The effect of spousal communication on contraceptive use in Central Terai, Nepal

Contraceptive use among female head porters: implications for health policy and programming in Ghana

Objective

Despite the growing literature on the barriers to contraceptives use among women, the perspective of female head porters has not been exhaustively researched. Using Bronfenbrenner's socio-ecological theory, we explore the factors that influence the contraceptive decision-making of migrant female head porters in the Kumasi Metropolis and the implications for health policy and planning.

Methodology

A case study of female head porters in the Kumasi Metropolis was conducted. We employed a qualitative approach in the collection and analysis of the data. A combination of cluster, purposive, and convenience sampling procedures was used to select 48 migrant female head porters to participate in semi-structured in-depth interviews. The data collected were analyzed using the thematic analytical framework.

Results

We found the main barriers to the uptake of contraception among the head porters to include high cost of contraceptives, perceived side effects associated with contraceptive use, and the disapproval of a male sexual partners.

Conclusion

The findings indicate that head porters' contraceptive decision-making is largely influenced by their social and economic circumstances. To address these, we recommend a carefully tailored approach, starting with a free National Health Insurance Scheme (NHIS) enrollment policy for all head porters in the country. There is also the need for the Ghana Health Service, and NGOs in health to work together to create effective awareness among female head porters on the benefits and misconceptions of contraception by incorporating culturally appropriate education that would facilitate the adoption of positive attitudes towards contraception. Additionally, NGOs in health in collaboration with the health facilities should initiate a process that encourages joint reproductive health decision-making among partners which recognises the added value of men's participation. We argue that men's active participation in contraception decision-making could potentially address their scepticism towards uptake.

"Females are always dominated and disregarded by males, just because they are female": the continuation of patriarchal norms for young trafficked women in Nepal

This article provides insights into the cultural aspects of sexual violence against young women trafficked into the sex industry in Nepal. Participant observation, participatory clay body mapping workshops and group interviews using photography were used to explore the reproductive body of six formerly trafficked women aged 14-22 years. Intimate partner violence against women, domestic violence and violence against women were important issues raised during the research process. Societal and familial patriarchal norms are the root causes of violence against women in Nepal and can be traced back to the Hindu legal code, the Muluki Ain of 1854, which was enforced for over 100 hundred years. Our findings indicate that tackling violence against women is complex for Nepali trafficked women because of its multiple forms and sources.

Women’s contraceptive profiles in Burundi: Knowledge, attitudes, and interactions with media and health services

Reproductive health program managers seek information about existing and potential clients’ motivations, behaviors, and barriers to services. Using sequence and cluster analysis of contraceptive calendar data from the 2016–17 Burundi Demographic and Health Survey, we identified discrete clusters characterizing patterns in women’s contraceptive and pregnancy behaviors over the previous 5 years. This study pairs these clusters with data on factors typically targeted in social behavior change interventions: knowledge, attitudes, and women’s interactions with media and health services, to create composite profiles of women in these clusters. Of six clusters, three are characterized by contraceptive use and three are characterized by its absence. Media exposure and attitudes regarding sex preference, wife beating, and self-efficacy largely do not explain cluster membership. Contraceptive knowledge is positively associated with two clusters (Family Builder 1 and Traditional Mother) and negatively associated with a third (Quiet Calendar). Clusters also differ in their members’ fertility desires, contraceptive intentions, and interactions with health services. Two “Family Builder” clusters are both characterized by the presence (but not timing) of multiple pregnancies in their calendar histories, but differ in that women with high contraceptive knowledge, intentions to use contraception, and well-articulated family size ideals are characteristic of one cluster (Family Builder 1), and low contraceptive knowledge, no use of contraception, and vague family size preferences are characteristic of the other (Family Builder 2). These results can guide reproductive health programs as they target social and behavioral change and other interventions to the unique subpopulations they seek to serve.

Male partners' participation in birth preparedness and complication readiness in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Maternal and neonatal health outcomes remain a challenge in low- and middle-income countries (LMICs) despite priority given to involving male partners in birth preparedness and complication readiness (BPCR). Men in LMICs often determine women's access to and affordability of health services. This systematic review and meta-analysis determined the pooled magnitude of male partner's participation in birth preparedness and complication readiness in LMICs.

METHODS

Literature published in English language from 2004 to 2019 was retrieved from Google Scholar, PubMed, CINAHL, Scopus, and EMBASE databases. The Joanna Briggs Institute's critical appraisal tool for prevalence and incidence studies were used. A pooled statistical meta-analysis was conducted using STATA Version 14.0. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis was carried out to validate publication bias and heterogeneity. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of birth preparedness and complication readiness. The review protocol has been registered in PROSPERO number CRD42019140752. The PRISMA flow chart was used to show the number of articles identified, included, and excluded with justifications described.

RESULTS

Thirty-seven studies with a total of 17, 148 participants were included. The pooled results showed that 42.4% of male partners participated in BPCR. Among the study participants, 54% reported having saved money for delivery, whereas 44% identified skilled birth attendants. 45.8% of male partners arranged transportation and 57.2% of study participants identified health facility as a place of birth. Only 16.1% of the male partners identified potential blood donors.

CONCLUSIONS

A low proportion of male partners were identified to have participated in BPCR in LMICs. This calls countries in low- and middle-income setting for action to review their health care policies, to remove the barriers and promote facilitators to male partner's involvement in BPCR. Health systems in LMICs must design and innovate scalable strategies to improve male partner's arrangements for a potential blood donor and transportation for complications that could arise during delivery or postpartum haemorrhage.

Communication, social norms, and contraceptive use among adolescent girls and young women in Lilongwe, Malawi

In Malawi, 50% of adolescent girls and young women (AGYW) have had a first child by age 19 and 45% report their pregnancies as unintended or mistimed. Yet, uptake of contraception remains low. Understanding how interactions with social ties impact AGYW contraceptive use might explain low uptake beyond individual and environmental factors. Data are from Girl-Power, a study among sexually active AGYW, aged 15-24, in Malawi. We used logistic regression models to examine whether contraceptive communication and social norms (descriptive and injunctive) were associated with contraceptive use (non-barrier methods and condoms) and how associations differed across social ties (older women in the family, peers, and partners). The sample included 942 participants: 28% reported using non-barrier methods and 66% reported using condoms. Contraceptive communication with older women in the family (aOR: 1.48, 95% CI: 0.99, 2.20), peers (aOR: 3.12, 95% CI: 1.96, 4.96), and partners (aOR 5.15, 95% CI: 3.13, 8.48) was associated with non-barrier method use. Descriptive norms were associated with non-barrier methods among peers (aOR 2.57, 95% CI: 1.63, 4.96) but not among older women in the family (aOR: 1.22, 95% CI 0.80, 1.88). There were no associations among contraceptive communication, social norms, and condom use across older women in the family, peers, and partners. The findings highlight the need to consider the influence of social ties in the design of future family planning interventions and suggest that interventions that encourage interpersonal communication about contraception and target peer-based descriptive norms have the potential to impact uptake of non-barrier methods.

Family planning use among young mothers in the peri-urban area of Osun State, Nigeria: the influence of spousal communication and attitude

Purpose

The purpose of this study is to examine the influence of spousal communication and attitude toward family planning (FP) use among young mothers in the peri-urban area of Osun State, Nigeria.

Design/methodology/approach

The study was limited to a primary cross-sectional dataset collected among 420 young mothers between the ages of 15 and 30 years residing in the peri-urban area of Osun State, Nigeria. The distribution of the use of FP across the socio-demographic, spousal communication and attitude was described, and multivariate logistic regression was used to assess FP use likelihood. The results were presented as crude odds ratios (cOR) and adjusted odds ratios (aOR) with their corresponding 95% confidence intervals. Statistical significance was set at p-value < 0.05.

Findings

FP use were more likely to be higher among the respondents whose male spouses have good communication [cOR = 35.5; 95% (15.93–78.99)], good attitude [cOR = 8.6 95% (3.59–20.65)] and this persisted after adjusting for significant covariates [aOR = 80.7; 95% (19.80–328.84)] and [aOR = 5.4 95% (1.34–22.17)].

Research limitations/implications

The study's strength is the ability to design questionnaires tailored toward the literature gap on nonuse of FP by young mothers. However, the study is without limitation because the focus was on young mothers alone why their spouses were not interviewed. Male spouse details were collected from the young mothers, and there may be inaccuracy in the reporting of male spouse socio-demographic characteristics used as a control variable in this study. Also, because this research was conducted among specific group, the results of the study cannot be used to generalize for other group.

Practical implications

Future studies should consider both partners to harness the true picture of poor communication and attitude toward each other. The future study will also be more robust if it can consider a qualitative research design as this will help unveil more underlining factors influencing the nonuse of FP among young mothers.

Originality/value

Young mothers with good spousal communication and attitude were more likely to use FP. Deliberate interventions should include focus group discussion and community sensitization to encourage good communication and attitude of male spouse toward their partner in the peri-urban area of Osun State, Nigeria.

Leaving no one behind: using action research to promote male involvement in maternal and child health in Iringa region, Tanzania

INTRODUCTION

Male involvement has been reported to improve maternal and child health (MCH) outcomes. However, most studies in low-income and middle-income countries have reported low participation of men in MCH-related programmes. While there is a growing interest in the involvement of men in MCH, little is known on how male involvement can be effectively promoted in settings where entrenched unequal gender roles, norms and relations constrain women from effectively inviting men to participate in MCH.

METHODS AND ANALYSIS

This paper reports participatory action research (PAR) aimed to promote male participation in pregnancy and childbirth in Iringa Region, Tanzania. As part of the Innovating for Maternal and Child Health in Africa project, PAR was conducted in 20 villages in two rural districts in Tanzania. Men and women were engaged separately to identify barriers to male involvement in antenatal care and during delivery; and then they were facilitated to design strategies to promote male participation in their communities. Along with the PAR intervention, researchers undertook a series of research activities. A thematic analysis was used to analyse the data. The common strategies designed were: engaging health facility committees; using male champions and male gatekeepers; and using female champions to sensitise and provide health education to women. These strategies were validated during stakeholders' meetings, which were convened in each community.

DISCUSSION

The use of participatory approach not only empowers communities to diagnose barriers to male involvement and develop culturally acceptable strategies but also increases sustainability of the interventions beyond the life span of the project. More lessons will be identified during the implementation of these strategies.

Factors associated with reported modern contraceptive use among married men in Afghanistan

BACKGROUND

Afghanistan has high maternal and infant mortality which is in part driven by high fertility and low modern contraceptive use. Using modern contraceptive methods can reduce maternal and infant mortality, however there are several barriers to modern contraceptive use in Afghanistan. Married men have the potential to hinder or facilitate their wives' contraceptive use. Internally displaced persons (IDP), a growing population in Afghanistan, are rarely included in reproductive health research. We explored whether married men's, including IDPs', gender-related attitudes and other factors were associated with reported modern contraceptive use to inform programming to meet reproductive health needs of married couples.

METHODS

Cross-sectional study using data from 885 married men determined to have contraceptive need in seven Afghan provinces. We explored associations between sociodemographic factors, IDP status, wives' involvement in household decision-making and men's attitudes towards intimate partner violence (IPV) with reported modern contraceptive use using logistic regression analysis.

RESULTS

Most men (78%) had ≥2 children, 60% reported any formal education, and 30% reported being IDPs. Only 38% of married men and 24% of IDPs with contraceptive need reported using modern contraception with their wives. Most (80% overall, 63% of IDPs) reported their wives' involvement in some/all household decisions, while 47% overall and 57% of IDPs reported IPV was justified in one or more listed circumstances. In bivariate analysis, men responding that IPV was not justified in any listed circumstance were more likely and IDPs less likely to report modern contraceptive use. In multivariable analysis, involvement by wives in household decision-making (AOR 2.57; 95% CI: 1.51, 4.37), owning a radio and/or television (AOR 1.69; 95% CI: 1.10, 2.59), having more children, age, and province of interview were independently associated with reported modern contraceptive use, while IDP status was not.

CONCLUSIONS

Our findings reflect positive associations between wives' participation in household decisions and mass media exposure (television/radio ownership) with reported modern contraceptive use. Reproductive health initiatives engaging men to promote communication within couples and through mass media channels may further increase modern contraceptive use and advance Afghanistan's family planning goals. As fewer IDPs owned a radio/television, additional outreach methods should be tested for this group.

Partner Discussion as a Mediator of the Effects of Mass Media Exposure to FP on Contraceptive Use among Young Nigerians: Evidence from 3 Urban Cities

Evidence suggests that despite high knowledge of family planning (FP), unwanted pregnancies and birth rates remain high among young Nigerians. There is a critical gap in understanding the nexus between exposure to FP information and contraception practices among this population. This study aimed to fill this gap and tested a pathway of the impact of media exposure to FP messages on modern contraceptive use. Data came from a 2018 cross-sectional baseline survey of young people aged 15-24 in three urban centers in Nigeria - Lagos, Kaduna, and Kano. This was part of an impact evaluation of a television-based drama designed to improve contraceptive use among young individuals. The study was limited to 777 young men and women who were sexually active. We found evidence of the mediation effect of media exposure to FP messages on partner discussion about FP, which in turn was associated with an increased likelihood of modern contraceptive use. Contraceptive self-efficacy also had positive associations with contraception. Our study elucidated a potential pathway through which media communication programs can significantly contribute to increased modern contraceptive use and underlined the importance of providing young people in Nigeria with opportunities to learn and practice obtaining and using contraception.

Multiplicity of stigma: the experiences, fears and knowledge of young trafficked women in Nepal

We undertook a reproductive health study on young formerly trafficked women in Nepal using a new research method – the Clay Embodiment Research Method – designed with their vulnerability and the cultural context in mind. Following a two-month period of participant observation, six formerly trafficked women participated in a series of seven themed (clay embodiment/three-dimensional body mapping) workshops and, afterward, a group interview using photoethnography. We discovered that these women are subject to cultural stigmas other than those related to sex trafficking, such as menstrual stigma, stigma related to pre-marital sex, stigma related to pregnancy before marriage and stigma for having a female child. These can have a deep impact across the entire reproductive lives of women. As a cultural force, the stigmatisation is generated by both men and women, and has roots that lie in Hinduism and the patriarchal value system in Nepal. Nepal is attempting to address some of these issues and we recommend a public health campaign to eliminate the practice of the menstruation and other stigmatising traditions.

Exploring the influence of family level and socio-demographic factors on women's decision-making ability over access to reproductive health care services in Balkh province, Afghanistan

In this paper, we analyze the family level and socio-demographic factors affecting women's decision-making ability over access to reproductive health care services in rural communities of Balkh province, Afghanistan. A questionnaire survey was conducted with a total of 176 married women. Using logistic regression analysis, we found that four out of seven variables significantly influenced women's decision-making ability over access to Reproductive Health Care Services (RHCS): extended family structure (OR = 14.31, p < 0.01), husbands accompanying their wives to RHCS (OR = 4.12, p < 0.05), discussing issues related to reproductive health with partner (OR = 3.57, p < 0.05), and distance from home to a health facility (OR =0.86, p < 0.01). Therefore, some policies or programs designed to improve husband-wife communication, in particular fostering discussions related to reproductive health and encouraging husbands to accompany their wives to health centers, are recommended to improve women's decision-making ability over access to RHCS.

Contraceptive method choice and spousal communication: Examining the effect of family planning method using an instrumental variable approach

OBJECTIVES

Spousal communication is an important factor in reproductive health outcomes, including family size, contraceptive use and conflict. A purported advantage of traditional contraception is that it increases communication about family planning, since both partners need to be involved in contraceptive practice. However, there is likely to be some degree of endogeneity due to selection: couples who communicate better are more likely to select methods requiring higher degrees of communication.

METHOD

This paper uses an instrumental variable approach to assess the causal effect of method choice on spousal communication in 7 countries in Sub-Saharan Africa. Religion is used as an instrument since this is correlated with method but not communication.

RESULTS

Results indicate that both traditional and modern methods are associated with greater discussion of family planning, and this is robust to the introduction of controls. However, when using the instrumental variable to account for selection effect, many of the significant results for traditional methods disappear although they persist for modern methods.

CONCLUSIONS

These findings indicate that the effect of traditional methods in improving communication is due to selection, rather than causation. While traditional methods still have a role to play in the contraceptive method mix, enthusiasm for side benefits such as family planning communication should be tempered.

Men's perception of barriers to women's use and access of skilled pregnancy care in rural Nigeria: a qualitative study

BACKGROUND

Greater paternal engagement is positively associated with improved access to and utilization of maternal services. Despite evidence that male involvement increased uptake of maternal and child services, studies show that few men are participating in MNCH programs. Community leaders have long been engaged in public health promotion in rural settings and have been shown to mobilize communities to enhance changes in cultural practices related to public health. With the ultimate goal of increasing men's involvement in maternal health, this study seeks to understand men's perceptions of community and health systems barriers to maternal access and usage of skilled care in rural Edo, Nigeria.

METHODS

This qualitative study involved the analysis of data collected from community conversations with male elders in Etsako East and Esan South East Local Government Areas of Edo State, Nigeria. Community conversations participants (n = 128) comprised of elders between the ages of 50-101. A total of 9 community conversations were conducted. Discussions were audio recorded, transcribed and imported into Atlas.ti 6.2 for content analysis.

RESULTS

Men's perceptions of barriers to maternal use of skilled care are presented in two overarching themes: community systems and health systems. Three sub themes were generated as community systems barriers to maternal healthcare use, they include: gender roles, traditional treatment and policy changes. Three sub themes emerged under health system barriers and they include: cost of health facilities, dissatisfaction with facilities and distance from facilities.

CONCLUSION

Findings suggest that community elders are not only in a good position to influence men's behavior, they are also a source of information to policy makers on strategies to overcome barriers to maternal health, especially at the community level. Furthermore, community elders need support to enact regulations that will promote men's involvement in maternal health, thereby increasing maternal use of skilled care.

Talking about reproduction with a migrating spouse: Women's experiences in Dhading, Nepal

Communication between Nepali women and their migrating spouses affects the transregional or transnational social fields of women "left behind" and may have implications for their reproductive health. We explored women's interactions with their absent spouses using data gathered from qualitative interviews. Conversations with migrant husbands were frequent, organized around husbands' schedules, and focused on children's needs and expenses. Couple power dynamics were challenged and reinforced in such conversations. Communication about family planning and childbearing was often delayed until the husband's return. In an increasingly mobile world, encouraging partner communication should be integral to reproductive health programs working with migrant couples.

Association between factors related to family planning/sexual and reproductive health and contraceptive use as well as consistent condom use among internal migrant population of reproductive ages in three cities in China, based on Heckprobit selection models

OBJECTIVE

With the increased population mobility and the transition in population policy, scholars are quite concerned about family planning/sexual and reproductive health (SRH) and related factors among internal migrant population of reproductive age. Therefore, the proposed study was designed to explore the association between factors related to family planning/SRH and contraceptive use as well as consistent condom use among the above-described population in China.

DESIGN

Cross-sectional study.

SETTING

Three municipalities in China, namely Beijing, Shanghai and Chongqing.

PARTICIPANTS

Among the 6545 participants, 2099, 2414 and 2031 subjects came from Beijing, Shanghai and Chongqing, respectively.

RESULTS

A total of 6545 eligible participants were included as the full sample, 6188 of whom who had intercourse in the last 3 months were selected as the subsample. Among the subsample, 80.88% (5005/6188) adopted any form of contraceptive methods and 49.14% (3041/6188) consistently used condom in the last three sexual intercourses. Meanwhile, the involved participants had a better mastery of knowledge on SRH than on contraception (p<0.0001). The results of the Heckprobit models revealed that the factors associated with both contraceptive use and consistent condom use were relationship with the first intercourse partner, communication frequency with spouse/sexual partners on sex, actual number of children and knowledge on SRH, while knowledge on contraception and age at first intercourse were associated with contraceptive use and consistent condom use, respectively (p<0.05).

CONCLUSIONS

In the current study, we revealed a high-level contraceptive prevalence, a relatively low-level consistent condom use and a poor mastery of knowledge on contraception and SRH. The Heckprobit selection model specified the existence of selection bias, providing evidence on the association between the factors on family planning/SRH and contraceptive use as well as consistent condom use, respectively. Our findings indicated that health institutions should offer appropriate technology and high-quality family planning/SRH services for the internal migrant population in China.

'Unless you come with your partner you will be sent back home': strategies used to promote male involvement in antenatal care in Southern Tanzania

Background: Male involvement in pregnancy and childbirth has been shown to improve maternal and child health. Many countries have used different strategies to promote participation of men in antenatal care services. While many strategies have been employed to promote male participation in antenatal care, few have been evaluated to provide much-needed lessons to support wider adoption.

Objective: This study aimed at describing strategies that were used by health providers and the community to promote male participation in antenatal care services and challenges associated with the implementation of these interventions in Southern Tanzania.

Methods: We used qualitative data and analytical methods to answer the research questions. The study relied on semi-structured interviews with health providers, men and women, village and community leaders and traditional birth attendants. Data were analysed using a thematic approach.

Results: The findings of this study revealed that different strategies were employed by health providers and the community in promoting participation of men in antenatal care services. These strategies included: health providers denying services to women attending antenatal care without their partners, fast-tracking service to men attending antenatal care with their partners, and providing education and community sensitisation. The implementation of these strategies was reported to have both positive and unintended consequences.

Conclusions: This study concludes that despite the importance of male involvement in pregnancy and childbirth-related services, the use and promotion of the male escort policy should not inadvertently affect access to antenatal care services by pregnant women. In addition, programmes aiming for men’s involvement should be implemented in ways that respect, promote and facilitate women’s choices and autonomy and ensure their safety. Furthermore, there is a need for sensitisation of health providers and policymakers on what works best for involving men in pregnancy and childbirth.

Regional Variations of Fertility Control Behavior among Rural Reproductive Women in Bangladesh: A Hierarchical Analysis

Women's fertility decision is quite difficult in male-dominant rural culture due to their poor reproductive autonomy. A cross-sectional survey was conducted in rural community of Bangladesh between November 2017 and February 2018 among 1285 respondents selected by multi-stage stratified sampling to explore regional variations of rural women's fertility control behavior and its determinants using hierarchical and other inferential statistics. Data collection was done by face-to-face interview using questionnaire. Average parity was 2.5 per woman and 41% respondents had three or more children. About 60% of them used modern contraceptives (MCs) and oral contraceptive pill (OCP) was their first choice. Male participation in contraceptive use was less than 5%. Regional variation, women's empowerment, fertility control knowledge, family planning (FP) attitude, social influence, perceived behavioral control (PBC) and fertility intention were significant predictors of fertility control behavior (p < 0.05). Significant regional variations were determined in fertility control behavior of rural women (p < 0.05). Almost all of its predictors explained by Theory of Planned Behavior (TPB) also showed significant regional variations (p < 0.05). Current fertility control policy should be strengthened more not only to improve fertility behavior of rural women but also to establish regional equity in fertility control by improving their reproductive decision-making in a rational way.

Predictors of post-partum family planning uptake in Webuye Hospital, western Kenya

Background

A short inter-pregnancy interval increases the risk for maternal and neonatal deaths in addition to other pregnancy complications including: preterm delivery, low birth weight, anaemia and premature rupture of membranes. However, only one half of Kenyan women, who have no desire to conceive immediately after birth, are using contraception one year after delivery.

Aim

The aim of this study was to determine the predictors of uptake of post-partum family planning (PPFP).

Setting

The study was conducted among post-partum women accompanying their children for their first measles vaccination at Webuye County Hospital (WCH), in western Kenya.

Methods

This was a cross-sectional study involving 259 randomly sampled post-partum women, accompanying their children for their first measles vaccination. A structured, interviewer-administered questionnaire was used to collect data. Logistic regression was used to identify correlates of PPFP uptake.

Results

The uptake of PPFP among women at 9 months post-partum at WCH was found to be 78.4% ± 5.0%. The odds of PPFP uptake among women living with their sexual partners was 88.2% less than among those not living with their partners with the true population effect between 97% and 51% (OR = 0.118; 95% CI: 0.028–0.494; p = 0.003).

Conclusions

Not living with her sexual partner in the same house is the key predictor of a woman’s PPFP uptake in WCH. This study recommends that any programme aimed at improving post-partum contraceptive use in WCH should target women who live with their partners in the same house.

Husband's involvement with mother's awareness and knowledge of newborn danger signs in facility-based childbirth settings: a cross-sectional study from rural Bangladesh

Objective

The aim of this study was to examine the association between husband involvement and maternal awareness and knowledge of newborn danger signs. This cross-sectional study was conducted in three rural hospitals of Bangladesh among the recently delivered women (RDW).

Results

RDW were interviewed to determine their knowledge and understanding of seven key neonatal danger signs. About 51.4% of the respondents were able to identify at least one danger sign. ‘Fever’ was the most correctly identified (43.7%), and hypothermia was the least (26.1%) identified danger sign. The factors associated with RDW possessing knowledge of at least one neonatal danger sign were: secondary education (COR: 1.3, 95% CI 1.1–1.6), increased ANC visits (COR: 1.2, 95% CI 1.1–1.3), previous history of facility delivery (COR: 1.3, 95% CI 1.1–1.4), and husband involvement in the mother’s facility delivery (COR: 1.3, 95% CI 1.1–1.5). RDW were more likely to recall at least one newborn danger sign (AOR: 1.2, 95% CI 1.1–1.4) when the husband was actively involved in his wife’s antenatal, delivery and postnatal care. In conclusion, this study found that husband involvement was significantly associated with the maternal knowledge related to identification of neonatal danger signs.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3386-6) contains supplementary material, which is available to authorized users.

Effect of Male Partner's Support on Spousal Modern Contraception in a Low Resource Setting

Background

As efforts continue to increase contraceptive uptake, male partner support remains important in spousal modern contraceptive use.

Methods

A prospective cross-sectional survey involving women on modern contraception was conducted at the family planning clinic of the University of Ilorin Teaching Hospital, Nigeria, between December 2013 and April 2014. All consenting participants completed a self-administered questionnaire designed for the study, and statistical analysis was done with SPSS version 20.0 using with chi square test and logistic regression; p value <0.05 was significant.

Results

There were 305 participants: 208(68.2%) were multipara, the commonest current and previous contraceptives used were IUD and injectables while male partner was responsible for discontinuation in 30(23.3%) of previous users. Covert contraceptive use was 22(7.2%), male partner support was 209(68.5%) as payment for the contraceptives (203; 66.6%) or transportation to the clinic (198; 64.9%). Also, 55(18.0%) women failed to comply with contraception recently due to male partner hindrance (25; 45.5%) or inability to pay for contraceptive (11; 20%) or transportation to the clinic (8; 14.5%). Male partners hindered contraception by reporting the woman to relatives/friends (8; 32%) or denying her money for feeding allowance (6; 24%); 277(90.8%) women want contraception to be couple decision while 261(85.6%) want contraception administered only if both partners consented. The significant predictors of male partner support were awareness about the contraceptive use (p<0.001, OR0.114; CI0.041–0.319), level of education (p0.007, OR1.488; CI1.114–1.9870) and social class (p0.029, OR0.690; CI0.495–0.963).

Conclusion

Male partner hindrances and costs of contraceptive or transportation to clinic are important in noncompliance. Male partner education, subsidized/free contraceptives and mobile/community services will improve compliance.

Contraception usage among young adult men of a Nigerian university

Background Family planning services recognize reproductive health as the joint responsibility of both men and women. Efforts need to be shifted to men's own sexual health in order to achieve the Millennium Development Goals (MDGs) for reduction of maternal mortality and HIV transmission. Aims To determine the methods of contraception used by young adult men and factors that influence their choice of contraceptive. Methodology A cross-sectional descriptive study was done using structured questionnaires to extract relevant information from consented young male adult between ages of 16 and 24 years of Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Nigeria. Data was coded using Microsoft Excel and was analyzed using the SPSS version 17. Results The majority of the respondents 212 (71.6%) had had sexual intercourse. Mean age at first sexual debut was 17.8 ± 2.5 years. The majority of the respondents 124 (58.5%) did not use any contraceptives during their first sexual experience and over 1/5th (21.2%) of respondents had impregnated a partner in the past with the majority, 39 (86.7%) of such pregnancies resulting in an induced abortion. Frequency of religious services attendance showed a statistically significant difference with respondents that were sexually active or had previous sex (p < 0.001). Conclusion Male involvement and education about contraceptive methods, use and consistency of contraception could have a drastic reduction in unwanted pregnancies and also a reduction in abortion complications.

Percepciones de las Mujeres Mexicanas Sobre el Uso de Métodos Anticonceptivos

Introducción:

Más del 50% de los embarazos a nivel mundial son no planeados. El 99% de los embarazos no planeados se presentan en países en desarrollo, el 38% de estos en América Latina y el Caribe.

Métodos:

Se realizó un estudio cualitativo, a través un análisis de contenido congruente con la descripción cualitativa. Se realizaron entrevistas semiestructuradas a mujeres de 18 a 24 años de edad.

Resultados:

La angustia por un cambio de vida, el tener planes para el futuro y una relación formal mayor a un año son los principales motivos para usar un método anticonceptivo de forma correcta y consistente. Las barreras reportadas para el uso de métodos anticonceptivos fueron los efectos secundarios, las creencias de los padres acerca de la sexualidad y la reproducción y el estigma hacia las mujeres que usan métodos anticonceptivos.

Conclusiones:

Las principales barreras en las mujeres son las de tipo cultural. Los hallazgos muestran que la influencia de la red social es más importante que las creencias individuales. Por lo que se debe de incluir al personal de salud y la comunidad en las intervenciones de salud.

Contraceptive knowledge, perceptions, and concerns among men in Uganda

BACKGROUND

Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men.

METHODS

Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men.

RESULTS

Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge.

CONCLUSIONS

Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions.

Prevalence and socio-economic factors determining use of modern contraception among married men in Kyrgyzstan: evidence from a demographic and health survey

OBJECTIVES

This study aimed to estimate the prevalence of modern contraceptive use (MCU), and to identify socio-economic factors that are associated with MCU among married men in Kyrgyzstan.

STUDY DESIGN

A cross-sectional study based on the 2012 Kyrgyzstan Demographic and Health Survey data.

METHODS

This study used data from 460 married men aged 20-49 years. Descriptive statistics, Pearson's Chi-squared test and logistic regression were used to estimate the prevalence of MCU, and to define factors that influence MCU among married men in Kyrgyzstan.

RESULTS

The prevalence of MCU among married men aged 20-49 years was 22.2%. Men in the richer quintile were less likely to use modern contraceptives than men in the poorest quintile (adjusted odds ratio [aOR] 0.267, 95% confidence interval [CI] 0.100-0.715). Men with three living children had higher odds of MCU than men with no children or one child (aOR 3.534, 95% CI 1.221-10.229). Men who were unemployed were more likely to use modern contraceptives than men who were employed as manual labourers (aOR 4.511, 95% CI 1.104-18.442).

CONCLUSION

Top priority should be given to strengthening family planning communication programmes among married men and male education. There is a need to pay attention to the socio-economic determinants of MCU among men in the development of family planning programmes. Emphasis should be placed on increasing MCU among men with high socio-economic status.

What Influences Adolescent Girls' Decision-Making Regarding Contraceptive Methods Use and Childbearing? A Qualitative Exploratory Study in Rangpur District, Bangladesh

Background

Bangladesh has the highest rate of adolescent pregnancy in South Asia. Child marriage is one of the leading causes of pregnancies among adolescent girls. Although the country’s contraceptive prevalence rate is quite satisfactory, only 52% of married adolescent girls use contraceptive methods. This qualitative study is aimed at exploring the factors that influence adolescent girls’ decision-making process in relation to contraceptive methods use and childbearing.

Methods and Results

We collected qualitative data from study participants living in Rangpur district, Bangladesh. We conducted 35 in-depth interviews with married adolescent girls, 4 key informant interviews, and one focus group discussion with community health workers. Adolescent girls showed very low decision-making autonomy towards contraceptive methods use and childbearing. Decisions were mainly made by either their husbands or mothers-in-law. When husbands were unemployed and financially dependent on their parents, then the mothers-in-law played most important role for contraceptive use and childbearing decisions. Lack of reproductive health knowledge, lack of negotiation and communication ability with husbands and family members, and mistrust towards contraceptive methods also appeared as influential factors against using contraception resulting in early childbearing among married adolescent girls.

Conclusions

Husbands and mothers-in-law of newly married adolescent girls need to be actively involved in health interventions so that they make more informed decisions regarding contraceptive use to delay pregnancies until 20 years of age. Misunderstanding and distrust regarding contraceptives can be diminished by engaging the wider societal actors in health intervention including neighbours, and other family members.

Male involvement and maternal health outcomes: systematic review and meta-analysis

BACKGROUND

The developing world accounts for 99% of global maternal deaths. Men in developing countries are the chief decision-makers, determining women's access to maternal health services and influencing their health outcomes. At present, it is unclear whether involving men in maternal health can improve maternal outcomes. This systematic review and meta-analysis aimed to investigate the impact of male involvement on maternal health outcomes of women in developing countries.

METHODS

Four electronic databases and grey literature sources were searched (up to May 2013), together with reference lists of included studies. Two reviewers independently screened and assessed the quality of studies based on prespecified criteria. Measures of effects were pooled and random effect meta-analysis was conducted, where possible.

RESULTS

Fourteen studies met the inclusion criteria. Male involvement was significantly associated with reduced odds of postpartum depression (OR=0.36, 95% CI 0.19 to 0.68 for male involvement during pregnancy; OR=0.34, 95% CI 0.19 to 0.62 for male involvement post partum), and also with improved utilisation of maternal health services (skilled birth attendance and postnatal care). Male involvement during pregnancy and at post partum appeared to have greater benefits than male involvement during delivery.

CONCLUSIONS

Male involvement is associated with improved maternal health outcomes in developing countries. Contrary to reports from developed countries, there was little evidence of positive impacts of husbands' presence in delivery rooms. However, more rigorous studies are needed to improve this area's evidence base.

Factors influencing the uptake of family planning services in the Talensi District, Ghana

INTRODUCTION

Usage of family planning services in developing countries have been found to avert unintended pregnancies, reduce maternal and child mortality, however, it's usage still remains low. Hence, the objective of this study was to investigate the factors that influence the decision of women in fertility age to go for family planning services.

METHODS

This was a descriptive cross-sectional study conducted in Talensi district in the Upper East Region of Ghana. Systematic random sampling was used to recruit 280 residents aged 15-49 years and data was analysed using SPSS version 21.0.

RESULTS

The study revealed that 89% (249/280), of respondents were aware of family planning services, 18% (50/280) of respondents had used family planning services in the past. Parity and educational level of respondents were positively associated with usage of family planning services (P<0.05). Major motivating factors to the usage of family planning service were to space children, 94% (47/50) and to prevent pregnancy and sexual transmitted infections 84% (42/50). Major reasons for not accessing family planning services were opposition from husbands, 90% (207/230) and misconceptions about family planning, 83% (191/230).

CONCLUSION

Although most women were aware of family planning services in the Talensi district, the uptake of the service was low. Thus, there is the need for the office of the district health directorate to intensify health education on the benefits of family planning with male involvement. The government should also scale up family planning services in the district to make it more accessible.

Relationship characteristics and contraceptive use among couples in urban kenya

CONTEXT

Few studies have used couple data to identify associations between individual- and relationship-level characteristics and contraceptive use in urban areas.

METHODS

Population-based survey data collected in 2010 in three Kenyan cities-Nairobi, Mombasa and Kisumu-were used to identify 883 couples. Bivariate and multivariate analyses were conducted to examine associations between relationship-level characteristics (i.e., desire for another child, and communication about desired number of children and family planning use) and contraceptive use among couples currently using contraceptives; additional analyses investigated intention to use contraceptives among couples currently not practicing contraception.

RESULTS

Sixty percent of couples reported current use of contraceptives. In multivariate analyses, couples who desired another child were less likely to use contraceptives than couples who wanted no more children (odds ratio, 0.5). Couples in which both partners reported spousal communication about family planning in the past six months had greater odds of contraceptive use than couples that reported no spousal communication on the subject (3.8). Results from analyses examining associations between relationship-level characteristics and intention to use contraceptives among current nonusers resembled those from analyses of current contraceptive users.

CONCLUSION

In this study, relationship-level characteristics were associated with current contraceptive use and intention to use contraceptives among couples in urban Kenya. Family planning programs that promote spousal communication about family planning and desired number of children may improve contraceptive use among urban couples.

The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15-49) contraceptive users in Zambia: a cross-sectional study

BACKGROUND

Zambia's fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia.

METHODS

This paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15-49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables.

RESULTS

Two thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively.

CONCLUSION

Joint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor determining use of these methods. As such, family planning programmes directed at increasing use of LAPMs ought to not only encourage spousal communication but should also consider rolling out interventions that incorporate economic empowerment.

Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Benefits of family planning: an assessment of women's knowledge in rural Western Kenya

BACKGROUND

The last two decades have seen an increase in literature reporting an increase in knowledge and use of contraceptives among individuals and couples in Kenya, as in the rest of Africa, but there is a dearth of information regarding knowledge about benefits of family planning (FP) in Kenya.

OBJECTIVES

To assess the factors associated with knowledge about the benefits of FP for women and children, among women in rural Western Kenya.

METHODS

Data are drawn from the Packard Western Kenya Project Baseline Survey, which collected data from rural women (aged 15-49 years). Ordinal regression was used on 923 women to determine levels of knowledge and associated factors regarding benefits of FP.

RESULTS

Women in rural Western Kenya have low levels of knowledge about benefits of FP and are more knowledgeable about benefits for the mother rather than for the child. Only age, spousal communication and type of contraceptive method used are significant.

CONCLUSIONS

Women's level of knowledge about benefits of FP is quite low and may be one of the reasons why fertility is still high in Western Kenya. Therefore, FP programmes need to focus on increasing women's knowledge about the benefits of FP in this region.

Partner approval and intention to use contraception among Zanzibari women presenting for post-abortion care

OBJECTIVE

We examined the effect of partner approval of contraception on intention to use contraception among women obtaining post-abortion care in Zanzibar.

STUDY DESIGN

Our data source was a 2010 survey of 193 women obtaining post-abortion care at a large public hospital in Zanzibar. We used multivariable logistic regression analysis to assess associations between partner approval and intention to use contraception.

RESULTS

Overall, 23% of participants had used a contraceptive method in the past, and 66% reported intending to use contraception in the future. We found that partner approval of contraception and ever having used contraception in the past were each associated with intending to use contraception in the future. In the multivariable model, adjusting for past contraception use, partner approval of contraception was associated with 20 times the odds of intending to use contraception (odds ratio, 20.25; 95% confidence interval, 8.45-48.56).

CONCLUSIONS

We found a strong association between partner approval and intention to use contraception. Efforts to support contraceptive use must include both male and female partners.

IMPLICATIONS

Public health and educational efforts to increase contraceptive use must include men and be targeted to both male and female partners. Given that male partners are often not present when women obtain health care, creative efforts will be required to meet men in community settings.

Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women's perceptions in two rural districts in Uganda

Background

Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives.

Methods

A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti.

Results

Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation.

Conclusion

Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.

Evaluation of the "let's talk" safer sex intervention in Nepal

This study is an evaluation of a pilot of the Let's Talk Intervention for Nepali women for effectiveness in increasing sexual health communication between women and the men in their lives. The intervention included 88 women in Kathmandu and spanned three 2-hour group sessions. Baseline, posttest, and follow-up knowledge, attitude, and behavior surveys were completed. Results showed women at posttest and follow-up spoke with more women and men about sex than they had at baseline. Attitudes regarding gender norms about sex improved as a result of the intervention, and shame about sex and sexuality for women decreased after intervention. Women also reported greater comfort discussing sex after the intervention. HIV knowledge scores increased after intervention but dropped again at follow-up, likely because of time constraints in addressing this topic in sufficient detail. This is the first program in Nepal that addresses communication about sexual health while focusing on education and prevention for HIV/STIs for women.

Family planning decisions, perceptions and gender dynamics among couples in Mwanza, Tanzania: a qualitative study

Background

Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania.

Methods

Twelve focus group discussions and six in-depth interviews were used to collect information from married or cohabiting males and females aged 18–49. The participants were purposively selected. Qualitative methods were used to explore family planning decisions, perceptions and gender dynamics among couples. A guide with questions related to family planning perceptions, decisions and gender dynamics was used. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually and subjected to content analysis.

Results

Four themes emerged during the study. First, “risks and costs” which refer to the side effects of FP methods and the treatment of side -effects as well as the costs inherit in being labeled as an unfaithful spouse. Second, “male involvement” as men showed little interest in participating in family planning issues. However, the same men were mentioned as key decision-makers even on the number of children a couple should have and the child spacing of these children. Third, “gender relations and communication” as participants indicated that few women participated in decision-making on family planning and the number of children to have. Fourth, “urban–rural differences”, life in rural favoring having more children than urban areas therefore, the value of children depended on the place of residence.

Conclusion

Family Planning programs should adapt the promotion of communication as well as joint decision-making on FP among couples as a strategy aimed at enhancing FP use.

Determinants of family planning use among Turkish married men who live in South East Turkey

This study assesses the determinants of family planning methods use by Turkish married men in South East Anatolia. A descriptive and cross-sectional survey research design was used among 1,352 men aged 20 to 52 years who lived in South East Turkey. A pilot-tested questionnaire was used to collect data. Descriptive statistics, chi-square, and multivariate regression analysis were used. The rate of nonusage of contraceptive methods among the participants was 60.4%. Within the nonusers, 34.9% reported a religious prohibition and 9.4% had misconceptions about family planning. Chi-square analysis determined four factors that were significantly related to the men's usage of contraception. These factors are the following: the men's age, educational level, number of existing children, and their perception of their household income level. These four factors were also subjected to multivariate regression analysis, the results of which were used to compute odds ratios for each value of each factor indicating the likelihood for using contraception by men within each group. Male-specific family planning programs can make an important contribution to the overall efforts to improve the usage of contraceptives by men. It is important to note that family planning services and education programs related to family planning should be appropriate for men.

Proud, not yet satisfied: the experiences of abortion service providers in the Kathmandu Valley, Nepal

OBJECTIVES

In Nepal, the change of the abortion law in 2002 extended the staff duties at family planning clinics to include performing induced abortions. This study investigated the experiences, opinions and attitudes of the staff about their work at safe abortion service centres in the Kathmandu Valley and identified areas in which the health care staff stated the need for improvement.

STUDY DESIGN

Fifteen qualitative semi-structured interviews were conducted with doctors and nurses working with induced abortion at one hospital and five clinics in the Kathmandu Valley. The interviews were transcribed verbatim and analysed using the constant comparative method.

RESULTS

The core category 'Proud, not yet satisfied' comprised a strong perception of providing an important service that is beneficial for women's health and a feeling of pride in providing quality service. Four related categories were identified: 'Beneficial legal framework', 'A will to reach out to all women', 'Frustration about misuse' and 'Dilemma of sex-selective abortion'. The respondents emphasised that improvements are necessary to (1) ensure that all women have access to safe abortion services; (2) prevent abortions from being used instead of contraceptives; (3) stop illegal medical abortions; and (4) deal with the dilemma of sex-selective abortions.

CONCLUSIONS

Respondents were proud of and had positive experiences from their work. They stated they have the opportunity to secure women's rights and health; however, changes are needed to bring the quality of abortion care to a satisfactory level.

Pile sorting innovations: exploring gender norms, power and equity in sub-Saharan Africa

Understanding gender norms, power and equity is important for developing successful sexual and reproductive health interventions. However, little attention has been given to how to capture the gender ideals and imbalances that inform these relationships in low resource settings. Pile sorting exercises were conducted in four gender-segregated focus groups in Ethiopia and Kenya. Each group received cards illustrated with a man, woman and man and woman together and cards labelled with duties and decisions. Participants discussed and decided together whether men, women or both performed each duty and decision and assigned the cards accordingly. Participants then reflected on and physically manipulated the piles to challenge gender norms, investigate role flexibility and identify agents of social change. Data collected included photographs of the pile sorts and recordings of the discussions. Conducting pile sorting within focus group discussions enabled comparative analyses of gender norms, while enriching data by focusing discussions and encouraging consensus building. Innovative applications facilitated participants' abilities to engage abstract concepts, reflecting on issues of gender norms, power and equity.