Helping men take the lead in family planning

IN A MAKESHIFT ROOM INSIDE AN UNFINISHED building at Manyatta slums in Kisumu, men congregate regularly to discuss community matters, usually in the presence of the local chief.

But the May 21 baraza (a chief’s gathering) was different. A community health worker engaged the over 50 men on family planning, an issue many are uncomfortable with.

“It’s only for women. And it makes them promiscuous. I would not advise my wife to use contraceptives because the role of a woman is to bear children,” says Zaddock Odhiambo, a 28-year-old father of six. His counterpart, Damascus Chemonges, agrees.

The response at meetings such as this has raised questions about male involvement in reproductive and maternal health.

Two years ago, a United Nations Population Fund report said: “Men usually decide on the number and variety of sexual relationships, timing and frequency of sex and use of contraceptives, sometimes through coercion or violence”.

There are many examples of this to date. “I started taking pills discreetly because I didn’t want more children, given that I have four already. When my husband found out, he threw the pills away and threatened to kill me if I continued taking them,” Margaret Akoth from Manyatta says.

She is now on a discreet, three-month injectable contraceptive.

COMMUNITY HEALTH WORKERS WHO PROVIDE family planning education and distribute contraceptives also face hostility from men, who accuse them of ruining families.

Rose Ochieng’, a community health worker in Nyalunya, 17km from Kisumu, says she has been confronted several times by men who have threatened to “teach her a lesson” if she continues with her work.

Health workers say the target of reducing maternal deaths by 75 per cent by the set deadline of 2015 will not be met without the concerted effort of all.

Men’s low acceptance of family planning is due to many reasons, says a joint study by the Kisumu Medical Education Trust and Boston University.

The research was conducted between December 2008 and January 2009 in Rift Valley, Nyanza and Western provinces. It found out that most men were reluctant to visit reproductive health clinics because they viewed them as “women’s domains.”

The overriding factors were widespread myths and misconceptions. The majority of the men said family planning made a woman cold in bed, while vasectomy rendered men impotent.

Healthcare workers cite the need to dispel such rumours. For example, vasectomy, regarded as one of the most effective means of birth control, is offered free of charge at Marie Stopes Clinic in Kisumu. Yet Charles Ochieng’ has conducted only six since the beginning of the year.

Dr Ochieng’ — who has had a vasectomy — wants the myths dispelled. “Vasectomy does not cause a man to lose his sex drive, or to become impotent. One is able to perform his sexual duties normally, only that a woman cannot get pregnant.”