FEATURE STORY

Men in Pakistan Want Fewer Children, Eager to Learn More About Family Planning

April 21, 2014

STORY HIGHLIGHTS
  • In 1950, the average Pakistani woman had more than 6 children. This has dropped to a little over 3 but has stalled in recent years.
  • Men show increasing interest about family planning and contraception due to the financial challenges of raising large families.
  • Interventions should be backed up by an improvement in the supply of contraceptives and availability of family planning services in accessible facilities.

In 1950, the average Pakistani woman had more than 6 children. This has dropped to a little over 3 but has stalled in recent years. Could greater involvement of men be the solution?

While healthcare systems have numerous opportunities for women to discuss family planning (e.g. antenatal care, deliveries, mother-and-child health services), far fewer opportunities exist for men. A recent study in Pakistan carried out by the Population Council with funding from the World Bank through the Bank-Netherlands Partnership Program (BNPP) found that men indeed want fewer children and are eager to receive technical information about family planning.

The study explored couples’ decision making processes regarding family size and contraceptive choices. It also looked at community perceptions of male-focused family planning interventions and men’s suggestions for future intervention strategies. 

The qualitative study took place in four districts in Punjab, Pakistan and consisted of focus group discussions with men and in-depth interviews with couples. Data from existing quantitative baseline and surveys in the same area were also reanalyzed to assess the impact of male-directed interventions on fertility intentions and behavior.

Key findings include:

Changes in men’s attitudes towards family planning: The study points to a real change over the last two decades in men’s attitudes towards family planning and their readiness to be involved increased access to information and services. As primary breadwinners and household decision-makers, their motivating force is meeting the needs of expenses. More children incur greater expenses.

Increasing spousal communication aids decisions on fertility issues: Economic concerns also stimulate communication between husbands and wives on family size and contraceptive use. Although there may be a divergence in opinion on ideal family size and contraceptive use or choice of method, increasing spousal communication makes it easier for women to convince their husbands about the need for family planning.

Supply side issues impede men from using contraceptives: The lack of availability of family planning services and contraceptive methods, method failure, and costs impede men from using contraceptives, despite their increasing acceptance of family planning. In addition, limited knowledge of specific family planning methods, perceived or experienced side effects of modern methods, and lack of provider skills for managing side effects, also act as barriers,.

Demand for male-focused interventions: The study shows strong interest among men in family planning programs. Male group meetings are suggested (both by men and women) as the most appropriate intervention for providing men with method-specific knowledge. A suggested male group meeting strategy includes involving local persons to organize meetings and an educated and skillful outsider (preferably a doctor) to conduct them. The strategy also includes immediate provision of contraceptives after the meeting so men who want to start using contraception are not delayed.

Women favor involving religious leaders as an intervention more than men: The study showed mixed opinions on involving religious leaders in family planning programs, with women more in favor than men. Those in favor of involving religious leaders suggest that they be trained and discuss family planning with reference to the Quran and Hadith. This suggests that religious leaders can play a supportive role by communicating and endorsing the message that family planning is permitted in Islam.

The role of the media is limited: Men were generally less supportive than women of the role of broadcast media in communicating family planning messages. This is primarily due to the impression that providing details on contraceptive methods is inappropriate for television because they cannot be viewed in the presence of other family members (i.e. elders, children).

Demand for male health workers: Appreciating the role and effectiveness of the government’s Lady Health Worker program, men suggested recruiting male health workers in communities, with roles similar to Lady Health Workers, providing services to men at the community level.

Conclusion

Men show increasing interest about family planning and contraception due to the financial challenges of raising large families. This concern has increased spousal communication about family size and contraceptive use. The next step is to effectively translate intention into practice. Supply side issues are the main factors hindering couples’ adoption of family planning and must be addressed. In addition, men’s positive attitudes and their readiness to be involved in family planning programs suggest it is an ideal time for direct health interventions for men in Punjab. A focused effort to mobilize men through male-specific interventions is likely to increase the demand for contraceptives. However, these interventions have to be backed up by an improvement in the supply of contraceptives and availability of family planning services in accessible facilities.

Recommendations

  • Make men a primary focus of family planning programs in Punjab. Male-specific interventions should be introduced to augment men’s lack of knowledge of family planning methods, encourage timely decisions on fertility issues, and increase contraceptive use.
  • Initiate male group meetings with full geographic coverage, facilitated by a local or community resident and conducted by an ‘outsider’ health professional (preferably a doctor). To minimize delay in contraceptive uptake, contraceptives should be made available at the end of these meetings.
  • Train religious leaders to deliver messages communicating that birth spacing and family planning are allowed in Islam.
  • Ensure regular supplies to clients in order to decrease supply-side barriers to family planning use.
  • Service providers should be knowledgeable and skillful, and trained on managing side effects to increase and sustain family planning use.