|Year : 2019 | Volume
| Issue : 1 | Page : 6-9
Male involvement in family planning in Northern Nigeria: A review of literature
Awawu Grace Nmadu1, Istifanus Anekoson Joshua1, Victoria Nanben Omole1, Nafisat Ohunene Usman1, Chinedu John-Camillus Igboanusi2, Abulrazaq Abdullahi Gobir3
1 Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Public Health, 2 Division Medical Services & Hospital, Headquarters 2 Division, Nigerian Army, Adekunle Fajuyi Cantonment, Ibadan, Nigeria
3 Department of Community Medicine, Ahmadu Bello University, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||31-Jul-2019|
Dr. Awawu Grace Nmadu
Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Demand and utilization of family planning (FP) in Northern Nigeria has been consistently low. Evidence from literature has demonstrated that male involvement in FP programming can be successful in increasing demand for FP services. Materials and Methods: A search of peer-reviewed and gray literature was carried out to explore the status of male awareness and utilization of FP methods, and the barriers to male involvement in FP, in Northern Nigeria. Results: Males in the region generally have a good awareness of FP. However, they had negative perceptions, low levels of usage of FP, and poor spousal communication about FP. Sociocultural and religious barriers played major roles in hindering male involvement in FP. Misconceptions about FP, such as that FP is a woman’s activity and that it also encourages promiscuity among women, were factors limiting its acceptance. Conclusion: There is a need to address the misconceptions and equip men with complete and correct information about FP. There is also a need for research on effective strategies to address the sociocultural and religious barriers to male involvement in FP in Northern Nigeria and the development of effective culturally sensitive male-involvement FP initiatives.
Keywords: Family planning, male involvement, Northern Nigeria
|How to cite this article:|
Nmadu AG, Joshua IA, Omole VN, Usman NO, Igboanusi CJ, Gobir AA. Male involvement in family planning in Northern Nigeria: A review of literature. J Med Trop 2019;21:6-9
|How to cite this URL:|
Nmadu AG, Joshua IA, Omole VN, Usman NO, Igboanusi CJ, Gobir AA. Male involvement in family planning in Northern Nigeria: A review of literature. J Med Trop [serial online] 2019 [cited 2020 Jun 7];21:6-9. Available from: http://www.jmedtropics.org/text.asp?2019/21/1/6/263743
| Introduction|| |
Globally, Nigeria is the seventh most populous country with a current estimated population of 183 million, which is projected to reach 285 million by 2050., This is not unrelated to the high fertility rates in Nigeria especially in the northern parts of the country. Total fertility rates are as high as 6.3 in north-east and 6.7 in north-west compared to 4.7 in south-east and 4.6 in south-west regions. In response to curbing population growth rate and improving the welfare of the populace, Nigeria enacted two population policies in 1988 and 2004,, of which family planning (FP) and fertility management are main strategies for curbing population growth. Despite this, the northern part of the country has one of the lowest contraceptive use rates in the world. Contraceptive usage among married women of reproductive age in Northern Nigeria ranges from 15% in the north-central zone to as low as 3% in the north-eastern zone as compared with 29% in the south-east to 38% in the south-west.
The contribution of FP programs to reductions in population growth and maternal mortality and morbidity is universally acknowledged.,,,, FP programs have been shown to reduce total fertility rates in developing countries., FP, especially modern methods of FP or contraception, are considered to be key health-promoting and cost-effective activities, with the potential to avert approximately 30% of maternal deaths and 10% of childhood deaths. Contraception plays a key role in decreasing maternal mortality by providing significant protection for women by preventing unintended pregnancies, which often end in unsafe abortions., FP can prevent closely spaced and ill-timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates.,
The society in Northern Nigeria is patrilineal with a strong male influence on many household decisions including those involving FP. Traditionally, men in this region are the heads of households, sole providers, and also control economic resources of their family. This makes the attitudes of males toward FP and contraceptive use a significant factor influencing women’s preferences and opinions in this region. For example, there is evidence that in many contexts, husbands play significant and important roles in reproductive health decision-making. Understanding the role of male involvement in FP could contribute to efforts aimed at increasing the uptake of FP in the region. Many reproductive health initiatives in the region are targeted at women, to the exclusion of men although men play significant roles in contraceptive behaviors of women. This review explores the status of male awareness and utilization of FP methods and the barriers to male involvement in FP, in Northern Nigeria.
| Methods|| |
A narrative review of original research, reports, and reviews was carried out using secondary data identified through literature searches of peer-reviewed articles published between 2001 and 2018 in databases such as PubMed, Medline, African Journals Online (AJOL), Bioline international, POPLINE, and Google Scholar. The literature search also included reports and research briefs from WHO, UNFPA, UNICEF, and Population Council published in English language. Data from the Nigerian Demographic Health Surveys (NDHS) were also used. Search words utilized included male involvement, men’s opinions, men’s attitude, men’s practice, contraceptive knowledge, FP knowledge, FP awareness, partner attitude, contraceptive attitude, FP attitude, contraceptive practice, contraceptive use, FP use, contraceptive awareness, FP methods, FP decision-making, spousal communication, married men, and Northern Nigeria.
| Results|| |
Awareness of FP methods
Studies showed that there is generally a high level of awareness about FP methods among men in Northern Nigeria.,,, A study conducted by Duze and Mohammed reported generally high levels of male awareness of FP with 63.6% of the respondents indicating knowing at least one method. A study conducted in Zaria, Nigeria, similarly reported a high level of awareness among the men with 67.4% of them being knowledgeable about FP. According to the NDHS (2013), the northern region of the country reported higher values of awareness (95%) about a contraceptive method among men, which was not different from the national average of 95%. A more recent study conducted in Jos, north-central Nigeria, reported that 98.8% of the men were aware of FP.
According to the NDHS (2013), among the northern states, awareness of contraceptive methods among men was lowest in Niger (84%) and Yobe (86%) States. There were only small differentials in the knowledge of any contraceptive method by age group, but differentials were greater by place of residence, zone, educational level, and wealth quintile. The most commonly known method of contraception among men was the male condom (91%), followed by pills (65%) and injectables (61%). The least known methods were male sterilization (27%), lactational amenorrhea (20%), and IUCDs (20%), and the most popular source of information about FP among men in Northern Nigeria has been reported to be from the media through the radio.,
Men’s attitude and practice regarding FP
Studies have reported that males in Northern Nigeria desire large families due to multiple factors ranging from religious beliefs to economic security.,,, A review of studies on FP knowledge, attitudes, and behavior in Northern Nigeria revealed that due to the high value placed on children, limiting childbearing was found to be a controversial or disliked practice whereas child spacing was generally accepted. A study conducted by Kabir et al. found that the attitude of men to FP was generally negative, 65% disapproved of the very concept of contraception, and disapproval was higher among those with low educational attainment. In the study by Duze and Mohammed, there was a generally negative attitude toward limiting family size. A large proportion (62%) were not willing to use and allow their spouses to use FP even for child-spacing purposes and 85% of the respondents were not willing to or allow their spouses to use FP for economic reasons. Respondents in the study who were willing to use contraceptives were more willing to use them for child-spacing purposes than explicitly for limiting family size. A more recent study by Kabir et al., conducted in Zaria, showed that more than half (54%) of male respondents approved of FP and 29% of these stated the reason for this was to promote family health, whereas 17% said it would help them cater for their children properly. The main reason for disapproval of FP was due to contradiction with religious beliefs (40%).
It has been noted that Islam does not support family size limitation, but it encourages child spacing. Most respondents in the studies reviewed believed that men should not accompany their wives to the FP clinics to obtain contraceptive supplies and counselling., Some studies have also highlighted that in Northern Nigeria some married women are not allowed to go out unless they seek permission from their husbands and if he is not around, the authority rests in the hands of the father or mother in-law.,,
Contraceptive use by men in most of the communities in Northern Nigeria has been very low.,,, According to NDHS (2013), 30% of the sampled male population was currently using contraception, with condom use as the dominant method (66%). The level of contraceptive use was significantly higher among sexually active single men, at 68%, compared to 19% among monogamous married men and 9% among polygamous men. Other factors influencing contraceptive use among sexually active men included socioeconomic status, religion, educational attainment, and age. There was a higher level of use at younger than at older ages. Education showed a statistically significant positive relationship with contraceptive use. Socioeconomic status was a key determinant of men’s modern contraceptive use, and high socioeconomic status favored contraceptive usage. A study conducted by Hussain et al., among male soldiers in Sobi Barracks, Ilorin, north-central Nigeria, similarly reported low practice of contraception usage (12.3%).
Spousal communication about FP decision-making
Majority of men in the studies reviewed had not discussed FP with their wives.,,,, The study by Izugbara and Ezeh suggested that husbands and wives in the region have plenty of incentives to keep having children and hence do not bring up the issue of contraception. The lack of spousal discussion in the study was found to result largely from a mix-up in the expectation of couples regarding who should initiate it. In the study by Mandara, the main reasons for men not discussing FP with their spouses were due to the religious objection of FP and that it was a cultural taboo. In a recent study conducted in Zaria, spousal communication about FP was also low, and the most common reasons given for not engaging in spousal communication was that religion forbids the act and such discussion is not important. Another common reason given for not engaging in spousal communication is that it is embarrassing. Such male embarrassment and shyness in discussing FP issues have been observed in previous studies. This observation could be as a result of social stigma resulting from the perception of pregnancy and childbirth as exclusive affairs of women., The implication of variations in reasons for not engaging in spousal communication is that any approach to improving spousal communication must be tailored to fit the target population.
Barriers to FP
Religious norms especially the religious conviction that God has asked people to procreate and that there should be no need to limit or stop childbearing was one of the major barriers identified as decreasing the uptake of FP among men in the various studies.,,,,,,, The sociocultural norm of having many children enhances the social status of the household head and provides a reliable source of labor was also a deterrent to the utilization of FP in the studies reviewed.,,, The stigma attached to the utilization of FP in many communities in Northern Nigeria featured as a barrier to acceptance and utilization of FP methods among men.,,, The stigma attached to the utilization of FP by communities in Northern Nigeria could not be unrelated to the sociocultural beliefs and religious taboos associated with the use of FP. The misconceptions about FP such as perceptions that FP is a woman’s activity and that it also encourages promiscuity among women were factors limiting its acceptance.,,, These misconceptions could stem from a general lack of knowledge and could be attributed to men having limited access to correct reproductive health information. This was similar to findings in a study in Zimbabwe where men’s lack of involvement, fear, and negative health beliefs stemmed from their overall lack of knowledge that was attributed to the limited number of community-level reproductive health campaigns which targeted men. Findings from the literature in Sub-Saharan Africa including Nigeria revealed that FP information and services are not targeted toward men; services are instead traditionally presented within the context of maternal and child health.,, Other reasons for nonacceptance and nonuse of FP included fear of health side effects and concerns about long-term infertility and also barriers related to service provision such as unavailability of contraceptives, cost of contraceptives, poor attitudes of service providers, and lack of male service providers.,,,
| Conclusion|| |
Males in Northern Nigeria have a good awareness of FP but have negative perceptions and low levels of usage. Spousal communication was poor and male involvement in FP was low. Sociocultural and religious barriers played major roles to hinder male involvement in FP, and men desire large families. Given these facts, efforts focused on limiting childbearing will likely not succeed in this context. Poor attitude and wrong misconceptions about FP by men can infringe on the rights of their spouses. It is therefore important to address the misconceptions and equip men with complete and correct information about FP. There is a need for research on effective strategies to address the sociocultural and religious barriers to male involvement in FP in northern Nigeria and the development of effective culturally-sensitive FP initiatives with male involvement.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
National Bureau of Statistics. Demographic Statistics Bulletin 2015. A Publication of Demographic Statistics Division National Bureau of Statistics. Available at nigerianstat.gov.ng/download/490
. [Accessed July 11, 2018].
National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey (NDHS) 2013. Abuja, Nigeria: National Population Commission and ICF Macro; 2014.
Federal Republic of Nigeria. National Policy on Population for Development, Unity, Progress, and Self-Reliance. Lagos: Federal Ministry of Health/Department of Population Activities; 1988.
Bongaarts J, Cleland J, Townsend JW, Bertrand JT, Gupta MD. Family Planning Programs for the 21st Century. New York: Population Council.
Miller G, Babiarz KS. Family planning program effects: Evidence from microdata. Population Dev Rev 2016;42:7-26.
Robinson WC, Ross JA, editors. The Global Family Planning Revolution: Three Decades of Population Policies and Programs. The World Bank 2007.
Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet 2012;380:149-56.
Duze MC, Mohammed IZ. Male knowledge, attitude, and family planning practices in Northern Nigeria. Afr J Reprod Health 2006;10:53-65.
Dudgeon MR, Inhorn MC. Men’s influences on women’s reproductive health: medical anthropological perspectives. Soc Sci Med 2004;59:1379-95.
Ameh N, Shittu OS, Abdul MA. Role of men in contraceptive use in Northern Nigeria: a cross-sectional study. Trop J Obstet Gynaecol 2011;28:43-7.
Kana MA, Tagurum YO, Hassan ZI, Afolanranmi TO, Ogbeyi GO, Difa JA et al.
Prevalence and determinants of contraceptive use in rural Northeastern Nigeria: results of a mixed qualitative and quantitative assessment. Ann Nig Med 2016;10:3.
Daniel G, Okoli N, Kumzhi P, Wina F, Ari E, Onyejekwe G. Awareness and use of family planning methods among men in Mista Ali District, Jos, Plateau State, Nigeria. Afr J Midwifery Women’s Health 2016;10:120-5.
Abubakar M, Mamman M, Laah JG. Family planning practice amongst men in a northern Nigerian urban centre. Zaria Geogr 2012;19:84-93.
Izugbara CO, Ezeh AC. Women and high fertility in Islamic northern Nigeria. Stud Fam Plan 2010;41:193-204.
Sinai I, Anyanti J, Khan M, Daroda R, Oguntunde O. Demand for women’s health services in northern Nigeria: a review of the literature. Afr J Reprod Health 2017;21:96-108.
Kabir M, Iliyasu Z, Abubakar IS, Maje BS. The role of men in contraceptive decision-making in Fanshekara village, Northern Nigeria. Trop J Obstet Gynaecol 2003;20:24-7.
Adamu YM. Maternal Mortality in Nigeria: A Case Study of Kano State. Germany: VDM, Moller; 2010.
Mohammed IZ. Knowledge and attitude of Hausa men towards family planning. J Soc Manage Sci 2005;9:107-34.
Giwa A. Contraceptive Decision-making in North-Central Nigeria [Doctoral Dissertation, submitted], Postgraduate School, University of Sheffield, 2015.
Blackstone SR, Iwelunmor J. Determinants of contraceptive use among Nigerian couples: evidence from the 2013 demographic and health survey. Contracep Reprod Med 2017;2:9.
Hussain NA, Akande TM, Osagbemi GK, Olasupo ST, Salawu KY, Adebayo ET. Perception and practice of contraception among male soldiers in Sobi barracks, Ilorin, Nigeria. Afr Health Sci 2013;13:415-22.
Mandara M. Family planning in Nigeria and prospects for the future. Int J Gynecol Obstet 2012;117:1-4.
Ibrahim MS, Sabitu K, Bashir SS, Olorukooba AA. Spousal communication on family planning, pregnancy, and delivery care among men in rural Northern Nigeria. Sahel Med J 2018;21:88-9. [Full text]
Lewis S, Lee A, Simkhada P. The role of husbands in maternal health and safe childbirth in rural Nepal: a qualitative study. BMC Pregnancy Childbirth 2015;15:162.
Mullany BC. Barriers to and attitudes towards promoting husbands’ involvement in maternal health in Katmandu, Nepal. Soc Sci Med 2006;62:2798-809.
Nesane K, Maputle SM, Shilubane H. Male partners’ views of involvement in maternal health care services at Makhado Municipality clinics, Limpopo Province, South Africa. Afr J Primary Health Care Fam Med 2016;8:e1-5.
Kabagenyi A, Jennings L, Reid A, Nalwadda G, Ntozi J, Atuyambe L. Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health 2014;11:21.