Family planning decision-making among young males in Southern Africa

Abstract

Male partners play a crucial role in reproductive health matters and seem to be identified as the main contributors responsible for
the large proportion of poor reproductive health suffered by their female partners. Limited evidence exists, however, on effective
strategies to increase male involvement in family planning. Therefore, this study aims to examine the prevalence and factors
associated with male involvement in family planning decisions. Using recent data from Demographic and Health Surveys of seven
countries in Southern Africa (Lesotho, Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe), age, education,
wealth index, religion, occupation, exposure to media, contraceptive knowledge, and sex of household head showed significant
associations of male involvement in family planning, and these associations differed by country. By country, the adjusted odds
ratio (AOR) showed that education (Malawi (primary) AOR: 1.12; 95% CI: 0.91–1.38; South Africa (secondary/ higher) AOR:
1.44; 95% CI: 0.95–2.19), religion (Lesotho (Muslim) AOR: 2.10; 95% CI: 0.54–8.12; Zambia (Muslim) AOR: 1.01; 95% CI:
0.69–1.49; Zambia (Traditional) AOR: 1.06; 95% CI: 0.77–1.47), marital status (Malawi (widowed) AOR: 1.06; 95% CI: 0.55–
2.05; Lesotho (divorced/separated) AOR: 1.18; 95% CI: 0.84–1.66; Mozambique (divorced/separated) AOR: 1.03; 95% CI: 0.80–
1.33), and sex of household head (South Africa (female) AOR: 1.11; 95% CI: 0.96–1.27) were significant predictors of male
involvement in family planning decision-making in Southern African countries. Certain socio-economic factors such as wealth
status (Malawi (middle) AOR: 1.04; 95% CI: 0.91–1.19, ρ< 0.05; South Africa (Rich) AOR: 1.06; 95% CI: 0.91–1.23), and
occupational status (Mozambique (working) AOR: 1.12; 95% CI: 0.97–1.29) were found to be positively associated with males’
participation in family planning decision-making in Malawi, South Africa and Mozambique. Suggested strategies include
programmes targeting couples jointly and family planning education for men provided by male outreach workers, especially in
communities at the grassroots level. Therefore, to encourage men’s involvement and approval of family planning, communitybased intervention programmes that openly target men are required to reduce stigma and misconceptions and boost consciousness
of the advantages of family planning utilization.