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India. Male Involvement in Family Planning

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The present paper addresses to the knowledge, attitude, belief and practices of rural males towards various aspects of family formation including reproduction and contraceptive use. The study was undertaken in the rural areas of Agra district, located in western parts of Uttar Pradesh. To assess the knowledge and attitude of the males, altogether 517 currently married males, whose wives were in the reproductive age (13-49 years) were randomly selected and interviewed. Out of 517 males who were interviewed, in 317 cases their wives were also interviewed about a month before the male survey. The two sets of data gave an opportunity to compare the attitude of males and females on selected issues related with family formation.
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MALE INVOLVEMENT IN
FAMILY PLANNING
A KABP Study of Agra District
Uttar Pradesh
M. E. Khan
Bella C. Patel
POPULATION COUNCIL
NEW DELHI
June 1997

MALE INVOLVEMENT IN
FAMILY PLANNING
A KABP study of Agra District
INDIA
Final Report
M. E. Khan
Bella C. Patel
POPULATION COUNCIL
June 1997

"Changes in both men's and women's knowledge, attitudes
and behaviour are necessary conditions for achieving the
harmonious partnership of men and women. Men play a key
role in bringing about gender equality since, in most
societies, men exercise preponderant power in nearly every
sphere of life ... . It is essential to improve communication


between men and women on issues of sexuality and
reproductive health, and the understanding of their joint


responsibilities, so that men and women are equal partners
in public and private life."

ICPD Programme of Action

CONTENTS
Executive Summary
ix
Introduction
1
Objectives of the Study
3
Data
4
Findings
4
Profile of the respondents
4
Access to mass media
6
Ideal family size norm
6
Attitude of Respondents about Various Reproductive
Decision Making Processes

8
Perceived ideal age at marriage
8
Husband-wife communication
8
Decision making in family formation
11
Family Planning
13
Knowledge, attitude and practice of family planning
13
Attitude towards family planning
14
Current use of contraceptives
15
Purpose of contraception and method used
16
Past Use
16
Unmet need of family planning
17
Why men prefer tubectomy over vasectomy?
17
Reasons why condom use is low?
21
Awareness of legal status of abortion and its approval
23
References
27

The Population Council, India
LIST OF TABLES
1
Socio-economic characteristics of the couples
5
2
Access to media
6
3
Ideal number of children
7
4
Perception about time when a girl should get married
8
5
Husband-wife communication on reproductive matters
9
6
Male perception on what discourages spouses from
discussing contraception and number of children
at an early stage of married life
10
7
Perceived reaction of men, if their wives initiate
discussion on their reproductive intentions soon
after marriage
11
8
Who decides in the family about various reproductive
behaviour
11
9
Awareness and correct knowledge of men and women
about different family planning methods
13
10
Current use of contraceptive
15
11
Reasons why tubectomy is preferred over vasectomy
18
12
Reasons for shift from vasectomy to tubectomy
19
13
Comparison of males' attitude towards vasectomy and
tubectomy
20
14
Reasons for preferring tubectomy over vasectomy
20
as given by sterilized couples
15
Reasons for disapproving MTP
25
16
Approval of abortion by knowledge of the legal
status of abortion in India
25

The Population Council, India
LIST OF FIGURES
1
Percentage of vasectomies to total sterilization, 1956-1995
2
2
Exposure of men and women to number of mass media (M.M.)
6
3
Perceived ideal number of sons and daughters
7
4
Percentage correctly aware of the legal age at
marriage for girls and boys
8
5
Who should initiate discussion on reproductive goals
or contraception
10
6
Who decides when or which doctor to be consulted
12
7
Approved of FP and timing when contraceptive could
be used
14
8
Purpose of contraceptive and method used
16
9
Level of unmet need
17
10
Suggestions to popularize vasectomy
21
11
Reasons why condoms are not used
22
12
Reaction to unwanted pregnancy of male and female
respondents not wanting any more children
24
13
Awareness of the legal status of abortion
24
14
Approval of abortion
25

The Population Council, India
EXECUTIVE SUMMARY
The present paper addresses to the knowledge, attitude, belief and practices of rural
males towards various aspects of family formation including reproduction and
contraceptive use. The study was undertaken in the rural areas of Agra district, located
in western parts of Uttar Pradesh. To assess the knowledge and attitude of the males,
altogether 517 currently married males, whose wives were in the reproductive age (13-49
years) were randomly selected and interviewed. Out of 517 males who were interviewed,
in 317 cases their wives were also interviewed about a month before the male survey. The
two sets of data gave an opportunity to compare the attitude of males and females on
selected issues related with family formation. The following gives the salient findings.
1.
The study shows that while nine out of ten men were exposed to at least one mass
media and four out of ten to three or more sources of information, the
corresponding number in the case of women were limited to three and one
respectively.
2.
On an average both men and women want three children - two sons and a
daughter. However, it was also noted that slightly less than one-third of the males
(31 percent) as well as females (29 percent), preferred four or more children.
3.
Son preference was shown both by men and women, but it was slightly stronger
among men than their wives. For instance, about one-fourth of the men as against
about one-third of the women felt that they would be satisfied with only one son.
Overall, the study shows that the desired family size is still large (three or more)
and concept of two child family has not been accepted by majority of the couples.
4.
One-third of the men and more than two-thirds of the women were not correctly
aware of the legal age at marriage for girls. Further, a sizeable proportion (35
percent) of the men and (46 percent) of the women still believe that ideally girls
should be married at young age, preferably before completing 17 years of age.
5.
The study reveals major lack of communication between the husband and the wife
on their reproductive goals and acceptance of contraceptive. More than half of the
men reported no communication or discussion with their wives on their reproductive
goals. And, whenever it occurred, it was initiated by the husband - that too after
having two or three children.
6.
On-fourth of the men believed that reproduction is a natural process and need not
be discussed. An equal proportion felt that these are meaningless things and do
not help in any way. About two-thirds of the males (65 percent) believed that
discussion on these issues should be always initiated by men/husbands. 28 to 34
percent also felt that they would be offended and would react adversely if their
ix

The Population Council, India
wives take initiative to discuss either on reproductive goals or contraceptive use.
7.
38 to 52 percent of the men said that in their families all decisions related to
reproduction and family planning were taken by husband alone. Another half felt
that decisions were generally taken jointly with wife while very few (less than 10
percent) felt that women alone could take such decisions.
8.
The study also reveals that most of the men and women are aware of vasectomy,
tubectomy, pills and condom. However, only about 44 percent of the men as
compared to 72 percent of the women were aware of the IUD. Except condom, in
the case of all other contraceptives, less than half of the male respondents had
correct knowledge as to how the method is used. Only 18 percent of the males had
correct knowledge of IUD.
9.
While most (85 percent) of the men approved family planning, majority (56 percent)
felt that it should be adopted only after having two children. Knowing fully well that
without husband's permission a woman cannot adopt any contraceptive, such
conditional approval of contraception by males could be a serious bottleneck in the
acceptance of contraceptive at low parity or its use for spacing purposes.
10.
While, according to the husband's interview, 33 percent of the couples were using
modern family planning methods, only 20 percent of their wives reported use of
contraceptive. Wide gap was observed in the case of condom use (10 percent
reported by men as compared to 4 percent by women).
11.
Use of contraceptive for spacing purpose is still an alien concept as most of the
acceptors (79 percent were using family planning for stopping childbearing. About
42 percent of the family planning users were depending on non-terminal methods,
largely condom and pills, for limiting childbearing.
12.
The study thus reveals that most of the men, who adopt family planning, do so for
stopping childbearing and even among those, four out of ten prefer to use non-
terminal methods. This indicates that the general programme emphasis on
promoting sterilization, even among those having many children, may not succeed
in motivating a substantial proportion of couples with unmet need for limiting
children. This underlines the need of offering a wide range of contraceptives so
that they could have choice as well as possibility of switching over from one method
to other, if they desire so. Adding of contraceptives like DMPA (injectable),
Diaphragm and non-scalpel vasectomy, the programme could provide some more
choice of methods to prospective family planning acceptors.
13.
The total unmet need as reported by men was only 29 percent as compared to 39
percent reported by the women. This gap was mainly because very few men
expressed unmet need for spacing. The stated unmet need for limiting child-
x

The Population Council, India
bearing was almost identical. This indicates that men are less concerned about
spacing between births than women.
14.
A probing on why men prefer tubectomy over vasectomy revealed four concerns
which were frequently mentioned by male respondents: (a) vasectomy makes men
weak and less productive which they cannot afford being the main bread-earner of
their families. Many women also felt the same way; (b) vasectomy demands rest
for several days which again males cannot afford, particularly if they have to earn
their living on a day-to-day basis; (c) women do not do hard work, they live in home
and hence can take rest; and (d) tubectomy is easier than vasectomy and does not
require much rest. Yet another important concern which was shared by majority of
the males was failure of vasectomy and its social consequences for the couples.
Their typical thinking is well reflected in the following quote verbatim:
"We know that vasectomy can fail and suspecting wife is wrong but all do not
think in that way. How can you stop others saying that my wife had an affair
with other man, that is why she became pregnant even after my accepting
vasectomy".

15.
Some of the men felt that the shift from vasectomy to tubectomy has taken place
largely because of the side effects of vasectomy and availability of simpler and easy
tubectomy method (laparoscopic). Majority (52 to 61 percent) of the men believed
that tubectomy is easier, has less chances of complications and need shorter post-
operative rest.
16.
For many men when an easier and less complicated method like laparoscopy is
available for women sterilization, there is no reason why should men undergo a
more `risky' operation. Clearly, the study is reflecting the impact of aggressive
campaign and motivational efforts put in by the family welfare programme focussing
females as their targets and the misinformation often the extension workers
generated during their effort to recruit the `cases' for meeting their family planning
targets.
17.
Not many men including male family planning workers felt that vasectomy could be
made again a popular method. As one of the male community members puts it:
"It has now become a custom that only women undergo sterilization. Now
if I adopt vasectomy, people will laugh at me."

18.
In general, four suggestions for reintroducing vasectomy were made:
(a) provision of an attractive incentive; (b) aggressive educational campaign;
(c) detailed and focussed counselling of men explaining both advantages and
disadvantages of the method; and (d) increased availability of operation facilities
xi

The Population Council, India
and organizing regular vasectomy camps. The last recommendation is particularly
important. Though, theoretically, vasectomy is available and offered to prospective
clients, in reality, its service is almost non-existent at rural PHCs or CHCs. Today,
most of the doctors posted at PHCs have no skill and/or practical experience of
conducting vasectomy.
19.
Several reasons were identified for the low use of condom. They include: dislike
for the method (39 percent); poor quality of condom/fear of its failure (22 percent);
unawareness of the method (21 percent); non-availability in the villages (15
percent); loss of sexual enjoyment (13 percent); and storing/disposal problems (12
percent). Indepth case studies are required to assess how far these complaints are
correct and to what extent failure of the condom is due to incorrect use of the
method.
20.
In India, where spacing is still an alien concept, the chances of increasing
acceptability of condom use among men in face of their existing dislike for the
method is doubtful. To ensure higher acceptability of condom, the main target
group should be young couples. Selling of the concept of `safe sex' and `spacing
as key to sexual enjoyment', perhaps would be more effective. Awareness about
STD and AIDS among men and about the condom as a preventive measure could
alter cultural bias against condoms both among men and women, and may increase
the acceptability and use of the contraceptive.
21.
Analysis of the men's awareness about the legal status of abortion and their attitude
towards it revealed that less than one-fourth (22 percent) were aware that abortion
is legal. 68 percent believed that MTP is illegal and undergoing abortion is a
criminal offense. The study also revealed that two-thirds of the males were against
MTP as `it is a sin' or amount to `killing of an unborn child'.
Further analysis shows a direct relationship between awareness of the legal status
of abortion and approval of MTP. For instance, 35 percent men who were aware
that MTP was legally approved abortion as compared to only 3 percent who
believed that MTP is illegal. This indicates an urgent need of launching educational
campaigns to make the community aware of the legal status of MTP. Such
awareness could help in making community attitude favourable to MTP and thus
facilitate women to seek help from recognized safe hygienic abortion services for
MTP rather than approaching untrained illegal abortionists.
xii

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