Knowledge and use of family planning among men in rural Uganda

Determinants of men's perspectives on women contraceptive use in Ghana: an analysis of the 2022 Ghana demographic and health survey

BACKGROUND

Male dominance in reproductive health decision-making, specifically regarding family planning and contraceptive use among women, has been argued to have a significant influence on Africa's fertility transition. However, there is a paucity of research evidence on the extent to which men influence contraceptive adoption and the factors shaping their perspectives on contraceptive use among women in Ghana. This study aims to examine the factors influencing men's perspectives on women's contraceptive use in Ghana.

METHODS

Data for this study was obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 7,044 men aged 15-59 was extracted from the men's data file. Data was analyzed with SPSS version 27, employing both descriptive and binary logistics regression modeling. Statistical significance was set at p < 0.05.

RESULTS

The results indicate that 63% of men disagreed with the opinion that contraception is solely a woman's concern, while 59% agreed with the view that contraceptive use encourages promiscuity among women. With factors that significantly influence men's opinion on contraception being solely a woman's concern, men with secondary (aOR = 0.69; C.I: 0.57-0.82) and higher education, residing in urban areas, belonging to other Christian faiths, Ga/Dangme, Ewe, and Mole-Dagbani men were less likely to agree with such opinions. Conversely, men dwelling in the Coastal zones were more likely to agree with that view. Men exposure to FP messages on radio and during community durbars had higher odds of agreeing with that opinion. Regarding the factors influencing men's perspective on the perception that contraceptive use by women encourages promiscuity, men who are 20-24 (aOR = 1.51; C.I:1.12-2.03) and 35-39 years in Coastal and Middle Belt zones, cohabiting and formerly married men were more likely to agree with such opinions. Conversely, men with higher educational levels, in urban areas and unemployed had lower odds to agreeing with such perception.

CONCLUSIONS

The study underscores the importance of men's socio-demographic characteristics and their exposure to FP messages in shaping their perspectives on women's contraceptive use. Policy implications highlight the need to involve men in promoting safe sexual and reproductive health practices.

Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study

Current evidence shows that male involvement in family planning (FP) is crucial to women's contraceptive use decisions. This study explored the reasons for male involvement in FP and contraception in slum areas in Nakawa Division, Kampala, Uganda. A qualitative study was conducted among sexually active males in a slum area in Nakawa Division, Kampala. A purposive sampling technique was utilised to recruit 40 men for a Focus Group Discussion (FGDs), and 2 key informants (KI) for critical perspective interviews. A semi-structured FGDs and interview guides were used to collect the data. The FGDs were conducted in both English and the local language, Luganda. All interviews were recorded and transcribed verbatim. Transcripts for both FGDs and KI interviews were imported into the NVivo Qualitative Data Analysis Software version 10 application, and thematic data analysis was conducted. The findings show that males' involvement in FP and its decisions were minimal. The findings also show that several factors emerged as contributing to male's participation in FP and utilisation of contraceptives. Inadequate understanding of FP and contraceptives, lack of clarity on males' role in FP, unfriendly healthcare environment and community members' perceptions of male involvement in FP were reported as reasons contributing to male participation in FP and contraction. There is limited involvement of males in FP. There is a need for renewed efforts that will positively alter the factors that impact male involvement favourably. Promotion and education about FP for males will significantly address issues of limited understanding and clarity of males' role in FP services.

Factors associated with men's participation in postpartum family planning: a study of Kiswa Health Centre III, Kampala, Uganda

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning.IMPACT STATEMENTWhat is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning.What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning.What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement.

Enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda: a qualitative study

BACKGROUND

Male involvement plays a critical role in the utilization of various sexual and reproductive health services. We explored enablers and barriers of male involvement in the use of modern family planning methods in Eastern Uganda.

METHODS

This was a qualitative study in Mbale, Eastern Uganda done between November and December 2022. We conducted three group discussions comprising of four participants each, with male partners and eight key informant interviews with midwives. We followed a group discussion guide during the group discussions and an interview guide during the key informant interviews to explore enablers and barriers of male involvement in the use of modern family planning methods. All the interviews and group discussions were audio-recorded with permission from the participants, transcribed verbatim, and analyzed following thematic content analysis approach.

RESULTS

Two sub-themes emerged from the analysis; perceived enablers and barriers. The perceived enablers included positive attitude, subjective norms, need to support the woman, mutual consent, limited resources and expected benefits of reducing gender-based violence and sexually transmitted infections. Lack of male partner consent, busy work engagement, social stigma, religious prohibition, desire for many children and gender roles incompatibility hindered male partner involvement in family planning. Fear of side effects and misconceptions, unconducive hospital environment in form of mistreatment, family planning considered a female's issue, and lack of consideration of male partner needs in family planning clinic were additional barriers to male involvement.

CONCLUSION

Male involvement in family planning was related to positive attitude and subjective norms towards family planning, mutual consent, and recognition for limited resources to support a large family size. Lack of male partner approval, fear of side effects and misconceptions, unconducive hospital environment and social, cultural and religious prohibitions discouraged male partner involvement in family planning. Community based approaches to family planning sensitization, such as community education campaigns, may be an important step toward reducing barriers to male involvement in the use of modern family planning methods.

Exposure to mass media family planning messages among men in Nigeria: analysis of the Demographic and Health Survey data

Background

Family planning (FP) is essential for improving health and achieving reproductive goals. Although men are important participants in FP decision-making within households in Nigeria, a country with one of the highest rates of maternal mortality, we know very little about their exposure to mass media FP messages.

Methods

Drawing theoretical insights from the structural influence model of health communication and using the 2018 Nigeria Demographic and Health Survey (n = 13,294), and applying logistic regression analysis, we explored the factors associated with men's exposure to mass media FP messages in Nigeria.

Results

A range of socioeconomic, locational, and demographic factors were associated with men's exposure to mass media FP messages. For example, wealthier, more educated, and employed men were more likely to be exposed to mass media FP messages than their poorer, less educated, and unemployed counterparts. In addition, compared to those in rural areas and other regions, men in urban areas as well as South East Region, were more likely to be exposed to mass media FP messages. Finally, younger men and those who belong to the traditional religion were less likely to be exposed to mass media FP messages, compared to their older and Christian counterparts.

Conclusions

Based on these findings, we discuss implications and recommendations for policymakers as well as directions for future research.

Reassessing the level and implications of male involvement in family planning in Indonesia

BACKGROUND

Although there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning.

METHODS

A mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying "dimensions" of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.

RESULTS

Indonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent "dimensions" of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings.

CONCLUSIONS

Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?

The participation of males in joint spousal decisions is urgently needed in achieving the fundamental indicators of reproductive health. The low involvement of males in family planning (FP) decision-making is a major determining factor in low FP usage in Malawi and Tanzania. Despite this, there are inconsistent findings regarding the extent of male involvement and the determinants that aid male participation in FP decisions in these two countries. The objective of this study was to assess the prevalence of male involvement in FP decisions and its associated determinants within the household context in Malawi and Tanzania. We used data from the 2015-2016 Malawi and Tanzania Demographic and Health Surveys (DHSs) to examine the prevalence and the determinants inhibiting male involvement in FP decisions. The total sample size of 7478 from Malawi and 3514 males from Tanzania aged 15-54 years was employed in the analysis by STATA version 17. Descriptive (graphs, tables and means), bi-variate (chi-square) and logistic regression analyses (unadjusted (U) and adjusted odds ratio (AOR)) were performed to identify the determinants associated with male involvement in FP decisions. The mean age of respondents in Malawi was 32 years (±8 SD) and in Tanzania, 36 years (±6 SD), with the prevalence of male involvement in FP decisions being 53.0% in Malawi and 26.6% in Tanzania. Being aged 35-44 years [AOR = 1.81; 95% CI: 1.59-2.05] and 45-54 years [AOR = 1.43; 95% CI: 1.22-1.67], educated (secondary/higher) [AOR = 1.62; 95% CI: 1.31-1.99], having access to media information [AOR = 1.35; 95% CI: 1.21-1.51] and having a female head of household [AOR = 1.79; 95% CI: 1.70-1.90] were determinant factors of male involvement in FP decisions in Malawi. Primary education [AOR = 1.94; 95% CI: 1.39-2.72], having a middle wealth index ranking [AOR = 1.46; 95% CI: 1.17-1.81], being married [AOR = 1.62; 95% CI: 1.38-1.90] and working [AOR = 2.86; 95% CI: 2.10-3.88] were higher predictors of male involvement in FP decisions in Tanzania. Increasing the role of males in FP decisions and involvement in FP utilization may improve uptake and continuity of FP usage. Therefore, the findings from this cross-sectional study will support redesigning the ineffective strategic FP programs that accommodate socio-demographic determinants that may increase the likelihood of male involvement in FP decisions, especially in the grassroots settings in Malawi and Tanzania.

An Evaluation of an Enhanced Model of Integrating Family Planning Into HIV Treatment Services in Zambia, April 2018-June 2019

BACKGROUND

We designed and implemented an enhanced model of integrating family planning (FP) into existing HIV treatment services at 6 health facilities in Lusaka, Zambia.

METHODS

The enhanced model included improving FP documentation within HIV monitoring systems, training HIV providers in FP services, offering contraceptives within the HIV clinic, and facilitated referral to community-based distributors. Independent samples of women living with HIV (WLHIV) aged ≥16 years were interviewed before and after intervention and their clinical data abstracted from medical charts. Logistic regression models were used to assess differences in key outcomes between the 2 periods.

RESULTS

A total of 629 WLHIV were interviewed preintervention and 684 postintervention. Current FP use increased from 35% to 49% comparing the pre- and postintervention periods ( P = 0.0025). Increased use was seen for injectables (15% vs. 25%, P < 0.0001) and implants (5% vs. 8%, P > 0.05) but not for pills (10% vs. 8%, P < 0.05) or intrauterine devices (1% vs. 1%, P > 0.05). Dual method use (contraceptive + barrier method) increased from 8% to 18% ( P = 0.0003), whereas unmet need for FP decreased from 59% to 46% ( P = 0.0003). Receipt of safer conception counseling increased from 27% to 39% ( P < 0.0001). The estimated total intervention cost was $83,293 (2018 USD).

CONCLUSIONS

Our model of FP/HIV integration significantly increased the number of WLHIV reporting current FP and dual method use, a met need for FP, and safer conception counseling. These results support continued efforts to integrate FP and HIV services to improve women's access to sexual and reproductive health services.

Polycyclic aromatic hydrocarbons in breast milk of nursing mothers: Correlates with household fuel and cooking methods used in Uganda, East Africa

Maternal breast milk, which is a complete food for the infant's growth, development, and health, contains fats and lipids making it susceptible to accumulation of lipophilic compounds like polycyclic aromatic hydrocarbons (PAHs). This study aimed at analyzing correlates of measured levels of PAHs in breast milk of nursing mothers to frequently used household fuels and cooking methods in Uganda, and estimate the potential health risks of PAHs to infants through breastfeeding. Sixty breast milk samples were collected from healthy and non-smoking mothers who had lived in Kampala capital city (urban area) and Nakaseke district (rural area) for at least five years. Sample extracts were analyzed for PAHs using a gas chromatograph coupled with a triple quadrupole mass spectrometer. ∑₁₃PAHs in samples from Kampala ranged from 3.44 to 696 ng/g lw while those from Nakaseke ranged from 0.84 to 87.9 ng/g lw. PAHs with 2-3 rings were more abundant in the samples than PAHs with 4-6 rings. At least 33 % of the variance in the levels of ∑₁₃PAHs in the breast milk samples was attributable to the fuel type and cooking methods used. Nursing mothers who used charcoal for cooking accumulated higher levels of ∑₁₃PAHs in their breast milk samples compared to those who used firewood. Levels of ∑₁₃PAHs in breast milk of mothers increased depending on the cooking methods used in the order; boiling< grilling< deep-frying. In all samples, hazard quotients for PAHs were <1 and estimated incremental cancer risks were all between 10^-6 and 10^-4, indicating that the health risks to infants due to the ingestion of PAHs in breast milk was tolerable. Further studies with large datasets on PAHs and their derivatives and, larger samples sizes are needed to confirm these findings.

Partner support and women's contraceptive use: insight from urban poor communities in Accra, Ghana

Background

Despite the benefits associated with contraceptive use, there is a low prevalence of contraceptive use in sub-Saharan Africa and Ghana. Previous studies have partly and consistently attributed the low prevalence of contraceptive use to partner opposition. However, little is known about the influence of men in contraceptive related choices of their partners, particularly within the context of urban poverty. This study examines the influences of partners on women’s contraceptive choices.

Methods

The study utilized a cross-sectional household survey data of 1578 currently married women and women in a union of reproductive ages 16–44 years. Women who were pregnant and those trying to be pregnant were excluded from the analysis. The dependent variables for the study were current use of any contraceptive method, types of contraceptive methods and types of modern contraceptive methods. The independent variable for the study was a woman’s report of partner support in contraceptive related choices. A binary logistic regression model was used to examine the associations between partner support in contraceptive related choices and contraceptive use of women.

Results

The results of the study show that partner support of contraceptive related choices has a significant influence on contraceptive use of women. Women who indicated support from their partners were more likely to be current users of any contraceptive method, yet were less likely to use modern contraceptive methods.

Conclusion

The study highlights the need to involve men in family planning programs and research, as well as educating them on the various contraceptive modern methods and the side effects.

Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda: a randomized controlled trial

Introduction

Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use.

Methods

Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use.

Results

Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040).

Interpretation

Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.

Trial registration

The study was registered by the Pan African Clinical Trial Registry on 03 July 2021 with a Trial Registration Number PACTR202107891858045. “Retrospectively registered”.

Understanding the contextual and cultural influences on women's modern contraceptive use in East Uganda: A qualitative study

Unmet need for contraception, defined as the percentage of women who are sexually active and want to avoid, space or limit pregnancies, but are not using a method of contraception, stands at 28.4% of all married women in Uganda. An understanding of women's contraceptive behaviours, and the motivations that drive these, are key to tackling unmet need, by way of designing, implementing and improving family planning programs to effectively meet the needs of different population groups. This qualitative study sought to understand women's contraceptive use and identify strategies to strengthen contraceptive uptake among women in the Busoga region of east Uganda (chosen due to its low contraceptive prevalence of 31.3% and high unmet need of 36.5% among married women of reproductive age). Six focus group discussions were conducted with single and married women across different age groups (18-24, 25-34, and ≥ 35 years), living in three urban and three rural districts. Thematic analyses of the data highlighted three major themes pertaining to the complex, multi-level nature of contributors to unmet need and women's use of contraception in the Busoga region. Within a largely patriarchal society, women had to navigate many obstacles. Some of these included: fears about contraceptive side effects; partner opposition, community beliefs and stigma that dissuaded contraceptive use; traditional gender and socio-cultural norms that dictated women's fertility choices; and service delivery limitations. Changing community narratives about family planning through testimonies from satisfied users, increasing male acceptance of contraception, and encouraging joint-decision making on matters of reproductive health are strategic focal areas for family planning initiatives to effectively tackle the problem of unmet need among women, and make contraceptives more accessible to women in Uganda.

"They will say you want to make their home die": A mixed methods study to assess modern family planning use in partnered South Sudanese refugee and host populations in Northern Uganda

The unmet need for family planning among conflict-affected populations is high globally, leaving girls and women vulnerable to unintended pregnancies and poor sexual and reproductive health outcomes. Ours is the first known mixed-methods study to assess the use of modern family planning (FP) methods amongst married or partnered South Sudanese refugee and host populations in Northern Uganda and to explore differences between them. We conducted a cross-sectional survey in July 2019 which included 1,533 partnered women of reproductive age (15-49 years) from host and South Sudanese refugee communities in Kiryandongo and Arua. Qualitative data were collected in October 2019-January 2020 via 34 focus group discussions and 129 key informant interviews with refugee and host populations, health workers, community and religious leaders, health workers, local authorities and humanitarian actors. Our study did not find large differences between South Sudanese refugee and host populations in regard to modern FP use, though refugees reported somewhat poorer FP knowledge, accessibility and utilisation compared to Ugandan women. Reported barriers to FP use relate to access, quality of services, health concerns and family/community opposition, all of which emphasise the importance of men's gendered roles in relationships, cultural and religious beliefs and lack of agency for most women to make their own decisions about reproductive health. Sexual and gender-based violence related to FP use was reported among both refugee and host populations. Additional barriers to FP use include lack of privacy at the public health facilities which reduces confidentiality, mistrust of health workers, and stockouts of FP commodities. Facilitating factors for FP use included: free government health services; the presence of well-trained health workers; and NGOs who give support to populations and conduct community outreaches. The findings of this study underscore the importance of developing and implementing tailored sexual and reproductive health information and services, especially for modern FP methods, in partnership with South Sudanese refugee and host populations in Northern Uganda.

Awareness and Attitudes of Mongolian Adolescents and Youth toward Alcohol Consumption and Alcohol-related Harm

BACKGROUND

This study aimed to examine alcohol consumption among Mongolian adolescents and youth, as well as their awareness and attitudes toward alcohol-related consequences.

METHODS

We analyzed cross-sectional data collected from students in secondary schools, colleges, and universities in Ulaanbaatar, Mongolia, using descriptive analysis methods.

FINDINGS

More than half of respondents had tried alcohol in the past, and 15.9% of high school students and 58.8% of university students had consumed alcohol in the last month (P = 0.0001). In total, 70.0% of respondents celebrated holidays with alcohol, 23.4% had economic problems due to alcohol consumption, 7.8% had health problems 1-2 times in the last 30 days, and roughly 36.0% had negative attitudes toward alcohol. Approximately, 15.0% of adolescents and young people had an insufficient understanding of anti-alcohol measures and laws.

CONCLUSION

Our findings suggest that Mongolian adolescents and youth have a high level of alcohol consumption and insufficient awareness and attitude regarding alcohol-related harm.

Barriers and Facilitators of Family Planning Use in Fishing Communities of Lake Victoria in Uganda

Introduction: Family planning (FP) is a key element in the conduct of research and is essential in managing family sizes. Although fishing communities (FCs) are targeted populations for HIV prevention research, their FP practices are poorly understood. We explored barriers and facilitators of FP use in FCs of Lake Victoria in Uganda. Methods: We employed a mixed-methods approach comprising a cross-sectional survey, in-depth interviews, and focus group discussions in 2 FCs. Multivariable logistic regression was used to analyze quantitative data and a thematic approach to generate themes from the qualitative data. Results: Up to 1410 individuals participated in the survey and 47 in the qualitative study. Just over a third (35.6%) used FP. The most commonly used methods were condoms, pills, and injectables. In Kigungu community, participants whose religion was Anglican and Muslim were more likely to use FP than Catholics (adjusted odds ratio [aOR] 1.45; 95% CI 1.05-1.99 and aOR 1.45; 95% CI 1.05-2.07, respectively). Participants were more likely to use FP if they had satisfactory FP knowledge compared to those with no satisfactory FP knowledge (aOR 1.79; 95% CI 1.23-2.61), or if they were married compared to their single counterparts (aOR 1.84; 95% CI 1.32-2.57). In both communities, participants were more likely to use FP if they had 2 or more sexual partners in the past 12 months than those with less than 2 sexual partners (aOR 1.41 95% CI 1.07-1.87 and aOR 2.60; 95% CI 1.36-4.97). Excessive bleeding and delayed fecundity; fertility desire; gender preferences of children; method stock outs and lack of FP trained personnel constituted barriers to FP use. There were also cultural influences in favor of large families. Conclusion: FP use in FCs is suboptimal. Barriers of FP use were mainly biomedical, religious, social, and cultural, which underscores a need for FP education and strengthening of FP service provision in FCs.

Male partners and medical staff's perception on contributing factors of Family Planning (FP) in Fiji

Introduction

Male partners play an important role in Family Planning (FP) as they are directly involved in the decision making of FP with their partners. Medical staff are also involved with FP services that have a direct relation to usage of FP among the men and women. This study is aimed to explore the perception of male partners and the medical staff about factors affecting FP decision in Fiji.

Materials and methods

The qualitative study was carried out among men who were partners of the pregnant women, and medical staff at Ba Mission Hospital (BMH), Fiji in 2019. The study utilised semi-structured questionnaire to guide four Focus Group Discussions (FGDs) among 10 male partners and 10 medical staff. Interview was audio transcribed and analyzed using thematic analysis.

Result

The common themes identified from the male interviews were the opposition of male partners, religious norms and cultural beliefs, accessibility of contraception, and previous FP failure. The common themes identified from the medical staff interviews were; effectiveness of counseling, concerns on men involvement in FP, and barriers towards FP.

Conclusion

This study reveals the need for better counseling, more awareness on FP for men and more involvement of men by the medical staff in FP practices.

Male Involvement in Family Planning Utilization and Associated Factors in Womberma District, Northern Ethiopia: Community-Based Cross-Sectional Study

BACKGROUND

Reproductive health issues are an inclusive concern for both men and women. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. Yet, men are still the main decision-makers in the family in Ethiopia, especially in the rural community. There is little concrete evidence of the extent of male participation in family planning and its barriers in rural settings.

PURPOSE

To assess the magnitude of male involvement in family planning utilization and its associated factors in the rural community of northern Ethiopia.

MATERIALS AND METHODS

A community-based cross-sectional study design was carried out on 620 currently married men. A multi-stage sampling technique was used to select the participants of the study. Data were collected using interviewer-administered structured questionnaires. Multivariable logistic regression analysis was performed to identify variables associated with male participation in family planning.

RESULTS

In this study, only 12.5% of males were directly involved in the use of family planning using a male contraceptive method, and about 60.0% of males were involved in family planning through spousal communication and approval. Being educated [AOR=1.64; 95% CI: (1.12-2.62)], having an educated partner [AOR= 1.77; 95% CI: (1.17-2.94)], having a positive attitude towards family planning [AOR=2.27; 95% CI: (1.53-3.36)], discussing with wife [AOR= 2.51; 95% CI: (1.69-3.72)] and having adequate knowledge about family planning [AOR=1.92; 95% CI: (1.28-2.87)] were positively associated with male involvement in family planning utilization whereas having more than three children [AOR=0.32; 95% CI: (0.15-0.70)] was negatively associated with male involvement in family planning utilization.

CONCLUSION

In general, as compared to the national recommendation, the level of male participation in family planning utilisation was low. In order to improve male participation in family planning, improving male knowledge and attitudes towards family planning is essential.

Correlates of knowledge of family planning among people living in fishing communities of Lake Victoria, Uganda

Background

Knowledge of family planning (FP) is a key determinant of contraceptive use which ultimately plays a role in attainment of good health and in conduct of clinical research. People living in fishing communities (FCs) have limited access to health services including FP and are targeted for future clinical research but their knowledge of FP and its correlates are scantily known. We determined correlates of knowledge of FP among people living in FCs of L. victoria in Uganda to inform future FP education programs in FCs.

Methods

We conducted a comparative cross-sectional survey among participants aged 15–49 years from Kigungu and Nsazi. Participants were asked if they were aware of any FP method. All those who responded in the affirmative were further asked to mention what FP methods they had heard of or knew. Those who reported knowledge of at least one FP method were asked a series of questions about FP methods and their side effects. Knowledge was categorized into good or poor knowledge based on their mean total score. Poor knowledge constituted a score below the mean while good knowledge constituted a score of more than or equal to the mean total score. To further explore attitudes and perceptions of FP, ten in-depth interviews and four focus group discussions were conducted.

Results

Of the 1410 screened participants, 94.5% were aware of at least one FP method. Pills and injectable hormonal methods were the most commonly known methods. Slightly over a third (38%) had good knowledge of FP. Correlates of knowledge of FP were; being female (aOR: 1.92 95% CI: 1.39–2.67), residing in Kigungu (aOR: 4.01 95% CI: 2.77–5.81), being married (aOR: 1.59 95% CI: 1.11–2.28) and currently being in a sexual relationship (aOR: 1.75 95% CI: 1.18–2.60). Concerns about safety and effectiveness of some modern FP methods exist. Misconceptions on effects of FP like sterility, cancers and foetal abnormalities were common.

Conclusion

FP awareness among people living in FCs of L. Victoria in Uganda is high. However, good knowledge about specific methods tends to be low. Correlates of knowledge of FP include gender, residence, marital status and sexual engagement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09762-7.

Predictors of modern contraceptive use among women and men in Uganda: a population-level analysis

OBJECTIVES

Despite substantial and rapid improvements in contraceptive uptake in Uganda, many women continue to have unmet need for contraception. As factors affecting contraceptive use are dynamic and complex, this study seeks to identify current predictors and provide effect size estimates of contraceptive use among women and men in Uganda.

STUDY DESIGN

A nationally representative cross-sectional population survey, using secondary data from Uganda's 2016 Demographic and Health Survey. Stratified by sex, weighted bivariable and multivariable logistic regression models were derived from a suite of potential predictor variables. Predictive abilities were assessed via 10-fold cross-validated area under the receiver operating characteristic curves (AUCs).

SETTING

Uganda.

PARTICIPANTS

All women aged 15-49 years who were permanent residents of the selected households or stayed in the household the night before the survey were eligible to participate. In one-third of the sampled households, all men aged 15-54 years who met the same residence criteria were also eligible.

PRIMARY OUTCOME MEASURES

Modern contraceptive use.

RESULTS

Overall, 4914 (26.6%) women and 1897 (35.6%) men reported using a modern contraceptive method. For women and men, both demographic and proximate variables were significantly associated with contraceptive use, although notable differences in effect sizes existed between sexes-especially for age, level of education and parity. Predictively, the multivariable model was acceptable for women with AUC=0.714 (95% CI 0.704 to 0.720) but less so for men with AUC=0.654 (95% CI 0.636 to 0.666).

CONCLUSIONS

Contemporary significant predictors of contraceptive use among women and men were reported, thereby enabling key Ugandan subpopulations who would benefit from more targeted family planning initiatives to be identified. However, the acceptable AUC for women and modest AUC for men suggest that other important unmeasured predictors may exist. Nonetheless, these evidence-based findings remain important for informing future programmatic and policy directions for family planning in Uganda.

Assessing the Acceptability of Vasectomy as a Family Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini

The uptake of vasectomy in many countries in sub-Saharan Africa is low. In Eswatini, a kingdom with strong patriarchal norms, the use of vasectomy is at 0.3%. This is despite great efforts to introduce vasectomy and involve men in reproductive health. This study explored the views of men about the acceptability of vasectomy and their willingness to adopt vasectomy as a family planning option. Focus group discussions were conducted with adult men recruited from health facilities located in rural, semi urban, and urban areas in two of the regions of Eswatini. A thematic approach was used to analyze the data. The acceptability of and intention to use vasectomy as a family planning option was very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influenced the acceptability of vasectomy greatly. The participants could not grasp the concept of a family planning method that is as permanent as vasectomy. However, the decisions to accept or reject vasectomy were influenced by their misconceptions and fears about vasectomy and were not based on facts. To address the need to involve men in reproductive health and improve the acceptability and adoption of vasectomy, planning should be conducted with them and informed by their understanding of their needs.

Health care providers' perceptions of family planning and contraception education for adolescents in Kampala, Uganda - A qualitative study

OBJECTIVES

Unsafe abortions are a reproductive health problem in low-income countries, but can be prevented by decreasing unintended pregnancies. The objective was to describe health care providers' (HCPs) perceptions of family planning and contraception education for adolescents in Kampala, Uganda.

STUDY DESIGN

A qualitative study with a semi-structured interview guide was used for individual face-to-face interviews. Eight participants from two different Non-governmental organisations were interviewed. Qualitative content analysis was used to analyse the data.

RESULTS

Data analysis resulted in three main categories of HCP perceptions: counseling, education and availability; peer-educators and community leaders; and stigma, inequality and myths. The providers emphasized the importance to discuss and eradicate the myths and misconceptions among adolescents regarding family planning methods by giving information, preferably at early ages. Peer-educators and community leaders were the most successful methods for accessing and involving the community. Approaches mentioned for reaching out to adolescents included involving parents, using social media, and offering education in schools. Furthermore, the providers highlighted to involve the males in family planning.

CONCLUSIONS

Health care providers emphasized the importance to discuss and eradicate the myths and misconceptions among adolescents regarding different family planning methods by education in school and information in sexual and reproductive health.