Improved communication between a husband and wife key to family planning use
Public health organizations have long advocated for the inclusion of men in family planning services, and researchers have suggested a link between male involvement and increased use of contraception. However, there have been few published evaluations of such interventions, and even fewer that are grounded in theory.
Building the evidence base, FHI 360 researchers — funded by the U.S. Agency for International Development — evaluated Save the Children's Malawi Male Motivator project, the first application of the well-established Information-Motivation-Behavioral Skills model for the promotion of male involvement in women's contraceptive use. Not only did the study find that contraceptive use increased significantly post-intervention, but the results provided evidence to guide future interventions, namely that increased and improved communication between a husband and wife is key to contraceptive use.
"Before the educator came to shed more light on this issue I was doing what I could, basing on guesswork without even discussing with my wife. After the educator came I was able to discuss and communicate with my wife very well."
The Malawi Male Motivator project was designed to increase family planning use among young married couples. Use of contraception is low among young women in general in Malawi, and Save the Children identified married women under 25 as a particularly hard-to-reach population. Thus, participants were male partners of young women, who had not used modern contraception — such as oral contraceptive pills, condoms and contraceptive implants — with their primary partners in the previous three months. The nearly 400 men were randomized into an intervention group or a control group, and a subset of men from the intervention group was interviewed to provide context.
Since men were believed to get their reproductive health information mostly from their peers, the intervention recruited male outreach workers — known as "Male Motivators" — to reach the husbands. Motivators were married men over 30, and were chosen based on their high standing in the community, as well as their own use of and enthusiasm for modern contraception. Motivator training included discussions about gender norms and family planning, and provided participants with tools and links to family planning and community services. At regular meetings, motivators engaged participants in a series of discussions about family planning, ideal family size, communication skills, and shared decision making within couples.
Communication within couples was shown to be the only significant predictor of contraceptive uptake among participants. The interviews support this, pointing to increased and improved spousal communications that extended even beyond discussions about family planning. One man interviewed said: "we are now free with each other." The men also spoke of increased trust within their relationships.
FHI 360 conducted a follow-up qualitative study with female partners of male participants. The results complemented the men's interviews, pointing to more — and enhanced — communication about family planning within couples. One woman stated:
"There is an improvement in the way we discuss family planning issues because I have been telling my husband about family planning, but he never believed me until the coming of the Male Motivator."
Moreover, women reported a shift in couples' decision-making processes:
"I have seen my husband consulting me in some issues, a thing I think he has learned from the study initiatives. This attitude gives me the impression that I am considered worthy and trustworthy friend in the family."
FHI 360's evaluation of the Malawi Male Motivators project is an important contribution to the evidence base on men's role in meeting women's reproductive health and family planning needs. Peer-led interventions can promote the transfer of communication skills to ensure men's role as partners in reproductive health. These skills can then lead to improved communication and shared decision making, which in turn can improve contraceptive uptake among hard-to-reach populations of young women.