Majority of family planning programmes across the world, including in India, have traditionally focused on women. Low use of male contraceptives, to an extent, reflects the lack of male involvement in family planning. The “basket of choices”—contraception methods available in the public health system—includes only two (out of a total of seven) male-specific family-planning methods, namely male sterilization and condoms. According to the fourth National Family Health Survey (NFHS-4 2015-16), of all modern family-planning methods available, female sterilization is the most used method (75 per cent) followed by condoms (12 per cent) and oral pills (9 per cent). Despite male sterilization being an easier procedure than female sterilization, the share of the former in the methods used is less than 1 per cent (0.6 per cent to be exact). In addition, there has been no significant change in the uptake of male sterilization between the last two rounds of the NFHS survey (NFHS-4 2015-16 and NFHS-5 2019-20).
Numerous factors influence the use of family planning methods among women and men, in both positive and negative ways. These include interpersonal relationships, such as those with partners, family members, community members, religious leaders and healthcare providers. The most significant interpersonal relationship in family planning is the intimate relationship with the male partner. Men hold considerable power over women and exclusive control over family planning-related decision-making. This can mainly be attributed to men’s culturally elevated status over women due to gender dynamics, patriarchal mindsets, and unequal power relationships between men and women. Male dominance is reinforced through social, political and economic mechanisms that limit women’s financial and reproductive autonomy and therefore their ability to access and use family planning methods and services, despite the desire to do so.
According to NFHS-4, 37 per cent of currently married women do not make decisions about their own health care, major household purchases, and visits to their own family. The lack of reproductive autonomy among women has resulted in a high unmet need (13 per cent) for family planning among women of reproductive age in India, which means they face several barriers in accessing contraception although they want to limit or delay their pregnancies.
The historically low uptake of male contraceptives and limited male participation can also be attributed to the dearth of interventions that focus on improving male engagement in family planning. A review of family planning programmes shows that men and boys are not particularly well-served. Most programmes operate from the perspective that women are contraceptive users and that men should support their partners. There is insufficient attention to reaching men as primary contraceptive users in their own right. There is also stigma around discussions on safe sex and relationships. Most importantly, young men lack access to correct information on sexual and reproductive health, including condom use and male sterilization, and these misunderstandings get perpetuated among their peers. Men do not feel comfortable discussing their family planning needs with female frontline workers and therefore it is important to have male health workers who can be ambassadors of change to promote family planning uptake among men.
In addition, there is a lack of specific budgets directed for family planning campaigns targeted at men. An analysis of the family planning budget allocations under the National Health Mission over three years beginning from 2017-18 up to 2019-20 reveals that the budgets for Information, Education and Communication/Behaviour Change Communication (IEC/BCC) have only marginally increased from 3 per cent of the family planning budget in 2017-18 to 4 per cent in 2019-20.
With gender equity gaining recognition as a prerequisite for better health, more attention needs to be directed at deliberately engaging men in learning about, supporting, and using family planning products and services. Efforts to expand constructive male engagement are evolving, from encouraging men to be supportive partners in improving women’s sexual and reproductive health (SRH) outcomes to focusing on meeting men’s own SRH needs and engaging them as contraceptive users and agents of change in families and communities.
We can learn from and adopt good practices of male engagement in family planning within and outside India in the National Family Planning Programme. Global evidence suggests that targeted interventions focusing on men can effectively change their behaviour and gender-related attitudes about family planning. Using peer-education sessions with men in rural India to increase men’s knowledge, promote positive attitudes about contraception and improve family planning communication within couples could go a long way in promoting male engagement in family planning. Involving community influencers, such as religious leaders, to address myths and misconceptions around male-specific contraceptive methods and encourage men to adopt family planning could also be an effective strategy.
Targeted social and behaviour change communication campaigns and gender transformative programmes must promote male engagement in family planning and change perceptions about masculinity. There should be an emphasis on changing mindsets and stereotypes so as to enable women to make decisions regarding their own health and increase spousal communication. Such initiatives must engage boys from a young age in innovative ways as future agents of change and champions of gender equality. Male participation is about being responsible and respecting equality rather than about decision-making solely. It should also extend to view men as enablers and beneficiaries, in the process of ensuring dignity, equal voice and reproductive rights for women.
Sanghamitra Singh is Senior Manager, Knowledge Management and Partnerships, Population Foundation of India. She is a Health Scientist and holds a PhD in Cell Biology from the George Washington University (GWU), Washington D.C. The views expressed in this article are those of the author and do not represent the stand of this publication.