The progress in the increasing use of contraceptives has been gender biased by marginalising male engagement. Focus on women for family planning and contraceptive utilisation is heavily skewed because more methods are available for women, and also owing to multiple barriers in access to specific methods of contraception that affects use. These include availability, awareness, myths and misconception.
Among the male methods of contraception available, CPR (contraception prevalence rate) for condoms is 12.6% and less than 1.5% for male sterilisation. The acceptance of male methods of contraception is marred by a number of myths and misconceptions such as loss of virility, libido, etc. This implies that improving accessibility and availability, and engaging men as partners to support family planning, may be a key to turning the tide.
In many parts of South Asia men do not participate in discussions and informed decision making about family planning and the onus is on women to use contraceptives. In fact, NFHS III data reveals that 22% men feel that contraception is women’s business. Studies reveal that men often control contraception decision-making and male reproductive control of female partners can impede contraceptive use and increase risk of contraceptive failure. Data from multiple Indian states (NFHS IV) reveal no improvement in contraceptive uptake across the past decade, with some states registering a decline in modern contraceptive use. The data also shows that health worker outreach to women for family planning promotion has improved in many states, with no corresponding improvements in contraceptive uptake. This implies that factors such as male influence or engagement are either acting as barriers or contributing to maintaining a status quo.
Male engagement could act as a catalyst in improving contraceptive uptake in already aware and willing population.
Efforts to improve and sustain male engagement in India are riddled with social barriers and challenges. So a systematic integrated approach with behaviour change communication for men, and awareness about myths and misconceptions, could result in a better uptake of contraceptives and shared responsibility by men in family planning. Sustained behaviour change communication and on-ground work to engage men, while still promoting women’s rights and decision making could go a long way in effecting a positive change.
The emphasis needs to be on beginning this involvement at an early age, through discussions with adolescents on sexual and reproductive health and rights and integrating various schemes in health, education and vocational training. The government’s effort to engage male peer educators as part of the Rashtriya Kishor Swasthya Karyakram programme is a move in the right direction.
Male engagement intervention needs a multi-sectoral approach. Education, age at marriage, health seeking behaviour and socio-cultural norms need to be addressed simultaneously and concurrently. There is also a need to involve male frontline health workers and doctors in the programme, where family planning counselling is largely done by female workers
Given the government’s emphasis on strengthening counselling at hospitals, an increased focus on couples counselling and follow-ups is likely to bear fruit. A study for Maharashtra under the CHARM project (Counselling Husbands to Achieve Reproductive health and Marital equity) revealed that counselling sessions delivered by male healthcare providers to married men, alone and with their wives, over three months, appears to be an effective approach to engage men in family planning and improve marital contraceptive communication.
Lastly, the involvement of other stakeholders, including civil society organisations and private practitioners, to draw men into this process needs to be underlined. Innovative ways to ensure this under existing PPP and social franchising models will positively impact health and family planning at the community level. It’s important to realise that family planning and related maternal and child health goals cannot be achieved without male engagement.
Viplove Thakur is a Rajya Sabha MP. The views expressed are personal.