children. However, several participants emphasized that having many children
brought some families into poverty and that these families were not respected
by others. Based on the interviews, most of the participants claimed that four
to five children were the ideal number of children, but the number was decided
by economic limitations or possibilities.
All participants from the interviews answered that they preferred to
have both male and female children, and most of the participants thought it
was ideal to have more male children than female children. They also
mentioned that it may be troublesome to have only male child, though, stating
different reasons related to their type of marriage system and succession
system. Firstly, when male children get married, they are still considered as the
family member of their parents’ house, the same as before their marriage,
whereas females are considered a member of their husband’s family when they
marry. Many participants therefore claimed that female children could not truly
be considered as “our children”. As a result, male children were thought of as
more important to the parents and the parents also expected their male
children to take care of them when they became older. On the other hand,
parents were also expected to give their male children, their property, such as
farmland and livestock, when they got married. This custom was another
reason why participants preferred to have children of both sexes; the parents
could not afford to give their property to their male children if they only had
male children.
Another reason why people desired children of both sexes were that
their daily tasks were very rigidly divided by gender. If parents had children of
both sexes, they could get different kinds of support. Some of the participants
said they would choose to have more children if the male-female composition
was not satisfactory, even if they felt the number of children was enough. One
of the wives of the interview told: “I want to have more male children than female
ones. If the number of male children is less than female children, I will try to get male
children. Even if the sex of children is a gift of God, I want to try until I get more male
children.”
The importance of sex composition may encourage people to have
more children than their ideal or desired number of children, or in some cases
more than they can financially handle.
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2. Knowledge and Attitudes Towards Family Planning
It is observed that knowledge about FP was relatively high among
respondents, with a proportion of 98% having ever heard of family planning,
this can partly be attributed to the aggressive family planning campaigns on
Radio/ TV and barangays health centers being organized in the city by health
professionals and other development partners. Two percent, however, had
never heard of any family planning methods.
To find out the depth of knowledge, respondents had on FP, 57%
said, family planning gives couples the opportunity to plan the number of their
children (limiting family size), 25% said family planning is a strategy designed
to avoid unwanted pregnancy, 38% responded that, family planning is a way
spacing childbirth. From the data, 96% of respondents interviewed said they
had ever heard of methods to delay or avoid pregnancy, and 4% responded
they never heard any family planning method before.
Findings reveal that, a large proportion of the respondents (98%) had
accurate knowledge about FP by indicating that FP gives couples the
opportunity to plan the number and spacing of their children. It is observed,
91% have heard the pills; 71% have heard about the used either the male or the
female condoms; 47% had ever heard of injectables; 34% said they have heard
vasectomy; 21% heard about tubal ligation; 13% have heard about abstinence.
Other family planning methods like intrauterine device, norplant, spermicidal,
and prolonged breastfeeding were also heard by the respondents. The
overwhelming proportions that have ever heard of pills and condoms indicated
its easy accessibility and relatively moderate price as some of their reasons for
use of the method.
When respondents were asked to find out the importance of family
planning, the following responses were given; 99% said “Yes” and only 1%
said “No”.
Eighty-five percent (85%) of the respondents said, they want to use
family planning methods in the future; 6% answered “No”; and 9% are
“unsure”. Moreover, it is observed, 60% said that the safest method to use is
pills and condoms (52%). Other family planning methods considered to be safe
by the respondents are injectable, tubal ligation, abstinence and prolonged
breastfeeding.
To find out the depth of knowledge, respondents had on FP relative
to the purpose of child spacing or fewer number of children, 56% said, lack of
money may not allow rearing many children, 55% said for the mother’s health,
35% responded that, for the health of the children, yet, 2% said “I don’t
know”.
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Family planning is a deliberate effort by couples to regulate the
number of children and spacing of births. It aims at improving family life at the
micro level and contributing to sustainable development at the macro level.
This is through fertility decline among other mechanisms. However, variables
such as education, religion, socio – economic as well as cultural factors affect
the effectiveness of family planning programs. One factor that deserves
attention is the active involvement of males in family planning.
Male involvement in family planning means more than increasing the
number of men using condoms and having vasectomies; male involvement also
includes the number of men who encourage and support their partners in
contraception and peers to use family planning and who influence the policy
environment to be more conducive to developing male related programs. In
this context male involvement should be understood in a much broader sense
than male contraception, and should refer to all organizational activities aimed
at men as a discrete group, which has the effect of increasing the acceptability
and prevalence of family planning practice of either sex (Toure 1996).
Based on the interviews with both health workers and regular people,
the second common method of contraception seemed to be the birth control
pill, which has been in use in this area for a while. Although some participants
had sufficient knowledge of how to use the pill, a majority of the participants
lacked knowledge on this topic or had misunderstood important issues. For
example, one participant from a focus group said that pills should be taken
twice every day instead of once a day. When asked about the duration of one
birth control pill’s ability to prevent pregnancy, respondents had different
opinions: one pill could prevent pregnancy for three months, six months, eight
months, one year, or even three years. Overall, female participants tended to
know more about this contraceptive than the male participants, and male
participants were more often misinformed. For example, one male participant
from one of the focus groups claimed there existed a birth control pill which
had the same effect but was used by men. Other male participants believed that
birth control pills had the effect of killing the fetus in the third month of
pregnancy. Moreover, several male participants in the focus groups reported
that they told women that the pills they swallowed did not dissolve in the body
and it had bad effects on them and their fetus. Many shared ideas and stories
related to how birth control pills accumulated in the body, as described by a
male participant:
“The pills accumulated in her stomach. Then she got pregnant. She
suffered from a pregnancy complication. She couldn’t deliver the baby (in a
normal way). Then the family took her to a hospital. The pills she took were
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not dissolved. They were like stones. The pill didn’t work, so she got
pregnant. Then a doctor took out both the pills and the baby from her body
by surgery. She had 4 children safely before she started to take pills. Then she
started to take the pill and that made her unable to have the fifth baby safely.
It may have happened due to other causes, but a pill is generally harmful.”
Many seemed to believe that the pill actually remained in the body, and
this caused problems during delivery. The beliefs that the pill could be stored
in the body made people fear it, also due to the risk of infertility. Therefore,
many participants preferred to use other contraceptive methods than the pill.
The health extension workers, on the other hand, believed that low
usage of birth control pills was due to the fact that women had to come to get a
new supply of birth control pills each month at the health post or other
medical facility, which was inconvenient for most women. The health extension
workers did not seem to be aware or understand patients’ attitudes and fears
related to this particular contraceptive method.
Many of the participants talked about the experiences of contraceptive
use and the side effects in a general way, expressing the public or community
opinion. Most of the participants said that the attitude towards contraceptive
use in the community had changed. Although contraceptives were unpopular
when they first arrived, most participants said that the people in the
community gradually had accepted the use of contraceptives. They also claimed
that their “culture” in general did not prohibit contraceptive use. However,
some female participants reported that they were still met with some
opposition to contraceptive use, and claimed that women in general did not
talk about their own contraceptive use, but took it secretly. A few of the wives
of participants said that sometimes their husband’s family and relatives insulted
them for using contraceptives. However, the majority of participants said the
attitude towards women who use contraceptives had been improving, because
many seem to have recognized the importance of family planning from an
economic point of view. A male participant from one of the focus groups
explains his view:
“In the previous period, people begged God to give them many
children. But now, it becomes difficult to live a life with many children because
of shortage of farmland and children’s education. For example, I have five
children and my friend has one child. I buy five pairs of shoes for my children,
but he buys one. So that’s why people are motivated to use contraceptives.”
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The participants observed positive changes due to family planning and
recognized the benefit of family planning in the household economy. The
participant also suggested that the community members had learned and
inspired each other due to the visible and practical effects of family planning.
Additionally, some participants mentioned that contraceptives often were used
by “educated” people who “understood” the advantage of family planning. The
fact that those who possessed more knowledge than others used contraceptives
seemed to have a positive influence on people’s perceptions of contraceptives.
In general, the findings indicate that negative attitudes towards
contraceptives and those who use contraceptives have been decreasing, and
that there is a movement in the direction of contraceptives being accepted as a
method for family planning.
3. Family Planning Practices
As gathered, 74% of respondents interviewed said they had ever used
contraceptives, 26% responded they had never used any contraceptives before.
The reasons given were not different from that given by those who do not
approve of FP. It is observed, the majority of them (52%) has ever used the
condom; 50% have used pills; 25% had ever gone for injectables. Other
contraceptive methods like, iud, withdrawal method, tubal ligation, vasectomy,
and prolonged breastfeeding were also used by a few.
Again, the
overwhelming proportions that have ever used condom and pills indicated its
easy accessibility and relatively moderate price as some of their reasons for use
of the method.
Currently, 57% of the respondents are using family planning methods.
The most common methods used by them are pills (43%) and condom (32%).
Some reasons for currently stopping from using contraceptives are
fear of side effects (51%); desire to have more children (15%); and my partner
doesn’t want it (7%). Other reasons given were the preferred method is not
available, religion, source of contraceptive is fair and some don’t know any
reason.
Historically, the traditional method of withdrawal (coitus interuptus)
has been used as a contraceptive method since biblical times (PAI, 1991), and
use of condom dated back 400 years ago (Ross and Frankenberg, 1993).
Despite the pioneering role played by the age-old male methods in the
evolution of family planning, the present contribution of male methods
(traditional and modern) to the total contraceptive prevalence rate is strikingly
low. Worldwide, one-third of the eligible couples using family planning rely on
methods (Vasectomy, Condom, Withdrawal and periodic abstinence) which
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require full male cooperation. In the developing countries, about one-fourth of
the contraceptors relied on male methods (Population Report 1986). In the
past decade, although there has been an overall increase in the level of
contraceptive prevalence, low use of male methods was likely to remain static
in most of the developing countries.
4. Involvement of Men in Family Planning
The majority (58%) of the respondents has ever convinced others to
use family planning methods; while 42% have never convinced others.
Moreover, the majority (75%) of them has ever convinced their partner to use
family planning methods. It means that 75% of the respondents have never
opposed their partner by using family planning. Thus, accordingly, the decision
on the utilization of family planning methods is done jointly by the husband
and wife (80%). There is discussion (81%) about family planning with partner;
the same with the discussion as to the number of children (76%) for at least
twice a month. Ninety percent (90%) of the respondents knows that there are
contraceptives for men. The majority (87%) of them mentioned condom;
followed by vasectomy (46%); abstinence (15%) and withdrawal (5%). They
even know where family planning is given (81%).
A question was asked those who had never attended family planning
clinics to find out the reasons why they do not attend the clinics. The following
were their responses, they do not attend family planning clinics because there is
no confidentiality at the clinics, some said they heard stories that, the nurses
sometimes mishandle them anytime they visited the facility, and others do not
visit the clinics because they claimed the clinics were far away from their
residence. A majority of them do not attend family planning clinics because,
they claimed too much time are spent at the facility. According to them, male
involvement is necessary because men are the breadwinners of many homes;
there is the need for their involvement so as to support their partners
financially in terms of giving women money to go for FP methods or
counseling services. Again, through discussing FP issues with their partners,
women would be in the position to choose the best method to suit them,
hence, women who until now would have hidden to practice FP, would instead
feel comfortable to consult their husbands in matters relating to FP methods
hence, leading to its effective and appropriate use.
Others also think that involving men in FP would help improve FP
coverage, since men are the decision makers in most families. This influence
could be used to impress upon their partners to adopt FP methods. Yet others
do not agree to men’s involvement in FP issues, they contended that, it is a
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woman’s business. Also, just like the above, the majority of the participants in
this group, asserted that, giving the man’s role in our traditional homes as the
head of the family and the fact that, he is the decision- maker in the family, it
would not be out of place to involve them in matters bordering FP issues.
The husband’s support is found to be a good predictor of future
practice and continued use. There are studies done in the Philippines, which
indicate that the continuation rate among women whose husbands support
their contraceptive practice is much higher than those whose husbands do not
give support to their wives (IPPF, 1984). Moreover, according to some health
workers and interviewees, most reproductive health and family planning service
delivery systems are almost entirely women oriented and provide little or no
information about male contraceptive methods. Health workers are sometimes
poorly trained in counseling men about safer sexual practices and male
methods and may communicate negative rumors about them.
Many family planning programs have now recognized that involving
men and obtaining their support and commitments in family planning
programs are of crucial importance because most decisions affecting family and
political life are made by men. Men hold positions of leadership and influence
of the family unit right through national level. Their involvement in family
planning matters would therefore not only ease the responsibility borne by
women in terms of decision making, but would also accelerate the
understanding and practice of family planning in general.
5. Socio-cultural Factors Affecting Family Planning
One hundred percent of the respondents have radio/ tv at home; and
97% ever heard of information about family planning through various media
such as radio/tv (78%); health professionals (47%); newspapers (37%); and
internet (8%). When they were asked where they think they can get
contraceptives, the majority (77%) said, from health institutions (barangays
health centers and hospitals); 49% said, from the pharmacy. Others mentioned
shop and friends. Moreover, the majority (56%) mentioned that they have gone
to health care institutions for advice or service for family planning and the
service providers were friendly (51%). A question was asked those who had
never gone to health care institutions for family planning to find out the
reasons why they do not attend the clinics. The following were their responses;
27% said they did not attend health centers because they lack knowledge about
family planning; 12% said they lack knowledge about the existence of the
service; and 10% do not visit the clinics because they claimed they expect that
the health workers may not be friendly; and the place is very far.
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Furthermore, the respondents mentioned, they have no gender
preference as a service provider (68%). Some supporters of the use of
contraceptives were also reported by them. Some were partner (83%); and
society (62%). But they don’t know whether their religion (44%) is against the
use of contraceptives.
Most reproductive health and family planning service delivery systems
are almost entirely oriented to women and provide little or no information
about male contraceptive methods. Health workers are sometimes poorly
trained in counseling men about safer sexual practices and male methods and
may communicate negative rumors about them (Green et, al. 1995).
Many family planning programs have now recognized that involving
men and obtaining their support and commitments in family planning
programs are of crucial importance in Ghana because most decisions affecting
family and political life are made by men. Men hold positions of leadership and
influence of the family unit right through national level. Their involvements in
family planning matters would therefore not only ease the responsibility borne
by women in terms of decision making, but would also accelerate the
understanding and practice of family planning in general.
In general, the participants’ perception of contraceptive use has
gradually changed and become more tolerant, probably partly due to
information and education provided by family planning programs and health
workers. The positive attitude towards contraception was also supported by the
image that educated people seemed willing to use it.
If a response on a certain issue becomes increasingly prevalent in the
community, and role models such as those being highly educated adhere to the
idea, it is likely that the perceived “costs” of the behavior will be less and the
perceived benefits may increase.
According to Blau, people might not adopt a behavior if they fear that
they are not following social values and norms, and that there will be social
sanctions, such as a reproach from family members and community members
(Blau, 2010).
Therefore, it suggests that what seems to be a positive change in the
community in general, is one of the factors which encourage people to use
contraceptives. There are some significant differences in reasons for non use
between married women and men. More men than women mention that they
oppose family planning. Men are also less likely to cite the reason such as
infrequent sex / having no sex than women. Religious prohibition, as the
reason of non-use, varies little between men and women. Another reason is
that most men want more children because of the socio-economic reasons
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attached to having more children; hence the use of contraceptive is seen as a
hindrance.
Furthermore, lack of desired communication between spouses about
family planning may also be a serious barrier to contraceptive use. Few men
said they had not discussed with their wives about family planning. Of the
remaining, while others had discussed it twice or less. Inter-spousal
communication about family planning was less frequent among men.
Thus, spousal communication indicated an encouraging proportion of
men who talks to their wives about family planning and any other issue relating
to reproductive health.
6. Implications Towards a Proposed Learning Module
The level of male involvement in family planning programs has been
good in the City of Olongapo. According to the findings of the research, male
support in FP practice is encouraging with an overwhelming average
proportion of doing anything to support their partners in FP practices.
However, inadequate family planning strategies continually
exacerbated the vulnerability of developing countries, culminating into high
maternal and infant mortality, increasing hard core poverty, disintegration of
the extended family system, high incidence of sexually transmitted infections
and a high incidence of morbidity and mortality. At least maternal deaths can
be prevented by family planning.
The population growth rate has strong linkages with the Economic
Growth and Sustainable Social Development. The above view points to the
fact that rapid population growth as against scarce resources has been and is
presently one of the major problems facing most countries in the world today.
As a result, attempts are being made globally to create awareness and find ways
of combating it. The widely accepted strategy is controlling or regulating
fertility.
Male participation in family planning is seriously hindered by paucity
of a desired number of modern male methods of contraception. In addition
message about the use of “Natural” methods is conveyed in the research. At
the field level efforts directed towards motivating the large population in
communities to use male methods (Condom and Pills) are high.
All these imply that targeting men actively in family planning should be
given proper attention in the national family program. There is now a
realization of the growing importance of male participation in family planning
which emerges from the fact that the females now shoulder largely the
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contraceptive burden. To ease the burden, men should, therefore, play a
greater role in contraceptive use as a joint and equal responsibility.
A high level of contraceptive prevalence in most of the developing
countries can be achieved through increased involvement of men in family
planning.
In addition, practicing family planning by males is now well recognized
to have important implications on needs of couples. For example, use of the
male methods (condom) may relieve women of various health risks posed by
their prolonged use of oral contraceptives. Despite the recognition that
condom can serve as a means of contraception; their primary association is
with sexually transmitted diseases (STD’s) prevention. Moreover, the most
effective technology against the spread of HIV/AIDS is still condom.
Also, on the grounds of gender equality, responsibility for birth
control should be shouldered by men and women alike. It is therefore
emphasized that further increases in the existing level of contraceptive
prevalence must come progressively from the use of methods, which require
male participation. The ultimate success of family planning based on total
family welfare rests on maintaining a balance in the choice of mix of gender
oriented contraceptives.
In the developed countries the high contraceptive prevalence rate
demonstrates (though not always) the compliance of equity in the use of
gender-specific contraceptives. In general, men posses a higher potential
contribution to family planning service delivery as well as in the extension of
the relationship between the partners and improved communication regarding
reproductive goals within the present patriarchal system. This fact recognizes
the need to encourage male contraception with increased efforts and also,
important to enhance the sustainability of the family planning programs. It is
an accepted fact globally that when a variety of methods are available for men,
male participation in family planning is likely to increase.
The government family planning program continues to enjoy favorable
and stable political support in the country. This immense opportunity can be
utilized to place the important issue of male involvement in family planning at
the community level in an egalitarian manner to gain emphatic public support.
It, therefore, implies that exploring various potential avenues for male program
development can augment the seemingly low level of male participation.
An initial step towards a successful involvement of male in the family
planning, including their awareness and knowledge level is the development of
an educational learning module for family planning.
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CONCLUSIONS AND RECOMMENDATIONS
The majority of the respondents were Roman Catholics, very few were
Iglesia Ni Cristo, Born Again, Muslim and Protestant; with at least college and
technical vocational education; and currently employed as service workers; and
the majority has 1-3 children. The knowledge about family planning was
relatively high among respondents, with a proportion of ninety-eight percent
having heard of family planning, which gave them the opportunity to plan the
number of their children (limiting family size) as well as proper spacing of
childbirth. The respondents were familiar with family planning methods like
pills, condoms, injectables; vasectomy, tubal ligation and abstinence. Other
methods like intrauterine device, norplant, spermicidal, and prolonged
breastfeeding were also noted by them. Thus, the majority of them wanted to
use safer FP methods such as pills and condoms in the future. Fewer numbers
of children and proper spacing of childbirth were due to lack of money for
rearing many children, mothers and child health. The respondents had ever
used contraceptives by using condoms, pills, and injectables. Some possible
reasons for stopping them from using such were fear of side effects, and desire
to have more children, and for some were a religion and source of
contraceptive. The majority of the respondents has ever convinced others,
including their partners to use family planning methods. Thus, the decision on
the utilization of family planning methods was done jointly by the husband and
wife through spousal discussion. A condom still ranked number 1 among male
users. They have radio/ tv at home; and ever heard of information about
family planning through various media and health professionals. Health
institutions (Barangay Health Centers and Hospitals), pharmacy, and friends
were their sources of contraceptives. Moreover, the majority has gone to health
care institutions for advice or service and the service providers were friendly
regardless of gender. Some supporters of the use of contraceptives such as
partner and society were reported, but they don’t know whether their religion
is against the use of contraceptives. The level of male involvement in family
planning programs has been good among communities in the City of
Olongapo. The male support in FP practice was encouraging. Thus, an
educational module was developed in support to the FP advocacy.
A more intensified advocacy and program should be conducted to
further educate men on the use, advantages and disadvantages of various
family planning methods. Natural family planning methods such as abstinence
and prolonged breastfeeding should be inculcated in the minds of husbands.
Spousal communication, open discussion and decision-making relative to the
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use of family planning methods should be sustained among married couples. A
family planning clinic and facilities for males should be established so that
males could feel comfortable and visit the clinic to access family planning
services. The Community Health Management Team (CHMT) should provide
resources and motivate public health nurses, midwives, community health
officers and health volunteers to effectively participate and cooperate in family
planning programs for men. The policy makers should use the mass media in
creating awareness and motivation for family planning. There is an urgent need
for contraceptive advertising to contain more information on male family
planning methods and facilities. Community drama programs should
emphasize on “Responsible Fatherhood” which can further lead to
internalizing of the male involvement in family planning concept. A parallel
study should be conducted in other cities and provinces to further encourage
male participation in family planning.
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