September 21, 2021

In Western Kenya, male partner resistance toward contraceptive use creates barriers to care for women and birthing people seeking access to contraception.

A new publication in Sexual & Reproductive Healthcare highlights how the resistance that husbands and male partners may have toward contraception can impact strategies for obtaining and providing necessary family planning resources in Kenya.

Dr. Laura Britton

Dr. Laura Britton

Dr. Katherine Tumlinson

Dr. Katherine Tumlinson

Caitlin Williams

Caitlin Williams

The paper, which includes work from researchers at the UNC Gillings School of Global Public Health and the Carolina Population Center, was led by Laura Britton, PhD, postdoctoral fellow at Columbia University School of Nursing and UNC-Chapel Hill alumna. The data for the analysis came from a mixed-methods parent study in Western Kenya conducted by Assistant Professor of Maternal and Child Health Katherine Tumlinson, PhD. Caitlin Williams, maternal and child health doctoral candidate, also collaborated on the paper.

“Family planning supports reproductive self-determination and has been shown to save the lives of women and children living in low- and middle-income countries,” said Tumlinson. “Yet nearly one in four women in sub-Saharan Africa with a desire to avoid pregnancy is not using a contraceptive method. The parent study that provided data for this analysis was designed to understand factors underpinning the unmet need for family planning in Western Kenya, with a focus on facility-level barriers.”

The team analyzed transcripts of focus group discussions with current and former contraceptive users, as well as in-depth interviews with health care informants and providers. Responses in these transcripts were used to create “journey maps” that helped to better understand the experiences of contraceptive service delivery by both providers and users.

Participants in the focus groups noted that male partner resistance arose from concerns that family planning may be unsafe or cause undesirable side effects. Men were also viewed as resistant to family planning due to a desire for more children. These opinions often created conflict between spouses and reflected perceptions of gender and family roles. Male resistance to contraceptive use could motivate women or birthing people to avoid the use of contraception or to use it covertly to avoid destabilizing their relationships.

Many who sought covert contraception worried about lack of privacy at health care facilities. Others found the process time-consuming, having to travel long distances, wait in long lines or make multiple trips for care if providers were absent. Some women seeking contraception covertly felt too rushed to have contraceptive counseling and initiated methods without being fully informed. Financial concerns also impeded access, especially among those who were afraid to ask male partners for money. Some who asked for money were declined and were at risk of becoming pregnant while waiting to obtain their own money.

Sometimes providers turned away those seeking contraception covertly due to lack of spousal support or directed them to more forms of contraception that patients did not prefer but were easier to hide from their partner. Some providers feared that men would confront them in anger if they discovered contraception, and to avoid confrontation, they would deny women their desired contraception despite personally believing women should have access to their desired method.

Participants were supportive of solutions that aimed to educate male partners on family planning and reframe perceptions of gender roles. But because these perceptions are deeply entrenched in both home and health care settings, the study team noted that such solutions should target education in the context of a decision-making process that involves the user, partner and provider together.

Tumlinson and collaborators at UNC are currently implementing and evaluating two interventions in Western Kenya designed to increase community empowerment and engagement and provider accountability to family planning patients.

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