Family planning in a post-COVID-19 world: Need for greater male engagement

Family planning in India has always been considered a women’s issue, with men only marginally responsible and engaged in family planning. The lack of male involvement is reflected, to an extent, in the very low use of male contraceptives. According to the fourth National Family Health Survey (NFHS4 2015-16), of all modern methods of family planning available in India’s public health system, female sterilization is the most used method (75%) followed by condoms (12%) and oral pills (9%). While male sterilization is an easier procedure compared to female sterilization, the share of male sterilization in the methods used is less than 1 percent (0.6%).

The basket of contraceptive choices in India includes two (out of seven) male-specific family planning methods, namely male sterilization and condoms, but their uptake has historically been low. The increase in condom uptake in 21 out of the 22 surveyed states in the first phase of the fifth round of the National Family Health Survey (NFHS) conducted in 2019-20 and released by the Ministry of Health and Family Welfare in December 2020 is a silver lining. According to NFHS-5, there are interstate variations with condom uptake ranging from 0.5% (Andhra Pradesh) -23% (Goa)  as opposed to the range of 0.25% (Andhra Pradesh) -13% (Himachal Pradesh) observed in NFHS-4 (2015-16). However, no significant change in the uptake of male sterilization has been observed between the two rounds of the survey, with the usage ranging between 0 to 3.4% in both rounds. This extremely low level of use of male contraceptives is a reflection of the poor levels of men’s involvement in family planning. 

Although there is evidence to show that male engagement in family planning can improve health outcomes, there are several factors preventing the same. Socio-cultural barriers include unequal gender norms fostered through generations, gender dynamics and power play, lack of spousal communication and false notions about masculinity held by both men and women.

Findings from the first phase of the International Center for Research on Women (ICRW)’s Couple Engage project underscores some of the barriers to male engagement in a domain that has historically been perceived as a woman’s burden. The report highlights the gap in knowledge on sex and related issues and limited understanding of consent, sexual and reproductive rights among couples. These challenges are exacerbated with limited emphasis on comprehensive sexuality education in schools and safe spaces to gather correct information on body, sex, contraceptives.

Unequal power relations between men and women determine how they approach family planning, and this, accompanied with fragmented knowledge, further inhibits couples from making informed choices. Men remain the primary decision-makers for women’s health. According to data from NFHS-4 (2005-16), 40% of men think it is a woman’s responsibility to avoid getting pregnant in India.

Institutional barriers preventing male engagement in family planning include, inadequate family planning and sexual and reproductive health programmes and services for boys and men, non-receptiveness by men to female frontline workers and lack of adequate knowledge and provider bias. Social norms and myths and misconceptions around male methods of contraception further deter the acceptance of male methods of contraception. 

While there are no 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% of the FP budget in 2017-18 to 4% in 2019-20.

Moving forward, program-makers and implementers should make sustained efforts, through special and differentiated strategies, to encourage men to be supportive partners in addressing both women’s and their own reproductive needs. In order to ensure sustained and consistent uptake of contraceptives, men must act as equals and supportive partners making informed, equitable choices in consultation with their partners. Targeted social and behavior change communication campaigns and gender transformative programmes will promote male engagement in family planning and change perceptions about masculinity. Such initiatives must engage boys from a young age in innovative ways as future agents of change and champions of gender equality. 

The author is Senior Manager, Knowledge Management and Partnerships at Population Foundation of India.

(Disclaimer: The views expressed above are the author's own and do not reflect those of DNA.)