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Getting men to take responsibility for family planning

There’s an elephant in the room, and it is up to men to get it out.

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On the chosen date, residents of Moro, Osun state gathered at the planned venue. They had one thing in common. All were male, and had turned out to learn about family planning.

Adebisi Adenipekun, a World Contraception Day ambassador, staged a football competition among youth, using sports to teach family planning.

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“The concept of family planning is not new to indigenous people in rural communities,” he says.

“In all, we had a direct reach of over 600 people with our advocacy message on family planning and an estimated overall reach of 2,000 people.”

His campaign, the Rural Contraceptive Access Campaign is in its second phase and surveyed 302 men and women of reproductive age in Moro. Nine in 10 people surveyed were aware of traditional methods of family planning.

In focused group discussions, they speak of “rings” worn on a finger or toe to prevent pregnancy. But the ring loses its potency when it is still on at the time of menses.

“With civilization and advancement in medical science, there are more reliable, credible and effective modern methods of family planning,” says the ambassador.

Wrong target

Family planning interventions, both local and donor-funded, have been circulating in Nigeria for up to 50 years.

Last July, Nigeria moved up its target to ensure 27 in 100 women of reproductive age are able to access modern contraception by 2020.

But the message has been squarely and for a long time centred on women. Now attention is turning to including men in the family planning discourse.

“It is a discussion that’s already overdue,” says Ada Ezeokoli, managing director of Nigeria Health Watch, behind the #elephantintheroom forum to take on men as change agents in family planning.

“The fact that we are having it now means that we are actually having it late. Family planning interventions have been on for the past 40 years, yet our modern contraceptive prevalence rate is still not going anywhere. Women are still not accessing family planning commodities.”

Over 200 million women—many of them poor and living in rural and remote parts of the world—lack access to voluntary family planning methods.

Still unreached

In the last 10 years, only around one in 10 woman over all of reproductive age is able to use modern contraception.

The difference is marked between urban and rural areas and varies according to region—25 in 100 women in the south west, compared with three in 100 women in the north east.

Conversely, up to 16 in 100 women who want to use contraception can’t get access. And only one in five public health facilities offer family planning services and products.

“If you look at the communities where we are having challenges with accessing family planning commodities, you find that the decision makers who decide whether women access family planning are usually in-laws and husbands,” says Ezeokoli.

“If men are not included in the conversation about family planning, we are really just going to be talking to a wall.”

Patriarchally, men decide the “if, when and what” with regard to family planning.

“The intervention should have begun with both men and women from the beginning,” says Ezeokoli.

“Because women are the ones who carry babies, it seemed more natural to sell to them. There has been a lack of focus on men, and it is time to change the narrative.”

The elephant in the room

The elephant in the room is Nigeria’s rapidly expanding population, compared with how much it is ready and able to contribute to programmes to limit family size.

“Comparing elephants, Nigeria commits $8m to $12 million a year to family planning,” says Diene Keita, country representative of the United Nations Population Fund in Nigeria.

“By comparison, India commits $1 billion.”

Money isn’t just the issue but how family planning space itself works.

“We have not been strategic enough in targeting men with our programmes, neither have we gathered enough body of evidence to see the impact of men,” says Effiom Nyong Effiom, country director for Marie Stopes International, which offers family planning services.

Research suggest planned families—having control over pregnancy numbers, timing and spacing—cuts maternal deaths by up to a quarter.

How men figure into the picture is rather ignored but advocates are about making men the face and spokespersons of family planning.

"When men don’t speak out for family planning, there is the perception that they are against it. There should be deliberate national effort to increase men’s interest and participation in family planning,” says Effiom.

“When men talk to men, they listen more. But failing to involve men or insist only on women, it is not a very sustainable practice.”

Over 200 million women—many of them poor and living in rural and remote parts of the world—lack access to voluntary family planning methods.

“Men are the problem”

The Federation of Muslim Women’s Association of Nigeria is part of a project, the Partnership for Advocacy for Child, Family and Adolescent Health.

One of its latest interventions is getting young men to be role models and teachers to encourage family planning services in communities in northern Nigeria.

“Men are our problem,” says Sa’adatu Hashim, leader of the group. “Men have to be involved in family planning. We have been targeting women. We have to educate our people.”

FOMWAN isn’t seeing family planning as just spacing, she says. “It is about having a manageable family size. If it is about spacing, what about when you have four wives, all giving birth each year?”

“Men always refer to the Qu’ran to support marrying many wives. But the Qu’ran was referring to a battle of old, where many men were killed and orphans and widows left behind. Where is the justice in what we are doing now? You marry one, two, three, four wives, they all give birth and take care of the children, and when you can’t take care of the children, you send them into the streets,” Hashim laments.

“We need to get men motivators to talk to men, tell them to marry how many they can take care of. Some will marry, send the children into the streets, divorce the woman and marry again. We should change all these, we should educate our people so that they do the right thing."

The motivation is an appeal of sorts to get men to support their partners in seeking family planning services—and take responsibility for it without depending on women.

“When you talk to a man about his wife, he might not be too interested,” says Ifeanyi Nsofor, director of policy and advocacy at Nigeria Health Watch.

“But when you talk about his daughter, he becomes interested.”

The men-for-men talk isn’t just is already using men in authority, and has included projects targeting young men of reproductive age though unmarried as well as youth considered already sexually active.

Starting with men, it is rippling out into different demographics.

“Family planning is something everyone should be aware of as soon as they are able to reproduce,” says Ezeokoli.

“People who aren’t married should still understand the issues around family planning. Young men and women who have not even got to marriage  should still be able to understand that family planning can be available to them and they should think about how they will reproduce and the consequences of their reproduction, from an early age.”

 


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