Barriers Associated With Having Men Participate in Family Planning Initiatives
Introduction
In society to achieve the Sustainable Development Goals (SDGs), including reducing maternal bloodshed, the participation of men in reproductive health problems, including family planning, is essential.ane,2 In developing countries, the promotion and provision of family planning tin can brand a significant contribution to the empowerment of women and the achievement of universal chief didactics. In improver, family planning tin can reduce maternal death by 32% and child decease by 10%.3–five However, the rates of contraceptive use in Sub-Saharan Africa (SSA) are still depression.half-dozen,7 In Africa, the opposition or non-involvement of men in family planning is one of the contributing factors for low contraceptive utilise or high unmet demand.8
While family unit planning programmes have traditionally been aimed at women, there is growing awareness that reproductive wellbeing is the responsibility of both men and women. Since the 1994 International Briefing on Population and Growth and the 1995 Beijing Conference, male participation in family planning has gained more consideration and attention worldwide.9 Yet, the programmes have non been more than stressed by the majority of African countries.10
Male participation in contraceptive use improves women's uptake and continuity of family planning approaches by increasing spousal coordination and decreasing opposition.xi–13 Past research has also demonstrated that male non-involvement in family planning leads to a high incidence of contraceptive discontinuation among women.fourteen,15 Peculiarly in SSA, like Federal democratic republic of ethiopia, men are primal decision-makers in family planning.
In Ethiopia, the contraceptive prevalence rate rose from xv% in 2005 to 36% in 2016. However, the unmet need for family unit planning is still high in the region (22%).sixteen–18 In Ethiopia, this high unmet demand and other factors such as lack of awareness, fearfulness of social rejection, resistance to spouses, religious or cultural values, and concern for contraceptive side-furnishings lead to a loftier fertility rate (boilerplate 4.6 children).18–21
As mentioned in the SDGs, fostering a rapid reduction in fertility to or below the level of substitution is necessary in lodge to foster economic evolution. In reaction to these global goals, the Ethiopian Federal Ministry of Health (FMoH) prepare a target for a contraception prevalence rate of 55% by 2020.20–22 All the same, almost family planning policy initiatives in Ethiopia focus merely on women. Moreover, the majority of rural women in the country have lilliputian control over their lives and are entirely dependent on their husbands. Improving male interest in family planning is also a crucial public policy intervention to achieve national and SDGs. Failure to include men in family planning services in a patriarchal community such as Federal democratic republic of ethiopia has significant repercussions, even though women are encouraged to use contraception strategies considering of resistance from the spouse.19,22–24 This can also atomic number 82 to a loftier incidence of contraceptive discontinuation.14
Based on Ethiopian national survey results, the 12-month contraceptive discontinuation charge per unit for all methods was substantially high (35–37%).nineteen–23 Previous studies performed in diverse parts of Africa showed that male participation is mandatory to minimise contraceptive discontinuation rates.11–13 However in Federal democratic republic of ethiopia, the magnitude of male interest in family planning was significant.xi,25,26 Thus, identifying the barriers of male involvement is vital in the development and scale-up of testify-based male-involvement family planning interventions.
In the past, few studies have recognised obstacles to male person involvement in the apply of family planning, but most previous studies have been performed on urban environments that vary in socio-demographic and behavioural factors from a rural surroundings.11,25,26 Too, there is a dramatic difference in contraceptive prevalence and discontinuation rates between rural areas and urban areas in the 2016 Ethiopian Demographic and Wellness Survey (EDHS) report.23,27 However, at that place is piddling concrete knowledge of the extent of male involvement in family planning and its barriers in rural settings. To address this gap, this study assessed the level of male involvement in family planning utilization and its associated factors in the rural customs of northern Ethiopia. The Ethiopian Ministry of Health and other partners in intervention blueprint and futurity studies will benefit from the results of this report.
Materials and Methods
Written report Blueprint, Surface area, and Period
A community-based cross-sectional study was conducted from March to April 2017 in Womberma district, Northern part of Ethiopia. Womberma district had a full population of 127,000 of which about 24,800 were women with reproductive age group.28 It had a full of twenty health mail, 5 public health centers, and 9 individual clinics which were currently serving the population.28
Population and Eligibility Criteria
All currently married men who residing in Womberma district and whose partners with reproductive historic period grouping (xv–49) were the source population. All married men who resided in v selected kebeles and whose partners with reproductive age grouping (xv–49 years) were the written report population. Men who were critically ill, unable to talk or hear during the study period, and men whose partners were beyond reproductive age, ie anile above 49 years were excluded from the study.
Sample Size Determination
The sample size was determined by using the double proportion formula, considering the following assumptions: proportion of male interest in the exposed group=53.3% (by selecting the support of FP use as exposure variable) from a similar study conducted in Debre Markos town,25 margin of error (w) =5%, design upshot of 2, 10% non-response charge per unit, Zα/2 = 1.96 at 95% confidence interval. The concluding sample size was considered to be 620.
Sampling Procedure
A multi-stage sampling technique was used to select the study participants. In Womberema District, a total of 20 kebeles (one semi-urban and 19 rural) were plant. Shindi 01 Kebele is the authoritative capital of Womberema District. Still, information technology was not found in the list of cities or towns in Ethiopia.30 So, in the electric current study, it is considered a semi-urban area.
Start, stratification was done as semi-urban and rural, and so Shindi 01 Kebele selected deliberately and four rural kebeles from 19 rural kebeles were randomly selected past lottery method. Finally, the study participants were selected by a systematic random sampling method by using a Customs Based Health Information System (CHIS) registration book every bit a sampling frame. The study participants were proportionally allocated for each kebele based on the number of married males in the kebele. The beginning household was selected through the lottery method followed by the choice of every other twelfth household in that order. This process was continued, till the numbers of study participants were obtained from each kebeles, simply if the wife of the selected household was not in range of reproductive historic period, the next household with reproductive age was included in the study.
Written report Variables and Measurements
The main issue variable was the level of male involvement in family planning (involved/non-involved or low interest). The predictor variables include age, ethnicity, teaching level, occupation, faith, historic period of wife, educational condition of wife, occupation of wife, income, number of living children, a desired number of children, sex activity preference, spousal communication, husband approving, knowledge on family planning and attitudes towards family unit planning.
In this study, male interest in FP was computed from the following 5 "Yep" or "No" questions (1.) Practice yous use contraceptives currently? (2.) Do you support FP methods? (3.) Exercise you encourage your married woman to use FP? (4.) Do you approve of contraceptive use past your wife? (5.) Do y'all have a desire to use FP in the futurity?
If the participant responded "yes" to the get-go question, we considered every bit directly involved in family planning. Furthermore, questions 2−5 were intended to mensurate male involvement through spousal communication and approval about family unit planning. For questions 2–5, 1 point was given for each "aye" response and zero point for each "no" response. An additive summary score was created and which was then dichotomized to create a binary consequence variable. Based on the summative score of the question designed to assess male involvement through spousal communication and approval, men with scores 3 and to a higher place were considered every bit having better involvement in FP. If men scored 0–2 from the summative score of questions, it was considered as not-involved (depression interest).25
To measure out the participant's knowledge, they were asked the following five questions. 1.) Practice y'all know about FP? (Yes/no) two.) List benefits of FP (I do not know/one/2-iii/four or more) three.) Listing FP methods (none/only one/ii-3/4 and above) 4.) Practise you know male FP (yes/no) 5.) Average birth interval (Immediately subsequently delivery/6 months-i year/1-2 years/above 2 years/I do not know). For question 1 and 4, nada betoken was given for "no" response and one point was given for "yeah" response. For question 2, nil indicate was given for "I don't know", one indicate is given for men who listed one benefit of FP, two points were given for men who listed 2 or iii benefits of FP and 3 points were given for men who listed 4 or more benefits of FP. Similarly, for question 3, zero points were given for men who did not list whatsoever contraceptives ("none"), one point is given for men who listed 1 FP method, ii points were given for men who listed two or 3 types of FP methods and 3 points were given for men who listed four or more type of FP methods. For question 5, one point was given for the correct response (more than two years) and zero bespeak for all other responses. Knowledge scores were summed upwardly to give a full knowledge score for each respondent. Therefore, the full score of cognition questions ranging from zilch to nine was classified into two categories of response: proficient knowledge/poor knowledge. Male cognition on family planning was classified equally having skillful knowledge if men responded correctly to a higher place or equal to the mean value from cognition assessing questions. Men who scored below mean value were considered as having poor knowledge of family unit planning.31
Attitude on FP was measured using vii-Likert scale items. 1.) Using condoms does not reduce men's sexual pleasance. ii.) Men sterilization (vasectomy) has no harm. 3.) As well many family sizes strain the families' economical situation four.) As well many children make happy 5.) As well many children are often harmful to the health of the mother. 6.) Family planning practice improves trust between husband and wife. 7.) Men should share FP practice in the family unit. Based on these items, men who scored in a higher place or equal to the mean value of attitude assessment questions were considered as having a favorable attitude towards family unit planning and men who scored below the hateful value were considered as having an unfavorable attitude.13
Data Drove Procedure
Data were collected using an interviewer-administered structured questionnaire. The questionnaire was adjusted from similar studies13,29,32 and it was prepared initially in English language and translated to the local language (Amharic) by two secondary and high schoolhouse English teachers and 1 wellness officer. The information were collected by trained secondary school completed personnel during the weekends and holidays because this was the optimal time to go report participants at home. If the participant was not available during data collection, repeated visits were done to minimize non-response bias. The possessor of the household was selected in households where more than i married homo was presented.
To assure the quality of the information, 2-day long preparation was given to both data collectors and supervisors on objective, relevance, and purpose of the study. The questioner was reviewed by i researcher who is an expert on reproductive wellness enquiry and agreed that the tool is a valid measure of male person interest. Besides, two experts (researchers) reviewed all of the questionnaire items for readability, clarity, and comprehensiveness and came to some level of agreement as to which items should be included in the final questionnaire. The reliability of the questioner was done using the pre-test technique. A pre-test was washed on five% of the full sample size randomly selected men from Burafer kebele a week before the actual fourth dimension of data collection. The pre-exam checked on the answerability, sequence, and appropriateness of questions. The data collected from the pre-test were analyzed using SPSS and the reliability coefficient (blastoff) was 0.82 which implies acceptable reliability. The supervisors and the researcher were closely post-obit the day to solar day data collection procedure to complete the data collection. Confusing or inconsistent conditions were rechecked and corrected before entering the information into a computer.
Data Analysis
Participant characteristics were summarized using frequency and percentages for categorical variables. Mean values (± standard departure (SD)) were used to describe the continuous blazon of data. Multivariable logistic regression was used to identify factors contributing to male involvement. Variables with a p-value of less than 0.2 at bivariable analysis were entered into the terminal logistic regression model to control possible confounders. The odds ratio of the final model and their 95% confidence intervals were used every bit measures of association between the predictors and issue variable. A p-value of less or equal to 0.05 was considered statistically significant. All analyses were performed using SPSS version 20.
Upstanding Consideration
The written report was conducted following the Announcement of Helsinki. Initially, upstanding clearance was obtained from Debre Markos University's upstanding review commission (Reference number: DMU/RCS/064/2017). Then, the detailed purpose of the report was explained to all study participants and written informed consent was taken from every participant. All data collected from the respondents was treated as confidential in that no name was recorded on the questionnaire and the collected data were kept using a computer password.
Consequence
Socio-Demographic and Reproductive Health Characteristics
A total of 620 married men were included in the written report. The mean age of participants was 32 (±8SD) years. The bulk (ninety.six%) of participants were Amhara by ethnic group and 93% of participants were Orthodox Christian by faith. Virtually 44.0% of participants and more than half (53.0%) of their partners could not read and write (Table i).
 | Table one Sociodemographic Characteristics of the Respondents in Relation to Male Involvement in Womberma Woreda in 2017 |
More than one-half of the participants (52.7%) desired to take three–4 children and almost 34.0% of men wanted to have more than five children at the end of reproductive life. Of all participants, 58.4% of men had skilful knowledge of family planning. About 54.0% of men have ever discussed FP methods with their partners (Tabular array 2).
 | Table two Reproductive Characteristics of Respondents in Relation to Male person Involvement in Womberma Woreda in 2017 |
Male person Involvement Through Family Planning Utilization
In this written report, from a total of 620 married men, only fifty men 12.5% (95% CI; 8.iv–fifteen.9) used male person FP methods. Of l men who used FP method, 49 used condoms equally family planning methods and the remaining one participant used the withdrawal method. The reason mentioned for not employ of family planning was non known and did not know the source of FP, the need for more children, and fear of side effects (Figure i.)
 | Figure one Reason for not using FP methods in Womberma district, Northern Federal democratic republic of ethiopia. |
Male person Involvement Through Spousal Communication and Approval Nigh Family Planning
In the current written report, nearly sixty.0% of men were involved in family planning through spousal communication and approval. Amid all respondents, more than half (54.0%) of men have never discussed FP with their partner. The majority (61.v%) of men encouraged their partners to use family unit planning utilization. On the other paw, nigh 2-thirds (64.7%) of men supported the use of FP methods of their partners/wives. Similarly, 62.0% of men approved of family planning utilize. Regarding controlling on family unit planning, nearly 10.0% of men make a decision them self's and 81.0% decide with their partner.
Men'due south Noesis of FP Methods
Virtually 79.4% of the respondents knew near family planning and familiar with at least one method. More one-half (56%) of men were able to listing two to three family planning methods. Merely only 25.0% of them were aware of male family unit planning methods. Regarding the recommended birth interval, i-3rd of men reported less than 2 years. In general, just 58.4% of men had adept noesis of FP (Effigy 2).
 | Figure two Men'southward level of noesis on FP in Womberma Commune, Northern Ethiopia. |
Attitude of Men on Family unit Planning
Most half (49.ii%) of men disagreed that condom employ does not decrease sexual pleasure and near 40.0% of men disagreed on vasectomy exercise not harm individuals. I-fifth (20.2%) of men disagreed on also many children constrain the family economic system. In general more than half (52.1%) of men have an unfavorable attitude towards family planning methods.
Factors Associated with Male Interest in Family unit Planning Utilization
During \multivariable analysis, level of education, partners' level of pedagogy, number of living children, attitude on FP, knowledge on FP, and discussion on FP with wife were significantly associated with male interest (Table iii).
 | Table iii Multivariable Analysis of Male Involvement in Womberma District, 2017 |
Men's level of education was positively associated with male involvement in family planning. Men who attended formal didactics were 2 times (AOR=1.64; 95% CI: ane.124–ii.624) more likely to exist involved in family planning every bit compared to not-educated men. Similarly, men who have educated partners had 77% higher odds of being involved in family planning utilization (AOR=1.77; 95% CI: 1.167–2.943) than their counterparts. Men with a favorable mental attitude towards family planning were approximately 2 times more likely to be involved in family unit planning than those having an unfavorable attitude (AOR= 2.27; 95% CI: 1.533–3.356). Number of living children is also significantly associated with male involvement. Men who have 5 and more children had a 68% reduction in the odds of involvement in family planning utilization than those who take no children (AOR=0.32; 95% CI: 0.147–0.702). Similarly, men who had adept knowledge of family unit planning were 2 times more probable involved in family planning utilization [AOR=1.92; 95% CI: (1.284–ii.867)] than those who have poor knowledge. Men who were always discussed with wife were 2.51 times more probable to be involved than those who practice non hash out.
Discussion
In the rural community of Federal democratic republic of ethiopia, where men are family determination-makers and women have little influence over their problem of reproductive health,26,33 information technology is important to make up one's mind the extent of male engagement in the use of family planning. This analysis measured the magnitude of various degrees of male participation in the use of family unit planning and its factors in a rural region of northern Ethiopia. The results of this enquiry found that just 12.5% of men were involved on their ain past using strategies of family planning. This is comparable to the previous studies done in Ethiopia and Republic of kenya,25,34 only far lower than a recent survey of 40.0% in Uganda35 and 71.0% in Bharat.36 Surprisingly, 99.0% of males used only condoms in this survey of men who used contraception, suggesting that the employ of other forms of male person contraceptive methods was exceedingly poor. This might be related to the express option of bachelor male contraceptives in the rural customs. Therefore, efforts towards familiarizing permanent family planning for those who are absolutely sure do not want children in the futurity should be strengthened.
Male interest in family unit planning went beyond the employ of methods of contraception.37,38 Male person participation was also measured in the current study by spousal communication and approval. The effect showed that through spousal advice and approval, more half of men were engaged in family planning. Studies conducted in Kenya39 and Cameroon17 confirm this, but it was higher than a study conducted in Bahir Dar, northern Ethiopia, where 25.5% of men were interested in FP.40 The potential reason for the variability of the outcome is the operationalization of male involvement. The concept of male involvement differs significantly beyond the research. The interpretation of the findings should also be carried out with caution.
Evidence has shown that husband approval of family planning contributes to progress in women'due south contraceptive utilize.41 In this survey, 61.5% of men encourage and endorse the use of family planning and almost 63.0% of men support the form of family planning that is higher than a study conducted in Debre Markos, Ethiopia.25 In the current report, although only 12.five% of respondents used contraceptive methods, more than than 2-thirds (67.7%) of men have a desire to employ contraceptive methods in the futurity.
The finding of the current study showed that more than than half of men accept a negative mental attitude towards family unit planning and surprisingly nearly one-fourth of men agreed that males should non share the family planning method. This might contribute to the depression contraceptive prevalence rate in the rural community of Ethiopia. A significant number of men in Africa seemed resistant to accept the use of FP for financial and religious reasons.13,25,42 A study done in Tanzania indicated that men were feared that women would exist unfaithful if allowed to employ contraception. Men believed that condoms were useful for the prevention of HIV/AIDS with prostitutes and did non acquaintance use with FP.34,43 Therefore, the finding in this study implied that the need to introduce accurate data to accost negative attitudes towards the contraceptive method.
To improve the utilization of reproductive health programs including family planning identifying barriers and facilitators of male involvement is fundamental. Several important factors sally from the study which should be considered for future interventions. The offset determinant of male interest was the level of education of husband and partner. In agreement with previous studies done in unlike parts of Africa,17,44 the finding of this study showed that the higher educational status of the husband and his partner was positively associated with male involvement in family planning. The possible caption is related to educated men will more probable to have expert cognition of family planning which initiates them to involve in family planning. Moreover, educated women may initiate their partner to discuss family unit planning and reproductive wellness upshot which might encourage the male person to exist involved in family planning.17 Thus, the achievement of at least chief education for both sexes is an important intervention to better the level of male involvement in family unit planning.
2d, the number of children was the other factor that was identified every bit a determinant of male interest in this study. Previous studies indicated that families who had more children enhanced male interest.39 Unexpectedly, in the current study, men who had three and more children were less likely to be involved in family planning than those who accept no child. The discrepancy should be assessed with a strong study design in the future.
The tertiary primal determinant of male interest was knowledge virtually FP. Expert cognition about family planning methods was positively associated with male person involvement in family planning as similar to by pieces of bear witness.17,31 Men who know various family planning methods, specially male person contraceptive options, might directly involve in family planning utilization. The increasing trend in all these studies may betoken the fact that knowledge of family planning is pre-request for male person involvement in family planning utilization. Yet, in this study, a significant number of men (41.6%) had poor noesis of FP.
The fourth gene that was associated with male person interest was attitudes towards family planning. Men's positive attitude towards family planning is a facilitator for male person involvement in family planning in this study. All the same, only 47.ix% of men had a positive mental attitude in the electric current report. This finding implies that more than than one-half of men should change their attitude towards family planning.
The terminal determinant of male person involvement was a give-and-take between couples about family planning. One of the key barriers to the unmet need for family planning was women's perceptions of husbands' opposition. Thus, a discussion betwixt couples is key for reproductive health and family planning use. Information technology increases up taking and continuation of contraceptive use.11,12 The electric current written report also showed that word between couples most family planning increases the probability of male interest in family planning. Open discussion promotes the chance of joint decisions on family size which so enhances male involvement. Only in this report, only 46% of men discussed with their partner about family unit planning.
The master force of the current study was involving both semi-urban and rural men which better the generalizability of the finding. Secondly, the response charge per unit was 100%. But the study had besides several limitations. First, since the report was cantankerous-exclusive it does not show a causal relationship between factors and event of interest. Second, social desirability bias could be introduced considering of the use of the interviewer-administered type of data collection tool.
Conclusions
To conclude, just 12.5% of men utilise family planning methods themselves explicitly. However, past means of spousal advice and approval, more than half of the men in the Womberma commune were participated in family unit planning. Married man and partner educational status, number of living children, male person approach to family unit planning, male person family planning awareness, and conversation with the wife about family planning take been described as factors associated with male date in family planning. In Ethiopia, comprehensive health pedagogy initiatives should be fabricated to shift derogatory attitudes to family planning and increase the level of sensation relevant to family planning. Therefore, through mobilising and designing educational programmes, metropolis leaders, social workers, public and non-governmental organisations must come together and build awareness. Finally, to determine triggers for a pessimistic mindset, studies should be conducted using a qualitative sample design.
Abridgement
AOR, adapted odds ratio; COR, crude odds ratio; FP, family planning.
Data Sharing Statement
The data tin can be available from the corresponding writer.
Ethical Approval and Consent to Participate
The study was conducted following the Declaration of Helsinki. Initially, ethical clearance was obtained from Debre Markos University'south ethical review commission (Reference number: DMU/RCS/064/2017). The detailed purpose of the study was explained to all study participants and written informed consent was taken from every participant. All information nerveless from the respondents was treated every bit confidential in that no name was recorded on the questionnaire and the nerveless data were kept using a computer password.
Author Contributions
All authors made substantial contributions to formulation and design, acquisition of information, or analysis and interpretation of data; took function in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final blessing of the version to exist published; and agree to exist accountable for all aspects of the work.
Funding
There is no funding to study.
Disclosure
The authors declare that they take no competing interests.
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