Tackling attitudinal resistance towards use of family planning, time to focus on the man

Family planning (FP) has been taunted as the most cost-effective means of improving upon the health of children and women. It is also key to the attainment of the Sustainable Development Goals (SDGs). But socio-cultural factors remain a major demand-side constraint to such services in most communities in Sb-Saharan Africa including Ghana.

Key Issues and Challenges of FP in Ghana

Even though there has been a lot of education and activities to encourage people to use FP to protect themselves and prevent pregnancies, majority of those who are sexually active have not yet bought into the concept very well. As such a lot of people who are not ready for pregnancies continue to have sex without any form of protection. This, according to Mr Michael Tagoe, Youth Programme Officer of the Planned Parenthood Association of Ghana (PPAG), for the Western and Central Regions is worrying.

Mr Tagoe spoke about some challenging issues with respect to FP acceptance and said there are a lot of misconceptions about modern contraceptives, though they do not have any scientific basis.

‘We have a lot of people who do not want to go near FP methods simply because of the misconception out there. That makes the whole picture not good’, he lamented.

He also mentioned the lack of proper counseling and explanation which he said often created a lot of problems in the communities. Another issue he spoke about was how messages and content of FP is coined.

‘We paint FP as something that is for adults, so there are a lot of young people out there who do not feel the need to use FP. The Key word is, FP is for couples, but it's not only for couples. FP is basically for anybody who is sexually active, having sex and not ready to get pregnant or impregnate. So its not just couple’, he said.

Efforts made

Ghana has made significant strides to make FP services and methods available to all by establishing a legislative instrument to include FP in services provided under its National Health Insurance in 2017.

The country has also made FP services and commodities free of charge in its public health facilities. But despite these bold commitments, the country has not seen desired FP acceptance among the population. Low socioeconomic status of women, religious beliefs, educational level, misinformation about family planning, high child mortality, patriarchal nature of household decision-making processes, fear of potential side effects among others have been the contributing factors to low demand and use of contraception. Hence, despite the several initiatives, the country has not able to achieve the objectives outlined in its National FP policy.

Knowledge of Family Planning

Women’s knowledge of FP methods and services have significantly improved over time. Knowledge of contraceptive methods amongst Ghanaian women has been historically high since the early 1990s. More recent data from the Ghana Health Service (GHS) indicates that about 98 percent of women have knowledge of at least one modern method of family planning. However, the high level of knowledge and awareness about FP methods has not translated into an equivalent high use of FP services. According to the Ghana Family Planning Costed Implementation Plan 2016–2020 (GFPCIP), about thirty percent of married women have an unmet need for family planning. This often arise because of the strong resistance by their husbands.

The misconceptions and myths of FP

Many communities have misconstrue the concept of family planning as a means for birth limitation. The misunderstanding of the concept has caused many male community members not to allow their wives or daughters in-law access to family planning services. One major misconception of FP has been about the side effects of contraceptives.

‘Yes, it is is true that some devices have side effects that manifest in various ways in the women who use them. Yet, it is important to consider that virtually all medicines have side effects and people usually take them anyway, acknowledging their valuable benefits’ says Mr Tagoes.

Sadly, he said the issue is perceived differently when it comes to contraceptives and stressed the need for more counseling and education before one is signed onto any FP services.

Majority of complaints that come from women and men are the perceived negative side effects of contraceptives. Many often comments such as “we hear that when you do family planning and at a point you stop and want to have a child, it becomes impossible’ have been propagated.

Other existing myths also associate family planning with obesity, weight loss, and increasing susceptibility in falling sick.

Many people expressing these concerns are often unwilling to accept contrary information from health workers, despite their own lack of evidence to support these opinions about family planning.

The unmet need

According to the 2014 Demographic Health Survey (DHS), 56.6 per cent of married women ages 15–49 want to avoid pregnancy and therefore need contraceptives, whereas only 22.2 per cent are using modern contraceptives and 4.4 per cent using traditional family planning methods. This means that almost 30 per cent of married women want to avoid pregnancy yet are not using any method of family planning.This is against the backdrop that voluntary FP programmes play an important role in enabling couples to realise their reproductive preferences.

Mr Tagoe talks about how crucial it is to address the unmet FP need saying, it has the ability to contribute or otherwise to the rate of maternal mortality of the country.

‘When they get pregnant, they opt for abortion, unfortunately, majority of those opt for unsafe abortion, that is what contribute to maternal mortality and mobility. If we are able to get a lot of people to understand the concept of FP, and go onto it, then we will reduce the rate of maternal mortality in the country’, he said.

Do men have potential for inspiring FP acceptance

Despite the fact that voluntary FP programmes play an important role in enabling couples to realise their reproductive preferences, most Ghanaian men are unwilling to allow their wives patronise FP services. Again, most often, Family Planning programmes and strategies leave men of the equation with focus solely on women.

Many of the women interviewed for the purpose of this article indicated that they signed on to family planning services without telling their husbands because they were not sure whether their husbands would allow them to do it. Others also indicated that, their husbands said no when they brought up the issue for discussion.

Hasana Mohammed is a mother of three and she tells me she once did Family planning without telling her husband because she new the husband will not agree if she told him about it.

Another, Madam Rebeca Ackon revealed that her husband refused to take care of her and her four children when he found that she had done family planning. This, Mr Tagoe says its unacceptable.

According to him, men could share ideas, suggestions and recommendations but should not attach a condition.

‘Because a lot of people depend on their spouse financially, unfortunately a lot of them when they have to take decision, husbands take the decision for them’, he noted and said the woman who owns her body should be the one taking the decision and not the man.

‘Yes getting men on board would help greatly but then we still have to educate women and empower women to know that it's their body, the ultimate decision lies in their hands, he added.

A handful of men interviewed for this article were willing to agree and support their partners to roll onto FP services when the need arises. Some shared some weird reasons they would not support their partners. Among their reason were that the woman would cheat.

Way-forward

First, Mr Tagoe stressed the need to intensify education in communities to counter the misconceptions routed in the minds of the people.The education, he said should also focus on sensitizing people on the available policies on modern contraceptive use.

‘We also have to focus on education that will kill the misconceptions because for those who have the misconception, it means that they will not use FP’, he sated.

As part of the education, he underscored the need for FP advocates, saying ‘If there are people who are polluting peoples minds negatively, and it's working, then we can also get people who have used it for years and nothing is wrong with them, they can also influence people's perception positively to counter those misconceptions out there’.

He also advocated FP services to be pushed onto the NHIS. He says if it's absorb by the NHIS, all one needed was the NHIS card to access FP services. That, he said would help spread the cover of FP and contraceptive in the country.

Mr Tagoe further underscored the need to educate men to be more understanding, and supportive to women’s access to FP . This he said if well done, would be very helpful to close the unmet need gap.

‘You talk to her, encourage her but you do not have to force and push her. At the end of the day, if there is any problem, it will be on the woman, so it has to be her decision, that is something we need to focus on’.

‘Women ought to be given that right to decide what should be done to their body and not their husbands. That is not to say that their husbands opinions do not matter, they matter but when it comes to decision that will affect the person, then the person should take that decision’, he added.

Conclusion

Majority of the men interviewed for the purpose of this report had never involved themselves in FP with their wives. This could be attributed to negative perceptions recorded among them. Therefore FP Community sensitization programmes must aim at improving male involvement.

Various studies have shown that providing men with information and involving them in counseling sessions could help them to be more supportive of contraceptive use and more aware of the concept of shared decision making.

Our ability to do this will contribute significantly to national FP acceptance. Having a high FP acceptance as a country will contribute towards achieving SDG goal three which specifically talks about ensuring healthy lives and promote well-being for all at all ages.