Transcript Contraceptive behaviour of married men in Nepal

Contraceptive behaviour
among men in Nepal
Govinda Prasad Dahal, Andrew Hinde and Monique Hennink
Division of Social Statistics
Prepared for the annual conference of the BSPS, Leicester
13-15 September 2004
Structure of Presentation
1
Objectives
2
Background
3
Data and methods
4
Results
5
Conclusions
Objectives
To examine:
- the factors associated with the use of
contraceptive methods
- the reasons why don’t Nepali men use male
methods of contraception?
-whether Nepali men consent their wives to use
female methods of contraception
Background
•HIV/AIDS and unwanted pregnancies are
public health problems
•Men’s behaviour is reported to be the main
reasons for these risk
•ICPD emphasised the active involvement of
men to improve sexual and reproductive
health outcomes
•Nepal’s women focussed FP policy and
programmes overlooked men
Trend of CPR and TFR, Nepal 1976 - 2001
TFR
CPR
Female knowledge and use of contraception in Nepal
100
90
80
Per cent
70
60
50
40
30
20
10
0
1976
1981
Knowledge
Male methods use
1986
1991
Year
1996
Total use
Female methods use
2001
Per cent
Male knowledge and use of contraception in Nepal
100
90
80
70
60
50
40
30
20
10
0
98.5
99.6
46.7
28.7
18
Knowledge
48.2
30.3
17.9
Male method use
1999 VaRG
Female method use
2001 NDHS
Total use
Data and methods
 This study uses both quantitative and qualitative data
Quantitative data:
 2001 Nepal DHS
Included men respondents for the first time
 Considers 2,187 currently married men aged 15-59
continued….
 Logistic regression models
Two dependent variables:
Overall use of contraception
(1= used any method
0 = used no method)
Use of male method
(1= male method
0= female method)
Male method= Condom, Vasectomy, Withdrawal and Periodic Abstinence
Female method=Pill, IUD, Depo, Female sterilization, Foam/Jelly, Norplant
continued….
Qualitative data:
•Conducted eight focus groups with Nepali married
males aged 15-45 in order to discuss family planning
in terai and hill of Nepal during April-May 2004
•The groups ranged from 6-10 participants
•Thematic analysis
Results
Odd ratios from logistic regression assessing the associations
between contraceptive methods used and selected characteristics
Factors/Variables
Male methods
Overall methods
Current age
15-24
1.734**
25-34
1.786***
35-44
2.638***
45-59 ('r)
1.000
Number of living children
None
0.377***
3.395***
One or more
1.000
1.000
Desire for more children
Sterilised/infecund
117.378***
After 2+ years
2.303***
Want no more
3.643***
Want within two years
1.000
Respondent's education
Higher
1.727*
Secondary or less
1.000
Religion
Non-Hindu
0.582***
Hindu
1.000
Respondent's work status
Professional, Technical and Managerial
1.260
Clerical, Sales and Services
0.685*
Skilled and unskilled manual
0.605**
Agriculture
1.000
Continued…….
Final decision for women's health care
By both partners
2.010***
By wife alone
2.698***
By husband and others
1.000
Knowledge of FP methods
Heard 1-5 methods
0.662*
Heard 6-7 methods
0.584***
Heard 8-11 methods
1.000
Husband-wife communication
More often
3.440***
Once or twice
2.930***
Never
1.000
Exposure to mass media
Three media
1.703***
Two media
1.762***
One or none
1.000
Ecological region
Mountain
0.540***
Hill
0.747*
Terai
1.000
Residence
Urban
1.599***
Rural
1.000
0.455***
0.689*
1.000
1.141
0.706*
1.000
2.957***
1.930***
1.000
Significantly different from reference category at * p≤ 0.05; ** p≤ 0.01; ***p≤ 0.001
Summary of Results: Multivariate analysis
Men who are less likely to use contraception:
• are young
•have no children
•desire child within two years (of survey)
•have low knowledge of contraceptive methods
•are from mountain &
•are from non-Hindu background
Summary of Results (continued …)
Among users, men who use male methods:
• are highly educated
• possess professional, technical & managerial
job
•are from mountain and hill ecological regions
•have no living number of children
Among users, men who rely on female methods:
• posses jobs like clerical, sales and services
• live in terai
• have spousal communication only once or twice
• have low level of contraceptive knowledge
Why don’t men use male methods?
The results from qualitative survey show a range of
factors, which are:
• Young couples desire to have children immediately after
marriage because of three reasons:
(i) pressure from parents
…bride and groom’s parents show their greed to be grandparents as
soon as possible and apply force to the newly married couples to have
baby soon (FGD 1:35 years married farmer from rural terai)
(ii) limited knowledge of family planning and early child
bearing
Newly married couples may not have proper knowledge of contraceptive
use and the likely consequences of child birth in early age (FGD 1:35
years married farmer from terai)
Why don’t …….(continued …)
(iii) fear of developing sterility
If young women used any temporary female contraceptive methods
such as pills or depo injection before having the first child, it is
believed that they may be infertile for their whole life (FGD 2: 35
years, married NGO worker from hill).
Negative attitudes towards condom use
Condom is a tedious method of contraceptive (FGD 2: 30 years,
married farmer)
….storage and dumping (after use) is big problems to maintain privacy
if one intends to use condoms (FGD 1: 19 years farmer).
Fear of post surgical problems of vasectomy
Males do not want to do vasectomy operation because vasectomy
makes men weak and they can not support their family economically
(FGD 3: 27 years rural man).
Why don’t …….(continued …)
 Unavailability of suitable male methods
…..this is not because male do not want to involve but it is due to
unavailability of suitable methods for men. Male has only condom as
temporary method. This is annoying to use condoms for a long period
of time. How long we keep on using that condom! Instead it is good and
easy to rely on female method, depo injection (FGD2: 33 years service
men from hill).
Whether Nepali men consent their wives to use
female methods of contraception
-The findings suggest that generally Nepali men consent their wives
to use female contraceptive methods if wife’s health is good
However, uneducated and poor especially, from lower caste do not
intend adopting male methods and also do not want their wives to
use female contraceptive methods due to the fear of promiscuity.
 Except men of lower caste families, no other men generally object to
their wives to use female methods of contraception if wife’s health is
normal (FGD 1: 35 years married farmer).
 Generally educated couples decide who should adopt permanent
method of contraception based on the health and need of the couples.
However, in lower caste and uneducated society, some men who want no
more children often force women to adopt permanent method (FGD 3: 27
years manual worker)
Conclusions
• This analysis identified that certain groups of Nepalese
men were not using contraception
•A comprehensive FP programme targeted to their needs
should be needed
•FP programme should deliberate the massage about
advantages of using methods (especially use of condom
to avoid STIs and AIDS)
•Changing rooted cultural value takes time to change
but efforts should be continued
•Research on the development of new contraceptive
methods for men is needed
THANK YOU !