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, Leicester13-15 September 2004

Structure of Presentation

2 Background

3 Data and methods4 Results

5 Conclusions

1 Objectives

Objectives

- 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

To examine:

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

CPR

TFR

0

10

20

30

40

50

60

70

80

90

100

1976 1981 1986 1991 1996 2001

Year

Per c

ent

Knowledge Total useMale methods use Female methods use

Female knowledge and use of contraception in Nepal

98.5

18

28.7

46.7

17.9

99.6

30.3

48.2

0102030405060708090

100

Knowledge Male method use Female method use Total use

Per c

ent

1999 VaRG 2001 NDHS

Male knowledge and use of contraception in Nepal

Data and methods

This study uses both quantitative and qualitative data

Considers 2,187 currently married men aged 15-59

2001 Nepal DHS

Quantitative data:

Included men respondents for the first time

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

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

continued….

•Thematic analysis

•The groups ranged from 6-10 participants

Results

Odd ratios from logistic regression assessing the associations between contraceptive methods used and selected characteristics Factors/Variables Overall methods Male methodsCurrent age

15-24 1.734**25-34 1.786***35-44 2.638***45-59 ('r) 1.000

Number of living childrenNone 0.377*** 3.395***One or more 1.000 1.000

Desire for more childrenSterilised/infecund 117.378***After 2+ years 2.303***Want no more 3.643***Want within two years 1.000

Respondent's educationHigher 1.727*Secondary or less 1.000

ReligionNon-Hindu 0.582***Hindu 1.000

Respondent's work statusProfessional, Technical and Managerial 1.260Clerical, 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 methodsHeard 1-5 methods 0.662* 0.455***Heard 6-7 methods 0.584*** 0.689*Heard 8-11 methods 1.000 1.000

Husband-wife communicationMore often 3.440*** 1.141Once or twice 2.930*** 0.706*Never 1.000 1.000

Exposure to mass mediaThree media 1.703***Two media 1.762***One or none 1.000

Ecological regionMountain 0.540*** 2.957***Hill 0.747* 1.930***Terai 1.000 1.000

ResidenceUrban 1.599***Rural 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

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

Summary of Results (continued …)

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 bearingNewly 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 vasectomyMales 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).

Why don’t …….(continued …)

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)

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.

• 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

Conclusions

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