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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2016  |  Volume : 13  |  Issue : 3  |  Page : 112-116

The influence of male partners on contraceptive usage in sub-Saharan Africa-Lagos experience


1 Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria

Date of Web Publication4-Jul-2016

Correspondence Address:
Omololu Adegbola
Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, PMB 12003, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2468-6859.185247

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  Abstract 

Background: Family planning programs, researches, and studies have focused mainly on women with little attention to men's role in the contraceptive choices by the couple. Men's exclusion from these programs has serious implications on the acceptance and use of contraceptives by the couple. Objective: To determine the influence of male partners on contraceptive use of their spouses. Subjects and Methods: This was a cross-sectional descriptive study at a Tertiary Care Centre in Lagos, Nigeria. It was conducted from January 1 to April 30, 2010, where all consecutive consenting pregnant women were given structured questionnaires to give to their partners so as to evaluate the contribution of the male partners to contraceptives use in their spouses as well as assess their awareness and knowledge of contraception. Categorical variables were analyzed using Chi-square test or Fisher's exact test as appropriate while continuous variables by t-test. P < 0.05 was considered significant. Results: Of the 370 respondents, only 51.9% (192) knew about female contraceptive methods, while 50% (185) were willing to allow their wives to use contraception. Barrier method (17.3%) and periodic abstinence (15.7%) were the leading preferred choice for their wives. However, bilateral tubal ligation was the least preferred method (1.6%). Previous counseling of male partner significantly influenced their decision to allow their wives to use contraceptives (P = 0.001). Conclusion: Involving the male partner in family planning counseling plays an important role in increasing the acceptance and use of contraceptives by the couple.

Keywords: Contraceptive use, male partner influence, family planning


How to cite this article:
Adegbola O, Habeebu-Adeyemi FM. The influence of male partners on contraceptive usage in sub-Saharan Africa-Lagos experience. J Clin Sci 2016;13:112-6

How to cite this URL:
Adegbola O, Habeebu-Adeyemi FM. The influence of male partners on contraceptive usage in sub-Saharan Africa-Lagos experience. J Clin Sci [serial online] 2016 [cited 2019 Oct 20];13:112-6. Available from: http://www.jcsjournal.org/text.asp?2016/13/3/112/185247


  Introduction Top


Contraception has been established in maternal and child health promotion by fertility control. [1] The indications for contraceptive usage, the different methods, their risks, and side effects are well known, [2],[3] although it is assumed that women are primary decision makers in their contraceptive choices and had been used in contraceptive usage measurements. It is becoming obvious that their partner plays an important role in decision making regarding contraceptive use, choice of method, timing, and number of intended children. [4],[5]

In some societies, the male partner has greater influence than his spouse. [6] In Ghana, the attitude of a woman toward contraception is greatly influenced by her husband's attitude and education but his views are not similarly influenced by his wife. [7] In El Salvador, contraceptive usage is influenced by the husband's knowledge and status, [8] whereas in Taiwan, when couples disagree over when to have another child, the wife's decision tend to prevail. [9]

In developing countries, the female-only approach in promoting family planning has not only been criticized, but has also led to suspicion by the men as not only undermining their autonomy but also encouraging sexual promiscuity. [5] Husband and partners have been shown to contribute significantly to the use and choice of postpartum contraceptives. [5],[10]

Failure in involving men in family planning programs can hamper the contraceptive use of women even if they are educated and motivated because of opposition from their husbands. [11]

This has led to some researchers questioning the validity of the estimates of unmet need of contraception derived from data collected solely from women. [12]

There is a wide gap between awareness and usage of contraception [1],[5],[13] and one of the reasons adduced is the partner's objection. [5] The partner has a major influence on the choice of contraception by a couple. [5] Bearing all these in mind, this study was designed to evaluate the influence of the male partners in the decision to use contraceptives as well assess their awareness and knowledge of contraception.


  Subjects and methods Top


This was a cross-sectional descriptive study to evaluate the contribution of the male partners in the decision to use contraceptives and choices of contraceptive method by their spouse. It also assessed the male partners' awareness and knowledge of contraception. The study was conducted at the Lagos University Teaching Hospital from January 1 to April 30, 2010. During this period, all consecutive consenting pregnant women at booking or subsequent antenatal clinic visits were given structured questionnaires (which also explained clearly the purpose of the study) to give their male partners to fill after the study was explained to them and also implored them to explain to their partners. If the male partners agreed to be included in the study, they were required to sign consent forms and subsequently fill the questionnaire. The filled questionnaires were subsequently brought back by the wife to the clinic for analysis. Those questionnaires not signed were discarded; it was taken as consent not given. The women who came with their male partners to the clinic had the questionnaires administered to their male partners after explanation was done and consent signed. This was so because it is not the norm for the spouse to attend antenatal clinic with their male partners in this part of the world. [13] The structured questionnaire included sections on sociodemographic characteristics, reproductive history, actual practice of contraceptive methods, knowledge and awareness of contraceptive methods, reason for choice, factors influencing their intention, and the intended contraceptive choice they will prefer their wives to use. One thousand structured questionnaires were given out, but 410 questionnaires were returned, while 370 had signed consent and were completely answered and these were the ones analyzed. The criteria used in defining socioeconomic class in this paper are as earlier published. [3] The data were analyzed using Epi Info version 3.5.3 centers of disease control and prevention Atlanta, USA. Categorical variables were analyzed using Chi-square test or Fisher's exact test as appropriate while continuous variables were analyzed using t-test. A P < 0.05 was considered as significant.


  Results Top


A total of 370 questionnaires were completely answered, the mean age of the 370 respondents was 36.5 ± 5.8 years (range 21-60 years). As shown in [Table 1], 362 (97.8%) were married with mean duration of marriage being 4.7 ± 4.5 years (range 0.1-27 years). Majority of the respondents were of the Yoruba tribe, 162 (43.8%) whereas only one respondent (0.3%) had no formal education. Twenty-four (6.5%) formed a sect of respondents who went to learning institutions such as technical colleges and secretarial studies, as shown in [Table 1]. Two hundred and ninety-five (79.7%) of the respondents were Christians of different denominations with Protestants 123 (33.2%) being the majority, 65 (17.6%) were Muslims, while others including atheists, traditional religion made up the remaining 10 (2.7%). Fifteen (4%) of them were married to two wives, 1 (0.3%) had three wives whereas the other 354 (95.7) had only one wife. One hundred and fifty-six (42.2%) were in social Class 2; 103 (27.8%) in social Class 3; 65 (17.6%) in social Class 4; 25 (6.8%) in social 5; and 21 (5.6%) in social Class 1.
Table 1: Respondents age, marital status, ethnic group, and educational level (n=370)

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[Table 2] shows the respondents' knowledge of contraception. Three hundred and thirty-one (89.5%) had heard about contraception. [Table 3] showed respondents' awareness of female contraception and those whose wives or themselves had used contraception. One hundred and seventy-nine of the couples (48.4%) had used contraceptives before with condom being the most common method used.
Table 2: Respondents knowledge of contraception (n=370)

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Table 3: Respondents awareness of female contraception, respondents, and spouses' previous use of contraceptives (n=370)

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Two hundred and twenty-one (59.7%) respondents intended using contraceptives in the future, while 128 (34.6%) were not interested. However, 21 (5.7%) were yet to decide. The various reasons given for lack of interest in using contraceptive included personal opinion, against religious belief, desire for more children, spouse opposition, friends, and colleague frown at it, it encourages promiscuity while some others gave reasons such as health and side effects.

One hundred and eighty-five (50.0%) of the respondents want their wives to use contraception, which included 148 (50.1%) of the 295 Christians and 30 (46%) of the 65 Muslims. There was no statistically significant difference between respondents who want their wives to use contraceptives and those against it with respect to age, religion, and level of education (P > 0.05%).

[Table 4]a shows respondents preferred method of contraception for their wives. The most preferred form of contraceptive method intended to be used by their wives was barrier method 32 (17.3%), while the least form preferred was bilateral tubal ligation 3 (1.6%). Thirty-one (16.8%) of them was yet to decide the type of contraceptive they intend using. The reasons for their choice for their spouses were also indicated.
Table 4:

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[Table 4]b shows the respondents opinion on contraception. One hundred and twenty-two respondents (33%) believed contraceptives reduce the chances of having children, while 134 (36.2%) believed they reduce sexual pleasure.

One hundred and forty-five respondents (39.2%) had previous counseling on contraception, with 93 (64.1%) of these being counseled by a doctor or nurse, 16 (11.1%) by friends, 9 (6.2%) by spouse, while the others, 27 (18.6%) got their counseling from clerics, in-laws, and other relatives. Two hundred and twenty-five respondents (60.8%) had no previous counseling.

[Table 5] shows the association between previous counseling of respondents and their acceptance of their wives use of contraception. Of the 145 respondents that had counseling, 110 (75.9%) would want their wives to use contraception while 75 (33.3%) of the 225 respondents with no previous counseling would want their wives to use contraception. There was a significant association between respondents' previous counseling on contraception and acceptance of wife's use of contraception (P = 0.001).
Table 5: Association between previous counseling of respondents and their acceptance of their wives use of contraception

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  Discussion Top


The awareness of contraception among the male partners was 89.5% which is remarkably high and comparable to 83% in another study also in Lagos, Nigeria. [5] However, despite this high awareness, only 51.9% were particularly knowledgeable about female contraception. The fact that only 48.4% of the couple had ever used contraceptives is also indicative of the wide gap between awareness and use of contraceptives that had earlier been reported. [1],[5],[13]

It was noted that <50% of these male respondents had their information about contraceptives from health care providers and majority had to depend on mass media for such information. It is necessary that misconceptions about contraceptives be addressed and corrected by proper and adequate information and counseling as well as giving the male partners the opportunity to ask questions and express their fears in an appropriate and conducive environment. This interactive atmosphere is essentially feasible in family planning clinics if the male partners are present during the counseling session.

Only 50% of these men are willing to allow their wives to use contraceptives irrespective of their age, religion, and educational level. This emphasizes the need to involve the male gender in decision making concerning contraceptive use. This is particularly important in developing nations where the men play predominant roles in family decision. [4],[14]

The barrier method was the most preferred contraceptive method for the respondents' wives (17.3%); this is similar to other studies. [5],[15] The least preferred method was bilateral tubal ligation. One hundred and forty-five (39.2%) of the 370 respondents have actually been counseled on contraceptive use and this may have influenced them in willing to allow their partner to use contraceptives as 75.9% of this group were willing to allow their wives use contraceptive compared to 33.3% in those who were not counseled and this was statistically significant (P = 0.001). This shows that male involvement in family planning programs coupled with appropriate education about contraception will boost and motivate contraceptive usage by the couple.


  Conclusion Top


The attitude of men toward the use of contraceptives by their wives is generally positive and the male partners' influence in the contraceptive use of their wives in the developing countries is no longer in doubt. It is therefore needful to incorporate the male partners in contraceptives counseling to improve usage and ultimately ensure reduction in maternal mortality by preventing high risk pregnancies as well as achieve a healthy mother, family, and society.

Limitation of the study

The questionnaires not returned for analysis may have affected the result of the study, if available.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Oye-Adeniran BA, Adewole IF, Umoh AV, Oladokun A, Gbadegesin A, Ekanem EE, et al. Community-based study of contraceptive behaviour in Nigeria. Afr J Reprod Health 2006;10:90-104.  Back to cited text no. 1
    
2.
Kumar P, Malhotra N. Contraception. In: Kumar P, Malhotra N, editors. Jeffcoates Principles of Gynaecology. 7 th ed. New Delhi: Jaypee Brothers Medical Publishers Ltd.; 2008. p. 784-823.  Back to cited text no. 2
    
3.
Adegbola O, Ogedengbe OK. The acceptance rate of intrauterine contraceptive device (IUCD) amongst family planning clinic users in Lagos University Teaching Hospital (LUTH). Nig Q J Hosp Med 2008;18:175-80.  Back to cited text no. 3
    
4.
Kulczycki A. Husband-wife agreement, power relations and contraceptive use in Turkey. Int Fam Plan Perspect 2008;34:127-37.  Back to cited text no. 4
    
5.
Adegbola O, Okunowo A. Intended postpartum contraceptive use among pregnant and puerperal women at a university teaching hospital. Arch Gynecol Obstet 2009;280:987-92.  Back to cited text no. 5
    
6.
Lasee A, Becker S. Husband- wife communication about family planning and contraceptive use in Kenya. Int Fam Plann Persp 1997;23:15-20.  Back to cited text no. 6
    
7.
Ezeh AC. The influence of spouses over each other′s contraceptive attitudes in Ghana. Stud Fam Plann 1993;24:163-74.  Back to cited text no. 7
    
8.
Newmann SJ, Goldberg AB, Aviles R, Molina de Perez O, Foster-Rosales AF. Predictors of contraception knowledge and use among postpartum adolescents in El Salvador. Am J Obstet Gynecol 2005;192:1391-4.  Back to cited text no. 8
    
9.
Coombs LC, Chang M. Do husbands and wives agree? Fertility attitudes and later behavior. Popul Environ 1981;4:109-27.  Back to cited text no. 9
    
10.
Barber SL. Family planning advice and postpartum contraceptive use among low-income Women in Mexico. Int Fam Plann Persp 2007;33:6-12.  Back to cited text no. 10
    
11.
Khalifa MA. Attitude of urban Sudanese men towards family planning. Stud Fam Plann 1988;19:236-43.  Back to cited text no. 11
    
12.
Dodoo FN. A couple analysis of micro level supply/demand factors in fertility regulation. Popul Res Policy Rev 1993;12:93-101.  Back to cited text no. 12
    
13.
Ikiaki CU, Ekabua JE, Abasiattai A, Bassey EA, Itam IH. Spousal communication in contraceptive decisions among antenatal patients in Calabar, South Eastern Nigeria. Niger J Med 2005;14:405-7.  Back to cited text no. 13
    
14.
Bankole A, Singh S. Couples fertility and contraceptive decision-making in developing countries, hearing the man′s voice. Int Fam Plann Persp 1997;24:15-24.  Back to cited text no. 14
    
15.
Ogbonna C, Pam IC. Postpartum contraception: A study of a cohort of nursing mothers in Jos University Teaching Hospital, Jos, Plateau State. Nig Q J Hosp Med 1999;9:293-5.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Subjects and methods
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