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EXTENT AND SOCIO-DEMOGRAPHIC DETERMINANTS OF MALES’ INVOLVEMENT IN FAMILY PLANNING PRACTICES

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CHAPTER ONE

 

Introduction

Background to the Study

            Recognition is growing on a global scale that the involvement of men in family planning practices (FPPs) offers both men and women important benefits. Such benefits include a decreased maternal mortality rate and an increased contraceptive prevalence rate (CPR). According to Cleland, Bernstein, Ezeh, Faundes, Glasier and Innis (2006), an estimated ninety per cent (90%) of abortion-related and twenty per cent (20%) of pregnancy-related morbidity and mortality, along with thirty-two (32%) per cent of maternal deaths could be prevented by use of effective contraception. Hubacher, Mavranezouli and McGinn (2008) also noted that in Sub-Saharan Africa, an estimated fourteen million unintended pregnancies occur every year. These unintended pregnancies and subsequent abortions could have been avoided if the male partners had applied family planning (FP) methods.

In the past, men were considered to be beyond the scope of FP programmes; the reasons, according to Dahal, Padmadas and Hinde (2008), included the notions that reproduction was primarily a woman’s issue and that men usually did not take responsibility for reproductive health and FP. However, it has been widely acknowledged that men in developing countries, such as Nigeria, make most of the decisions regarding family formation (Bankole & Singh, 1998); and according to Morgan and Niraula (1995), despite women’s increasing influence on household decision making, their preferences regarding contraceptive choices and family size may not translate into practice unless they conform to their husbands’ wishes. Thus, without the husband’s approval and support, the wife may not be able to practise FP.

Studies in Sub-Saharan Africa, including Nigeria, revealed a high level of knowledge of FP methods and a strong positive attitude towards FP by men but the actual use of these FP methods remains uncommon (Mustapha & Mumford, 1984; Gallen & Kak, 1986; Obionu, 1998). This apparent refusal or reluctance by men to use male FP methods presents a source of concern, especially regarding the need for couples to share the responsibilities of reproduction. According to the Alan Guttmacher Institute- AGI (2003), studies conducted in Africa and Latin America had revealed that more than a quarter of men who wanted to limit or postpone their wives’ childbearing did not use any method to prevent unwanted pregnancy. Hence, the burden of contraception was borne by the women only. This confirmed the assertion by Lasee and Becker (1997) that in most developing countries, like Nigeria, women carry the burden of responsibility for contraceptive use often with little or no support and sometimes, with great resistance from their male partners. This may be the reason why in spite of an increased emphasis on FP programmes in Nigeria, the impact on fertility is still very low with a population growth rate of two point nine per cent per annum (Uzuegbunam, 2005). In line with this, Duze and Mohammed (2006) opined that one factor that might have contributed to the lack of success of the population control programmes may be that they tend to be directed toward women only, ignoring the role of men in FP decisions.

FP, according to Arkutu (1995), refers to the actions couples take to have the desired number of children, when they are wanted. He added that using a method of FP meant allowing choice, not chance to determine the number and spacing of children. This implied that people, especially couples, had a responsibility of deciding the number of children they wanted and the timing of their births, hence the birth of children need not be by accident. Similarly, FP was defined by Planned Parenthood Federation-PPF (2002) as the kind of services which help people to plan their families in such a way that they can have children when they want and help individuals to enjoy normal sexual relations without fear of unwanted pregnancy. This definition views FP as a range of services which enabled people to plan their families and avoid unnecessary anxiety brought about by fear of unwanted pregnancies. Similarly, FP was defined as the planning of when to have children and the use of birth control and other techniques to implement such plans (Family Health International – FHI, 2009). This highlights the importance of employing birth control techniques or FP methods to determine when or not to have children. These different FP methods or techniques are classified into natural and artificial; temporary and permanent; and male and female (Jones, 1982).

Natural FP methods, according to Kippley and Kippley (1996), refer to any use of fertility awareness methods which involve a woman’s observation and charting of her body’s fertility signs to determine the fertile and infertile phases of her cycle. Artificial FP methods, according to PPF (2002), refer to those methods that work in various ways to: physically prevent sperm from entering the female reproductive tract (for example, male condom and female condom); hormonally prevent ovulation from occurring (for example, oral contraceptives, injectables, implants and Intra Uterine Devices-IUCDs); or surgically altering the female or male reproductive tract to induce sterility (for example, tubal ligation and vasectomy).

Temporary FP methods refer to those that can be reversed if and when the individual or couple want to have children while the permanent FP methods are those that cannot be easily reversed such as tubal ligation and vasectomy (Jones, 1982).  Condom, withdrawal and vasectomy (FHI, 2009) are the only FP methods available for men. The rest are for females or require female participation. According to FHI (2009), the development of hormonal methods for women and subsequent development of IUCDs and modern surgical sterilization led to the development of a FP services focused on women often to the exclusion of men. There is, therefore, the need to reintegrate men into the FP programme, not just in supporting spouses’ use of FP methods but in practicing FP themselves.

Practice, according to Hornby (2001), is a way of doing something that is the usual or expected way in a particular organization or situation. In the same vein, Cornog, Vranken and West (2008) defined practice as the actual performance or application. In the above definitions practice implies one taking action concerning a particular thing. Therefore, in this study, FPPs refer to all the activities undertaken by individuals, especially males, to prevent unwanted pregnancies, determine the number of children they want and the interval between their births. It is one thing to get involved in these FP activities but it is the extent of such involvement that can determine their success or failure.

Extent is defined as the space or degree to which a thing is extended (Macdonald, 1980). He further referred to extent as bulk, scope or amount.  Cornog, Vranken and West (2008) defined extent as the point or degree to which something extends. They also stated that extent refers to dimension, magnitude or measure of something. These definitions indicate that extent has to do with the degree or magnitude of something in relation to others. In the present study, extent is regarded as the degree of males’ involvement in FPPs. The extent of males’ involvement in FPPs is determined by certain factors which are referred to as determinants in this study.

Determinant, according to Hornby (2001) is a thing that decides whether or how something happens. Cornog, Vranken and West (2008) also defined it as an element that identifies or determines the nature of something or that fixes or conditions an outcome. Macdonald (1980) defined determinant as that which serves to determine or decide how something happens. Determinant, according to these definitions, can be regarded as something that decides the outcomes of a thing. In this study, therefore, determinants refer to socio-demographic factors such as level of education, occupation, religious affiliation, age and geographical location. These factors decide or determine the extent of males’ involvement in FPPs.

To involve, according to Macdonald (1980), means to envelop or concern somebody with something. Similarly, Cornog, Vranken and West (2008) stated that involvement means to draw in as a participant, to oblige, to take part, to require as a necessary accompaniment and to include. Involvement, according to the above definitions, means concerning oneself with something or participating in it. Involvement, in this study, refers to the participation or inclusion of males in FPPs. It has also been asserted that male involvement in FPPs means, not only, increasing the number of men using condoms and having vasectomies but also includes the number of males who encourage and support their partners and their peers to use FP (Toure,1996).

Male is a state of being a man or a boy. It refers to the masculine gender or an individual that produces motile gametes (spermatozoa) which fertilize the eggs of a female (Cornog, Vranken & West, 2008). Males, as used in the present study, refer to currently married men. In developing countries such as Nigeria, males play significant roles as household heads, custodians of their lineage and providers for their family. Due to these roles, decision-making power within the family and society largely lies with males and is extended to decisions involving FPPs (Duze & Mohammed, 2006). Furthermore, males make most of the decisions regarding family formation (Bankole & Singh, 1998) and their reproductive preferences and motivation influence their wives reproductive outcome (Lasee & Becker, 1997). The need for males’ involvement in FPPs cannot be over-emphasized and the extent of such involvement can be determined by demographic and socioeconomic factors (Hossain, 1999).

There are several socio-demographic factors capable of influencing the extent of males’ involvement in FPPs. This study is concerned with such factors as level of education, occupation, religious affiliation, age and geographical location.

Level of education has been identified as a strong factor influencing males involvement in FPPs. Studies have indicated that men who are educated are more knowledgeable about FPPs. Obionu (1998) confirmed, in a study, that there was a significant association between the practice of FP by males and their level of education. The educational background of males, according to Akafua and Sossou (2008) determined their willingness to use a FP method. This may be because exposure to FP information through the mass media differed considerably by level of education (Bangladesh Demographic and Health Survey-BDHS, 2000). The more educated men were, the more they were exposed to information about FP and thus had a better chance of choosing to use or support their spouses’ use of FP methods.

Reports from researchers indicate that occupation, hence level of income, can determine the extent of males’ involvement in FPPs. According to Dahal (2005), a large proportion of women whose husbands were manual workers favoured female sterilization because of their fear that vasectomies would render men weak and too ill to work and hence potentially impair their ability to support the family. In the same vein, Dahal, Padmadas and Hinde (2008) stated that FP method choice differed by occupation. Thus men working in the professional sector reported the highest rates of male sterilization and condom use, while men who had manual or agricultural jobs were the most likely to use no contraceptives. Gaverick (2004) posited that the FPPs of men is shaped in part by the inherent cost of accepting the FP method including the cost of purchasing the contraceptive or service; cost of acquiring the information; cost of travel and time; cost associated with side effects; and the psychological cost of using a method that may be accompanied by social disapproval.

Religion is another factor that can determine the extent of males’ involvement in FPPs. Chaouch-Bouraoui (1984) noted that FP can be described as weak in some Arab countries and non-existent in others because of the religious belief that FP is contrary to the teaching of Islam. Motivating and involving men in FPPs in these countries, according to him, was difficult. The Catholic Church holds the view that altering, deliberately, fertility or the marital act with the intention of preventing procreation is sinful (FHI, 2009). Thus, artificial birth control is forbidden; only natural FP methods are acceptable to the church.

Age can also determine the extent of males’ involvement in FPPs. Duze and Mohammed (2006) asserted that knowledge of contraceptives varies with age. They noted that young people were more knowledgeable about contraceptives than older people. Similarly, Akafua and Sossou (2008) stated, in a study conducted in Ghana, that the prevalence rate of contraceptive use was higher among young men aged between twenty and twenty-nine than older men aged between fifty and sixty-five years. This, according to them, may be because older men are not inclined to use contraceptives due, probably, to lack of desire to do so as some of them may no longer be sexually active.

Geographical location or place of residence is another factor that can determine the extent of males’ involvement in FPPs. According to the BDHS (1996 – 1997), urban respondents were more likely to have been exposed to a media message on FP than their rural counterparts. Hence, urban residents may have more knowledge of contraceptives than the rural residents as noted by Duze and Mohammed (2006). In the same vein, Dahal, Padmadas and Hinde (2008) reported that a higher proportion of men who lived in rural than in urban areas used no contraceptives. One of the reasons for low condom use, according to Khan and Patel (1997), was that availability of retail outlets in rural areas was extremely low. These variables were surveyed in this study and some theories on behaviour were applied to explain the extent and socio-demographic determinants of males’ involvement in FPPs.

This study was anchored on three theories. These are theory of reasoned action, theory of planned behaviour and the health belief model. The theory of reasoned action suggests that a person’s behaviour is determined by his/her intention to perform the behaviour and that this intention is a function of his/her attitude toward the behaviour. The males who develop poor attitude towards FP are likely not going to participate in FPPs; whereas those who develop good attitude towards it will likely participate. The theory of planned behaviour holds that perceived behavioural control influences intentions. This perceived behavioural control refers to people’s perceptions of their ability to perform a given behaviour. When males perceive themselves as being capable of using FP methods, their intention to use these methods will become stronger. The health belief model is based on the understanding that a person will take a health related action if that person has a positive expectation that by taking the recommended health action, he/she will avoid a negative health condition. This will be useful because males who have the expectation that practicing FP will help them avoid unwanted pregnancies and the associated health problems, will likely be involved in FPPs to achieve this level of wellbeing.

This study was conducted in Ohafia Local Government Area of Abia State. The Local Government Area is located in Abia North senatorial zone. It shares boundaries with Afikpo South Local Government Area, Ebonyi State and Ehere in Akwa Ibom State to the south. It also shares boundaries with Arochukwu Local Government Area to the north and Bende Local Government Area to the east. There are three clans that make up Ohafia Local Government Area. The three clans are Ohafia, with nine political wards; Abiriba and Nkporo with five political wards each; thus making it a total of nineteen political wards in the Local Government Area. All the communities are of rural location except Ebem, Elu and Amaekpu which make up the urban. Ohafia Local Government is essentially inhabited by the Ohafia, Abiriba and Nkporo people who share similar customs and traditions with minor peculiarities. Other people from across the country are also resident in Ohafia Local Government Area. The males in Ohafia Local Government Area are predominantly farmers, traders and civil servants. Majority of them are Christians, with a few traditional religious practitioners. The typical Ohafia man is dominant in nature and as the head of the household, he dominates in decision making concerning every aspect of family life including decisions about FPPs. The Ohafia man considers the ability to procreate as a sign of his virility and masculinity and also views the use of FP methods as the woman’s business. All these may negatively affect his decision to use FP methods or support his wife’s use of FP methods. This may result to an increase in unwanted pregnancies and abortions with the attendant high maternal mortality rate.

Based on the fore-going, an investigation to find out the extent and socio-demographic determinants of males’ involvement in FPPs in Ohafia Local Government Area becomes imperative. Moreover, there seems to be no evidence that such studies have been conducted among males in Ohafia Local Government Area previously.

Statement of the Problem

It is widely acknowledged that males make most of the decisions regarding family formation. This is because most males contribute more resources in running the family, which gives them more authority. Men as husbands and heads of households control the sexuality of their wives; therefore they make reproductive decisions, deciding whether or not to have sexual intercourse, or the duration of abstinence to some degree and making the choice about the contraceptive method the wife is to use. It has been noted that involvement of males in FPPs ensures shared responsibility and promotes their active involvement in responsible parenthood and sexual/reproductive behaviour of both husbands and wives. Male involvement may result in greater social acceptance of FPPs as well as improved health of both men and women and increased CPR.

Unfortunately, men still consider FPPs as the responsibility of the women and so feel unconcerned about such issues as child spacing and use of contraceptives. Even where there is considerable knowledge about FP, there is still a high level of resistance or reluctance on the part of men towards practising it, especially regarding the use of male contraceptive methods. This apparent refusal or reluctance by men to use male FP methods or support their wives’ use of FP methods presents a source of concern, especially regarding the need for couples to share the responsibilities of reproduction.  A number of factors have been identified as being responsible for this low level of participation by males in FPPs. They include level of education, occupation, religious affiliation, age and geographical location. Today many women are left to bear the disproportionate burden for contraception while those who cannot use contraceptives are left to grapple with unwanted pregnancies with the associated risks and blames.

It is therefore, the above ugly situation and its negative consequences for the family and society at large that has given impetus to the present study: Extent and socio-demographic determinants of males’ involvement in FPPs. Similar studies have been conducted on male involvement in FP in many parts of the world including Nigeria. Incidentally, none of such studies, to the best knowledge of the investigator, has been conducted in Ohafia Local Government Area, hence the need to embark on this present study.

 

Purpose of the study

The purpose of the study was to find out the extent and socio-demographic determinants of males’ involvement in FPPs in Ohafia Local Government Area of Abia State. Specifically, the study was set to find out the extent of males’ involvement in:

  1. use of male FP methods;
  2. use of women-dependent FP methods;
  3. FPPs based on level of education;
  4. FPPs based on occupation;
  5. FPPs based on religious affiliation;
  6. FPPs based on age; and
  7. FPPs based on geographical location.

 

Research Questions

The following research questions were posed to guide the study:

  1. What is the extent of males’ involvement in the use of male FP methods?
  2. What is the extent of males’ involvement in use of women-dependent FP methods?
  3. What is the extent of males’ involvement in FPPs based on their level of education?
  4. What is the extent of males’ involvement in FPPs based on their occupation?
  5. What is the extent of males’ involvement in FPPs based on religious affiliation?
  6. What is the extent of males’ involvement in FPPs based on age?
  7. What is the extent of males’ involvement in FPPs based on geographical location?

Hypotheses

The following null hypotheses were postulated and tested at 0.05 level of significance:

  1. There is no significant difference among the mean scores of males’ involvement in FPPs based on their levels of education.
  2. There is no significant difference among the mean scores of males’ involvement in FPPs based on their occupations.
  3. There is no significant difference among the mean scores of males’ involvement in FPPs based on their religious affiliations.
  4. There is no significant difference between the mean scores of involvement in FPPs of males aged 18 – 40 years and above 40 years.
  5. There is no significant difference between the mean scores of involvement in FPPs of males in urban and rural areas.

Significance of the Study

The results of this study are useful to health educators, curriculum experts, health agencies, FP service providers, counsellors and policy makers. The results of the extent of males’ involvement in FPPs revealed the degree of males’ participation in FPPs which may have been affecting the success of FP programmes. The results will be useful to health educators and health agencies in planning and implementing FP campaigns for men in order to either sustain or improve their extent of involvement.

The findings of this study revealed the extent of males’ involvement in FPPs based on level of education. The results will be useful to health educators, curriculum experts and FP service providers. The health educators will develop Information, Education and Communication (IEC) materials on FP that will be easily understood by illiterate males. The curriculum experts will develop training manuals that will equip health educators and FP service providers with the skills to communicate FP messages effectively to both literate and illiterate men. The FP service providers will use the results to interpret FP messages in a way illiterate men can understand.

The results revealed the extent of males’ involvement in FPPs based on occupation and those occupational and economic factors that may be hindering men from taking part in FPPs. The results will be useful to health agencies and policy makers. The health agencies will utilize the results in organizing FP sensitization programmes for men in occupations recording low levels of involvement in FPPs and in providing FP commodities, such as condom, at little or no cost so that men, in low income occupations, can afford it. The policy makers can also use the results in formulating policies aimed at subsidizing the cost of FP commodities and procedures such as vasectomy and tubal ligation for low income earners.

The results revealed the extent of males’ involvement in FPPs based on religious affiliation. The results will be useful to health educators and health agencies. They will use the results to mount FP sensitization campaigns aimed at correcting the negative religious beliefs and practices and reinforcing the positive ones. The results will also arm health educators with an effective guide for Focus Group Discussion (FGD) targeted at improving males’ participation in FPPs.

The results also revealed the extent of males’ involvement in FPPs based on age. This will be useful to health educators and health agencies. The health educators will utilize the results in creating FP messages that will suit the different age groups of males and direct more FP sensitization campaigns at the age group least involved in FPPs. The health agencies, on the other hand, will use the results as a guide in sponsoring future FP programmes targeted at the age group with the greatest need.

The results revealed the extent of males’ involvement in FPPs by location. This will also be useful to policy makers and health agencies. The policy makers will utilize the results to formulate policies that will ensure the provision of adequate FP services or clinics in the areas where they are lacking. The health agencies will use the results in planning FP sensitization campaigns to the areas with difficult access to FP services, both in terms of FP information and FP commodities.     

Theoretically, the findings of this study are significant because there is need for empirical information for explaining the extent of males’ involvement in FPPs and the factors that determine such involvement. The theoretical significance of this study is anchored on the theory of reasoned action. This theory holds that a person’s behaviour is determined by his/her intention to perform the behaviour. This intention is a function of his/her attitude towards the behaviour. Thus, a man who develops negative attitude towards FP will likely not practice it whereas a man who develops positive attitude towards FP will likely practice it. This study will also contribute to knowledge on those factors that may make a man to develop negative or positive attitude toward FP and so determine whether he practices it or not.

Theoretically, this study will add valuable literature to the area of gender studies generally. It will also provide valuable knowledge on the extent of males’ involvement in FPPs thereby bridging the gap that exists with regards to literature in the area. The findings of this study will also be of immense benefit to future researchers who may wish to conduct further research in this area or other related areas.

 

Scope of the Study

The study was conducted in Ohafia Local Government Area of Abia State, and was restricted to currently married males residing in the Local Government Area. The study was also concerned with finding out the extent and socio-demographic determinants of males’ involvement in FPPs. Such factors as level of education, occupation, religious affiliation, age and geographical location as they affect the extent of males’ involvement in the use of male FP methods and in supporting their wives’ use of FP methods were adequately explored

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