The Challenge Initiative Is Engaging Males in Family Planning
With a shift towards increasingly urban living, how will cities absorb growing populations?
A cultural and gendered preference for large families is an important factor in the rapid growth of African populations that has been slow to budge. In Burkina Faso, 15- to 49-year-old men have an ideal family size of 6.3 children, compared to 5.5 children among Burkinabe women (DHS 2010). In Niger, the same age group of men hope for a family of 10.9 children, while women would like to have, on average, 9.2 children (DHS 2012). Across the continent, in Uganda, men report 5.4 children as their ideal family size and women cite 4.8 children as their ideal family size (DHS 2016).
The Challenge Initiative (TCI) partners with cities to implement evidence-based family planning and adolescent and youth sexual and reproductive health (AYSRH) programs that empower and enable both women and men to decide freely whether, when and how many children to have.
First things first
Men are scarcely targeted by traditional family planning programs. And, the vast majority of family planning methods are designed for female use. It is high time for that to change. Globally, male contraception is a small piece of the pie when you look at modern method use.
While we wait for much-needed male methods to be developed, TCI is focused on the ones that do exist. Male engagement is essential to female adoption and maintenance of contraception. And beyond their role as partners, men are potential users and champions of family planning.
In India, The Challenge Initiative for Healthy Cities (TCIHC) –TCI’s brand in India– is adapting approaches that achieved significant results under the Urban Health Initiative and PSI’s Expand Access and Quality to Broaden Method Choice project. TCIHC is working hard to engage men, especially as it relates to creating demand for non-scalpel vasectomy, one of the most effective methods of modern family planning. TCIHC’s demand generation strategy includes workplace interventions, rickshaw puller interventions, interventions at male congregation points like Chauraha (Cross Roads) and evening community meetings in slums.
In Bauchi State, TCI Nigeria’s demand generation activities are designed to identify potential male users in likely locations – outreach at association meetings, football matches, other live events and neighborhood campaigns – led to a 67% increase in uptake of male condoms in just one month.
A penny for your thoughts…
A deep understanding of the populations TCI aims to reach forms the backbone of its programming. Recent interviews performed using the Most Significant Change methodology offered significant insights, allowing men to tell stories that inform the delivery of tailored, proven approaches to each TCI community.
In East Africa, many male stakeholders said they wished they had known more about family planning earlier in their lives. They shared stories of feeling overwhelmed and overburdened by the demands of their large families. After learning more about family planning from TCI, they are ready to do their part not only as more supportive partners, but also as contraceptive users.
Patrick Baraza, District Health Officer in Busia Municipality, shared:
“I am … a father to 28 children – 7 of my own and 21 others of my late two brothers. This number is almost a full clan and these children are a burden to me. The challenges I have experienced are too much for me, but if I don’t look after my late brothers’ children, they will become a burden to my own children later on. So I have no choice but to educate and care for all of them.
“The knowledge and skills gained from TCI has helped me realize my mistake, and right now I cannot even think of having another child. I convinced my wife to accept a long-term family planning method and she is now using IUDs. I am also planning to go for vasectomy soon. If I had come across this program earlier before having children, I would be very happy and wouldn’t have had so many children. But, unfortunately, by the time it reached this town, I already had my children who have now turned into bitter fruits instead of good ones.”
Another father in Uganda echoed the worry that comes with the responsibility of supporting many children with modest resources:
“The mother said it was now my turn to look after the child. I felt frustrated because I did not know where I was going to get more money to supplement my already stretched budget.”
It’s never too late to engage men
TCI programs are engaging men as family planning champions regardless of their life stage. There is no time limit to become a family planning champion, supporter or user.
Thomas Mugambe Ssalongo, member of the volunteer health team (VHT) and community mobilizer from Buikwe, Uganda, shared:
“My mindset has changed and I am now a family planning champion in my community. I share my story as a learning experience for the youth in Buikwe District. I hope that the youth and young couples can learn from my story and make better decisions by adopting family planning to offer their children quality life. I intend to go for vasectomy soon.
“I now have new knowledge which I want to impart to others so that they do not go through the same experience like me.”
Male champions are noting encouraging trends
Shifting norms around family size among both women and men are providing an opportunity for TCI to not only encourage condom use but also non-scalpel vasectomy.
“Sincerely speaking, this program has changed the mindsets of the people in my community because the knowledge they have received has helped them minimize unplanned children. Within the next 3–4 years, the changes will be bigger than the ones I am seeing today. The number of children will be fewer and fewer until they give birth to the expected ones they can manage.
“It is high time we reduced the number of people to the magnitude that our country, Uganda, can manage and children that parents can manage.”
Men need solutions that respond to their specific needs
While youth, for example, need services to be offered outside of traditional clinic hours and without parental consent (and other accommodations included in TCI’s Adolescent & Youth-Friendly Services Approach), women can be screened as potential adopters of family planning when they are at a clinic for a child’s vaccinations through the ISBC approach used in French West Africa. And men and women should be counseled on their family planning options during antenatal and postpartum visits, so that there are no missed opportunities.
Research reveals that a primary concern of most men is income production and their ability to support their families. As a result, it’s important to frame family planning methods in light of these economic considerations. Furthermore, programming should identify and address barriers that might inhibit men’s access and uptake of male methods.
In the case of non-scalpel vasectomy, recovery can require two days. In India, when outreach occurs at the workplace, TCIHC advocates for employer buy-in, requesting two days of paid leave from supervisors so lost wages do not interfere with adoption of non-scalpel vasectomy. For a full report on an employer-based approach to long acting and permanent methods of contraception in India, check out the RESPOND Project’s final report.
Looking to engage more men and boys in family planning? Check out TCI resources, including examples of TCI’s work with religious leaders to communicate the health and social benefits of family planning, a comprehensive Guide for Promoting Sexual and Reproductive Health Products and Services for Men, and more.
The Challenge Initiative is one of the highest-scoring proposals – designated as the Top 100 – in the MacArthur Foundation's 100&Change competition for a single $100 million grant to help solve one of the world's most critical social challenges.
Sisi-Kwa-Sisi coached nurse transforms district and contributes to 28% increase in long-acting reversible contraceptive (LARC) users (from December 2019 to baseline)
ASHAs in India are building relationships with family decision-makers to promote family planning among young first-time mothers.
In Nigeria, TCI set out to bridge the gap between just making referrals to family planning services and successfully completing those referrals.