In Pakistan’s essentially patriarchal society, men’s views and opinions on subjects such as the ideal family size, spacing between births, and methods to be used for contraception have a strong impact on women's expectations and attitudes. With that in mind, it is indeed surprising that men have generally been less involved in both receiving as well as providing information on sexual and reproductive health. When it comes to family planning (FP), public health professionals the world over have been assiduously promoting the involvement of men as a critical ingredient for ensuring success of any FP program, yet in Pakistan male engagement in family planning remains an elusive reality.
Is Family Planning Only a Woman’s Job?
Though reproduction involves both men and women equally, family planning has traditionally been seen as the sole responsibility of women. Men, as decision makers, have greater say than women in matters such as when to start a family and the number of children to have. This means that women's capacity to enforce contraceptive use is very limited. Particularly when couples are discussing family planning, gender differences and the unilateral power exercised by husbands provide men with greater control in making decisions.
At the same time, it is women who are targeted by policy interventions. Family planning programs typically provide women and girls with information and messaging. This places them in a position where, while equipped with knowledge, they find themselves lacking the power to seek family planning services and the means to pay for them.
How do Gender Norms and Misconceptions Affect Male Engagement in Family Planning?
Gender norms — rules or standards in a society that form and control the acceptable behavior of men and women – influence the sexual and reproductive health of a woman. These gender norms idealize sexual ignorance for women, sexual power for men and affect men's acceptance of overall family planning, specifically of contraceptive options. In a patriarchal setup like the one prevalent in Pakistan, a son is always the preference of families. Moreover, the number of children, especially sons, are taken as a symbol of virility in men. This results in a state of affairs where women become pregnant repeatedly and keep on producing as many children as possible, in the hopes of having more sons.
Another problem associated with family planning is the usage of contraceptives by men. The use of contraceptive methods by men is surrounded by false myths and misconceptions. Misinformation and negative stereotypes or beliefs like the use of contraception makes men less "manly" or the use of contraception leads to infertility, creates a barrier to the access and use of contraceptives. These false beliefs may reduce the use of contraceptives by men and lead to the failure of Family Planning efforts.
Why is it Important to Include Men in Family Planning Programs?
Family Planning programs that specifically recognize the role of men in the decision-making process, and educate them about the socio-economic and health benefits of family planning, while disproving all kinds of myths are very important. Such Family Planning programs enhance spousal communication, improve gender equitable attitudes and increase family planning use.
With men ultimately responsible for the health and well-being of the entire family, their inclusion in family planning programs is only natural and should be advocated. Men can, and should, play a critical role in assisting their female partners in making successful use of any family planning tool. Additionally, there are many important male-centered family planning methods that they themselves can opt for. When men are equitably engaged in family planning and are supportive, the couple is better able to achieve their ideal family size and use contraceptives effectively.
Moreover, including men equally in family planning programs allows the couple to take mutual decisions. Sharing decisions allows the couple to listen to each other carefully in family planning discussions, respect their partner's opinion, and compromise for the couple's betterment whenever it is needed.
How to Get Men on Board?
In societies like Pakistan, there is a need to change the beliefs, knowledge, and attitudes especially of men toward family planning.
Men can be involved in family planning programs in a variety of ways. One strategy to involve them in family planning decisions is to provide awareness, effective Behavior Change Communication (BCC) and couple counselling services that focus on myths and misconceptions about family planning services.
The strategies for male participation in family planning services are not limited to couples counselling only, where both men and women gain knowledge and guidance at the same time and same place. Couple interventions are not always appropriate or achievable. For example, if home visits are the basis of a family planning intervention, it can be difficult to find a time when both the husband and wife are together at home. Therefore, professionals who support couples must be well-qualified to ensure that both participants can take part in a couple of counselling sessions and that both men and women participate in the decision-making process equally.
Nevertheless, there may be significant logistical and cultural barriers, where the presence of men at the family planning counselling sessions is not possible. In Pakistan, FP service providers are largely female, and, given socio-cultural restraints, they cannot communicate their message effectively to the male members of the family. In such cases, there should be male service providers so that the male partners can easily approach the service provider without any hesitation.
Alternatively, solutions to including men when couple counselling is not always feasible is to introduce men-only educational talks, male health advocates or service providers, gender-targeted BCC programs, unique messages in the local language and culture, and the inclusion of family planning material into non-health programs such as agricultural and sanitation projects.
It is indeed unfortunate that male engagement in family planning has not received the required attention and focus of policy makers. However, this is one mistake that can be rectified and the time to do it is now.
Photo by Population Council