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Men%C2%92s Participation in Family Planning & Reproductive Health -Learnings and Opportunities for India (Brief-3 Supported by UNFPA) |
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Men’s Participation in Family
Planning & Reproductive Health
Learnings and opportunities for India
Adolescent Friendly
Health Centres (AFHCs)
Government health centres
providing preventive, promotive,
curative and referral services to
young people
Mission Parivar Vikas
(MPV)
A programme launched by
the government in 2016
for increasing the access to
contraceptives and family
planning services in 146 high
fertility districts of seven states,
which had a Total Fertility Rate
(TFR) more than 3.
Modern contraceptive
prevalence rate (mCPR)
Percentage of currently married
women who use any modern
contraceptive method
Modern methods of
contraception
Include male and female
sterilization, injectables,
intrauterine devices (IUDs/
PPIUDs), contraceptive pills,
implants, female and male
condoms, diaphragm, foam/
jelly, the standard days method,
the lactational amenorrhoea
method (LAM), and emergency
contraception
Rashtriya Kishor Swasthya
Karyakram (RKSK)
A programme for adolescents in
the age group of 10 to 19 years
to address their health needs,
including sexual and reproductive
health, nutrition, mental health
and substance abuse, gender-
based violence, and risk factors
for non-communicable diseases,
among others
The success of India’s family planning (FP) programme depends on the involvement and
participation of both men and women. In particular, men need to overcome social and
cultural barriers to become equal partners in planning families, adopt contraceptive
methods, and support women’s contraceptive choices.
The criticality of engaging men was articulated at the 1994 International Conference on
Population and Development (ICPD) as well as in the National Population Policy 2000
and is now one of the proven strategies for improved family planning and sexual and
reproductive health (FP-SRH) outcomes globally.
However, men’s participation in family planning continues to be low in India. The
National Family Health Survey of 2019-21 (NFHS-5) shows that while the use of modern
contraceptives by currently married men the last time they had sex has increased by
about 4 percentage points between 2015-16 and 2019-21, a very large share (76%)
remains non-users.
Share of men reporting use of Family Planning methods
1 in 4 men* reported use of any modern method of
contraception by themselves or their partners the last
time they had sex
*currently married, 15 to 49 years old
Users
Source: NFHS-5, 2019-21
Non-users
What are the trends in men’s participation in family
planning?
Men’s share in modern methods of contraception
Modern contraceptive prevalence rate
(mCPR), measured by the percentage
of women who report using a modern
method (themselves or by their partner)
to delay or avoid pregnancy, constitutes of
a mix of male and female methods. As per
NFHS-5, the contraceptives used by men
(condom and male sterilization) comprise
a share of about 17 percent of the mCPR
(Figure 1). The major responsibility of
contraception among married couples
falls on women (83%), of which female
sterilization alone makes up 67 percent.
Men’s participation in family planning & reproductive health in India
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Figure 1
Proportionate share of modern contraceptive methods
currently used by men and women, 2019-21 (NFHS-5)
Female sterilization 67.1
Male spacing
16.8 methods: condoms
Male sterilization
0.5
15.6
Female spacing
methods: pills,
IUCDs, injectables,
female condom,
ECP, others
Regional patterns in younger men’s contribution to the contraceptive
method mix
Among the high fertility age-group of
20 to 29 years, women’s share in the
method mix of modern method was more
than twice than men’s share. Despite a
preference for spacing methods within
this cohort rather than terminal methods,
the utilization of modern contraceptives
remains low at only 42 percent.
Women’s share in the method mix was
significantly higher than men’s share in
states and union territories (UTs) with a
higher mCPR (close to, or more than 50
percent) except in Goa (61.33 percent)
and national capital territory of Delhi
(63.73 percent). This indicates that high
contraceptive prevalence is driven mainly
by women. Regional trends in the data
show that in a majority of states and
UTs of the northern region and in Uttar
Pradesh, the share of male methods
(condom and male sterilization) in the
mCPR is higher than female methods.
Uttarakhand has the highest share of
male contraceptive methods in the mCPR,
followed by Chandigarh and Himachal
Pradesh.
Notably, respondents from southern
states reported a very low share of male
methods in the mCPR. The lowest is in
Andhra Pradesh, where the permanent
method of female sterilization accounts
for almost the entire (97 percent) modern
contraceptive prevalence, even for this
young age-group (20-29 years).
Men’s desire to limit families and attitude towards women’s contraceptive use
NFHS- 5 data shows that if men aged 15
to 49 years were given a chance to choose
their family size, they would want to have
an average of 2.1 children, similar to
the response of women in the same age
group. With regard to fertility preference
among those with two children (2 sons or
1 son-1 daughter), 78 percent do not want
any more children. On the other hand,
among those with two daughters only, 59
percent do not want any more children.
This percentage goes down further to 43
percent and 33 percent among those with
one son and one daughter respectively.
Among currently married men with 3 or
more children (with at least 1 son), 83
percent do not want any more children.
At the same time, 35 percent of
men agreed with the statement that
contraception is women’s business and
a man should not have to worry about it.
20 percent agreed that women who use
contraception may become promiscuous.
Despite policy commitments on male
engagement in family planning, the
percentage of men reporting these
perceptions have virtually remained
unchanged between 2015-16 and 2019-21.
2
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Research has found that a single point
increase in the proportion of men who
believe that contraception is women’s
business was associated with a 12 percent
reduced likelihood of contraceptive use by
women1. The dichotomy of men’s desire
to limit their family size, while at the same
time having low contraceptive uptake
and negative perceptions about women’s
contraceptive use, reflects on their poor
engagement as supportive partners in
family planning.
Training health workers to promote equitable gender norms among couples
The CHARM project (Counselling Husbands to Achieve Reproductive Health and
Marital Equity) involved delivering five counselling sessions on family planning and
gender equity to married couples over four to six months. The counsellors were
health workers who received training on gender equity issues, family planning, and
the intervention, apart from the standard government FP training.
The intervention showed better couple communication and women’s agency over
an 18-month period and increased modern contraceptive use in the short-term2.
How well are men and boys informed about family
planning methods and safe SRH practices?
Men’s knowledge of contraceptives
The first step towards engaging in family
planning and healthy SRH practices is
access to timely and accurate information.
According to NFHS-5 data, currently
married men’s knowledge of any modern
method of contraception is universal
(Figure 2). Their knowledge of condoms is
also nearly universal (97 percent), although
a far lower share (55) said that if a male
condom is used correctly, it protects against
pregnancy most of the time. Significantly,
currently married men’s knowledge of male
sterilization is lower than that of female
sterilization (88 percent vs 96 percent).
Figure 2
Percentage of currently married men (15-49 years) with
knowledge of specific contraceptive methods, 2019-21
100
97
96
88
66
*Pills, IUCDs, Injectables, Female Condom or ECP. Source: NFHS-5
Men’s knowledge of spacing methods of
contraception used by women is much
lower than their knowledge of female
sterilization. NFHS-5 data shows that
66 percent of currently married men
were aware of at least three methods
of contraception used by women for
spacing births (Pills, Intrauterine
devices, Injectables, Female Condoms
or Emergency Contraceptive Pills). Of
these, 66 percent of men, 96 percent, 88
percent, 70 percent have knowledge of
female sterilisation, pills, and injectable
contraceptives respectively. This is an
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indicator of men’s limited engagement as
supportive partners in women’s decisions
on spacing births.
Men’s information about contraceptives
is also plagued by myths and
misconceptions, which affect their
participation in family planning as users.
Male sterilization is believed by many of
making men impotent or weak, thereby
hampering their ability to work and
continue their sexual life3,4. This is despite
the fact that male sterilization through
Non-Scalpel Vasectomy (NSV) is a simpler
and low-risk procedure as compared to
female sterilization. Often men also avoid
use of condoms due to the notion of
reduced pleasure.
Sources of information on family planning
According to NFHS-5, 62 percent of
men were exposed to family planning
messages in the past few months through
wall paintings or hoardings, while more
than half saw FP messages on television
(Figure 3). Twenty-two percent had not
been exposed to FP messages. The
percentage of men not exposed to FP
messages was significantly higher for
those who had less than five years or no
schooling (33% and 40%), those belonging
to the Scheduled Tribes (30%), and those
who were from the lowest wealth quintile
(33%). This indicates a gap in information
reaching the most vulnerable categories
of men.
Apart from media channels, frontline
workers play an important role in
building awareness on family planning,
contraception and sexual health. Due to
the historical focus of India’s population
programme on improving reproductive,
maternal and child health (RMNCH)
services, the public health system, and
especially the cadre of female health
workers (ASHAs, ANMs, Anganwadi
workers) are primarily geared towards
addressing the needs of women.
Programme reviews and research studies
have found that men are not comfortable
to discuss contraception with female
health workers, and commonly seek
information from unreliable sources,
such as friends or acquaintances like local
pharmacists5,6. Frontline health workers,
who are also part of the community and
adhere to prevalent gender norms, often
act as informal gatekeepers who avoid
engaging with men on issues related to
SRH and family planning7.
Even though the National Population
Policy 2000 acknowledges the need
to engage with men, there are no
interventions to specifically address men’s
needs, unlike innovations under the
Mission Parivar Vikas (MPV) programme
for high fertility districts focusing on
women, such as the Saas – Bahu sammelan
or Nayi Pahel kit. As a result, men have
limited opportunities for exposure to
messaging that could help them adopt
more participatory, responsive, and
gender egalitarian behaviours.
Figure 3
Percentage of men who had heard or seen a family planning
message on specific media in the past few months, 2019-21
Radio
Internet
Newspaper/Magazine
Television
Wall painting or hoarding
None of these media sources
Of men aged 15 to 49 years; Source: NFHS-5
15
29
22
47
57
62
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Engaging with men through gamification using a financial education
model
A project in Bihar titled ‘Hamari Shaadi, Hamare Sapne’ used a financial education
course to incorporate conversations on family planning, delaying, spacing and
limiting as a way to reach their aspirations. The results from the pilot showed an
increase in spousal communication and support by men of their wives on family
planning, better knowledge of contraceptive methods among men, and increase
in uptake of contraceptives8.
Awareness of sexual health
Sexual awareness and bodily changes
begin at the time of puberty in
adolescence (10 to 19 years), also setting
in motion psychological transformations
that lead to curiosity and experimentation
among young boys. Providing correct and
age-appropriate information on sexual
and reproductive health ensures their
well-being in adolescence, as well as helps
them adopt healthy behaviours and safe
sexual practices as adults.
NFHS-5 data shows that only 29 percent
of young men in the age-group of 15 to
24 years had comprehensive knowledge
of HIV/AIDS, although a majority of them
(87%) knew of a source for condoms.
The levels of knowledge about HIV/AIDS
among all men in the age-group of 15 to
49 years is only marginally higher at 31
percent.
Sources of SRH information and services for adolescent boys
Among adolescent boys, early
experiences of sexuality are clothed in
ideas of masculinity and gender norms
that place expectations on boys and
men as providers and protectors, and
promote behaviours such as risk taking,
hypersexuality, and aggression. As
they enter adolescence, boys begin to
disengage from healthcare services, and
face barriers due to stigma and shame in
seeking help9.
Life skills education in school, community
outreach through frontline health workers
and peer educators, and counselling as
well as health care at Adolescent Friendly
Health Centres (AFHCs)10 are important
programme components of the Rashtriya
Kishor Swasthya Karyakram (RKSK).
However, the implementation of these
components is found to have many gaps.
A rapid programme review carried out
by the World Health Organization in
2016 found that young people faced
geographical barriers in accessing
health centres, there were gaps in
training of counsellors and monitoring
of community outreach initiatives, and
interdepartmental convergence for
programme implementation was poor11.
A longitudinal study with youth and
adolescents found that just 14 percent
of older boys (aged 18 to 22 years) had
ever received any family life education,
and less than 10 percent had interacted
with any frontline workers in the last one
year12.
Lack of uniform access to information on
sexual health and well-being at school
or through out-of-school programmes
creates an early gap in the knowledge
of SRH among boys, and a missed
opportunity in shaping healthy behaviours
in their marital life as adults.
Gender and social norms, and men’s engagement
in family planning as supportive partners
Regressive social norms shape inequitable gender role attitudes, and in turn have a
lifelong influence on men’s engagement as supportive partners. Regressive gender
norms are not just harmful for women, but also bind men in a web of expectations
and behaviours that impede their own health seeking behaviours and wellbeing.
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Unequal power relations between men and women determine how they approach
family planning, and this, accompanied with fragmented knowledge, further inhibits
couples from making informed choices. Men remain the primary decision-makers for
women’s health.
Impact of social norms on men’s engagement in family planning
Patriarchal social norms, notions of
masculinity, and men’s perceived role
of continuing the family lineage puts
pressure on couples to start a family soon
after marriage, contributing to men’s low
participation in family planning. According
to data from NFHS-5, the use of any
modern contraceptive during their last
sex by currently married men was half of
the use by men currently not married (24
percent vs 50 percent).
Probably social stigma of unintended
pregnancy forces men to know about
and use FP methods when they are not
married. However, what prevents them
from using and participating when they
get married, and what are the drivers of
change in their beliefs and practices could
be an area of further research.
Intimate partner violence and its impact on family planning outcomes
Iniquitous gender socialisation of boys
and young men often leads to them
exercising spousal violence and marital
control behaviours as adults. These
behaviours affect spousal communication
and limit women’s ability to negotiate sex
and contraception with their partners.
As per NFHS-5, 32 percent ever married
women in the age-group of 18 to 49
years experienced any form of violence
(physical and/or sexual and/or emotional)
committed by their husband. This figure
has remained unchanged between 2015-
16 and 2019-21.
Studies show associations between
women’s experience of Intimate Partner
Violence (IPV) and discontinuation of
specific types of contraceptives, especially
those that require the husband’s
involvement or knowledge13.
Research has found that among condom
users, women who experienced emotional
violence were more than four times as
likely to discontinue use, as compared
to women who did not experience any
violence. Similarly, among women using
IUDs, those who experienced physical
violence were over three times more
likely to discontinue use, as compared
to women who did not experience any
violence14.
Changing stereotypes and fostering male role models through
entertainment
A popular transmedia serial, Main Kuch Bhi Kar Sakti Hoon (MKBKSH) sought to
change mindsets and stereotypes with the use of positive role models. The serial
advocated successfully for men to accept vasectomy, and turned the popular
term for sterilization – ‘nasbandi’ – into a positive phrase, ‘mastbandi’.
An end-line evaluation showed that after watching the serial women became
more confident in communicating with their husbands on contraception, and
accessing family planning services. A group of men from Chhatarpur in Madhya
Pradesh pledged to adopt contraception after watching MKBKSH. They advocate
for adoption of vasectomy in the community, moving from village to village in the
region and singing ballads to motivate other men15.
Policy recommendations to promote male
engagement in family planning
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Promote strategies that prioritise men as beneficiaries of the FP programme
Keeping men’s specific needs as clients in mind, they should be serviced through
existing, as well as new outreach channels. Activities within the Mission Parivar
Vikas (MPV) for high fertility districts need to have components focusing on men, to
specifically address the unique needs and challenges faced by them. Beyond health,
there are many far-reaching, catalytic effects of male engagement in family planning.
At the household level, men will be able to invest more of their scarce resources in the
education of their children.
Since men’s interaction with health workers is limited, contact with them through Village
Health, Sanitation and Nutrition Days (VHSNDs) and visits to health centres should be
used to extend SRH and family planning counselling and services.
Make greater investments in SBCC interventions to address social and
systemic barriers to male engagement
Sustained Social and Behaviour Change Communication (SBCC) campaigns can be
effectively used to debunk myths and misinformation regarding SRH and family
planning issues that are deeply embedded in social norms.
To effectively cover all demographic and socio-economic segments of men and boys,
transmedia SBCC campaigns, including grassroots civil society engagement and
cross-platform entertainment education programmes, should be developed. These
community-based and transmedia programmes can together generate conversations,
be amplified through digital networks, and prompt a positive shift in attitudes among
men as well as larger communities.
To address systemic biases in programme delivery, gender sensitive orientation needs
to be an integral part of trainings for various levels of service providers, including
frontline workers and programme planners. Policies to engage with men need to put
in place systems that promote equal access to information and services for all people,
irrespective of their sexual identities.
Formulate policies to mainstream gender sensitisation of young boys and
promote CSE in schools
Inequitable gender role attitudes take shape in adolescence, but can be transformed if
addressed effectively at an early age16. Long-term multistakeholder gender sensitisation
programmes need to work with families, teachers, and social influencers in the
community to create a supportive environment for boys to challenge iniquitous gender
norms. To address the gap in information on sexual health and wellbeing among boys,
provision of age-appropriate information and counselling facilities need to be integrated
within the school education system and in programs such as Ayushman Bharat School
Health and Wellness. Additionally, the peer educator network and adolescent-friendly
health centres (AFHCs) under the RKSK have to be strengthened to ensure that
adolescent and youth are able to access information and facilities without shame or
stigma.
Invest in research and evaluation of male engagement interventions and
scaling up of best practices
Greater investments are needed to build in evaluation and impact assessment of male
engagement interventions right from the concept phase, so as to generate enough
evidence of their efficacy, and enable replication at a wider scale. Such investments are
especially important for programmes focusing on men and their role in family planning,
considering there are few such interventions that have been studied adequately
to provide guidance on effective strategies. As part of the policy to engage men,
evidence from such projects should be collated and used in trainings for programme
implementers to adapt and scale up at the state level.
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Document and disseminate good practices of male engagement in family
planning
Recognizing the pivotal role that men play in family planning, it is important to identify,
document and disseminate successful approaches, strategies, and interventions that
have proven effective in fostering male involvement. Many projects implemented across
India and other parts of the world have shown promising results, best practices from
which should be compiled and disseminated with a wide range of stakeholders includ-
ing donors, government officials, CSOs, etc.
References
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Attitude Towards Contraception and Sexuality, Women’s
Empowerment, and Demand Satisfied for Family Planning in India.
Front. Sociol. 6:689980. doi:10.3389/fsoc.2021.689980
2 Raj, Anita, et.al 2022. Evaluation of a gender synchronized
family planning intervention for married couples in rural India:
The CHARM2 cluster randomized control trial. doi: https://doi.
org/10.1016/j.eclinm.2022.101334
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vasectomy is faring poorly almost everywhere—we can do
better to make it a true method option. Glob Health Sci Pract.
2023;11(1):e2200369. https://doi.org/10.9745/GHSP-D-22-00369
4Seth, K., Nanda, S., Sahay, A., Verma, R., Achyut, P. 2020. “It’s on
Him Too” – Pathways to Engage Men in Family Planning: Evidence
Review. New Delhi: International Center for Research on Women
5Seth, K. et al. 2020
6FAMILY PLANNING: WHOSE WORK IS IT? Review of Male
Engagement in India’s Family Planning Policies. https://ipc2021.
popconf.org/uploads/210487
7Seth, K., Vachhar, K., Sahay, A., Joseph, J., Dutta, D., Yadav, K.,
Jha, S., Kumar, S., Nanda, S. (2020). Couple Engage – Thematic
Barrier Two: Alienation of Men by the Health System. New Delhi:
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8https://www.engagemen.in/
9BMJ 2023;380:p385. http://dx.doi.org/10.1136/bmj.p385
10Health clinics established by the government to provide
preventive, promotive, curative and referral services to young
people
11Barua, A., Watson, K., Plesons, M. et al. Adolescent health
programming in India: a rapid review. Reprod Health 17, 87 (2020).
12Population Council. 2020. UDAYA – Understanding the lives of
adolescents and young adults. Infographic. New Delhi: Population
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13Lotus McDougal, Jay G. Silverman, Abhishek Singh, Anita Raj,
Exploring the relationship between spousal violence during
pregnancy and subsequent postpartum spacing contraception
among first-time mothers in India, EClinicalMedicine, Volume
23, 2020, 100414, ISSN 2589-5370, https://doi.org/10.1016/j.
eclinm.2020.100414.
142022. Association between Intimate Partner Violence and
Contraceptive Use Discontinuation in India. Ashish Kumar
Upadhyay, Kaushalendra Kumar, K. S. James, Lotus Mcdougal,
Anita Raj, and Abhishek Singh. Studies in Family Planning
published byWiley Periodicals LLC on behalf of Population Council
15Men in Chhatarpur script a new role for themselves. Population
Foundation of India
https://populationfoundation.in/wp-content/uploads/2020/04/
Fileattached-1480401077-MKBKSH-brochure.pdf
16Gupta AK, Santhya KG. Promoting Gender Egalitarian Norms
and Practices Among Boys in Rural India: The Relative Effect of
Intervening in Early and Late Adolescence. J Adolesc Health. 2020
Feb;66(2):157-165. doi: 10.1016/j.jadohealth.2019.03.007. Epub
2019 Jun 18. PMID: 31227386.
Population Foundation of India is a national non-
government organisation (NGO), founded in 1970 by
JRD Tata, that promotes and advocates for the effective
formulation and implementation of gender-sensitive
population, health and development strategies and
policies. Working with the government and NGOs, it
addresses population issues within the larger discourse
of empowering women and men.
Head office
B-28, Qutab Institutional Area, New Delhi - 110016
T: +91 11 43894 100 | F: +91 11 43894 199
Regional offices
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www.populationfoundation.in
@PopFoundIndia
@PopFoundIndia
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United Nations Population Fund (UNFPA) is the lead
UN agency for delivering a world where every pregnancy
is wanted, every childbirth is safe, and every young
person’s potential is fulfilled.
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