Pa ge 1 Pa ge 60 American Journal of Physical Education and Health Science (AJPEHS) Assessment of Married Men Involvement in Family Planning Practices: A Qualitative Study of Akure South Local Government Area of Ondo State, Nigeria Falokun Rosemary Ogundolapo1* Volume 2 Issue 2, Year 2024 ISSN: 2992-9679 (Online) DOI: https://doi.org/10.54536/ajpehs.v2i2.3142 https://journals.e-palli.com/home/index.php/ajpehs Article Information ABSTRACT Received: July 15, 2024 Accepted: August 18, 2024 Published: November 19, 2024 The non-accommodation of men in the family planning programs has been identified as one of the contributory factors for the low utilization of FP methods in this male- dominated society like Nigeria. Male involvement can lead to uptake in acceptance and prevalence rate of family planning methods and practices in Nigeria.This paper aimed to study the involvement of married men in the family planning practices in Akure South Local Government Area of Ondo State, Southwestern Nigeria. The primary data were collected from 250 married informants who satisfied the eligibility criteria and were assessed througha self-administered questionnaire and selected from the sample population across 11 political wards in the Akure South Local government area using a multi-stage random sampling technique. The secondary data were generated from government publications, journals, newspapers, and relevant internet materials. The presentation and analyses of data were done using descriptive statistics (frequency table, percentage and numbers). The study’s findings revealed that married men’s knowledge about family planning practices is high while exhibiting low involvement in FP and low utilization of the FP methods. However, the number of children, socio-cultural beliefs, financial status, education and religion are discovered to be among conditional factors that influence contraceptive use among married partners. The study therefore recommended increased health promotion and education of family planningprogrammes among the residents and involvement of men as a target in all FP programmes and introduction of family planning services in National Health Insurance Scheme in order to reduce associated misconceptions about contraceptives methods and increase the usage. Keywords Acceptability Theory, Data, Family Planning, Contraceptives, Misconceptions INTRODUCTION According tothe World Health Organisation (WHO), 2022 is defined as a conscious effort by a couple to limit or space the number of children they want to have through the use of contraceptive methods. Family planning (FP) programmes are centered primarily on women, however, with a focus on gender equity for optimal health, there is a shift to engage men in supporting and using FP services (Joshi,2015) opined that men, as the decision-makers in most African families, have an important role to play towards the utilization of family planning methods, which is an efficacious interventions recommended and approved by the World Health Organization (WHO) as well as Ministry of Health (MOH) in most countries. According to the same body, the benefits of family planning include reduced maternal and infant mortality, sustainable development through population control, and enhanced women’s participation in the workforce. The 2020 Nigerian Demographic and Health Survey (NDHS) reported that in Nigeria, almost two-thirds (65%) of the men disapproved of attending family planning programmeswith their spouses, while only 26 percent of them had ever done so. Poor communication between men and their female partners was associated with poor male involvement. Developing countries make up about 85% of the global population and account for 99% of all maternal mortality cases. According to the 2018 National Demographic and Health Survey (NDHs), the maternal mortality ratio stands at 512 deaths/ 100,000 level of births and Nigeria accounted for approximately one fifth of maternal deaths globally. The same body equal affirmed that, the lifetime risk of maternal death in Nigeria is 0.029 (1 in 34 compared to 1 in 4900 in most developed countries of the world). It can therefore be inferred from the above assertion that low level of male involvement in reproductive health practices is one of the drivers of high maternal morbidity and mortality. This has also reduced the impact of family planning interventions and intervenes with unregulated fertility that hinders economic development and created a political imbalance in a country. Globally, there is a growing risk in the recognition of the benefits of involving men in family planning services. It is known from research that gender dominance, particularly men’s disapproval of family planning has an impact on the subdued prevalence of contraceptive use in sub-Saharan Africa. According to findingsof a study conducted in Bandladesh 40% male involvement rate was reported, and a similar study carried out in western Nigeria documented 39.6%. This shows that male involvement remains low despite ongoing efforts. No doubt, the effect of male dominance on the decision-making process heightens the poor indices of reproductive health, as documented in a study conducted in Nigeria where 62% of women had 1 Nigeria * Corresponding author’s e-mail: foludolapo@yahoo.com Pa ge 61 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 their husbands as their decision-makers and only 6% of currently married women at the time of the survey made decisions for themselves. Aransola, Akinyemi and Fatusi (2014), noted in their study that male involvement in sexual and reproductive health is an integrated approach engaging men as clients, partners and agents of positive change in reproductive health issues. They therefore posited access to media; television and radio, spouse employment status, and average monthly income have all been identified as positive correlates of male involvement in family planning programmes. Statement of Problem The 2018 Nigerian demographic and Health Survey found that only 10% of married women of reproductive age use contraceptives. This is lower than the current sub-Saharan Africa average of 17%. The majority of married woman in Nigeria are not currently using contraceptive and have no intention of doing so in the near future. In addition, spousal disagreement can serve as deterrent because women might fear initiating a difficultconversation about family planning. Also, in Nigeria the use of any method of family planning is usually initiated by their husbands. Men have rarely been involved in either receiving or providing information on sexuality, reproductive health or birth spacing. Women are not considered decision makers, but implementers of what had been decided by men, without questioning men’s decisions. Many studies have established high level of awareness on contraceptive use, but very low level of use in Nigeria due to obstacles such as: Myths and misinformation or rumours, fear of complications, lack of understanding of the methods and fear of opposition from the husband. The above scenario is also observed among men in Ondo State Nigeria, particularly in Akure South Local Government Area of the State where issue of male dominance is pronounced in the use of family planning methods, due to cultural practices that are mostly in men’s favor. It is the light of the above, that the study aims at assessing the level of involvement of men in family planning activities in Akure South Local Government Area of Ondo State using a quantitative research methodology. Research Questions 1. What is the most utilized source of information about family planning in Akure-South Local Government Area of Ondo State? 2. What is the level of knowledge about family planning among married men in Akure South Local Government Area of Ondo State? 3. What is the level of involvement ofmarried men in family planning in Akure South Local Government Area of Ondo State? 4. What are the contributory factors that influence involvement of married men in family planning practices in Akure South Local Government Area? The general objective of this study is to assess the level of involvement of men in family planning in Akure South Local Government Area of Ondo State Specific Objectives The specific objectives of the study are: 1. To determine the most utilized source of information about family planning among married men in Akure South Local Government Area of Ondo State. 2. To ascertain the level of knowledge about family planning among married men in Akure South Local Government Area of Ondo State 3. To determine the level of involvement of married men in family planning in Akure South Local Government Area of Ondo State 4. To determine the contributory factors that influence the involvement of married men in family planning in Akure South Local Government Area of Ondo State. The scope of the study is delimited to men residing in Akure south local government area of Ondo state. Significance of the Study This study will contribute immensely to the understanding of men involvement in family planning practice as it has taken into account the geographical, socio-economic and cultural factors, particularly at community levelthat are responsible for men attitudes toward family planning. Therefore, it will serve as an input in the planning of men reproductive health improvement strategy at both local and national level. LITERATURE REVIEW Involvement of Men in Family Planning According to the United Nations Population and Family Planning Agency (UNPFPA), family planning involves the use of information, means and methods that will allow people to decide on the time and number of children to have. The issue of unwanted pregnancy in the rising global population is of concern. The world has hypothesized that the estimated global population would be surpassed due to this issue, showing the dire need for an intervention in form of family planning and contraceptive as the implementation of family planning will achieve a significant decrease in the projected population size. It needs to be actively practiced to reduce the adverse effects of overpopulation (Amuzie, Nwamoh, Ukegbu, Okedo- Alex, Umeokonkwo, Azu, Kalu, Izuka, and Odini (2022). The benefits of family planning are numerous. Not only will it reduce infant mortality and morbidity, it will also enhance child growth and development. Greater effects can be seen on the parents, where their pregnancy risks and intervals could be lowered and regulated. It also enables the achievement of a desired family size and helps parents make informed choices. Social health problems such as HIV/AIDS and teenage pregnancies could be better controlled. (Olubodun, Balogun, and Ogunsulu, 2020) Pa ge 62 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 According to Ozumba (2011) family planning is a family matter. Its initiatives are usually concentrated on women because traditionally, fathers made little or no efforts in child raising in Africa. Women are usually the ones on fertility and contraception is also concentrated on women possibly due to the variety of female contraceptive methods as opposed to those of the males. In reproductive and health matters men’s effort in family planning remained invisible but with evolving dynamics over the years, fathers’ involvement in family planning has now become crucial. Many factors of course affect men’s participation in family planning and affect their attitudes to embrace FP practices. Men’s support or opposition to their partner’s practice of family planning has a strong impact on contraceptive use in many parts of the world, including Africa. Within marriage in Africa, men typically have more say than women in the decision to use contraceptive and in the number of children that the couple will have. Spouse communication is a position associated with contraceptive use. DHC data from seven African countries (Botswana, Burundi, Ghana, Nigeria, Senegal, Sudan and Togo) show that the percentage of women using modern contraceptives is consistently higher in the group that had discussed FP with their husbands in the year before the interview than in the group that not (JHU/ PIN 2004) because of lack of communication, many women do not know what their husbands think about FP. Many women think that their husband disapprove of FP, when in fact the husband approves. In West Africa about three quarters of the men and women had not discussed family planning with their spouse in the year preceding the survey, except in Ghana and Cameroon. Men’s lack of access to services has been a barrier to family planning use. This is because men cannot share responsibility for reproductive health and family planning if services and information do not reach them. FP clinics cater for women, so men are uncomfortable about going to these clinics. Men must be reached in other ways. Married men are concerned that encouraging their wives to utilize family planning services may lead them to become promiscuous thereby becoming unfaithful. This unsupportive role of the husbands stemmed from the stigmatizing belief that contraception is most often used by female commercial sex workers or women with intentions to avoid pregnancy that might result from their extramarital relationships. The men’s anxiety from the fear of their spousal infidelity is a strong barrier in men’s involvement in supporting female’s utilization of reproductive health service. Some side effects observed as a result of contraceptive use include reduction in sexual pleasure, increasing women’s risks of infertility and illness, irregular and prolonged bleeding, vaginal dryness, reduced sexual desire, infertility, and illness. All these perceived side effects discourage or frustrate men to support their partners use of contraceptive method. Theoretical Framework The Health Belief Model According to Rosenstock and Becker (1994) health belief model is a social psychological health behavior change model developed to explain and predict health-related behaviours, particularly with regard to the utilization of health services. This implies that individual belief about the efficacy of an intervention will determine the acceptability of the intervention or otherwise. Therefore, the relevance of this theory to this work rest on the fact that men adoption of family planning will depend largely on their belief and perception of the efficacy of various family planning methods and the benefits they will derive from using them. Chapter Three METHODOLOGY Introduction This chapter presents the study settingresearch design, population of the study, sample and sampling technique, research instrument, administration of instrument and method of data analysis. Study Setting The study setting took place in Akure South Local Government Area of Ondo State. Southwestern, Nigeria. Akure South Local Government are consists of 11 political wards consisting about 40 selected communities. More than 30% of the population live in rural settings and the residents consists of civil servants, petty traders, artisans, and farmers. Christianity is the major religion followed by Islam and traditional religion. The Local Government Headquarters, Akure has the presence of Government offices, educational institutions, health facilities, traditional and modern elements. Research Design The research design to be adopted for the study is descriptive research design. This method allow for collection of data in quantitative manner which guarantee that all participants have equal choice of being selected. Population of the Study The study population comprises of 250 married men residing in Akure South Local Government Area of Ondo State. They are between 20-59 years old. Sample Size Determination To determine the sample size of this study, Leiz Fisher’s formular was adopted. Below is the calculation n= Z2pq/d2 Z= standardized normal 1.96 P= Prevalence of 0.20 derived from the previous study q= (1-P) d= is the level of precision n= 1.962 x 0.20 x 0.7931/0.052 = 252.1 Thus, 252 respondents were considered as the sample size. Pa ge 63 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 Administration of Questionnaire Questionnaire were administered by the researcher to 252 informants. Only two questionnaire were not properly filled. This did not have any negative effects on the findings of the study. Sampling Technique A multistage sampling technique was adopted for the selection of participants for the study. This type of sampling technique requires the research to choose his/her sample in stages until the required sample size is obtained. In using multistage sampling techniqueeleven(11) political wards in Akure South Local Government were first identified. They are: Aponmu, Gbogi/Isikan I, Gbogi/ IsikanII, Ijomu/ Obanla, Ilisa, Odopetu, Oda, Oke-aro, Iro 1, Oshodi/Isolo, Owode/Imuagun. Stage 1 This stage involved using of stratified sampling technique to stratify the eleven (11) wards in the local government are to 9 urban and 2 rural wards Stage 2 Here, two(2), urban wards and 2 rural wards sere selected by simple random sampling (balloting). Stage 3 Communities in the 4 selected wards were listed out and two (2) communities each will be selected randomly through balloting. Thus, 8 communities will be selected in all. Stage 4 At least one respondent willbe chosen from every household until the required respondents were gotten. The selected participants were assessed through a structured questionnaire. Data Presentation and Data Analysis The data generated were analyzed using descriptive statistics such as frequency table, percentage, and numbers. The analyses consists of socio-demographic profile of the respondents and the respondents opinions on research questions pertaining to the study. Table 1: Socio-demographic profile of the respondents Variable Frequency Percentage (%) Gender Male 250 100 Total 250 100 Age 0-39 76 30.4 0-49 112 44.8 0-59 62 24.8 Total 250 100 Education Primary School 28 11.2 Secondary School 79 31.6 Higher Institutions 124 49.6 Others 19 7.6 Total 250 100 Years of marriage <2 years 33 13.2 2-5 years 74 29.6 >5 years 143 57.2 Total 250 100 Occupation Employed 184 73.6 Unemployed 66 26.4 Total 250 100 Religion Christianity 129 51.6 Islam 58 23.2 Traditional 43 17.2 Others 20 8 Pa ge 64 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 The table above presents the socio-graphics characteristics of the respondents. The analysis of the findings revealed that all the respondents are male and married. Out of 250 respondents , 76 of them representing 30.4% are within the age bracket of 30-39 year, 112 respondents representing 44.8% fall within 40-49 years while 62 of them representing 24.87% are 50-59 years. Also, 28 of the respondents representing 11.2% attended primary school, 79(31.6%) respondents attended secondary schools, 124 respondents representing 49.6% attended higher institutions while 19 of them representing 7.6% attend other schools. Similarly, 33 of them representing 13.2% have spent less than 2 years in their marriage, 74 respondents representing 29.6% have spent between 2 to 5 years in their marriage, while 143 of them(57.2%) have spent more than 5 years in their marriage. In the similar vein, 184 (73.6%) are employed while 66 (26.4%) are unemployed. On their religion, 129 (51.6%) are Christians, 58 (23.2%) are moslems, 43(17.2%) are traditional worshippers while 20 (8%) engaged in other religious practices. Analysis of the respondents view on the number of living children they have , showed that 12(4.8%) respondents have not had children, 23(9.2%) have 1, 77(30.8%) have 2 while 138 (55.2%) have 3 children and above. The results of these findings showed that majority o the respondents are within the age bracket of 40-49 years, attended high institutions; have spent more than 5 years in marital relationship and employed. Also, majority of the respondents are Christians and have at least 3 children Research Question 1 What is the most utilized information sources on family planning in Akure South Local government Area? Total 250 100 Number of children 0 12 48 1 23 30.8 2 77 9.2 3 and above 138 55.2 Total 250 100 Source: Field report 2023 Table 2: Respondents view on the most utilized source of information on family planning in Akure Local Government Area Variable Frequency Percentage (%) Mass media( Radio, television, newspapers and internet) Lecture 106 42.4 Friends 50 20 Books 22 8.8 Health facilities 72 28.8 Total 250 100 Source: Field Report 2023 The table above presented the respondents in the most utilised source of information on family planning in Akure South Local Government Area.The analysis of the findings showed that out of 250 respondents, 106 (42.4%) chose mass media as the most utilized source of information on FP, 50(20%) chose friends, 22(8.8%) chose books while 72(28.8%) chose health workers. It can be inferred from the results that majority of the respondents opined that mass media ( Radio, Television, Newspapers and Internet) as the most utilised source of information on FP. Research Question 2 What is the level of knowledge about family planning methods among married men in Akure South Local Government Area? Table 3: Respondents view on the level of knowledge about family planning practices among married men in Akure South Local Government Area Variable Frequency Percentage(%) Reasons for family planning Limiting family size 95 38 Prevent unwanted pregnancies 72 28.8 Spacing births 63 25.2 Pa ge 65 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 The table above presented the respondents view on the level of knowledge about FP among married men in Akure South Local Government area. The analysis of the findings showed that out of 250 respondents, 95(38%) opined limiting family size was a major reason for FP, 72(28.8%) supported prevention of unwanted pregnancies, spacing of births was supported by 63(25.2%) respondents as the reason for FP while other reasons accounted for 8% from 20 respondents. From the results, it can be inferred that limiting family size is the reason for family planning among married men in Akure South Local Government Area. On the knowledge of family planning methods, Out of 250 respondents, 106(42.2%) opined that the use of condoms is the most commonly used FP method, 52(20.8%) opined that oral contraceptives, 20(*%) chose withdrawal method while 32(12.8) choose use of injections. The results of the findings showed that majority of the respondents supported condoms as the most commonly used family planning methods. Research Question 3 What is the level of married men’s involvement in family planning in Akure South Local Government Area? Others 20 8 Total 250 100 Family planning methods Condom 106 42.4 Oral contraceptive 52 20.8 IUCD 13 5.2 Vasectomy 10 4 Withdrawal method 20 8 Vaginal foamy tablets 17 6.8 Injectables 32 12.8 Total 250 100 Source: Field Report 2023 Table 4: Respondents views on male involvement in family planning practices in Akure South Local Government Area Variable Frequency Percentage(%) Discussion of FP with partners 83 (33.2%) 167 (66.8%) Provision of support for partner to use FP Partner approves to use of family planning 101 (40.4%) 149 (59.6%) Married men 103 (41.2%) 147 (58.8%) Source: Field Report 2023 The table above presented the respondents view on married men involvement in family planning in Akure south local government area. From the analysis of the findings, out of 250 respondent, 83(33.2%) respondents discussed family planning practices with their partners while 167(66.8%) did not. Also, 101(40.4%) provided support for their partners to practice FP, while149(59.6%) respondent did not. 103(41.2%) monitored the use of FP by their partners while 145 (58.8%) did not. 83(33.2%) made use of FP , while 167(66.8%) did not. It can then be inferred from the results that majority of the respondents discussed, FP with their partners; provided support for their partners to practice FP and monitor the practice of FP by their partners. In the same vein, majority of the respondents utilised one form of family planning methods. Research Question 4 What are the contributory factors that influence the adoption of family planning practices among married in Akure south local government area? Table 5: Respondents view on factors influencing the adoption of family planning practices among married men in Akure south local government S/N Variable Frequency Percentage(%) 1 Education 41 16.4 2 Occupation 29 11.6 3 Religion 38 15.2 4 No of living children 62 24.8 Pa ge 66 https://journals.e-palli.com/home/index.php/ajpehs Am. J. Phys. Educ. Health Sci. 2(2) 60-67, 2024 The table above presented the respondents view on factors influencing the adoption of family planning practices among married men in Akure South Local government area. Analysis of the findings revealed that out of 250 respondents, 41(16.4%) opined that education is the major factor influencing the adoption of family planning, 29 (11.6%) agreed that occupation: 38 (15.2%) agreed on religion, 62 (24.8%) agreed on number of living children already had by married couples, 37 (14.8%) agreed on culture while 43 (17.3%) agreed on financial status of the married couples. The results showed that majority of the respondents supported the number of living children of the couples is a major contributory factor that influence the adoption of family planning practices among married men in Akure South Local Government Area. RESULTS AND DISCUSSION The study investigated the involvement of married men in the family planning practices in Akure Local Government Area. Findings from this quantitative study revealed that majority (42.4%) of the married men accessed information about family planning on mass media which included radio, television, newspaper and internet sources, it was also revealed that the married men in Akure South has high level of knowledge about family planning practices as majority (38%) opined that the reason for family planning is to limit family size and majority(42.4%) agreed that the most commonly practiced family planning method is the use of condom among several variable listed as the family planning methods, This is probably because of the cheapest and availability of condom. Similarly, the majority of the married men (66.8%) did not discuss FP with their partners, 59.6% did not provide support for their partners to use FP, 58.8% did not monitor the use of FP by their partners while 66.8% of the married men did not use family planning methods with their partners. Also, the majority (24.8%) agreed that the number of living children already had by the couples is a major contributory factor that influences the adoption of FP practices by married men in Akure South. This study, therefore, revealed that married men’s low involvement in family planning practices despite their high level of knowledge is not unconnected with their attitude and socio-cultural practices toward family planning methods. Also, it was discovered that married men were not accommodated in FP sensitization programmes despite the fact that the environment is men-dominated and men are responsible for decision-taking as far as utilisation of any FP methods is concerned. The men involvement in the FP practices are noticeably tied to the number of children already possessed by the married partners. Partners with more than two children are more likely to adopt and adapt FP services utilization to limit the family size or space the birth rate. Men also with low financial status are not likely to be involved in FP because of the expensive nature of some FP methods in many of the public and private health facilities within the study area These findings are similar to the findings of a study conducted in rural Ghana by KwawukumeLaar and Abdulai (2022), which posited that the success of FP was positively associated with men’s involvement in FP service utilization. Further Research Though this study provides insight into the level of male involvement in FP practices in the Akure South Local Government area, further research should expand the sample population to capture generalised opinions of the populace. Also, for holistical investigation, future research should accommodate the roles of married women in effective utilization of family planning practices within the study area. RECOMMENDATIONS The following recommendations were preferred to address the barriers of men’s participation in family planning which is crucial to utilization and promotion of family planning services and removal of misconception about FP thereby providing improved reproductive health services in the society. 1) Governments at all levels should target men in the programmes more to increase acceptance and effective use of FP 2) The media should increase health promotion and education about family planning among the populace and 3) Governments should incorporate family planning services into their health insurances scheme for easier access to the health services by the citizens. REFERENCES Abubakar, B. G., Oche, O. M., Isah, B. A., Augo, J. T., Raji, I. A., & Ezenwoko, A. Z. (2021). Factors influencing male involvement in family planning in Sokoto, Nigeria. International Archives of Medical and Health Research, 2(1), 1–8. Adelekan, A., Omoregie, P., & Edoni, E. (2014). 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