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Involving men in family planning in Pakistan.

A new analysis by the Population Council shows that engaging men in family planning decisions and dialogue can be a powerful way to help change attitudes and behaviors regarding family planning in Pakistan.

Researchers from the Evidence Project examined data from the Council-led USAID-funded Family Advancement for Life and Health project (FALAH) in Pakistan, which was implemented between 2007 and 2012. The Evidence Project, a five-year USAID-funded project led by the Population Council, uses implementation science to strengthen, scale up, and sustain family planning services to reduce unintended pregnancies worldwide.

Through FALAH, the Council worked with health and population-welfare departments of the Pakistani government, religious leaders, and rural communities in more than 20 rural, socially conservative districts to promote birth spacing as an acceptable health intervention to protect the lives of women and infants. A critical objective of the project was including men in family planning efforts, both to address their lack of opportunities to discuss family planning and obtain services, and to counter the widely accepted belief that family planning is solely a women's concern.

FALAH reached more than 9 million married men and women. Among its major achievements were a decrease in fertility (by 0.5 children), an increase in contraceptive use (from 29 percent to 38 percent), and a drop in the percentage of women who say that they want to avoid or delay pregnancy but who are not using contraception (from 14 percent to 11 percent).

FALAH took a unique approach by actively involving men in creating a supportive environment for family planning.

By using the message "Birth spacing saves lives," family planning was positioned as a health intervention. The project encouraged an interval of 24 months from birth to next conception and raised awareness of the age-related risks of pregnancy.

There were five components to FALAH's male-engagement strategy:

1. Individual counseling through community-based volunteers (falahi workers);

2. Men's group meetings at the community level;

3. Friday sermons at mosques by sensitized local religious leaders;

4. Interactive community theatrical performances;

5. Electronic media (radio spots and television broadcasts of messages, documentaries, and discussions on family planning).

While there was some variation in approach, and the combination of interventions used in individual districts differed, the focus on the core message regarding healthy timing and spacing of pregnancy was consistent in all information, education, and communication materials, direct interactions, and media campaigns.

The Council's recent analysis of FALAH data shows that exposure to the male-engagement components has been influential in changing family planning attitudes and behaviors. For example, men who participated in male group meetings were more likely than nonparticipants to perceive themselves as approachable and cooperative if their wives brought up the subject of family planning, as well as more likely to use contraceptives. In addition, men who were exposed to the television campaign were more likely to communicate with their wives about family planning, cooperate if their wives mentioned family planning, and actually use contraceptives.

Based on these findings, the researchers make five recommendations for future family planning programs in Pakistan:

* Shift the focus to a more gender-balanced approach where men are seen as partners in contraceptive decision-making.

* Design messaging around the theme of healthy timing and spacing of pregnancies, rather than limiting family size.

* Engage religious leaders and publicize their support for family planning, which is consistent with Islamic thought and has been recognized in many other Muslim countries.

* Use male health workers to meet, counsel, and provide contraceptives to men, and organize male group meetings.

* Use interpersonal, community, and mass communication to promote and reinforce family planning messages, including contraceptive options, service availability, and arguments to counter misconceptions about family health and well-being.

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"Men are frustrated at their lack of access to family planning information and programming," said Seemin Ashfaq, Council deputy director for reproductive health programs in Pakistan. "The FALAH project demonstrated that including men in family planning efforts is both a feasible and effective way to help shift attitudes and behaviors in Pakistan. These findings may also apply to other countries in the region."

SOURCES

Ashfaq, Seemin and Maqsood Sadiq. 2015. "Engaging the missing link: Evidence from FALAH for involving men in family planning in Pakistan." Case Study. Washington, DC: Population Council, Evidence Project.

Kamran, Iram, Zeba Tasneem, Tahira Parveen, and Rehan Niazi. 2015. "Family planning through the lens of men: Readiness, preferences, and challenges." Policy Paper. Washington, DC: Population Council, Evidence Project.

FUNDING

US Agency for International Development
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Title Annotation:REPRODUCTIVE HEALTH
Publication:Population Briefs
Geographic Code:9PAKI
Date:Dec 1, 2015
Words:739
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