1
UKEAGU NGOZI CHIDINMA
PG/MSC/06/46322
MALE INVOLVEMENT IN FAMILY PLANNING IN SOME
SELECTED RURAL COMMUNITIES IN ENUGU EAST LOCAL
GOVERNMENT AREA IN ENUGU STATE, NIGERIA.
Department of Nursing Sciences
Faculty of Health Sciences & Technology
Fred Attah
Digitally Signed by: Content manager’s
Name
DN : CN = Weabmaster’s name
O= University of Nigeria, Nsukka
OU = Innovation Centre
2
MALE INVOLVEMENT IN FAMILY PLANNING IN SOME
SELECTED RURAL COMMUNITIES
IN ENUGU EAST LOCAL GOVERNMENT AREA
IN ENUGU STATE, NIGERIA.
M.Sc DISSERTATION
BY
UKEAGU NGOZI CHIDINMA
PG/MSC/06/46322
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCE AND TECHNOLOGY
UNIVERSITY OF NIGERIA
ENUGU CAMPUS
JUNE, 2014
3
TITLE
MALE INVOLVEMENT IN FAMILY PLANNING IN SOME
SELECTED RURAL COMMUNITIES IN ENUGU EAST
LOCAL
GOVERNMENT AREA IN ENUGU STATE, NIGERIA.
M.SC DISSERTATION
BY
UKEAGU NGOZI CHIDINMA
PG/MSC/06/46322
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCE AND TECHNOLOGY
UNIVERSITY OF NIGERIA
ENUGU CAMPUS
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE
AWARD OF MASTER OF SCIENCE (M.SC) DEGREE IN
NURSING SCIENCE
(COMMUNITY HEALTH NURSING)
SUPERVISOR: DR (MRS) I. O. EHIEMERE
JUNE, 2014
4
APPROVAL
This dissertation; Male Involvement in Family Planning in some
selected rural Communities in Enugu East Local Government Area,
has been approved for the award of Masters of science Degree (M.Sc)
in Nursing, in the Department of Nursing Sciences, Faculty of Health
Science and Technology, College of Medicine, University of Nigeria
Enugu Campus.
By
………………………………
Dr. (Mrs.) I.O. Ehiemere
(Supervisor)
…………………………
Date
………………………………
Dr. (Mrs.) U.V. Okolie
(Head of Department)
…………………………
Date
5
CERTIFICATION
I, Ukeagu Ngozi C; certify that this dissertation is an original work
carried out by me, and that neither the work nor any part of the work
has been submitted to this University or any other Institution for the
award of any Degree.
………………………………
Ukeagu Ngozi C.
(Student)
…………………………
Date
………………………………
Dr. (Mrs.) I.O. Ehiemere
(Supervisor)
…………………………
Date
6
DEDICATION
To the God Almighty who made this research work a success.
7
ACKNOWLEDGEMENT
My profound gratitude goes to God Almighty, who had sustained me
emotionally, physically, financially and in all other ramifications. To
Him alone be ascribed all the glory and honor.
My special appreciation also goes to my able and diligent supervisor,
Dr (Mrs) I. O. Ehiemere who had encouraged and taught me, out of
her wealth of knowledge, motherly disposition and experience how to
work hard and go about this research work, and had assisted me
consistently in bringing this work to required standard. Mummy may
the good God bless and repay you abundantly in Jesus name Amen.
My thanks also goes to the Head of Department of Nursing Sciences
Dr. (Mrs.) U.V. Okolie for her motivation and to all the lecturers in
the department for their assistance in one way or the other. I say thank
you all.
I am highly grateful to my friends Mrs S. J. Kanu, Mrs Zubie Okolo,
Mrs Chinenye Arinze, Mrs Uzoma Azor, Mrs Nneka Umeh (Nee
Nwankwo)) and Engr. & Mrs Caleb .C. Onovo, Mr & Mrs D I
Nwaniji
for the support and assistance they accorded me in carrying
out this research work. I pray that God reward you all richly.
I specially appreciate my beloved children, Chisom, Chijindu,
Chibuokem, Chioma and Sopuruchi who supported me and
prayerfully had contributed immensely to the success and conclusion
of this work.
8
TABLE OF CONTENTS
Title
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Certification .
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Dedication
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Acknowledgement
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Table of Contents
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List of Tables .
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List of Figures .
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List of Appendices
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Abstract
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Background to the Study
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Statement of Problem .
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Purpose of the Study .
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Research Question
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Research Hypothesis .
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Significance of the Study
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Scope of the Study
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Concept of Family Planning. .
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History of the Family Planning
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Family Planning Methods
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Health Benefits of Family Planning .
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Factors that Affect Men’s Involvement in Family Planning .
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Approval
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CHAPTER ONE
INTRODUCTION
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Operational Definition of Terms
CHAPTER TWO
LITERATURE REVIEW
Conceptual Review
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Overview of Men that Practice Family Planning, the
Methods and Services Available to them
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Family Planning Methods and Services Available to Men
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Nature of Men’s Involvement Men in Family Planning
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Theoretical Framework Review
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Core Assumptions and Statements of Health Belief Model
as Identified by Murphy (2003)
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Application of Health Belief Model to Male Involvement in
Family Planning in rural Communities
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Empirical Review
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Summary of Literature Review
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CHAPTER THREE
RESEARCH METHODS
Research Design
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Area of Study .
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Population of the Study
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Sample
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Sampling Procedure .
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Instrument for Data Collection
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Validity of the Instrument
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Reliability of Instrument
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Ethical Consideration .
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Procedure for Data Collection
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Method of Data Analysis
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Inclusion Criteria
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CHAPTER FOUR
ANALYSIS AND PRESENTATION OF RESULTS
Analysis of Presentation of Results .
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CHAPTER FIVE
DISCUSSION OF FINDINGS
Discussion of Major Findings .
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Summary of the study .
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Implication of the study to nursing practice .
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Conclusion
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Recommendation
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Limitation of the Study
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Suggestion for Further Studies
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References
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Appendix
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LIST OF TABLES
Table 1:
Socio-Demographic Characteristics of the
respondents
Table 2:
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Factors affecting men’s involvement in family
Planning
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Table 4:
Nature of men’s involvement in family planning.
Table 5:
Method of family planning adopted mostly by men in these
communities .
Table 6:
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Association between men’s involvement in family
planning and their occupation .
Table 9:
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Association between men’s involvement in family
planning and their level of education .
Table 8:
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Association between men’s involvement in family
planning and their age .
Table 7:
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Percentage of men who get involved in practicing
family planning
Table 3:
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Association between men’s involvement in family
planning and their religion
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LIST OF FIGURES
Health belief model
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13
LIST OF APPENDICES
Appendix I:
Sample of the Questionnaire for
Data Collection
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communities and proportion studied. .
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Appendix II: Informed Consent Form
Appendix III: Showing the population of different
Appendix IV: Determination of sample size with total
population
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Appendix V: Reliability
Appendix VI: Identification Letter from the Department
Appendix VII: Application for Ethical Approval
Appendix VIII: Letter of Ethical Approval
Appendix XI: Application for Permission from Enugu East Local Government
Chairman
Appendix X: Approval from Enugu East Local Government Chairman
14
ABSTRACT
Men involvement in family planning would increase its recognition, acceptance
and practice by people especially within the rural communities. This is because
in rural communities in Nigeria including Enugu, men are still the gate keepers in
our families who control power and major decision making. Some of them
decide whether their wives will practice family planning or not and the methods
to be adopted. This implies the men seem to have the finally say on the number
of children the family should have, the spacing, maternal health and general level
of reproductive health in the family.
In Nigeria male involvement in family
planning from previous studies is low, pregnancy and delivery problems are
treated as women affair. Though men do not carry pregnancy, they are the
initiators of the process and therefore should be involved in family planning for
better success. The purpose of the study was to examine Male involvement in
family planning in some selected rural communities in Enugu East Local
Government Area in Enugu State, Nigeria. The target population of the study
were 3320 men. Sample size was 360 men. The instrument for data collection
was a researcher developed questionnaire which was also used as an interview
guide for illiterate subjects. Data were analysed using descriptive statistics such
as frequencies, percentages, mean and standard deviation. Statistical analyses
was done using the statistical Package for Social Sciences (SPSS) version 17.
Chi-square inferential statistics was used for testing the hypothesis at 0.05 level
of significance. Results showed there was a significant association between male
involvement in family planning and socio demographic variables (age,
educational level, occupation and religion). Other findings revealed that less than
half of the respondents (46%) got involved in family planning practice in the
rural communities studied. There were low mean response values of 2.21, 2.11
and 2.25 to the nature of men’s involvement in family planning. The main factors
that affected their involvement were inadequate knowledge (40.5%), lack of
many contraceptives options (34.8%). Most of the men used withdrawal method
(35.5%) or condom (23.8%) and a combination of withdrawal and condom
(27.5%) while (13.1%) use vasectomy. The study concluded that men’s
involvement in family planning was low in the communities studied. Adequate
information, education and communication is needed in the communities to
improve their knowledge. Some cultural and religious beliefs that hinder men’s
involvement in family planning should be discouraged. More male contraceptive
options should be promoted as well as made available.
15
CHAPTER ONE
INTRODUCTION
Background to the Study
Family planning is a way of thinking and living that is adopted voluntarily on the
basis of knowledge, attitude and responsible decision by individuals and couples
in order to promote health and welfare of the family, groups and thus contribute
effectively to the social development of the country (WHO, 2011).It involves
practices that will enable couples or individuals to determine the number of
children they would like to have, when to have them, that is both the timing and
spacing and most importantly, those they have the capability or the means with to
cater for. (Fumilayo and Kolawole, 2000).
Men are pivotal decision makers at all household level within the rural
communities. The duty of men in the society seems supreme; especially in rural
communities they are in charge of the family, they run the world governments,
they control religious organizations and they co-ordinate all social systems.
(Okeke, 2005). Furthermore, they play vital role in pregnancy and delivery and
transmission of sexually transmitted infections.
Onuoha (2000) stated that
African men are mainly responsible for deciding whether their wives will practice
family planning and the methods to be adopted. He further stated that the true
position is that in traditional African societies, including Nigeria, men are
conferred with authority to determine who gets what, how and when in the
family. This authority implies that they have the final say on the number of
children the family should have, the spacing, maternal health and general level of
16
reproductive health in the family. Thus any family planning programme that
excludes men is may to have minimal impact on the targeted population.
Male involvement in family planning would increase its recognition, acceptance
and practice by people especially within the rural communities. This is because in
rural communities in Nigeria, including Enugu, men are still the gate keepers in
the families who control power and decision making. Their involvement will
help to achieve huge success in the numerous campaigns aimed at reducing,
population explosion in Africa, arrest the increasing surge of sexually transmitted
infections and reduce maternal and infant morbidity and mortality (Onuoha,
2000).
In European countries, statistics show that an average of 65% of men go for
family planning yearly. In America about 70% of males go for treatment of
sexually related infections like HIV/AIDS yearly due to awareness campaigns
about the importance of involving men in family planning (Davidson, 1999).In
African countries, for example in South Africa, about 35% of the people that
attend family planning and immunization clinics are males. In Togo, it was noted
that male involvement in family planning and voluntary health screening and
counseling compared with the females is in the ratio of 1:3 (Robert and Brown,
2000).
Despite global recognition of the importance of male involvement in family
planning, Nigeria has not developed programmes in family planning that fully
involve men. Most family planning programmes in our environment seem to
focus on women only, the non- inclusion of men in various family planning
17
programmes by program planners has made men not to know much about family
planning and the benefits to their spouses and family especially in rural
communities. Yet men can participate in family planning either as users of male
methods or as supportive partners of users. (Fumilayo and Kolawole, 2000).
With the above scenario, one wonders what then will be the situation in rural
communities in Enugu East Local Government Area where tradition is still highly
upheld. Rural communities have typical characteristics such as: they share
common interest, bound or tied to tradition and culture, resist change among
others. These make men exercise undue authority or control over their wives in
family matters such as issues of child bearing and contraceptive use. All these
seem to make the acceptance of family planning more difficult in these rural
communities (Onuoha, 2000).
Therefore, it is very important to get them involved in family planning in order
to achieve better success. This will improve health of both themselves and their
spouses.
Statement of Problem
Documented evidence shows that three hundred million pregnancies occur in sub
Saharan Africa and eleven million Nigerian women get pregnant yearly.
(Ntadom, 2007), while half a million women die from complications related to
pregnancy and child birth each year, with 99% of these deaths occurring in
developing countries including Nigeria. (Chuwa, 2012). It is estimated that
approximately, 200 million couples in developing countries would like to delay
or stop child bearing but are not using any method of contraception (World
Health Organization (WHO), 2011).
18
In Nigeria, male involvement in family planning is low, for example, a study
conducted in Ilorin on male involvement in family planning showed that only
20% of respondents were using contraceptives (Levy, 2006). Men control
pregnancy especially in the rural communities, yet they treat pregnancy and
delivery problems as women’s affair and at the same time control the family size
without any reference to the health of the mother. Women bear the brunt of the
risks associated with reproductive health matters. For example, they are left to
bear the entire burden of prevention of unwanted pregnancies, sexually
transmitted infections, as well as the use of contraceptives alone.
This is
particularly the issue in the rural communities. Though males do not carry
pregnancy, they are the initiators of the process. Women in rural communities
still depend on the consent of their husbands before taking decisions on matters
that affect them directly such as adopting family planning methods, frequency of
sexual intercourse, family size, etc.
In most cultures in Nigeria, men are the sole decision makers and are normally
called the gatekeepers in such communities. So their participation or lack of
participation in family planning is critical in its acceptance or rejection among the
women especially in the traditional rural communities. These problems were
observed during the researchers’ community posting in some communities in
Enugu East LGA.
Records from the maternity department in ESUT Teaching Hospital Parklane
from January to August (2010), showed that out of 40 referral cases from health
centres in rural communities in Enugu East Local Government area, 20 were of
high parity, with its associated complications. This high parity was attributed to
their husbands’ decision and cultural values. Records in the same hospital
19
showed that family planning attendance by males between 2005 – 2010 was 10%
(Records from family planning unit in ESUT Teaching Hospital Park lane, 2011).
One wonders what then could be the practice in the rural communities where
men’s dominating rights are highly preserved.
Purpose of the Study
The purpose of the study is to determine men’s involvement in family planning in
some selected rural communities in Enugu East Local Government Area, Enugu
State Nigeria.
Objectives
Specifically the study intends to:1.
Determine the percentage of men who get involved in practicing family
planning in the communities studied.
communities studied.
2.
Identify factors that affect men’s involvement in family planning in these
communities.
3.
Define the nature of men’s involvement in family planning
4.
Identify methods of family planning mostly adopted by men in the
communities studied.
Research Question
The study seeks answers to the following questions.
1.
What percentage of men get involved in practicing family planning in
the communities studied?
2.
What are the factors that affect men’s involvement in family planning
in these communities?
3.
What is the nature of men’s involvement in family planning?
20
4.
What method of family planning do men adopt mostly in the
communities studied?
Research Hypothesis
There is no significant association between male involvement in family planning
and socio-demographic variables such as level of education, age occupation and
religion.
Significance of the Study
Male involvement is a promising strategy for addressing the world’s most
pressing family planning needs (Population Reports, 2008). The findings of this
study will therefore, reveal the percentage of men that practice family planning
and the methods in rural communities in Enugu East Local Government Area, so
as to provide evidence based information for health education.
The findings of this study will also reveal the nature of involvement of men in
family planning. This will help to build better communication within the family
and eventually lead to better decision making concerning continuing
contraceptive use. Health workers and programme planners will utilize the
findings to plan strategies to offer counseling and quality information education
and communication services to men, for example, establishing men’s clinic to
address their reproductive health needs.
Policy makers will also utilize the findings to enact laws that will see to the
establishment of programmes that will encourage men’s participation in family
planning such as male family planning clinic. Other researchers will use the
findings as baseline information in their own research projects. They will equally
add to existing body of knowledge.
21
Scope of the Study
The variables of interest; include the nature of men’s involvement in family
planning, the methods mostly adopted by men, factors that affect men’s
involvement in family planning and the percentage of men that practice family
planning. This study is limited to all males resident in Nkwubor, ObinaguOnuogba and Ugwuomu communities all in Enugu East Local Government Area
in Enugu State.
Operational Definition of Terms
Males in this study refers to married men aged (20 – 70) years whose wives are
within reproductive age (15 – 49) years.
Extent of men’s involvement means the level of their involvement in terms of
whether they use family planning methods, support their wife use of family
planning method, make decision in favour of contraceptive use, discuss family
planning freely with wife, etc.
The mean involvement will be calculated and
compared with the criterion mean for the individual items and for all the items
together. This will be interpreted as follows: High extent – a mean of > 3.5,
Moderate extent - > 2.5 < 3.5, Low extent > 1.5 < 2.5, Very low extent -> 0< 1.5
Rural community refers to a geographical area located outside the city and
town. It also applies to individuals living in countryside, towns outside the urban
area. It also refers to people living in a rural area as defined by National
Statistical Office and is calculated as the differences between total population and
urban population.
Rural communities also refers to a population that has
common interest, live in the hinter land, lack basic social amenities such as good
road network, electricity, water supply and basic health facilities.
22
Nature of men’s involvement in family planning means the type of the things
they do to show their involvement in terms whether they use family planning
methods themselves, support wives use of family planning methods, decide in
favour of contraception in the home when needed etc.
Factors affecting means involvement are those things that encourage or
discourage men from involving in family planning such as inadequate
knowledge, lack many contraceptive option for men, poor education, information,
communication, inadequate knowledge, religious beliefs and culture.
Means < 2.5 = negative response, Means > 2.5 = positive response
Socio-demographic variables in the study are age, educational level,
occupation and religion.
23
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the literature review from books, journals, abstracts and
conference proceedings under the following headings:Conceptual review
•
Concept of family planning
•
History of family planning
•
Family planning methods
•
Health benefits of family planning
•
Overview of men that practice family planning, the methods and
services available to them
•
Factors that affect men’s involvement in family planning
•
Nature of involvement men engage in family planning
Theoretical Review
•
Health belief model
Empirical studies
Summary of literature review
Conceptual Review
Concept of Family Planning
Family planning, according to World Health Organization, is a way of thinking
and living that is adopted voluntarily upon the basis of knowledge, attitudes and
responsible decision by individuals and couples, in order to promote health and
welfare of the family, groups, and thus, contribute effectively to the social
development of the country, (WHO, 2011).
24
An expert committee on health described family planning as, practices that help
individuals or couples to attain certain objectives to avoid unwanted birth, to
bring about wanted births, to regulate the intervals between pregnancies, to
control the time at which birth occurs in relation to the ages of the parents and to
determine the number of children in the family, most importantly that they have
the capability or the means with which to do so (Parks, 2007).
This also implies that people have the ability to reproduce, to regulate their
fertility and to practice and enjoy sexual relationships. They also have right to be
informed and to have access to safe, effective, affordable, acceptable methods of
family planning services of their choice (Onuoha, 2000).
History of Family Planning
Historical development of man’s desire to control his reproduction is as old as
humanity. Thus family planning is as old as history itself (FMOH, 2005).
The history of family planning was traced to 1912, when Margaret Sanger was
called out with a doctor to a truck driver’s wife in New York who had just
committed an abortion. The woman was nursed back to health and warned that
another abortion would kill her.
In 1914, Margaret Sanger was called out again to the same woman who had
committed abortion again. But before Sanger could arrive she died. The incident
gave Sanger concern about the suffering of women with unwanted pregnancies
and abandoned children.
In 1916 Margaret Sanger opened the first family planning clinic which was
closed down nine days later by the authorities which were against family
planning. Sanger and her sister were imprisoned. She went on hunger strike for
25
103 hours. This made the United States women to demonstrate and make an
appeal to the government. She was eventually released and allowed to carry on
with her pioneering work in family planning. In 1920 Margaret Sanger alone
founded the first family planning clinic in U.S.A (Fumilayo and Kolawole, 2000).
In 1921, the first birth control clinic was opened in England by Marie Stopes and
the society for constructive birth control was founded. In 1952 the International
Planned Parenthood Federation (IPPF) comprising 32 countries was founded. In
Nigeria, Pathfinder fund sponsored the survey of the country’s need for Family
Planning. In 1960, the IPPF and Pathfinder fund aided in the formation of Family
Planning Council of Nigeria which was formally launched at Napo Hall Ibadan
and thereafter family plannaing clinics were established at other places. (FMOH,
2005).
Simultaneously late Professor Ojo started the programme in U.C.H. Ibadan in
1964. He later got Mrs Adeyemi on as part time, then Mrs Delano who later
became the programme co-ordinator of Fertility Research Clinic. The College of
Medicine University of Ibadan took over the unit in 1975 and since then it has
been under the Department of Obsteterics and Gynaecology and is currently
known as Fertility Research Unit, College of Medicine U.C.H., U. I. Ibadan
(Fumilayo and Kolewole, 2000; FMOH, 2005).
Family Planning Methods
According to Fumilayo and Kolawole (2000), the natural family planning method
is said to be the monitoring of the natural physiological signs and symptoms in a
female reproductive system within the reproductive life to determine the fertile
periods for the approach to the timing of pregnancy. It can be called fertility
awareness methods (FAM) These include the Basal body temperature method,
26
the
cervical mucus
method
(CMM)
or Billings
Ovulation
methods,
symptothermal method (STM). Others are withdrawal method, prolonged
lactation and abstinence.
Parks (2007), opined that contraceptive methods are preventive methods to help
women avoid unwanted pregnancies. They include all temporary and permanent
measures to prevent pregnancy resulting from coitus. Contraceptive methods may
be broadly divided into two classes, Spacing methods and terminal or permanent
methods. The spacing methods include:- Barrier methods, intra uterine devices,
hormonal methods, post conceptual methods.
Terminal or permanent methods: includes. Male sterilization and female
sterilization. Barrier methods aim to prevent live sperm from meeting the ovum.
However in the rural communities of this study we are focusing on condom use
among men and their support for their wives contraceptive usage. Parks, (2007)
stated that condom is the most widely known and used barrier devices by males
around the world. He also noted that its non contraceptive advantages has some
protection from sexually transmitted infections, a reduction in the incidence of
pelvic inflammatory diseases and possibly some protection from the risk of
cervical cancer. Condoms can be a highly effective method of contraception, if
they are used correctly and consistently.
Health Benefits of Family Planning
The health benefits of family planning are numerous as it has impact on the
mother, infant/children, father and the community in general.
27
Maternal
To the mother according to Parks (2007), family planning helps couples or
individuals to control the number, interval and timing of pregnancies and births.
This affords time to recuperate or recover well after each pregnancy, thereby,
reducing material mortality. Furthermore it offers mothers opportunity for
smaller family size for better provision of adequate nutrition for her y.
KOM (2005) opined that family planning is an important factor in the prevention
of unwanted pregnancies with its potential complications, which may result from
unsafe induced abortion. About 150,000 unwanted pregnancies are terminated
everyday, out of which one-third are unsafe abortion resulting in about 500
deaths everyday. In the African sub-region, abortion is in the first three highest
causes of maternal mortality. Hatcher, Rinehat, Blackburn and Gella, (2000),
further stated that everyday, 1,600 women and more than 10,000 new borns die
from preventable complication during pregnancy and child birth.
Almost 99% of these maternal and 90% of neonatal deaths occur in the
developing countries. Family planning as a pillar of safe motherhood plays a
major role in reducing maternal and newborn morbidity and mortality.
To the Father:
Family planning gives the father ability to provide financially for the family and
spend more time with the family.
Infant/Children’s health.
Parks, (2007) noted that child’s proper growth, development and nutrition can be
achieved with family planning as birth spacing and smaller family size enhances
child survival.
28
To the Community
Family planning helps the community to plan her needs. It shows the rate of
population growth which offers more opportunity for education and employment
to the community. Family planning also improves the quality of life for the
people within the rural community, for example, it helps the government to
provide adequate food supply, housing, health care services, portable water
supply, good road network system to her members. It reduces or prevent the
spread of sexually transmitted infections, for instance, condom offers some
degree of protection to sexually transmitted infection. Thus reducing mortality
indices for the community (FMOH, 2005).
Factors that Affect Men’s Involvement in Family Planning
Lack of many contraceptive options for men: One of the greatest deterrent to
greater men’s involvement in family planning is the lack of contraceptive options
for men. Apart from withdrawal, only vasectomy and condom are available to
men but while male condom provides effective protection against pregnancy and
sexually transmitted infection, there is often reluctance to use them (Khannc and
Van 1998).
Poor information, education and communication (IEC): some men are
unaware of the concept and the importance of their involvement in family
planning. Poor IEC causes non motivation and communication of males to the
programmes, for instance the introduction of programmes on radios and
television on male involvement in family planning and the advantages that are
associated to the responsibilities and participation will go a long way in
increasing the number of males that get involved in family planning (Onuoha,
2000).
29
Inadequate
knowledge:
Even
though
procreation
is
the
co-operate
responsibilities of both males and females, in most cultures in African sub
regions, pregnancy and child birth are often perceived as a woman’s problem
alone. Consequently, most men assume that women should bear the entire
burdens of preventing unwanted pregnancies, sexually transmitted infections,
using of contraceptives alone (Kom, 2005). Also levy, (2006) opined that women
who want to discuss family planning with their spouses may be perceived as
promiscuous or unworthy of trust.
Religious beliefs: some religious beliefs of people are against male participation
in family planning. Artificial family planning is a crime to some religions
example Roman Catholic denomination in Christian religion do not believe in
artificial family planning of any type such as the practice of vasectomy and
condom are prohibited by males. Also the Muslims believe in a man marrying
multiple wives as many as four. This encourages gender inequality and
deprivation of women’s right and empowerment (Grillo, 2009).
Culture: According to Kom (2005), in the African sub-region, there is a belief
that expression of wealth of a man is in the number of children or wives he has.
Thus polygamy and extra marital relationships are common practices in many
rural communities. Also in the literate communities, having concubines is an
acceptable norm. consequently men may tend to believe that they need not to be
involved in family planning.
Also, Grillo (2009), observed that it is also believed in some cultures that man reincarnates after the life on earth. The cultural belief has gone a long way in
preventing men to get involved in family planning, example vasectomy, with the
notice on that if they are rendered sterile in this life, they will come again in their
30
next world as impotent human beings and will not be able to reproduce. Then
some others believe that vasectomy is equal to castration which impairs sexual
functions. And still more misinformation include the ideas that vasectomy will
make the man fat or weak or less productive.
Economic concern: According to a study by Bunce, Guest, Searing, Frajzyngier,
Riwa, Kanama and Achawal (2007), in Tanzania, economic hardship was the
most frequently mentioned reason for vasectomy acceptance among men. The
respondents commented on the general economic benefits of a smaller family and
anticipated problems covering the basic needs of many children, including
adequate foods, healthcare and education. Similarly, a study in Jordan on men’s
knowledge of and attitude towards birth spacing and contraceptive use revealed
that economic considerations were the main reason that they used or intended to
use family planning. Also, some of the respondents cited ability to provide a good
quality of life for their children as the most pressing reason for wanting to limit
their family size. (Nustas, 1999).
Spousal influence: A wife’s approval was seen as key to many vasectomy
decisions that was seen in a study in Tanzania by Bunce et al., (2007), where
most of the men (vasectomy clients) reported discussing the decision with their
spouses and more than 50% mentioned wife’s approval as a factor in the
decision. Concern for one’s wife was also mentioned by many of them, as it
encompassed a desire to stop the cycle of problems of pregnancies and births, to
free her from family planning methods perceived to be potentially harmful.
Provider availability and reputation: Providers are seen as often unavailable or
inaccessible and there was confusion as to when providers would be seen in the
area to answer questions or to provide services or to assist the clients. The family
31
planning providers should be permanently stationed in the communities or at the
very least, have regular scheduled days in the area to provide services. These
were observed in a study in Tanzania by Bunce et al., (2007), the men simply
described the difficulty involved in obtaining the family planning services due to
lack of provider availability.
Overview of Men that Practice Family Planning, the Methods and Services
available to Men
Men’s involvement in family planning can be either as user of male methods or
as supportive partner of female users (Fumilayo and Kolawole, 2000). The vision
to involve men in family planning is to increase men’s awareness and support of
their spouses in family planning services. It is also expected to raise men’s
awareness of the need to safeguard their spouses and their own reproductive
health, especially by preventing sexually transmitted infections. And to enhance
couples access to male methods of family planning (Onuoha, 2000).
Family planning methods and services available to men
Condom
The family planning method include withdrawal, condom and vasectomy are
available to men. Male latex condom offer very effective prevention from
unplanned pregnancy and HIV/AIDS infection. They are therefore considered a
“dual” protection method. When used correctly and consistently for each sex act,
condom is 97% effective in preventing pregnancy (Vogelsong, 2010).
Condom Preference
According to a cross – sectional study done in inhabitants of Chandigar, India,
men prefer condom usage 36.1% to vasectomy 1%. Their reasons were:-
32
Easy availability. This was the most common perceived reason in favour of
condom usage. As condom can easily be procured from chemist shops, health
centres and family planning clinics.
Knowledge and awareness. More than 75% of men were aware of its usage.
(Puri, Walia, Mangat and Sehgal, 2010). Kom, (2005) observed that in Iran the
use of oral contraceptive pills increased from 12% to 90% when the pills was
distributed by husbands. Studies conducted in rural areas of Agra district New
Delhi India by Khan and Patel, (1997) to access the involvement of men in family
planning revealed that among 517 males, 52% take all decisions regarding to
family planning alone while 10% of them felt that women alone could take such
decisions. The report further showed that about 42% of family planning users
prefer non terminal methods, largely condoms over vasectomy. The study further
revealed that 89% of men had correct knowledge of condom and how to use it
correctly.
In Northern Chandigarh India Puri et al., (2010) found that contraceptive use rate
among men was more than 50% and out of these almost half were condom users.
Another study done in the same population by them showed that condom usage to
be 31% that increased to 70% after intervention. In Tanzania among men in
Mbeya region plan revealed that though the awareness about condom was high
the usage rate was low. (Plann, 2001).
Vasectomy or Male Sterilization
Vasectomy or male sterilization is the most effective of male methods of
contraceptive currently available worldwide. More than 40 million couples use
vasectomy as their method of fertility regulation. However, this method is
33
popular in only a few countries. Expanding the use of vasectomy requires
overcoming several obstacles or factors viz;
Social cultural and political barriers
Provider bias
Inadequate information regarding its safety and efficiency of the procedures.
Dispelling myths and misconceptions (Lohiya, Manivanna, Mishra, and
Patha, 2001).
Other factors include the need for a surgical intervention, that is the surgical
nature of the procedure put many men off using the methods.
Again the fact that the procedure needs to be considered permanent as the
success rate of reversal is low (Vogelson, 2010).
According to Bunce et al., (2007) vasectomy make up of only 7% of all modern
contraceptive used world wide. And although vasectomy prevalence is low in
most developing regions, it is especially low in Africa where it rarely exceed
0.1%.
Nature of men’s involvement in family planning
Decision making on contraceptive use within the family.
Men are the dominate decision makers regarding family affairs in developing
countries. Men have the final say in decision making about family size and use of
contraceptives especially in the rural communities (Puri et al, 2010).
In Bangladesh, decision about family size and of contraceptives by wives and
their continuation depends largely on the decision of their husbands (Hossain,
2003). The study by this author (2003) revealed that decisions about adoption of
family planning are mainly taken by males. The study further stated that the
males had the highest influence in deciding about the acceptance of sterilization.
34
Onuoha (2000), observed that importance of African men in decision making
about family size, giving their wives permission to use contraceptives and
obtaining traditional methods of family planning to be supreme.
Onuoha (2000), stated that the true position is that in traditional African societies,
men are conferred with authority to determine who gets what, how and when in
the family. This authority also implies that the men have the final say on the
number of children the family should have, the spacing, maternal health and
general level of reproductive health in the family. Thus, any family planning
programme that isolates men is bound to have minimal impact.
Clark, (1999) noted that the decision making process within a cultural group are
indicative of its activities towards authority. Traditional Asia or Latino family
identifies the husband/father as the primary decision maker in all family issues.
Many decisions are jointly made by husbands and wives particularity in those
families where the women are employed.
In Agra district a rural community in India, men dominate in decision making in
the family in all reproductive processes – number of children, choice of
contraceptive method and abortion of unwanted pregnancies. The women have no
right of independent decisions other than to abide by their husbands decisions
(Khan and Patel, 1997).
Spousal communication
Spousal communication is positively associated with contraceptive use.
Demographic health survey data from seven African countries (Botswana,
Brundi, Ghana, Kenya, Senegal and Togo), showed that the percentage of women
using modern contraceptive is consistently higher in the group that had discussed
family planning with their husbands in the year before the interview than in the
35
group that had not (Toure, 1996). A similar study by Eze, Seroussi and Roggers,
(1996), revealed that because of lack of communication, many women do not
know what their husband think about family planning. Many women think that
their husbands disapprove, when in fact their husbands approve. In West Africa,
about three quarters of the men and women had not discussed family planning
with their spouses in the year proceeding the survey. Decision about using family
planning and fertility control measures are not entirely individual decision.
Spousal communication between a husband and wife has been found to be a
prime indication of the extent of knowledge and acceptance of family planning
practices that couples will be willing to adopt and use, (Share and Valente, (2002
in Akafua and Se ssou, (2008). Lack of desired communication between spuses
about family planning, may also be a serious barrier to contraceptive use. In
recent years, over half (52%) of currently married women said they had not
discussed with their husbands about family planning in Bangladesh. (Hossain,
2003).
According to Jordanian National population commission, men play a principal
role in reproductive decision making in their country as in other countries.
Jordanian men expect to take the initiative in family matters. Women are
reluctant to discuss family planning with their husbands unless their husbands
introduce the subject. With good spousal communication, their women can
possibly discuss family planning and practice them (Nustas, 1999).
Approval of a contraceptive method. Men’s approval or opposition to their wives
practice of family planning has a strong impact on contraceptive use in many
parts of the world including Africa (Toure, 1996).
36
Grillo, (2009) in a recent study in Ile – Ife observed that 89% of men approved
their wives use of family planning methods and this increased their wives
contraceptive usage.
A study by Kamal, (2003) in Bangladesh on influence of husbands on
contraceptive use by the women, revealed that husbands’ approval of family
planning led to the increase of any family planning method used by females. He
further observed that women in Bangladesh have a tendency to use contraceptive
only when they perceive that their husbands do not object. In other countries for
example Siri Lanka women whose husbands disapproved of contraceptive use
had a four times higher risk of unwanted pregnancy compared with those whose
husbands approved.
The husband’s approval is found to be a good predictor of future practice and
continued contraceptive use. There are studies done in Phillipines which
indicated that the continuation rate among women whose husbands approved
their contraceptive practice is much higher than chose whose husbands do not
give approval to their wives. In South Korea researchers found that 71% of
women whose husbands approved of family planning had used contraception at
some time compared with 23% of women whose husbands did not approve
(Toure, 1996).
According to a survey in Jordan it was observed that among couples women who
had never used contraceptives reported that their wives main reason was their
husbands opposition. Also 40% of men said that they should continue having
children until they have a son. (Nustas, 1999).
37
Caring for their spouses.
According to Puri et al (2010), men being dominate decision makers regarding
family affairs in developing countries can directly or indirectly affect women’s
contraceptive use thereby affecting women’ reproductive health. Men can
promote safe motherhood by participating in family planning as well as
occupying their wives to meet health provides where they can learn about the
available contraceptive methods correctly. And men can also encourage their
wives to seek help from healthcare providers if side effects occur and also
provide emotional support to them.
According to Insterinbey and Hubly, (2009) in Mali a programme was conducted
to encourage men to accompany their spouses to family planning and
gynaecological services, for such will actually encourage the women to practice
family planning.
According to Grillo, (2009) the findings from a study among Nigerian men and
women on family planning in Ibadan showed that women whose husbands were
present during their child birth were more likely to use contraceptives than those
whose husbands were not present. The study further revealed that also among the
group whose husbands supported their wives during child birth, the husbands
were more likely to initiate the use of contraceptives among their wives.
Khan and Patel, (1997) observed that in Agra district in India, a rural community,
men dominate in decision make in all matters related to timing of pregnancy,
number of children and contraceptive use. They also dominate in decision make
as regards to health care, who decides when or which doctor to be consulted
when sick. So women have no right of independent decision about timing of
medical consultation or source of treatment. It also implies that when men
38
adequately care for their wives when sick, such women are likely to use
contraceptives.
Financial or economic involvement
KOM, (2005) observed that women are fully dependent on their spouses for
economic support and decision making especially in the rural communities. She
further observed that women believed that any decision from men cannot be
rejected even though it may not favour them.
Hence, exclusion of men from family planning means couples would be unable to
use modern contraceptive. She noted that in Iran the use of oral pills
(Contraceptive) increased from 12% to 90% when pills was distributed by
husbands. Akafua et al., (2008) observed that there is however a growing
recognition in Ghana that men play significant and influential role in reproductive
decision making and family planning practices. They also revealed that lack of
economic resources and power differentials have prevented many women from
effectively negotiating use of contraceptives with their male partners. This
implies that when men provide financial resources to their wives, they will be
encouraged to use family planning services.
Theoretical Framework Review
The Health Belief Model (HBM). Theory related to behaviour was used as
framework for this study. The Health Belief Model is a psychological model that
attempts to explain and predict health behaviours. This is done by focusing on the
attitudes and beliefs of individuals. The HBM was first developed in the 1950’s
by social psychologists Hochbaum, Rosenstock and Kegels working in the United
States Public Health Services (Murph, 2003).
39
The model was developed in response to the failure of a free tuberculosis (TB)
health screening programme. Since then the HBM has been adapted to explore a
variety of long and short term health behaviours including the transmission of
HIV/AIDS.
Core assumptions and statements of health belief model as identified by
Murphy (2003):
The HBM is based on the understanding that a person will take a health related
action. (a man can get involved in family planning) if that person:
Feels negative conditions such as getting the number of children they could not
cater for, increases chances of unwanted pregnancies and increases maternal and
infant morbidity and mortality can be avoided.
Has a positive expectation that by taking a recommended action such as (actively
participating in family planning) he will avoid a negative health condition and
believes that he has successfully taken a recommended health action, such as,
determining number of children to have, that is timing and spacing, adopting
male method of contraception or supporting wives` usage of contraception with
confidence.
The HBM was spelt out in terms of four constructs representing the perceived
threat and net benefits ,perceived susceptibility, perceived barriers. These
concepts were proposed as accounting for peoples :readiness to act”. An added
concept. Cues to action would activate the readiness and stimulate overt
behaviour. A recent addition to the HBM is the concept of self efficacy, or ones
confidence in the ability to successfully perform the action.
40
This concept was added by Rosenstock stretcher and Becker in 1988 to help the
HBM better fit the challenges of changing habitual unhealthy behaviour such as
smoking, poor hand hygiene etc. (Glanz, Rimmer and Lewis, 2002).
The Health Belief Model is used by health education specialist to analyse factors
that contribute to clients perceived state of health or risk of diseases and to client
probability of taking appropriate health plans of actions.
41
CONCEPTUAL MODEL
Cues to Action
Messages through health
education via mass media,
town criers using men’s
forum example Igwe’s cabinet
and men’s church group
Men in Rural
Communities will
Participate in family
Planning (Health Related
Action)
If they feel negative condition
- danger of having more children
than they
can cater for
- increased chances of unwanted
pregnancy
- increased maternal and infant
mortality
( Perceived susceptibility)
Perceived Threat of
Condition
- Has confidence to participate
in Family planning through
use of male methods,
- support wives’ use of
contraceptives.
- Trust it is safe and has
acceptable level of risks.
(No Barriers to Behavioural
Change)
Believes that male involvement
in Family Planning will eliminate
- the dangers of unwanted
pregnancy,
- maternal and infant mortality,
- having more children than one
can cater for (Perceived
benefits).
Likelihood of behavioural change
Involvement in family planning
Application of Health belief model to male involvement in family planning in
rural communities
Adapted from Health Belief Model
42
This model is one of the oldest attempts to explain health behaviour. It is based
on the premise that for a behaviour change to succeed, individual must have the
incentive to change, feel threatened by their current behaviour and feel that a
change will be beneficial and be at acceptable cost. They must feel competent to
implement that change. (Glanz et. al, 2002).
Application of Health belief model to male involvement in family planning in
rural communities:Men in the rural communities will actively participate in family planning
programme if they:
Believe there is a danger of having greater number of children one cannot cater
for, increased chances of unwanted pregnancy and increase incidences of
maternal and infant morbidity and mortality associated with male noninvolvement. (Perceived susceptibility).
Believe that male involvement in family planning is effective at eliminating the
dangers such as, wanted pregnancies, having more children than one can cater for
and increased incidence of maternal and infant mortality and morbidity etc.
(Perceived benefits).
Trust that the method (actively participating in family planning) is safe and has
an acceptable level of risk (possibly through education and mass media).
Has the means to actively participating in family planning such as adopting male
methods of contraception, supporting wives’ usage of contraceptives, attending
clinics for the treatment of sexually transmitted infection etc. (no barriers to
behaviour change).
43
Males in the rural communities receive reminder cues as appreciation for being
involved in family planning from government and non governmental bodies. Also
it can be inform of receiving message, through use of town criers etc, reminding
them of how to be actively involved in family planning.
Men become confident in actively participating in family planning such as
adopting a contraceptive method and supporting the wives’ usage of
contraception etc. This is achieved through regular and repeated education and
guidance by health workers and programme planners using different men’s forum
such as Igwe’s cabinet, men church group etc.
Empirical Review
Studies done in male involvement in family planning by Hossain, (2003) in
Bangladesh with other selected countries in Asia and Middle east with regards to
current use of male methods of contraception revealed that there is great variation
across countries in the percentage of men that practice family planning. In
Bangladesh 54% of the eligible couples currently practicing family planning,
only 40% use the male methods current rate of marital condom use in Bangladesh
is very low 4%. In Turkey, with high level of contraceptive prevalence rate
62.6% withdrawal is the most popular method 26.2% and condom use 7% of all
current users. The study further revealed that in Philipines, with 40% of couples
using contraceptives, withdrawal is 7%.
In Bangladesh the rate of male participation in family planning is low. With even
half of the eligible couples (54%) currently practicing contraception only 14%
use the male methods. The low level use of male methods use indicates the
increase contraceptive prevalence rate in the country can only be achieved by
promotion of active male involvement in family planning. (Hossain, 2003).
44
In Indonesia – there is low use of all male methods 3.2% out of contraceptive
prevalence rate of 50%. In India, contraceptive prevalence rate 41%, participation
of male methods is 9.8% and current use rate of vasectomy is 3.4%. In Pakistan,
half of total contraceptive use is 9.8% and is shared by male methods (Hossain,
2003). Also in a study done in Cameroon on Men’s attitude towards family
planning by Leke, (2010) revealed that 64% of men in the rural areas of
Akonoling and 63% of men in the rural areas of Obala practice family planning.
In a survey in Jordan couples who are currently practicing contraception 86%,
among couples who had never used contraception, only 40% had discussed
family planning. Also 20% of women who had never practiced family planning
reported that the main reason was their husbands opposition. (Nustas, 1999).
Studies done among men in slum inhabitants of Chandigarh India on prevalence
of various contraceptive methods found out that 65.9% of the respondents were
practicing family planning and condom use among them 58.9% Another study
done in same population showed that condom usage to be 31% that increased to
70% after intervention in Chandigarh (Puri et. al., 2010). Studies done on sex
preference and contraceptive behaviour among men in Mbeya region in Tanzania
revealed that though the awareness of condom was high the usage rate was low.
(Plann, 2001).
Studies done on male involvement in family planning: women’s perception in
Port Harcourt Nigeria by Nte, Odu and Enyindah, (2009) revealed that about
15.8% would depend on their husbands for choice of contraceptive methods and
52.7% would discontinue family planning if their husbands objected. Studies
conducted on men’s knowledge of and attitudes towards birth spacing and
contraceptive use in Jordan by Nustas (1999) revealed that communication
45
between partners is significantly associated with contraceptive use. And men who
are currently practicing family planning are twice as those who likely have never
discussed contraception with their wives. Studies one on men’s attitudes,
acceptability and participation towards family planning in Ilorin Nigeria showed
that vasectomy and withdrawal are among the least known methods among men
while the use of condom being the widely recognized. The study further revealed
that 62% of men have used a method at one time or the other and this approved
the use of family planning techniques by themselves and their spouses. While
58% of men are currently practicing family planning. (Olawepo and Okedare,
2006).
Again studies conducted in Ghana to examine knowledge, attitude and use of
family planning among Ghanaian men revealed that spousal communication is a
key factor in the adoption and sustained use of family planning because such
discussions allow couples to exchange new ideals and clarify information, which
might change some wrong beliefs about the use of some family planning devices.
They further observed that open communication between couples about family
planning also provides couple with an opportunity to discuss family size
preferences and the means to achieving them. (Akafuah and Sossou, 2008).
Similarly Sharen and Valente, (2002) in a study in Nepal on spousal
communication
and
family
planning
adoption
observed
that
spousal
communication between a husband and wife has been found to be a prime
indicator of the extent of knowledge and acceptance of family planning practices
that couples will be willing to adopt and use.
46
Also a study in Kenya on discussion on family planning among couples revealed
that a desired family size by men positively co-relates with their women to
practice a contraceptive methods. (Kimune and Adachak, 2001).
According to Sabir, Rahamanda and Islam, (2003), a study in Bangladesh
revealed that decision about family size and the use of contraceptives by wives
and their continuation depends largely on the decisions of their husbands. In
another study in Bangladesh by Sabir et. al. (2003) revealed that the males had
the highest influence in deciding about the acceptance of sterilization. They
further observed that decisions about adoption of family planning are mainly
taken by the males.
Also studies done in Zimbabwe according to Zimbabwe Reproductive health
survey revealed that 42% of married women stated that it was the husbands’
responsibility to decide whether his wife should use family planning methods.
The studies further revealed that men are the ultimate decision makers on family
size and all family planning matters. They also observed that men need more
information about family planning to make better decisions (Onuoha, 2000).
Studies conducted by Puri et al (2010) in slum population in Chandigarh India on
current scenario of contraception and Indian men revealed that men are the
dominate decision makers regarding family affairs in developing countries can
directly or indirectly affect women’s reproductive health. They can promote safe
motherhood by practising family planning as well as accompanying their wives
to meet health provides where they can learn about the available contraceptives
methods. They can also help their wives use contraceptive methods
correctly,
47
can encourage them to seek help from health providers if side effects occur and
also they themselves can opt for male contraceptive methods.
Studies conducted on differentials in current use of male methods in Bangladesh
further revealed that the level of current contraceptive use is higher in urban area
60% than in rural area 52% among couples. There is a considerable difference in
urban 10% and rural areas 3% probably indicating easier availability of the
method in urban areas. (Hossain, 2003). Another study done in Bangladesh on
the influence of husband on contraceptive use by the women revealed that
husbands approval of family planning had to the increase of any family planning
method used by the wives. Also women in Bangladesh have a tendency to use
contraceptives only when they perceive that their husbands do not object.
He further observed that in other countries for example Siri Lanka women whose
husbands disapproved contraception had a four times higher risk of unwanted
pregnancy compared with those whose husbands approved. (Kamal, 2000).
Studies done in Phillipines also revealed that the contraceptive continuation rate
among women whose husbands support contraceptive practice is much higher
than those whose husbands do not give support to their wives. This study further
observed that husbands support has been found to be a good predictor of future
practice and continued use. (Toure, 1996).
Studies carried out in South Korea according to Population Reports 1994 also
revealed that 71% of women whose husbands approved family planning had used
contraception at some time, compared with 23% of women whose husbands did
not approve. While in Madagascar, nor plant continuation rates were higher after
one year among couples in which the husbands has being involved in the decision
48
making process, and among these couples both wives and among these couples
both wives and husbands were more satisfied with Nor plant than those in which
only the wife was counseled. ( Toure, 1996).
According to studies done in Tanzania to find out factors affecting vasectomy
acceptability among men revealed that economic hardship was the most
frequently mentioned reason for vasectomy acceptance among men. The
respondents enumerated the general economic benefits of a smaller family and
anticipated problems covering the basic needs of many children including
adequate food, health care and education. (Bouce et. al. 2007).
Similarly, in study in Jordan on men’s knowledge of and attitudes towards birth
spacing and contraceptive use revealed that economic considerations were the
main reason that they used or intended to use family planning. Also some of the
respondents cited ability to provide a good quality of life for their children as the
most pressing reason for wanting to limit their family size. Studies in Tanzania
also revealed that attitudes towards contraceptive use vary by religious
denominations. The respondents reported that in Tanzania, the seventh day
adventist church is a strong advocate of contraception. For example vasectomy
services are provided at Heri Seventh Day Adventist hospital and contraception is
discussed and promoted in sermons. Furthermore, the denomination organizes
educational seminars and advertises the availability of family planning providers.
Also, the respondents further revealed that the Roman Catholic Church in
Tanzania actively discourages the use of modern methods. And most other
denominations, including Islam, Anglicanism, Lutheranism and Pentecostalism
were seen as falling some where between the stances of the Seventh Day
Adventist Church and the Roman Catholic Church (Bounce et. al. (2007).
49
Studies done by Isaac Ndong of the Engender Health on Men’s Roles in family
planning in sub – Saharan Africa observed many misconceptions about
vasectomy among Africans. One of the myths maintains that vasectomy is equal
to castration. Another says vasectomy impairs sexual functions and that is will
make man fat or weak or less productive (Grillo, 2009). Similarly, studies in
Tanzania
on
factors
affecting
vasectomy
acceptability
revealed
man
misconceptions about vasectomy these include rumours of decreased sexual
desire or performance. Additional rumours include equating vasectomy with
castration, believing it causes cancer, believing that sperm will accumulate in the
body and have negative effects and fear that vasectomy causes weight gain and
physical weakness. These misunderstanding and rumours about the vasectomy
process contributed to many people’s reluctance to choose the method. (Bunce et.
al., 2007).
Also studies conducted on male involvement in family planning by KOM, (2005)
observed various misconceptions across African sub-region that even though
procreation is the co-operate responsibility of both males and females but in most
cultures in the African sub-region, pregnancy and child birth are often perceived
as a woman’s problem alone. Consequently most men assume that women should
bear the entire burdens of preventing unwanted pregnancy and using
contraceptives alone. According to studies done by Khanna and Van (1998)
Reproductive health research revealed that one of the greatest deterrent to greater
male involvement in family planning is lack of contraceptive options for men.
Apart from withdrawal, only vasectomy and the condoms are available to men.
50
Summary of Literature Review
A conceptual review on family planning, the health benefits of family planning,
overview of men that practice family planning, the methods and services
available to them, factors that affect men’s involvement in family planning, type
of involvement men engage in family planning was carried out. Theory related to
behaviour (Health Belief Model) was also reviewed and used as the framework
for the study. A conceptual model was adopted for the study.
Empirical review on male involvement in family planning in rural communities
was also carried out. Many works have been done world wide on men’s
participation in family planning but there has not been enough researches on
similar issues in Nigeria as regards to the nature of men’s involvement in family
planning, percentage of men’s involvement in family planning, methods mostly
adopted by men and the factors that affect men’s involvement in family planning
especially when it comes to people of traditional background and the rural
communities. This is the gap this work will fill.
51
CHAPTER THREE
RESEARCH METHODS
This chapter presents the: methods used for the study under such headings as
research design, area of study, population of the study, sample and sampling
procedure, Instrument for data collection, Validity of instrument, Reliability of
instrument, Ethical consideration, Procedure for data collection and Method of
data analysis.
Research Design
A cross-sectional descriptive survey design was used for the study. This is
because survey design obtains information from population regarding prevalence,
distribution and interrelations of variables within the population, and also
observes, describe and document aspect of a situation as it naturally occurs. (Polit
& Beck, 2012.) This design was successfully used by Puri et al (2010) in a study
on “current scenario of contraception and Indian men in slum population in
Chandigarh India”. Hence it is considered appropriate for use in this study to
determine male involvement in family planning in some selected rural
communities in Enugu East Local Government Area in Enugu state, Nigeria.
Area of Study
Enugu East is one of the Local Government Areas in Enugu state which was
created in 1996 with its headquarters located at Nkwo Nike. The local
government area is bounded on the north by Isi-uzo LGA, South by Enugu North,
East by Nkanu East LGA and on the west by Udi LGA. Presently, the LGA is
made up of four development centres namely:- Enugu East Central Mbulujodo,
Mbulu Iyiukwu and Mbulu Owelle. It comprises nine communities namely:
Amorji Nike, Nkwubo, Ugwogo Nike, Ugwuomu, Iji Nike, Ibagwa Nike,
52
Obinagu-Onuogba, Mbulu Owelle, Mbulu Iyiukwu. The inhabitants are
predominately Igbo with few Fulani settlers at Amorji and Mbulu Iyiukwu. The
three communities studied were Ugwuomu, Nkwubo and Obinagu-Onuogba. The
three communities are located at the remote or extreme parts of the LGA.
Ugwuomu and Nkwubo do not have health facilities. Even Obinagu Onuogba
that has, is under utilized with few schools located there.
The places are typical rural communities some are civil servants, peasant farmers
and petty traders. Also there are no good road network to assist them in
transporting their farm products to the urban areas for more profitable sales. Due
to poor system of farming and difficulties in transportation they do not sell in
large quantities to the urban areas.
Population of the Study
The population of the study consisted of all married males in the three selected
communities studied. Married males between the ages of (20-70) years were
about three thousand three hundred and twenty (3320). (Source: Department of
Planning, Research and Statistics Ministry of Health, Enugu, 2012).
Sample
The sample size of three hundred and sixty males (360) from Ugwuomu, Nkwubo
and Obinagu-Onuogba communities was used for the study. The sample was
statistically determined using Taro Yamane formula for a finite population (See
Appendix).
Inclusion Criteria
All married males aged (20-70) years whose wives were within the reproductive
age (15-49) years were included in the study.
53
Sampling Procedure
Systematic random sampling was used to select houses where respondents were
located. The houses in each community were systematically enumerated and
assigned numbers, then a number was randomly selected for a start and the
number 10 was selected. For instance every 10th house was visited and any
number of respondents who fulfilled the inclusion criteria was selected from each
house. The locked houses and those dwellings where respondents were not
willing or did not fulfill the inclusion criteria were not selected. This process
continued until the sample size was obtained.
The sample size for each of the three communities studied was determined
proportionately. See appendix III.
Instrument for Data Collection
A researcher developed questionnaire which was also used as interview guide for
illiterate respondents was used for data collection. The content of the
questionnaire was divided into two sections. Section A and B. Section A
addressed the socio demographic characteristics of the respondents. It consisted
of four (4) items. While section B addressed the objectives of the study. Section
B contained simple structured questions to be used to elicit personal information
relating to research questions. It consisted of seventeen (17) questions.
Question 5 dealt with objective 1 which is the percentage of men who get
involved in practicing Family Planning in communities studied. Questions 6 – 11
are on a 4 point Likert Type Scale which dealt with objective 2 which is the
nature of men’s involvement in family planning. The 4 point Likert scale
indicates the degree or extent at which men get involved in practicing Family
Planning. Very low extent is the lowest extent of involvement and is scored 1,
54
whereas high extent is the highest degree of involvement and is scored 4, low
extent is scored 2, and moderate extent is scored 3. Question 12 dealt with
objective 3 which is the methods mostly adopted by men in the rural
communities. Questions 13 – 22 dealt with objective 4 which is the factors that
affect men’s involvement in family planning. The items were on a 4 point Likert
Type scale of self developed questionnaire which indicated the degree at which
men agree with the factors that affect men’s involvement in family planning.
Strongly Disagree is the lowest degree of agreement and is scored 1, while
strongly agree is the highest degree of agreement and is scored 4. Agree is scored
3, and disagree is scored 2.
(See Appendix 1).
There were a total of 22
questions.
Validity of the Instrument
Validation was done by the researcher’s Supervisor, a Community Health
Specialist and two others who were experts in the field of measurement and
evaluation for face validation. Their observations were used to make necessary
modifications before final approval by the supervisor.
Reliability of Instrument
The reliability of the instrument was checked using test-retest method. This was
done by administering the same questionnaire to 30 respondents a similar rural
community in Nkanu West Local Government Area in Enugu State to 30
respondents.
After a period of two weeks then administer the same test to the same group who
took the test previously. Two sets of test scores were obtained. The two sets of
scores were used to compute a correlation co-efficient using Cronbach Alpha
55
formular or coefficient alpha (α) and 0.845 was obtained which indicated that the
instrument was reliable
Ethical Consideration
Application for ethical approval and introduction letter endorsed by the Head of
Department of Nursing Sciences, University of Nigeria Enugu Campus and
abridged copy of the research proposal were submitted to the Research and
Ethical Committee of Ministry of Health Enugu and approval was given, after
due consideration by the ethical committee, the ethical clearance was granted for
the study. (See Appendix VII) Permission to carry out the study in the rural
communities was also obtained from Enugu East Local Government Area
Chairman and the Traditional Rulers of the three selected communities (See
Appendix IX), following the presentation of an introductory letter from the Head
of Department Nursing Sciences University of Nigeria Enugu Campus and an
application for the permission to carry out the study and their approval was
secured before data collection.
Finally, individual informed consent was obtained from each study participant
who met the inclusion criteria. Confidentiality and anonymity were assured to
the respondents with respect to the information they have shared. These enabled
them to give the necessary assistance on the collection of data.
Procedure for Data Collection
Five research assistants were trained on aims, purpose and objectives of the
research, sampling and sampling procedure, the use of informed consent form.
Arrangements was made and through the traditional rulers of the three
communities, village heads, Age grade leaders and town criers was used to create
56
awareness to the communities about the study. To reach the individual
respondents, a pre-determined starting point which should be stream, village
square or church was identified. The researcher moved in clock wise direction
from the starting point. Each selected house was numbered and research assistant
was assigned to collect data from the respondents. In a house where inclusion
criteria was not met the next house was used. The respondents who could not
read or write were assisted by the researcher and her assistants. Data collection
was done in the evenings, and market days was excluded because being rural
communities the respondents go to the farm or market during the morning and
afternoon hours. The data collection lasted for eight (8) weeks.
Methods of Data Analysis
Data collected were analysed using descriptive such as frequency, percentages,
means and standard deviations for answering the research question. Cross
tabulation was done to obtain chi square values for testing the hypothesis at 0.05
level of significance. All analysis was done using the Statistical Package for
Social Sciences (SPSS) version 17. For the four point Likert type scale the item
mean were computed and compared with the criterion mean to show the level of
involvement.
57
CHAPTER FOUR
ANALYSIS AND PRESENTATION OF RESULTS
This chapter dealt with presentation and analysis of data collected.
Three
hundred and sixty (360) copies of questionnaires were distributed to men while
three hundred and forty-eight (348) were duly completed and returned, giving a
return rate of 97%. The responses were tallied and presented in frequency tables
and percentages according to research questions.
Data were analysed using
descriptive statistics such as percentages, frequency, means and standard
deviation for answering research questions and inferential statistics such as chi
square analysis was used for testing hypothesis.
Table 1:
Socio demographic characteristics of the respondents
n = 348
Demography
Frequency
Percentages
Age range
20 – 29
-
-
30 – 39
84
24.1
40 – 49
75
21.6
50 & above
189
54.3
Mean Age
45.2 years
Level of education
No formal education
54
15.5
Primary education
42
12.1
Secondary education
93
26.7
Tertiary education
159
45.7
Farming
78
22.4
Trading
62
17.8
Public servant
196
56.3
Artisan (plumber, electrician)
12
3.4
Christianity
306
87.9
Moslem
18
5.2
Traditional religion
24
6.9
Occupation
Religion
58
Table 1 shows that 75 (21.6%) of the respondents were within 30 and 39 years,
84 (24.1%) were within 40 and 49 years while 189 (54.3%) were 50 years and
above. The table also reveals that 54 (15.5%) of the respondents have no formal
education, 42 (12.1%) attained primary level of education, 93 (26.7%) attained
secondary level of education while 159 (45.7%) of them attained tertiary level of
education. As regards their occupation, 78 (22.4%) of the men are farmers, 62
(17.8%) are traders, 196 (56.3%) are public servants while 12 (3.4%) of them are
Artisans. Most of the men are Christians (87.9%), 18 (5.2%) are Moslems while
24 (6.9%) of them are traditionalists.
Research question 1: What percentage of men get involved in practicing
family planning in the study communities?
In order to answer the above research question, the respondents’ responses to
item (5) five was analysed and presented on Table 2.
Table 2:
Respondents responses to the percentage of men who get
involved in practicing family planning
n = 348
Are you currently involved in family
planning
Yes
No
Total
Frequency
Percentages
160
188
348
46
54
100
Table 2 shows that 160 (46%) of the men are currently involved in practicing
family planning while 188 (54%) are not. Therefore less than 50% of the men in
the communities practice family planning.
59
Research question 2: What are the factors that affect men’s involvement in
family planning in these communities?
In order to answer the above research question, the respondents responses to
items 14, 15, 16, 17, 18, 19, 20, 21, 22 were analysed and presented in Table 3.
Table 3:
Respondents response to the factors affecting men’s
involvement in family planning
n = 348
S/N
Factors
1
Inadequate
knowledge
2
Lack of many
contraceptive
options for men
Lack of exclusive
family planning
facilities for males
Poor IEC
3
4
5
6
7
8
9
Religious beliefs
Culture
Economic concern
Spousal influence
Provider
availability
Overall mean
Strongly
agree (4)
F
%
148
42.5
Agree (3)
Disagree (2)
Mean ± SD
%
14.4
Strongly
disagree (1)
F
%
32
9.2
F
118
%
33.9
F
50
126
36.2
141
40.1
46
13.2
35
10.1
3.03 ± 1.27
55
15.8
81
23.3
103
29.6
109
31.3
2.24 ± 1.45
79
22.7
128
36.8
67
19.3
74
21.3
2.61 ± 1.33
87
112
71
101
56
25.0
32.2
20.4
29.0
16.1
119
106
109
120
73
34.2
30.5
31.3
34.5
21.0
62
68
87
39
114
17.8
19.5
25.0
11.2
32.8
80
62
81
88
105
23.0
17.8
23.3
25.3
30.2
2.61 ± 1.32
2.77 ± 1.52
2.49 ± 1.49
2.67± 1.45
2.23 ± 1.37
3.10 ± 1.26
2.64
Table 3 shows that 32 (9.2%) of the respondents strongly disagree that cultural
Inadequate knowledge is a factor affecting men’s involvement in family
planning. 50 (14.4%) disagree, 118 (33.9%) agree while 148 (42.5%) strongly
agree. A high mean value of 3.10 indicated that majority of the respondents agree
while a small standard deviation of 1.26 indicated low variability of responses as
majority tend towards agreement. The table also reveals that 35 (10.1%) strongly
disagree that lack of many contraceptive options for men is a factor affecting
men’s involvement. 46 (13.2%) disagree, 141 (40.1%) agree while 126 (36.2%)
strongly agree. A high mean value of 3.03 indicated that majority of the
60
respondents agree while a small standard deviation of 1.27 indicated low
variability of responses as majority tend towards agreement. As regards lack of
exclusive family planning facilities for males as a factor, 109 (31.3%) strongly
disagree, 103 (29.6%) disagree, 81 (23.3%) agree while 55 (15.8%) strongly
agree. A low mean value of 2.24 indicated that more of the respondents disagree
that lack of exclusive family planning facilities for males is a factor while a small
standard deviation of 1.45 very close to the mean, indicated low variability of
responses as more of the responses tend towards disagreement. For poor IEC, 74
(21.3%) of them strongly disagree that it is a factor, 67 (19.3%) disagree, 128
(36.8%) agree while 79 (22.7%) strongly agree. A high mean value of 2.61
indicated that more of the respondents agree that poor IEC is a factor while a
small standard deviation of 1.33 very close to the mean, indicated low variability
of responses as more of the responses tends towards agreement. As regards
religious beliefs as a factor affecting men’s involvement in family planning, 80
(23.0%) strongly disagree, 62 (17.8%) disagree, 119 (34.2%) agree while 87
(25.0%) strongly agree. A high mean value of 2.61 indicated that more of the
respondents agree while a small standard deviation of 1.33 very close to the mean
indicated low variability of responses as more of the responses tends towards
agreement. The table shows that 62 (17.8%) of the respondents strongly disagree
that culture is a factor affecting men’s involvement. 68 (19.5%) disagree, 106
(30.5%) agree while 112 (32.2%) strongly agree. A high mean value of 2.77
indicated that more of the respondents agree while a small standard deviation of
1.52 very close to the mean, indicated low variability of responses as more of the
responses tends towards agreement. As regards economic concern as a factor, 81
(23.3%) strongly disagree, 87 (25.0%) disagree, 109 (31.3%) agree while 71
61
(20.4%) strongly agree. A low mean value of 2.49 indicated that more of the
respondents disagree while a small standard deviation of 1.49 very close to the
mean indicated low variability of responses as more of the responses tends
towards disagreement. 88 (25.3%) of the respondents strongly disagree that
spousal influence is a factor, 39 (11.2%) disagree, 120 (34.5%) agree while 101
(29.0%) strongly agree. A high mean value of 2.67 indicated that more of the
respondents agree while a small standard deviation of 1.45 very close to the mean
indicated low variability of responses as more of the responses tends towards
agreement. Finally as regards provider availability as a factor, 105 (30.2%)
strongly disagree, 114 (32.8%) disagree, 73 (21.0%) agree while 56 (16.1%)
strongly agree. However, a low mean value of 2.23 indicated that more of the
respondents disagree while a small standard deviation of 1.37 very close to the
mean indicated low variability of responses as more of the responses tends
towards disagreement. Generally, a high overall mean value of 2.64 indicates that
these factors determine their participation.
62
Research question 3: What is the nature of men’s involvement in family
planning?
In order to answer the above research question, responses to items 6, 7, 8, 9, 10,
11, 12 were analysed and presented in table 4
Table 4:
Respondents responses to the nature of men’s involvement in
family planning
S/N
Items
1
I use contraceptive
method
I support my wife
to use a family
planning method
I decide in favour
of contraceptive
use and continuity
within the family
2
3
High extent
(4)
F
134
%
38.5
Moderate
extent
(3)
F
%
92
26.4
Low
extent
(2)
F
%
54
15.4
Very low
extent (1)
Mean ± SD
F
68
%
19.5
2.83 ± 1.53
64
18.4
70
20.1
88
25.3
126
36.2
2.21 ± 1.55
115
33.0
129
37.1
54
15.5
50
14.4
2.89 ± 1.38
4
I discuss family
planning freely
with my wife
59
17.0
66
19.0
113
32.5
110
31.6
2.21 ± 1.46
5
I accompany my
wife to the facilities
to obtain family
planning services
I give my wife
money for family
planning
Overall mean
68
19.5
33
9.5
117
33.6
130
37.4
2.11 ± 1.52
62
17.8
68
19.5
114
32.8
104
29.9
2.25 ± 1.46
6
2.42
n = 348
Table 4 shows that 68 (19.5%) of the men in these communities use contraceptive
methods to a very low extent, 54 (15.4%) use to a low extent. Whereas 92
(26.4%) use contraceptives moderately, 134 (38.5%) use it to a high extent. A
high mean value of 2.83 confirmed that they use contraceptives to a high extent
while the small standard deviation of 1.53 indicated that their responses did not
vary much. In other words, more of their responses tend towards a particular
63
direction (great extent).
The table also reveals that 126 (36.2%) of the
respondents support their spouse to use a family planning method to a very low
extent, 88 (25.3%) of them support their spouse to a low extent. Whereas 70
(20.1%) of the men do that moderately, 64 (18.4%) do that to a high extent. A
low mean value of 2.21 indicated that they give low support to their spouse to use
a family planning method while a small standard deviation of 1.55 indicates low
variability in the responses. This implies that more of their responses skewed
towards low extent. Decision making on contraceptive use and continuity within
the family are made by 50 (14.4%) of the respondents to a very low extent, 54
(15.5%) to a low extent, 129 (37.1%) to a moderate extent while 115 (33.0%) to a
high extent. A high mean value of 2.89 confirmed that they do that to a great
extent while a small standard deviation of 1.38 indicated low variability of
responses as many of them tend towards great extent. As regards discussing
family planning freely with spouse, 110 (31.6%) do so to a very low extent, 113
(32.5%) to a low extent, 66 (19.0%) to a moderate extent, while 59 (17.0%) do so
to a high extent. A low mean value of 2.21 indicated that they discuss family
planning freely with spouse to a low extent while a small standard deviation of
1.46 indicated low variability of responses as many of them tend towards low
extent. As regards accompanying spouse to the facilities to obtain family
planning services, 130 (37.4%) do so to a very low extent, 117 (33.6%) to a low
extent, 33 (9.5%) to a moderate extent, 68 (19.5%) to a high extent. A low mean
value of 2.11 indicated that they accompany spouse to a low extent while a small
standard deviation of 1.52 indicated low variability of responses as many of their
responses skewed towards low extent. Finally, 104 (29.9%) to a very low extent
give spouse money for family planning, 114 (32.8%) do so to a low extent, 68
64
(19.5%) to a moderate extent, 62 (17.8%) to a high extent. A low mean value of
2.25 indicated that they do that to a low extent while a small standard deviation
of 1.46 indicated low variability of responses as many of their responses skewed
towards low extent. An overall mean value of 2.42 indicates poor involvement
generally.
Research question 4: What method of family planning do men adopt mostly
in the communities studied?
In order to answer the above research question, respondents’ responses to item 12
were analysed and presented in Table 5.
Table 5:
Respondents responses to the methods of family planning
adopted mostly by men in these communities.
n = 160
Which of the following
family planning methods
do you use
Condom only
Vasectomy only
Withdrawal only
Both condom & withdrawal
Total currently using
Frequency
Percentages
38
21
57
44
23.8
13.1
35.6
27.5
160
100
Table 5 shows that out of 160 men who are currently involved in family planning,
38 (23.8%) use only condom, 21 (13.1%) use only vasectomy, 111 (31.9%) use
only withdrawal while 44 (27.5%) use both condom and withdrawal methods of
family planning.
Hypothesis Testing
Ho: There is no significant association between male involvement in family
planning
and
socio-demographic
occupation and religion).
variables
(age,
educational
level,
65
Table 6:
Assocation between men’s involvement in family planning
and their age
Age
Male involvement
Yes (%)
No (%)
24 (15.0)
60 (31.9)
37 (23.1)
38 (20.2)
99 (61.9)
90 (47.9)
160 (100.0)
188 (100.0)
30 - 39
40 – 49
50 & above
Total
Mean
P- value
13.706
< 0.001
Table 6 shows that there is a significant association between male involvement in
family planning and their age (mean =13.706, P-value = 0.001). The table also
reveals that 24 (15.0%) of the males who are involved in family planning are
within 30 and 39 years of age, 37 (23.1%) are within 40 and 49 years while 99
(61.9%) are 50 years and above. These figures show that males’ involvement
increases with age.
Table 7:
Association between male involvement in family planning and
their level of education
Level of education
Male involvement
Yes (%)
No (%)
No formal
12 (7.5)
42 (22.3)
Primary
6 (3.8)
36 (19.1)
Secondary
57 (35.6)
36 (19.1)
Tertiary
85 (53.1)
74 (39.4)
Total
160 (100.0)
188 (100.0)
Mean
P-value
41.615
< 0.001
Table 7 shows that there is a significant association between male involvement in
family planning and their level of education (mean = 41.615, P < 0.001). The
table also reveals that 12 (7.5%) of the males who are involved in family
planning have no formal education, 6 (3.8%) attained primary level of education,
57 (35.6%) attained secondary level while 85 (53.1%) attained tertiary level of
66
education. These figures show that males’ involvement increased as their level of
education increased.
Table 8:
Occupation
Farming
Trading
Public servant
Artisan
Total
Association between male involvement in family planning
and their occupation
Male involvement
Yes (%)
No (%)
18 (11.3)
60 (31.9)
32 (20.0)
30 (16.0)
104 (65.0)
92 (48.9)
6 (3.8)
6 (3.2)
160 (100.0) 188 (100.0)
Mean
21.300
P - value
< 0.001
Table 8 shows that there is a significant association between male involvement in
family planning and their occupation (Mean = 21.300, P-value <0.001). The table
also reveals that 18 (11.3%) of the males who are involved in family planning are
farmers, 32 (20.0%) are traders, 104 (65.0%) are public servants while 6 (3.8%)
are artisans. These figures show that majority of the males involved are public
servants, followed by traders while few are farmers and artisans.
Table 9:
Religion
Christianity
Moslem
Traditional
Total
Association between male involvement in family planning and
their religion
Male
involvement
Yes (%)
No (%)
148 (92.5) 158 (84.0)
12 (7.5)
6 (3.2)
0 (0.0)
24 (12.8)
160
188 (100.0)
(100.0)
Mean
P - Value
24.231
< 0.001
Table 9 shows that there is a significant association between male involvement in
family planning and their religion (Mean = 24.231, P-value <0.001). The table
also reveals that 148 (92.5%) of the males who are involved in family planning
67
are Christians, 12 (7.5%) are Moslems while none are traditionalists. These
figures show that most of the males involved are Christians.
Decision rule:
Since the P- values of the chi square statistic are less than 0.05 level of
significance, for each of the socio-demographic variables tested, we reject the
null hypothesis and accept the alternative. Therefore, there was a significant
association between male involvement in family planning and socio-demographic
variables (age, educational level, occupation and religion).
Summary of Findings
•
The findings from the study were summarized under the following
paragraphs:
•
Majority of the men are 50 years and above (54.3%), while 45.7%
attained tertiary level of education. Majority of them are public servants
(56.3%), followed by farmers (22.4%) and they are predominantly
Christians (87.9%).
•
Findings from the study show that (46%) of the men are involved in
family planning. High mean values of 2.83 and 2.89 indicated that the
men make use of contraceptives to a high extent. While low mean
response values of 2.21, 2.11 and 2.25 indicates that the men do the
following to a low extent: support their spouse use family planning
method, discuss family planning freely with spouse, accompanying
spouse to the facilities to obtain family planning services and give spouse
money for family planning. An overall mean value of 2.42 indicates low
involvement generally.
68
•
Family planning methods mostly used by the men include: Condom
(23.8%), Vasectomy (13.1%), withdrawal (35.6%) and a combination of
condom and withdrawal methods (27.5%). Factors such as Inadequate
knowledge, lack of many contraceptive options for men, poor IEC,
religious beliefs, culture, economic concern and spousal influence were
found to be determinants of men’s participation in family planning. This
was indicated by high mean response values ranging from 2.61 to 3.10.
Whereas, low mean values of 2.49 and 2.23 indicated that lack of
exclusive family planning facilities for males and provider availability
were insignificant factors. An overall mean of 2.64 confirmed these
results
•
Finally from the findings, a significant association was found between
male involvement in family planning and socio-demographic variables
such as age, educational level, occupation and religion (P<0.05).
69
CHAPTER FIVE
Discussion of Findings
This
chapter
presents
discussion
of
findings,
summary,
conclusions,
recommendations, limitation of study and suggestion for further research.
Discussion of major findings
Major findings were discussed based on objectives and empirical review.
Objective 1: To determine the percentage of men who get involved in
practicing family planning in the communities studied.
The result revealed that men involved in practicing family planning are 46%.
This implies that les than half of the respondents practice family planning in the
communities. The findings agree with those of studies done in male involvement
in family planning by Hossain, (2003) in Bangladesh where it was found that the
rate of male participation in family planning is low (40%). However, this varies
with the study in India, 65.9% of the males got involved in family planning (Puri
et al., 2010). Also in Port Harcourt 58% practiced family planning (Olawepo and
Okedare, 2006).
Objective 2: To identify factors that affect men’s involvement in family
planning in these communities.
Results also revealed that the men were of the opinion that the following factors
affect men’s’ involvement in family planning. They are: inadequate knowledge,
lack of many contraceptive options for men, poor IEC, religious beliefs, culture,
economic concern and spousal influence. In conformity, with Nustas, (1999)
found in Jordan that spousal influence is a significant factor. He concluded that
men who are practicing family planning are twice the number who has never
discussed contraception with their wives. Similarly Akafuah and Sossou, (2008)
70
found that communication between spouse is associated with contraceptive use.
According to Hossain, (2003), the difference in family planning practice between
men in the urban and rural areas indicates easier availability of some
contraceptive options in the urban areas. The study was in conformity with
studies done in Tanzania, Bouce et al., (2007) revealed that economic hardship
was the most frequently mentioned reason for vasectomy acceptance among men.
Similarly, in Jordan, Bunce et al., (2007) found that economic considerations
were the main reason for using a family planning method. The findings also agree
with studies in Tanzania showed that men’s involvement in family planning
varied by religious denominations. Similar findings was obtained by Grillo,
(2009) some men in Tanzania maintain certain myths about family planning
methods. For instance, they were of the opinion that vasectomy impairs sexual
functions; hence they do not practice the method.
Objective 3: To identify the nature of men’s involvement in family planning
The results showed that 24.7% of the males use contraceptives to a high extent
while 35.3% make decisions favourable on contraceptive use and continuity
within the family. However, just few support their spouse to use a family
planning method, discuss family planning freely with spouse, accompanying
spouse to the facilities to obtain family planning services and give spouse money
for family planning. This shows a low level of contraceptives use among males in
the communities. The finding is not in conformity with Hossain, (2003), who
found 62.6% prevalence rate of contraceptive use among males in turkey, but the
findings of the study was in conformity with Sabir et al., (2003) also found that
in Bangladesh, males decide the adoption of family planning in their families.
Similar findings were obtained in a study in Zimbabwe (Onuoha, 2000). This is
71
also in conformity to the findings in the study, Khanna and Van (1998) found that
males show little or no support to their wives in family planning matters.
Objective 4:
To identify methods mostly adopted by men in the
communities studied.
Results showed that the commonest family planning methods used were
withdrawal, condoms and vasectomy among the males in the communities. The
findings are in line with the studies done in Chandigarh India, 31% of the males
use condoms (Puri et al., 2010). Similar in Indonesia, low use rate of vasectomy
(3.4%) was also recorded (Leke, 2010). Hossain (2003) found withdrawal method
to be the most popular in Turkey but with a low rate of use (26.2%). Similar
findings were also obtained in a study in Ilorin also showed that vasectomy and
withdrawal are among the least known or used methods of family planning
(Olawepo and Okedare, 2006).
Hypothesis testing :Socio-demographic variables such as age, educational level,
occupation and religion are significantly associated with male involvement in
family planning. The findings showed that their involvement increased with age
and educational level. A greater number of the men attained tertiary level of
education which explains why a greater number of public servants were more
involved in the practice. Also, majority of them who are involved are Christians.
This is in line with Bounce et.al., (2007) who found that religious beliefs and
denominations are significantly associated with use of family planning methods
among men in Tanzania. Similarly, Puri et al (2010), examined the effect of
knowledge on use and found a 70% increase in use after intervention in India.
72
Summary of the study
The main purpose of the study was to determine men’s involvement in family
planning in some selected rural communities in Enugu East Local Government
Area.
The specific objectives were to identify percentage of men who get
involved in practicing family planning, define the nature of men’s involvement
in family planning, identify methods mostly adopted by men, and to identify the
factors that affect men’s involvement in family planning in these communities.
The study answered four research questions and tested a hypothesis. Relevant
literatures were reviewed and health belief model was used to anchor the study.
A systematic random sampling was used to select a sample of 360 married men
from Nkwubor, Ugwuomu and Obinagu Omugba communities.
adopted a cross sectional descriptive survey design.
The study
Instrument for data
collection was researcher developed questionnaire which was also use as
interview guide for the illiterate ones.
The questionnaire was validated by experts after which 30 of them were
administered for a pilot study and subjected to test retest reliability analysis.
Data were analysed using descriptive such as frequencies, percentages, means
and standard deviation for answering research questions. All analysis was done
using statistical package for social sciences (SPSS) version 17. An inferential
statistics which include chi-square analysis was used for testing the hypothesis at
0.05 level of significance.
The findings of the study showed that less than half of the respondents get
involved in practicing family planning in the communities. Majority of the men
73
are only involve in using contraceptive and making decision on contraceptive use
within the family. They adopted withdrawal method of family planning more
followed by condom. Various factors such as Inadequate knowledge, lack of
many contraceptive option for men, culture, religious beliefs and poor
information, education and communication affect male involvement in family
planning. A significant association was found between male involvement in
family planning and socio demographic variables (age, educational level,
occupation, and religion). Therefore recommendation were made to improve
male involvement in family planning, adequate information, education,
communication must be employed to increase awareness reduce various
inadequate knowledge and more male contraceptive option should be promoted
as well as made available.
Implication of the study to nursing practice
The result of this study found that less than half of the respondents in the rural
communities get involved in practicing family planning. Therefore to improve
men’s involvement in family planning, adequate information, education and
communication through health education sessions on family planning methods
and benefits must be employed by nurses to increase awareness, acceptance and
practice: on the males at various men’s forum such as Igwe’s cabinet/age grade
meetings and men’s religious organization. This is to enable them have correct
information and knowledge about family planning pbecause they are the major
decision makers who control power and authority at household level especially
within the rural communities. While on the women, at various immunization and
74
postnatal clinics as spousal influence has been found as one of the determining
factor to male involvement.
Also more male options should be promoted as well as made available by the
nurses as service providers. There should also be improved nurses’ availability
and reputation as this positively affects involvement in family planning. Nurses
as service providers should be available and accessible to clients to avoid
confusion as to when providers can be seen at service areas especially in the rural
communities. The nurses should be permanently stationed or have scheduled
days and time that will suit men provided services.
Conclusion
From the study the following conclusions were made:
•
From the foregoing, this study has been able to examine male’s
involvement in family planning in some selected rural communities in
Enugu East Local Government Area.
•
The study has shown generally that men’s participation in family planning
is poor especially in the rural areas. Among these participants, use of
contraceptives was common.
•
Methods of family planning such as withdrawal, use of condoms and
vasectomy were mostly adopted by men who are involved in family
planning.
•
Probably because these are popular options available to them. However,
majority of them do not support their spouses to get involved in any
family planning method.
75
•
Various factors such as Inadequate knowledge, lack of many
contraceptive options for men, poor IEC, religious beliefs, culture,
economic concern and spousal influence were found to be determinants of
men’s participation in family planning.
•
Therefore to improve men’s involvement, adequate IEC must be
employed to increase awareness and more male options should be
promoted as well as made available.
•
This study has also confirmed to the fact that socio-demographic variables
such as age, educational level, occupation and religion are significantly
associated with men’s involvement in family planning. Their sociodemography determined to a significant extent their level of participation
and methods used.
Recommendations
In view of the findings of this study, the following recommendations were made:
•
Efforts should be made by the Federal Ministry of Health and other
stakeholders to organize training and intervention programmes to create
awareness on family planning, its methods and benefits.
•
Government should through the ministry of health make policies that will
improve men’s participation to help control the population in the country
so that available resources can go round.
•
More family planning options should be made available to men in the
rural areas to increase their level of participation.
•
Since this situation could be worse at the periphery and among the rural
areas, it is recommended, therefore, that efforts should be made to
76
improve family planning practices, through improved educational
measures at the medical centres and hospitals; focused policies including
non-government organizations.
Limitations of the Study
The limitations during the execution of this study were:
•
This study was carried out in only three communities in Enugu, hence
cannot be generalized for the whole country.
•
Other constraints such as lack of funding and time available for the
research limited the study.
Suggestions for further studies
The following areas were recommended for further research.
i) Effect of health education on male involvement in family planning.
ii) Male involvement in family planning in Enugu metropolis.
77
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Hossain, K. J. (2003). Male involvement in family planning in Bangladesh:
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Khan, M.E and Patel, B. C. (1997). Male involvement in family planning. Male
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progress/47/new/47/-1 en. Html Retrieved on 20/11/2010.
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81
APPENDIX I
Sample of the Questionnaire for Data Collection
Department of Nursing Sciences
University of Nigeria
Enugu Campus.
Dear Respondent,
I am an M.Sc student of the above Department conducting a research study on the
topic: Male involvement in family planning in some selected rural
communities in Enugu East Local Government Area in Enugu State for my
dissertation.
This research work is purely for academic purpose. You are therefore, requested
to participate in this study. Please spare few moments to complete the
questionnaire as honestly and carefully as it applies to you.
Your answer on each question will be highly appreciated and confidentiality is
assured and your names are not required.
Thanks for your anticipated co-operation
Ukeagu N. C.
82
Section A: (Socio – demographic data)
Tick [√] in the correct option in the box provided.
1.
What is your age range?
a)
b)
c)
d)
2.
]
]
]
]
No formal education
Primary education
Secondary education
Tertiary education
[
[
[
[
]
]
]
]
What is your occupation
a)
b)
c)
d)
4.
[
[
[
[
What is your level of education?
a)
b)
c)
d)
3.
20 – 29
30 – 39
40 – 49
50 and above
Farming
Trading
Public servant
Artisan (plumber, electrician)
[
[
[
[
]
]
]
]
What is your religion?
a)
b)
c.
d.
Christianity [ ]
Islam
[ ]
Traditional religion [ ]
Any other please specify …………………………………….
83
Section B
5.
Do you get involved in Family Planning matters in your home?
a)
Yes
[]
b)
No
[]
If `Yes’, to what extent are you involved in these ways of family planning?
_____________________________________________________________
Instructions for Questions 6 - 11
Please respond to each of the following statements by ticking in the
column that best indicated the extent to which the statement applied to you.
The response format is as follows:
HE
ME
LE
VLE
S/N
High Extent (4)
Moderate Extent ( 3 )
Low Extent (2)
Very Low Extent (1)
Description
6
7
I use conceptive method
I supporting my wife use a family
planning method
I decide positively on contraceptive
use and continuity within the
family
I discuss family planning freely
with my wife
I accompany my wife to the
facilities to obtain family planning
services
I give my wife money for family
planning
8
9
10
11
HE
(4)
ME
(3)
LE
(2)
VLE
(1)
12.
What is the nature of your involvement in family planning. Tick good to
indicate whether you practice or do not practice each of the underlisted items
Yes No
a)
b)
c)
d)
e)
f)
Use of family planning method
Support wife use of family planning method
Decide positively on contraceptive use
Discuss family planning freely with wife
Accompanying wife for family planning
Give wife money for family planning
84
13.
Which of the following family planning method do you use?
a)
b)
c)
Condom
vasectomy
withdrawal
[ ]
[ ]
[ ]
Instructions for Questions 14 - 22
Please respond to each of the following statements by ticking in the
column that best indicates your opinion about the following factors that affects
your involvement in family planning. The response format is as follows:
SA
A
D
SD
-
Strongly Agree (4)
Agree ( 3 )
Disagree (2)
Strongly Disagree (1)
SA
4
14
15
16
17
18
19
20
21
22
How do you agree to the following as
factors that affect your involvement in
family planning.
Inadequate knowledge
Lack of many contraceptive options
for men
Lack of exclusive family planning
facilities for males
Poor IEC
Religious beliefs
Culture
Economic concern
Spousal influence
Provider availability
A
3
D
2
SD
1
85
APPENDIX II
INFORMED CONSENT FORM
I am a post graduate student of Department of Nursing Sciences, Faculty of
Health science and technology, College of Medicine University of Nigeria Enugu
campus.
Voluntary Nature of participation: - Respondent’s participation in this study is
purely voluntary. You have the right to withdraw your consent and discontinue
participation in the study at any given time.
Study procedure: I am carrying out an Assessment of male involvement in
family planning in some selected rural communities in Enugu state. In this study,
you will be required to fill the interview guide. Please feel free to ask for
clarification on any question you do not understand.
Risk: The process of filling the interview guide will not cause you any harm.
Confidentiality: Please note that any information you give will be kept
confidential. Your name will never be used in connection with any information
you give.
Feedback : In case of any clarification you can contact me via this phone number
07069750089.
Response : The study has been explained to me and I finally understood the
details of the study process.
------------------
------------------------
Signature of participant
Signature of witness
-------------------Date
-----------------------Date
------------------------Signature of Researcher
------------------------Date
86
APPENDIX III
Showing the population size of different communities and proportion
studied.
Community
Population Size
Proportion to be Studied
Nkwubo
1440
156
Obinagu-onuogba
1160
126
Ugwuomu
720
78
Total
3320
360
To statistically determine the number to be selected from each of the
communities:Community proportion
community size
to be studied
=
total population
Nkwubo
=
1440
3320
Obinagu Onuogba
Ugwuomu
=
=
X
1
360
X
1160
1
=
156
=
126
360
3320
X
720
X
3320
sample size
1
360
1
=
78
87
APPENDIX IV
Determination of sample size with total population
Yaro Yamane formula for a finite population. The formular is given as:
n
=
N
1 + N (e)2
(Uzoagulu, 2010)
Where
n
=
the sample size
N
=
the finite population
e
=
level of significance or ( limit of tolerable error)
I
=
unit (a constant),
n
=
3320
1 + 3320 (0.05)2
=
359.5
Sample size
= 360