Conception or Contraception
Men‘s Role in the decision making process in Minya, Egypt
Adel Takruri
PhD Candidate
Johns Hopkins Bloomberg School of Public Health
October, 2010
Fertility in Egypt
•TFR in Egypt was 3.1 in 2005
•In Southern rural Egypt: 3.8
•Contraceptive use in Egypt in 2005: 57%
•In Southern rural Egypt: 41%
•Unmet need for contraception in 2005: 7% in
Northern Egypt
•17% in Southern Egypt
•Decelerating fertility
•Decrease unwanted fertility or wanted fertility?
Source: EDHS, 2005
The benefits of reducing fertility
•At the household level
•Educational opportunity
•Lower maternal mortality
•Better nutrition
•At the economic level
•Better job opportunities
•Poverty reduction
•At the environmental level
•Better sanitation
•Less strain on natural resources
•Less environmental degradation
Source: Greene & Merrick, 2005
Reproductive Interventions
The missing actor?
•Family planning programs mostly target women
•Reproductive health studies rarely include men
•Most family planning surveys collect data from
women
•Reproductive health services mainly focus on
women
The question?
•Do men matter?
Study Objectives
•To determine the effects of husbands desire for more
children on contraceptive use
•To determine factors that empower women to use
contraception
•To determine the influence of husbands attitudes
towards family planning on wives attitudes and
subsequent use of contraception
Study data
•A panel survey of three years: 2004, 2005, and 2007
•Included 1927 couples
•Based on the questions asked in DHS
Conceptual framework of the influences of community, couple, and individual level factors on
fertility intentions and behaviors
Background Variables
Community
Couple
Proximate/Individual
Outcomes
C
A
Culture
Modernity
Patriarchy
Fatalism
Religion
Policies
FP services
availability
B
Partners’
age
Husband’s
Knowledge and
Attitudes
Husband’s
Intentions
Partners’
schooling
Partners’
employment
Residence
Social
networks
Son
preference
H
D
Contraceptive
use or nonuse
Couple
communication
Parity
Media
F
I
Fertility
outcome
G
E
Wife’s
Intentions
Wife’s
Knowledge and
Attitudes
Shaded variables will not be included in the analysis
Adapted from Becker 1996
Preliminary Results
Use of contraception in relation to men-related factors
OR
95% CI
Heard about FP past 6 months
1.3
(1.08-1.55)
Staff talked about FP
2.06
(1.2-3.4)
Staff talked about side effects FP
0.56
(0.21-1.5)
Thought most people use FP
1.3
(1.08-1.55)
Desire for a future child
•86% of couple are concordant in their desire for a
future child
•14% are discordant
Desire for Future Child among Discordant Couples,
Minya, Egypt
90
80
70
Percent
60
Woman wants to stop
birth, man wants more
50
40
Man wants to stop birth,
woman wants more
30
20
10
0
2004
2005
2007
Contraception among couples in which the woman wants to
stop childbirth and the man want more children
Woman's Schooling
Percent contracepting
Not contracepting
Attended School
80.3
19.7
No Schooloing
76.6
23.4
Less than 4
81
19
4 or more
73
27
30 or less
85
15
Above 30
61
39
Yes
83
17
No
74
26
Number of children
Age
Discussed FP with husband
Pending hypothesis?
Spouses influence each other
Wife’s desire
Husband’s desire
Wife’s desire
Husband’s desire
Policy Implications
•Including men men in reproductive and family
planning services
•Empowering women to take control of their fertility
•Encouraging communication between spouses
Further Research
•How to define or refine the concept of unmet need to include
husbands, wives or couples (Becker 1999)
•How do couples negotiate their fertility and contraceptive desires
•Who initiates the discussion
•Verbal or nonverbal expressions
•How to include men in reproductive health
•With wives
•Separately
•Men groups
•Men’s attitudes towards involvement? Childbearing and rearing are
women’s issues?
•What is the value of children for men and for women?
•Unwanted fertility versus wanted fertility
•Informed
•Free from influence