Swazi men's contraceptive knowledge, attitudes, and practices

Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men's health in sub-Saharan Africa

BACKGROUND

Sex and gender have been shown to influence health literacy, health seeking behaviour, and health outcomes. However, research examining the links between gender and health has mainly focused on women's health, which is a long-standing global health priority. We examine literature focused on the 'missing men' in global health research, in particular empirical studies that document interventions, programmes, and services targeting men's health issues in Sub-Saharan Africa. Within these studies, we identify dominant conceptualisations of men and men's health and how these have influenced the design of men's health interventions and services.

METHODS

This is a scoping review of published and grey literature. Following comprehensive searches, we included 56 studies in the review. We conducted a bibliographic analysis of all studies and used inductive methods to analyse textual excerpts referring to conceptualizations of men and service design. An existing framework to categorise services, interventions, or programs according to their gender-responsiveness was adapted and used for the latter analysis.

RESULTS

From the included studies, we distinguished four principal ways in which men were conceptualized in programs and interventions: men are variously depicted as 'gatekeepers'; 'masculine' men, 'marginal' men and as 'clients. Additionally, we classified the gender-responsiveness of interventions, services or programmes described in the studies within the following categories: gender-neutral, -partnering, -sensitive and -transformative. Interventions described are predominantly gender-neutral or gender-partnering, with limited data available on transformative interventions. Health systems design features - focused mainly on achieving women's access to, and uptake of services - may contribute to the latter gap leading to poor access and engagement of men with health services.

CONCLUSION

This review highlights the need for transformation in sub-Saharan African health systems towards greater consideration of men's health issues and health-seeking patterns.

Access to information and decision making on teenage pregnancy prevention by females in Tshwane

BACKGROUND

The increase in the number of teenage pregnancies and its negative consequences has encouraged various researchers to explore the possible causes of teenage pregnancy. Findings from previously-conducted research have indicated different preventable factors that predispose female teenagers to pregnancy, such as staff attitudes and the lack of information resulting from poor access to health facilities.

OBJECTIVE

To explore and describe access to information and decision making on teenage pregnancy prevention by females using a primary healthcare clinic in Tshwane, South Africa.

METHOD

In this study, the researchers used a descriptive qualitative and exploratory research design to explore and describe the verbal reports regarding prevention of teenage pregnancy by females using a primary healthcare clinic in Tshwane, South Africa. Face-to-face semistructured interviews were conducted with 15 female participants aged between 15 and 26, who had been pregnant once or more during their teens.

RESULTS

Two themes emerged, namely, access to information and decision making by female teenagers. Five categories that emerged were: access to information on pregnancy prevention; ignoring of provided information; the use of alternative medicine with hormonal contraception; personal reasons for use and non-use of contraception; and decisions made by teenagers to not fall pregnant. Females in this study fell pregnant in their teens, even though they had access to information.

CONCLUSION

Given the complexity of this problem, female teenagers should use their families as primary sources of information for reproductive health promotion and educational institutions should build on this to aid the prevention of teenage pregnancy.

Men's susceptibility to HIV in Swaziland

HIV prevention that uses gender as an analytical framework tends to focus on the ways in which gender inequalities differentially affect women's susceptibility to HIV infection. Men, in this context, are often conceptualized as aggressors, as opposed to women, who are seen as passive victims of HIV infection. In recent years, a growing number of researchers and public health officials have called attention to the pitfalls of this paradigm, pointing out that gender inequities harm both women and men. The first step towards transforming gender norms is to understand what norms currently exist. With this in mind, the aim of this paper is to consolidate and analyse literature that examines structural factors that contribute to the continued HIV infection of men in Swaziland, the country with the highest prevalence of HIV. Gaps in current literature related to this topic are also elucidated. Findings highlight the need for research to be conducted in Swaziland and elsewhere that investigates the effects of gender norms on the wellbeing of both women and men.

Perceptions of family planning among low-income men in Western Kenya

BACKGROUND

Men have rarely been involved in either receiving or providing information on sexuality, reproductive health or birth spacing. They have also been ignored or excluded in one way or the other from participating in many family planning programmes as family planning is viewed as a woman's affair.

AIM

To describe the perceptions of family planning among low-income men in Western Kenya.

METHODS

A qualitative study using focus group interviews and content analysis was conducted, with 64 men aged 15-54 years participating actively.

FINDINGS

Perceptions of family planning were manifold. For example, some perceived it as meaning having the number of children one is able to provide for. Most men knew about traditional and modern methods of birth control, although their knowledge was poor and misconceived. Modern methods were thought to give side effects, discouraging family planning. Low instances of family planning were also because of the fact that culturally, children are considered wealth. A law advocating family size limitation was regarded as necessary for the future.

CONCLUSION

Men's perceptions of family planning are manifold. Their knowledge about contraception is poor and sometimes misconceived. Preferences regarding a child's gender are strong, thus attitudes and cultural beliefs that might hinder family planning have to be considered. A policy on male contraception and contraceptive services is seen as necessary.