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RG137. D12 
b l t h r C . l  
G365741
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ROLE OF MEN IN FAMILY PLANNING  
IN THE AKATSI DISTRICT
BY
DR JULIUS AFEDI DADEBO
A DISSERTATION SUBMITTED TO THE SCHOOL OF 
PUBLIC HEALTH, UNIVERSITY OF GHANA, LEGON,  
IN PARTIAL FULFILLMENT FOR THE AWARD OF 
THE MASTER OF PUBLIC HEALTH DEGREE
SEPTEMBER, 2001
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DECLARATION
I declare that all the work in this study has been made; and that it has not been submitted 
towards any other degree, nor is it being submitted concurrently in candidature for any 
other degree.
Academic Supervisors:
1. PROF. FRED BINKA
2. PROF. JOHN. S. NABILLA.
Signed ...
Candidate:-
DR. JULIUS. AFEDI DABEBO 
Signed
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ABBREVIATIONS
D H M T D is t r ic t  H e a l th  M a n a g e m e n t  T e a m
FP F a m i ly  p l a n n in g
C H N C o m m u n i t y  H e a l th  N u r s e
M C H M a te r ia l  an d  c h i ld  H ea l th
M O H M in is t ry  o f  H ea l th
A N C A n te  N a ta l  C a re
G D H S G h a n a  D e m o g r a p h ic  H e a l th  S u rv e y
HIV H u m a n  Im m u n o d e f i c i e n c y  V i ru s
!U D In tra u te r in e  C o n t r a c e p t iv e  D e v ic e
N P C N a t io n a l  P o p u la t i o n  C o u n c i l
U N F P A U n i te d  N a t io n s  F u n d  fo r  P o p u la t i o n  A c t iv i t i e s
A ID S A c q u i r e d  I m m u n e  D e f i c i e n c y  S y n d ro m e
MI M a c r o  In te rn a t io n a l
N P P N a t io n a l  P o p u la t io n  P o l ic y
IEC In fo rm a t io n  E d u c a t io n  an d  C o m m u n i c a t i o n
C P R C o n t r a c e p t iv e  P re v a l e n c e  R a te
A V S C A c c e s s  to  S a fe  an d  V o lu n ta r y  C o n t r a c e p t io n
F G D F o c u s  G r o u p  D i s c u s s io n s
G O G G o v e r n m e n t  o f  G h a n a
S T D S e x u a l ly  T ra n s m i t t e d  D is e a s e s
D H S D e m o g r a p h ic  &  H e a l th  S u rv e y
C H P S C o m m u n i ty  - B a se d  H e a l th  P l a n n in g  S e rv ic e s
G S S  &  MI G h a n a  S ta t is t ica l  S e rv ic e s  &  M a c ro  In te rn a t io n a l
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ACKNOW LEDGEM ENT
I would like to thank God for His continuous guidance and provision and to express my 
sincere gratitude and appreciation to all those who in one way or the other helped in 
successful completion o f this project.
1 acknowledge with special thanks the material made available to me as well as the 
ad\ice and suggestions offered by my supervision: Professor John. S. Nabila. Professor. 
Tied Binka. and Dr. Timothy Letsa. The same thanks goes to my Academic adviser Mrs. 
Matilda Pappoe.
1 am also grateful to all the members o f the DHMT at Akatsi for their support during the 
field work.
My sincere gratitude also goes to the Volta Regional Director o f Health. Services. Dr. 
Frank \ \o n a to r  and other members o f the Regional Health Administration.
I also express my sincere gratitude to my family for the support they gave me to enable 
me complete this work.
Lastly. 1 thank all the staff o f the school o f Public health and Mr. John. Akpalu and all 
individuals who had in various ways helped to make this work a success.
Ill
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EXECUTIVE SUMMARY
The rationale for this study is to provide a baseline information for male involvement in 
family planning programmes for the District Health Administration and N G O ’s the 
opportunity to redirect or improve upon their programmes in the Akatsi district.
The study was cross -  sectional study employing the use o f  both qualitative and 
quantitative methods to study the characteristics and the extent o f the role o f  men in 
family planning in the district.
Data were collected using a simple structured questionnaire for a total of 252 
-respondents, besides 3 FGD’S and in -  depth interviews. This was to sought out men s 
know ledge o f family planning, current use, couple communication and family planning 
decision -  making in the district.
Data analysis showed that the level of knowledge about family planning in the Akatsi 
district was about 92.5% and the level o f education, religion .age and residence w ere the 
most significant as far as knowledge level was concerned.
For specific methods o f family planning the one most known was the male condom and 
the least known methods were IUD. Diaphragm and male sterilization.
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Approval and use o f family planning methods were influenced by education, residence, 
number o f living children and age, but education and place o f residence were the most 
significant factors.
There was big gap between knowledge o f family planning. 92.5% compared to 49.2% ot 
the men who were using contraceptives at the time o f the study; with condoms, pill and 
injection being the methods commonly used. Norplant and herbs were the least; Norplant 
is not a\ailable in the Akatsi district. 62.1% o f men who wanted tr, delay having children 
for two years were using contraceptive, the rest 37.9% were not using contraceptives, 
showing the level o f unmet need in the district.
Some o f the causes o f unmet need for contraception were lack of knowledge .fear o f side 
effects, socio -  cultural, familial disapproval and fear of vasectomy.
This study had showed that partner communication has a positive impact on the use of 
contraceptives with 62.4% o f men who had talked to their partners using contracepti\ es. 
The qualitative study however showed a negative attitude o f both men and women 
towards partner communication. While men in the district will divorce their wives for 
want of more children, the women after reaching their desired family size will go in for 
the injectables without informing their husbands.
The in -  depths interviews with health workers showed that men are not interested in 
family planning, but beat and force the women for sex. Some of the reasons g i\en  for the
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low level o f male involvement are as follows; fear o f vasectomy, polygamy, unsuitable 
opening hours o f family planning clinics, shyness, side effects and lack o f  information 
about family planning methods.
In \ iew o f the wide gap between knowledge and use of family planning among men in 
the district, lapses in spousal communication, misconception about family planning 
methods and lack o f information, there is the need for male involvement programmes to 
increase the contraceptive prevalence rate in the district.
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TABLE OF CONTENTS
PAGE
1. D ECLA RA TIO N ................................................................................................ ..... I
2. A BBREV IA TIO N S........................................................................................... ......II
3. ACKNOW LEDGEM ENT..................................................................................... Ill
4. EXECUTIVE SU M M A R Y ....................................................................................IV
5. TABLE OF CONTENTS.................................................................................. ......VII
6. LIST OF TABLES.............................................................................................. ......XI
7. LIST OF M A P S ................................................................................................. .......XIII
8 CHAPTER ONE
1.0 IN TRO D U CTIO N ..................................................................................... 1
1.1 B ackground..................................................................................................1
1.2 Statement of P rob lem ......................................................................... ....... 4
1.3 Rationale for the S tu d y .................................................................... ......... 6
9 CHAPTER TWO
2.0 LITERATURE REVIEW  AN D  STU D Y O B JE C TIV E S ............ .... 7
2.1 Literature R ev iew ................................................................................... ....7
2.1.1 Demographic and Health R ela ted ............................................................7
2.1.2 Social, Economic and Cultural F ac to rs.................................................. 8
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2 13 PROGRA M M E -  RELA TED FA C T O R S ............................. 12
2.1.3.1 Lack o f inform ation........................................................ 12
2.1.3.2 M en's Knowledge o f  Specific Male Methods ol FP 13
2.1.3.3 Programme -  Related fac to rs ...................................... 13
2 2 STU D Y OBJECTIVES ................................................................ 17
2.2.1 General O bjectives.......................................................... 17
2.2.2 Specific O bjectives.......................................................... 17
2.2.3 A ssum ption ...................................................................... 17
CHAPTER THREE
3.0 M E T H O D S ................................................................................................. 18
3.1 Study D esig n ................................................................................................ 18
3.2 V ariab les...................................................................................................... 18
3.3 Definitions of Some o f the Main C oncep ts........................................... 19
3.4 Study A re a .................................................................................................... 21
3.5 Study P opulation ........................................................................................ 22
3.6 Sample S iz e ................................................................................................. 22
3.7 Sampling P rocedure................................................................................... 23
3.8 Plan for Data C ollection ............................................................................ 23
3.9 Data C o llec tion ........................................................................................... 25
3.10 Data Analysis .............................................................................................. 26
3.11 Ethnical C onsideration............................................................................. 26
3.12 L im itations................................................................................................... 26
VI I I
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CHAPTER FOUR
4.0 STU D Y F IN D IN G S ............................................................................................  27
4.1 S U R 1 EY F IN D IN G S ..........................................................................................  27
4.1.1 Socio -  Demographic Characteristics o f Respondents.................................  27
4.1.2 Knowledge o f Family P lann ing .........................................................................  29
4.1.3 APPROVAL OF FAMIL Y PLANNING ........................................................  33
4.1.3.1 Ever use o f Family Method ................................................................  34
4.1.3.2 Reasons for using C ontraceptives.....................................................  36
4.1.3.3 Current Use of Family P lann ing ........................................................  36
4.1.3.4 Unmet Need for C ontraceptive............................................................. 38
4.1.3.5 Future use o f Contraceptives.................................................................  40
4.1.4 Attitude Towards Family P lann ing ...................................................................  41
4.1.5 Initiation o f Family P lann ing ............................................................................... 42
4.1.6 Partner Communication............................................................................................ 44
4.1.7 Perception o f the Role of Men in Family P lann ing .........................................  47
4.1.8 Reasons for Men taking Part in Family P lann ing ..............................................48
4.1.9 Use o f the Health Centre or Hospital for Family P lanning .............................48
4.1.10 Finding from the Health Facilities...................................................................  49
CHAPTER FIVE
5 0 DISCUSSION OF STUDY F IN D IN G S ..........................................................  51
5.1.1 Family Planning K now ledge................................................................................. 51
5.1.2 Approval and Ever Use o f Family Planning........................................................52
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5.1.3 Reason for Using Contraceptives, Current Use, concept o f Unmet Need and 
Future Use o f Contraceptive................................................................................. 53
5.1.4 Altitude Toward Family P lann ing ........................................................................ 55
5.1.5 Partner C om m unication..........................................................................................56
5.1.6 Perceptions o f the Role o f Men in Family Planning and Use o f Health Centres 
For Family Planning..............................................................................................  57
5.1.7 Finding from the Health Facilities........................................................................ 57
CHAPTER SIX
6.0 CONCLUSIONS AND RECOM M ENDATIONS  ....59
6.1 CONCLUSIONS ....59
6.2 RECOM M ENDATIONS.....................................................................................  62
REFERENCES.....................................................................................................................  64
APPENDIX 1.....................................................................................................................  68
APPENDIX 2 .....................................................................................................................  75
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LIST OF TABLES
PAGES
TABLE 1 DISTRIBUTION OF RESPONDENTS BY NUM BER OF
LIVING CHILDREN THEY HAD ........................................ 28
TABLE 2 OCCUPATION OF R ESPO N D EN C E.........................................  28
TABLE 3 EDUCATIONAL LEVEL OF R ESPO N D EN TS.....................  29
TABLE 4 SELECTED BACKGROUND CHARACTERISTICS OF MEN 
HAVING KNOWLEDGE OF ANY FAMILY PLANNING 
METHOD ...................................................................................................31
TABLE 5 MALE KNOWLEDGE OF FAMILY PLANNING METHODS 32
TABLE 6 SELECTED BACKGROUND CHARACTERISTICS OF MEN
APPROVING OF AND EVER USING FAMILY PLANING ... 35
TABLE 7 CURRENT USE OF FAMILY PLANNING
METHODS IN THE A K A T S I.......................................................... 37
TABLE 8 M EN'S ATTITUDE TOWARD AND PRACTICE OF
FAMILY PLANNING IN AKATSI D IST R A C T .......................... 41
TABLE 9 M EN’S ATTITUDE TOWARD INITIATION OF
CONTRACEPTION BY PARITY ...................................................  43
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TABLE 10 PARTNER COMMUNICATION ABOUT FAMILY PLANING
BY SELECTED BACKGROUND CHARA CTERISTICS........ 45
TABLE 11 PERCEPTION OF THE ROLE OF MEN IN FAMILY PLANNING 47
TABLE 12 FAMILY PLANNING ACCEPTORS IN THE AKATSI
DISTRICT BY METHOD AND BY YEAR 1999 AND 2000... 49
XI I
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AKAT 3J DISTRICT
GORNIKOPE
SREMANU
AVEVI NUDOWUKOPE
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SUB-DISTRICT
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C Avenorpem PHASE 1 CHN •  t  r ----^
C PHASE 2 CHN
T TRAINED TBA
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AKATSI DISTRICT CROP PRODUCTION
MAlZfc
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& crtafse/rieAH/a  
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MamCmD Production
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CHAPTER ONE
1.0 INTRODUCTION
1.1 Background
Male involvement in family planning means more than increasing the number o f men 
using condoms and having vasectomies. Male involvement also includes the number of 
men who encourage and support their partners and their peers, to use family planning and 
who influence the policy environment to be more conducive to developing male - related 
programmes. In this context "male involvement' should be understood in a much broader 
sense than male contraception and should refer to all organization activities aimed at men 
as a discrete group, with the objective o f increasing the acceptability and prevalence of 
family planning practice in either sex.
In the past, family planning programmes have focused attention primarily on women, 
because of the need to free women from excessive child bearing, and to reduce maternal 
and infant mortality through the use of modern methods o f contraception most o f the 
family planning services were offered within maternal and child health centres: most 
research and information campaigns focused on women. This focus on women has 
reinforced the belief that family planning is largely a woman's business, with the man 
playing a very peripheral role.
A recent publication o f the UNFPA (1995) listed the following reasons for the growing 
importance of male involvement in initiatives for family planning:
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• The advent of the AIDS epidemic has spurred on intense interest in condom 
promotion.
• Men are more in favour of general principles of family planning than has been 
assumed.
• Male support affects both the adoption and the correct use of female contraceptives.
• Male in\olvem ent proprammes can be cost-effective if  they are highly focused and 
offer male contraceptive methods directly or by referral.
• Men's role in the abuse of reproductive rights and sexual violence directed towards 
female partners and relatives should no longer be ignored.
• The consensus reached at the International Conference on Population Development 
(ICPD) has created the necessary momentum for action.
One major difference between the concern for increasing male participation in family 
planning as at the late 1 9 8 0 's and now is the conceptual shift in the objectives. Earlier, 
the main concern had been increasing contraceptive use and driving demographic goals. 
In contrast, the Cairo Declaration demands the participation o f  men in family planning 
and reproductive health, in terms of gender equality and fulfilling various reproductixe 
responsibilities.
It is argued that men are partners in reproduction and sexuality, and therefore it is logical 
that they equally share satisfying sexual lives and the burden o f preventing diseases and 
health complications (Green et al. 1995). This broadening o f the concept o f male 
involvement to " male responsibility requires changes in the strategies of educational
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campaigns and motivational efforts, where men and women need to be educated and 
informed about gender equality and their reproductive rights and responsibilities, and not 
only about the adoption of contraception.
Involving men and obtaining their support and commitment to family planning is of 
crucial importance in the African region, given their elevated position in the African 
society. Most decisions that affect political life are made by men. Men hold positions of 
leadership and influence from the family unit right through the national level (IPPF 
International Planned Parenthood Federation. 1984). The involvement of men in family 
planning would therefore not only ease the responsibility borne by women in terms of 
decision making for the family planning matters, but would also accelerate the 
understanding and practice o f family planning in general.
Studies in Sudan, showed a substantial difference in attitude according to literacy, 
educational level and income towards family planning.
Despite these findings, however, other studies have shown that religious beliefs 
concerning family size show no association with the decision to practice family planning.
Ghana was the third country in Sub - Saharan Africa to formulate and adopt strategies to 
address the effects o f rapid population growth. (This was contained in a document 
entitled "Population Planning for National Progress and Prosperity: Ghana Population 
Policy o f March 1969). One of the major objectives o f the policy was to reduce the 
population growth from 3.0 to 1.7 per cent by the year 2000. [NPC/GOG. 1994, p.25]. 
However, the Ghana Statistical Services and Macro international o f 1993 estimates the
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rate o f growth to be still around 3.0 percent per annum (2.9 to 3.1 percent), but with a 
marked decline o f the total fertility rate from 5.5 to 4.6 births per woman (GSS&MI 
1998. p.27).
Several factors account for the slow progress towards attainment of the rational growth in 
fertility reduction, one of which is the low national family planning acceptor rate of 13 
percent (GSS&MI 1998, p 43).
In a critical review of the Ghana population Policy, Batse and Kumekpor (1989. p. 62) 
cited the over concentration on women and lack o f concerted, male participation, as one 
of the major set -backs of the family planning component o f the policy.
The authors recognized the decision making role o f men in family planning as they stated 
" the internationalization by social acceptance of the role o f the male partner as the 
conventional head and supporter of the family/household and as the person who 
determines the number o f children, makes the decision making role of the male partner in 
family planning acceptance and use. o f considerable importance; (Batsa and Kumekpor. 
1989. p.80).
1.2 STATEMENT OF THE PROBLEM
Generally contraceptive knowledge in Ghana is very high with 93 percent o f currently
married women and 96% of currently married men knowing at least one modern method
of family planning. However, the percentage of currently married Ghanaian women using
a family planning method is 22%. and for modern method 13% (GSS& M I.1998). There
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is therefore the need to address the wide gap between knowledge and practice of 
contraception.
It has been observed that even though FP awareness in Ghana is high, its acceptance and 
practice is low since Ghanaians are predominantly pronatalist. Traditionally, in most 
rural Ghanaian communities men take most decisions affecting the family including the 
fertility o f their women.
In the Ghanaian context it is a sign of masculinity, wealth and prosperity and prestige for 
a man to have many wives and children. (Sabina Mensah, 1992,pp.60). These create the 
problem o f high maternal morbidity and mortality, high infant morbidity and mortality, 
which need to be addressed.
The most popular method o f contraception in the Akatsi district is the injectable for 
women, depo medroxy progesterone (Personal Communication with Health Pro\iders). 
Norplant is not available in the Akatsi district but tubal ligation is done only in the private 
clinic St. Paul's Clinic, which performs about twenty in a year. 1UD usage is low 
because, the women have the perception it might enter into their stomach and the men 
think it might give their partners cancer. Male condom is the most common method for 
men in the district. Vasectomy, a long term family planning method is non existent in 
the district, and as confirmed by service providers most o f the men in Akatsi District are 
afraid o f vasectomy, and as such they do not come to the health centre for family 
planning counselling. For example, only about two percent o f clients bring their husbands
for counselling at the Akatsi Health Centre. Twenty percent o f husbands agree that their
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wives should practice family planning. (Personal communication with Akatsi health 
providers. 2001). Apart from the above, family planning clinics are geared towards 
women, and Antenatal clinics, Post natal clinics and child welfare clinics and are not 
meant for men.
L2  RATIONALE FOR THE STUDY
The outcome of this study will provide a base line information for male involvement in 
famih planning programmes geared toward men for the DHMT and will give NGO'S the 
opportunity to redirect or improve upon their programmes, in the Akatsi district.
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CHAPTER TWO
2.0 LITERATURE REVIEW AND STUDY OBJECTIVES
2.1 Literature Review
2.1.1 Demographic and Health - Related Factors
The revised national population policy o f 1994, recognising the role o f  males as 
important partners in family planning and for that matter contraceptive use and decision 
making, attempts to address the matter thus: special emphasis on IEC programmes shall 
be provided to reach the male population in their homes, clubs and associations on the 
health, social and economic hazards of prolific child bearing and on the need for the male 
populations to assume greater responsibility for the upkeep o f their wives and children. 
Family planning services specifically directed at the male client shall be vigorously 
pursued [ GOG/ NPP. 1994. p.32 ].
In spite of this laudable idea nothing or very little has been done in practical terms to 
address this issue o f male involvement in family planning. Planned Parenthood 
Association of Ghana has established " Daddies Clubs" in workplaces for family planning 
information and limited service during leisure periods [Addo. 1996. pp. 14.15 ].
A world Bank report has indicated that 30% o f the people of Ghana are below the poverty 
line ( Daily Graphic, April 25, 2000 ),and one of the causes of poverty has been cited as 
the inability of large family size, to adequately cloth, feed and educate their children. 
The vision 2020 of the Government of Ghana expects that Ghana will be among the
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middle income countries by year 2020. However, this status can only be achieved if  we 
are able to improve on our health status, among other things.
2.1.2 Social, Economic and Cultural Factors.
The literature on reproductive decision making in Sub - Saharan Africa strongly suggests 
that men play an important and often dominant role in couples adoption o f modern 
contraception. [ Dodoo, 1993 p. 95; Ezeh. 1993 p .163. Bankole, 1995. p. 325 ]. Cadwell 
and Cadwell [ 1987. p430 ], reported that the wife merely co operated with the 
husband, the ancestors and even God in creating a child. They further stated that the 
African family structure placed reproductive decision making in the hands o f the husband 
and the economic burden on the shoulders of the wife. Thus when family planning 
decisions were made they were likely to be surreptitious decisions by the wife alone or 
unilateral ones by the husband. [Beckman. 1983, p.415] identified the husband as the 
chief pro- fertility decision maker. Surveys indicate that at least one third o f men 
believe that family planning decision making should be a joint decision [Green. 1990. 
pp.4.5 ]. This is particularly important for a patriarchal society whose children derive 
their legitimacy and inheritance from the father.
In Sudan, the role of men in making family decision has been recognised in the 
demographic literature. Studies conducted to assess the involvement o f males in family 
planning issues and attitudes o f urban Sudanese men towards family planning revealed 
that husbands are often involved in making family planning decisions and wives are 
influenced by their opinions. The data showed that husbands determined the use o f family
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planning, and that in general, attitudes of men are more favourable than previously 
believed by the service providers.
The study found that a large family size is desirable among low - income as well as high- 
income Sudanese men. The belief that Islamic teachings encourage large family size is 
widespread. Two -thirds of all men reported this belief for all circumstances except when 
the family is constrained financially or the mother's health would be endangered by 
repeated pregnancies. Substantial differences were found in these attitudes according to 
literacy, educational level and income. Despite these findings, however, other studies 
have shown that religious beliefs concerning family size show no association with 
decision to practice family planning.
In Ghana, a study has identified the following cultural factors as important in influencing 
contraceptiv e use: most men occupy leadership positions and dominate policy famulation 
- making decision both at the work place and in the home. Polygamy encourages men to 
have many children, and besides, the wives compete with their rivals for more children in 
order to please their husband. Children are believed to be gifts from God, and the more a 
couple has the better for the extended family and stronger the clan. (Odjiambo, 1995,pp. 
8-45).
Even in some communities, it is the in - laws who dictate the number of children a couple 
should have.
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The pro natalist culture in the rural communities, is apparently a response to their 
difficult socio economic environment characterised by, labour intensive agricultural 
system coupled with unavailability of improved or mechanised technologies. Such a 
situation is further aggravated by the absence o f social security scheme for rural self 
employed persons, including farmers, fishermen, food processors, against sickness and 
old age. The low level of education coupled with lack o f awareness or appreciation for 
the health hazards associated with frequent pregnancy, labour and delivery had resulted 
in high infant mortality.
The absence of spousal discussions on contraceptives can be a serious impediment for the 
adoption o f family planning. Inter spousal communication is thus an important step 
towards the eventual adoption and sustained use o f contraceptive methods. The Ghana 
Demographic and Health Survey (1998) indicates that nearly one in two women have 
never discussed the practice of family planning with their husbands. Just over one in four 
women have discussed family planning once or twice, while similar percentages said they 
had talked with their spouse more often. A lack o f discussion could be a reflection of lack 
of personal interest, or the presence of hostility or reticence in discussing such matters 
openly. Women aged 25 39 report more frequent inter - spousal communication on the 
practice o f family planning than older women.
In another study (Knodal et al, 1979) comparison o f the husband's and wife's responses 
concerning reproductive goals indicates only low to moderate agreement, suggesting a
lack of meaningful communication between spouses, on the matter.
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In a qualitative research to understand the dynamics of husband wife communication 
and the reported discrepancy the men who reported no communication with their wives 
on reproductive goals or contraception or had discussed these issues only after having 
two or more children, were further asked about what discourages spouses from discussing 
their reproductiv e goals
According to them, the main reasons why spouses do not take the initiative on early stage 
of married life to discuss their reproductive goals are shyness (34%). illiteracy (20%) 
never occurred to them (24%) and the perception that these discussions are useless and do 
not help in any way. Interestingly, a small proportion (7%) felt that women cannot give 
any advice on such matters, so why talk with them? This perhaps reflects the typical 
thinking o f men that decisions on reproductive goals and contraception is a male domain 
and women do not have any role in such matters. [National Population Council. 1995. ]
According to Omondi - Odhiambo (1997) even when a woman is favourably inclined to 
family planning, she may not take the initiative in using contraception without her 
husband's consent. Even the use. o f the most modern contraceptive methods, which are 
independent of coitus requires the husband's approval or financial support or both. He 
asserts further that in many less developed countries, men deny their wives access to 
contraception because they fear that it will encourage promiscuity. The studv therefore 
suggests the need to obtain collaboration of men in family planning in order to ensure the 
success of programmes. This collaboration is important, as it is the man's opinion within
the family, the village, the community and the nation as a whole that is critical.
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2.1.3 Programme - Related Factors
2.1.3.1 Lack of Information
Although numerous studies have been conducted in Africa on the knowledge, attitudes 
and behaviour o f women, who use contraceptives, there is limited data on the 
characteristics o f men and their impact on fertility control according to a pilot study 
done on male involvement in family planning in Pakistan, Zimbabwe and Columbia. It 
was found that lack of useful information and services rather than lack of interest have 
kept men from taking a more active role in family planning.
One important measure for the assessment o f targets for Information. Education and 
Communication (IEC) and services is the proportion o f unmet need for contraception. 
Unmet need refers to a discrepancy between expressed fertility goals and contraception 
practice. The most fundamental discrepancy is between an expressed preference to limit 
or space birth in the absence o f contraceptive behaviour. Using data from the 
Demographic and Health Surveys of Ghana (1988 1998) and Kenya (1988 1993). 
married men were found to have high levels o f unmet need o f 24.3 percentage points and
23.5 percentage points, respectively.
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2.1.3.2 Men's Knowledge of Specific Male Method of Family Planning
The best known methods are the male condom and periodic abstinence. Knowledge and 
use of the condom is on the rise due to the AIDS epidemic, and the prevention of 
Sexually Transmitted Diseases. O f all methods, African men know the least about 
vasectomy. The lack of availability o f vasectomy in family planning programmes may. in 
part explain the absence o f knowledge about the method. (Lynam. P. at el 1993).
Research indicates that where vasectomy is accessible and promoted, men tend to know 
more about it and use it. Examples are Non Scapel vasectomy in China, Turkey and 
Ghana (AVSC. 1995). Increasing acceptance of vasectomy will require overcoming 
misinformation and cultural barriers among African men, such as confusion o f vasectomy 
with castration, and fear o f its effects on male sexuality.
2.1.3.3. Programme - Related Factors:
The 1993 Annual Report o f MOH (Ghana) observed numerous progamme constraints 
that affect utilisation o f contraceptives: Mentioned in the report are: inadequate 
equipment, occasional shortage of contraceptives, Low male involvement, insufficient 
facilities, unavailability of adequate number o f well trained and motivated staff, lack of 
reliable means o f transport, constraining the effective implementation o f family planning 
out - reach services and lack of supervision of satellite clinic activities.
In 1997. Ghana participated in an AVSC International's inter-regional workshop on 
m en's involvement in reproductive health, held in Mombassa. Kenya, from may 18-22. 
1997. over 140 participants discussed practical ways to provide services to men and to 
support their constructive involvement in the health of their female partners. Some o f the 
resolutions taken are as follows:
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Address male needs and services in family planning and reproductive health 
programme design and implementation.
Provide information to men about various services available, types, site, time, etc. 
Use convenient and appealing design:
■ Separate clinics for males
■ Improved services at a exiting clinics
■ Work place services
■ Community-based services
■ Commercial and social marketing 
Increase contraceptive choice for men
Train providers about male family planning and reproductive health needs.
Use appropriate information Education and communication (IEC) interxentions.
It was further decided that steps to initiate services are:
Sensitize policy makers, programme managers, service providers and other key 
personnel on men as partners in reproductive health.
Pro\ ide update o f knowledge on STDS and male contraceptive options.
Provide establishment o f  good quality no-scalpel vasectomy service facilities at 
all PHCS.
Focus on IEC activity
Promote family life education to adolescent addressing, sexuality, human 
reproduction and premarital counseling.
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Between 1980 to 1997 the Planned Parenthood Association of Ghana. (PPAG), embarked 
on the male involvement in sexual and reproductive health project.
The basic goal o f the project was to change male attitudes for increase acceptance and 
practice o f family planning and to sensitize men about gender issues.
The project was initiated by three branches o f the associations o f the PPAG, namely 
Ashanti. Northern and Western Branches. Male groups are identified at workplaces such 
as industrial establishments and institutions including the National vocational Training 
Institute (NVT1). taxi drivers unions and functional literacy groups. Some o f the activities 
and target groups are o f follows.
• Daddies clubs at factories and plantations to mobilize men and their subsequent 
involvement in family planning progrmmes
• Hotel managers and drinking bars-keepers are used as a point for introducing a 
wide range o f contraceptive to their clients.
• Functional literacy groups: The Association organizes seminars for the 
facilitators o f functional literacy groups coupled with film shows on family 
planning and STD/AIDS, to their adult learners.
• Trainers at the NVTI / ITTU also benefit from the male involvement 
programme through lectures and video films shows on various health issues 
related to family planning.
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• Drivers and Artisans union are formed in the various cities. A Recourse person 
like medical doctors come and talk to them on issues related to reproductive 
health such as STD/AIDS and family planning.
• The Family Life Education programme of the Association, which is organized 
among in- schools and out-of-school youth. The subject taught are:
• The reproductive cycle
• Healthy relationship among boys and girls
• Dangers o f early sexuality, teenage pregnancy and abortion.
In order to target specific concern of males, PPAG in 1995 with the assistance from 
Engender Health (formally known as VSO international) started clinic based SRH 
services for men in Accra. The services included male sterilization (vasectomy) 
and the patronage was quite appreciable. The clinic services were subsequently 
extended to Cape Coast and Takoradi.
As at now PPAG has planned to:-
• Review and develop a standardized curriculum in male involvement in family 
planning and reproductive health activities.
• Turn Daddies clubs into couples clubs.
• The Association currently has merged the project with the empowerment of 
women project. In the ensuing years, the thrust will be to mainstream gender in to 
all programmes under taken under the project.
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2 2 STUDY OBJECTIVES
2 2 1 GENERAL OBJECTIVES
To study the characteristics and the extent o f the role of men in family planning in the
Akatsi district.
2 2 2 SPECIFIC OBJECTIVES
1. To determine the role o f men in family planning decision making in the study 
population.
2. To determine males knowledge, attitudes and practices o f family planning in the 
Akatsi district
3. To determine the extent of spousal communication about family planning in the 
study population
4. To identify the factors that inhibit or enhance male involvement in family 
planning in Akatsi district.
2.3.3 ASSUMPTION
The assumption o f this study is that men in the Akatsi district participate actively in
family planning programmes at all levels and family planning progammes need not be
geared towards them.
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CHAPTER THREE
3.0 M ETHODS
3.1 Study Design
The study is a cross sectional study, employing the use o f both qualitative and 
quantitative methods to study the characteristics and the extent o f the role of men in 
family planning in the Akatsi District.
3.2 * Variables 
Dependent: - Variable:
Male Involvem ent.-( Definition on page 16)
Independent Variables:
1. Knowledge o f  family planning methods
2. Age 3. Occupation 4. Sex 5. Marital 
Status
6. Educational Level.
7. Place o f residence.
8. Religion
9. Cultural beliefs/ Attitudes.
10. Approval o f Family Planning
11. Partner Communication
12. Service Factors
• Clients satisfaction
•  A c c e s s i b i l i t y  /  A v a i l a b i l i t y
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Definitions of some Main Concepts
Mate involvement. Is the use of male contraceptive, including men who 
encourage and support their partners and their peers to use family planning and 
who influence the policy environment to be more conducive to developing male - 
related programmes.
Partner Communication'. When a man and a woman are talking regularly with 
their partners about FP and agreeing that decisions on the use o f F.P should be 
made together.
Knowledge o f  Family Planning Methods. A man is said to have knowledge of 
family planning method if he mentions the method spontaneously or after 
description by an interviewer.
A pproval o f  Family Planning. A man is said to approve o f family planning when 
he has positive attitude towards family planning and answers yes to a question 
such as Do you approve o f family planning
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VARIABLES CHARACTERISTICS OPERATIONAL DEFINITIONS
Demographic Age Age at last birthday 
Sex Male or female
Socio -  cultural Education Highest level attained 
Marital Status Single, married, W idowed, or 
divorced
Religion Form o f worship., such as Christians, 
Moslems & Traditionalists.
Cultural Any beliefs on taboos associated with 
male involvement
- Residence Urban or Rural
Economic Occupation Employment -  Status, such as farmers, 
fishermen, Artisans, Salary worker, 
unemployed.
Services Factors - Clients Satisfaction with care Adequate care rendered 
-  Accessibility and Living within five kilometers from 
Availability FP Clinics. FP Facility.
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3.4 Study Area
Akatsi District is located on the southern part o f the Volta Region. The district is bounded 
on the south by Ketu District on the north by Ho District on the west by South Tongu and 
east by Ketu District. The district has a population of 87,793 according to provisional 
result from the 2000 population and housing census,with five sub -  districts, namely 
Akatsi. Gefia. Ave - Dakpa. Averorpeme and Wute.
The people are spread out among at least 500 villages and hamlets, many o f which have 
population o f less than fifty people. The district - occupies an area of approximately 906 
square kilometers. The climate is characterised by two rainfall seasons. The major one 
last from April to July and the minor one from September to November. December to 
March is a dry period.
The economy o f the district revolves mainly around subsistence agriculture with main 
staples being cassava and maize.
The people are predominately Ewes. The principal religions are Christianity and 
traditional religion. Many shrines and fetishes can be found in most communities. The 
district is mainly rural with infrastructure gradually developing. Electricity has been 
extended to the major communities. Most communities do not have source o f potable 
water and streams and dams remain their major sources of water. The road network is 
poor and apart from the two trunk roads (Ho Akatsi and Accra Aflao) that are 
motorable throughout the year, there are a number of feeder roads, which are rendered 
unmotorable during the rainy season.
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The educational institutions are both publicly and privately owned:
There are 18 health facilities: 5 ministry of Health. 8 Reproductive and child health 
family planning. 2 private maternity Homes, 2 private clinics. There is no Hospital. 
Many o f the communities are far from health centres and people find it difficult to make 
the journey on foot. In addition, outreach services and supervision are hampered due to 
lack o f transportation.
3.5 Study Population
The study population comprised all males 1 5 - 6 0  years in the Akatsi District. This gave 
a population base o f 25.025 (Akatsi District - DHMT. 2001)
3.6 Sample Size
The estimation of sample size was computed with Epi info 6-computer software based on 
a study population of 25.025. Level o f contraceptive acceptor rate for Volta Region. 
30.80% (GSS &MI, 1998) and a worst acceptable results o f 25.0%. (It is assumed that the 
acceptor rate for Akatsi District is similar to that of the Volta Region)
This yielded a sample size o f 241 at 95.0% confidence level.
A total of 252 questionnaires were sent out as shown below.
Confidence Level Sample Size.
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3.7 Sampling Procedure
1) In the quantitative study a systematic random sampling technique was used in the
2 sub - districts - Akatsi sub - district and Ave - Dakpa Sub - district (the rural Locality). 
Each Sub - district was divided into four zones. The minimum number o f respondents per 
day was determined by proportionate sampling based on the sample size o f 250, with 
each research person interviewing 10 12 respondents each day. There were 4 research 
assistants.
The various u llages w'ere selected at random, by a team o f research persons led by the 
supervisor, starting from the center o f each sub district and randomly selecting a 
different village each day. From the villages, clusters were selected and from each cluster 
compounds were selected. And within the compounds households were selected. From 
the households respondents were interviewed, serially, till the required number of 
respondents were obtained.
2). In the qualitative study. Focus group discussions for both men and women in the 
reproductiv e age group ( 1 5 - 6 0  years) were held. In all three such discussions were held
two for men (one in Akatsi and the other in Ave Dakpa and one Focus group 
discussion for women in Akatsi Sub -  district). The male FGDS consisted o f 10 men each 
while the female FGDS was made of 8 participants 
Participants were selected by contact persons from the communities
3.8 Plan for Data Collection
Two Sub - districts were selected for the study, namely Akatsi Sub district and Ave 
Dekpa Sub - districts (Which is the rural community)
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Permission for the study was sought through the District Director o f Health Services, 
from the following;
The District Chief Executive Akatsi, Traditional Authorities, Assemblymen and the 
Heads o f the health facilities in the Sub - districts.
The DHMT helped to identify four research assistants for the quantitative study, and 2 
for the focus group discussion.
A day was set at the DHMT conference Hall for the pre testing o f the FGD's. The 
facilitator and note taker went through how to conduct a focus group discussion and 
especially the use of open-ended questions, probing, seeking clarification and 
paraphrasing responses o f participants. The principal investigator reviewed the questions 
to eliminate any ambiguities.
Three days were used for pre testing o f the quantitative study. The four -research 
assistants went through the questions, translating them into the Ewe Language, with the 
facilitator making corrections and giving clarification, when necessary. The 4 research 
assistants took turns to review the questionnaires until they were able to interpret them in 
the Ev\e language.
The FGDS and quantitative study were held simultaneously.
Pre testing for the quantitative study was held in Gefia, a sub district not far from 
Akatsi sub - district. (After the days work, the principal investigator and the team went 
through the questionnaires and made corrections and explained mistakes to the research 
assistants)
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3.9 Data Collection
In all 3 FGDS were held, 2 for men between the ages 15 60 years and 1 for women,
within the same age group.
The facilitator and a note taker conducted the focus group discussions in the Ewe
language and recorded on audiotapes.
The) were later translated and transcribed into English.
(2) In the quantitative study, data collection was done using simple structured 
questionnaires. These were administered by the four trained research assistants to 
eligible respondents, (in the two Sub - districts).
The principal investigator did daily checks of filled questionnaires, to ensure 
completeness and accuracy o f data entry.
(3) In depth interviews were held with health workers providing family planning 
sen  ices at both health centers. Structured questionnaires were administered to the 
Head o f Ave Dakpa health center and the Nurse in charge of the MCH/FP 
units. The same in depth - interview was repeated at Akatsi health center, to the 
public health nurse in change of the FP unit and one to the CFIN's. Through 
these interviews, service provider and service related factors that affect male 
involvement in FP in Akatsi district were obtained.
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3.10 Data Analysis
The Data collected were analysed using SPSS software. A coding manual was prepared 
based on the questionnaires and dummy tables were also prepared for the presentation of 
the findings. The data were summarised by using, descriptive statistics o f simple 
frequencies, percentages, cross tabulations, means and p values for any relationships 
between the independent and dependent variables.
Data collected from the Focus Group Discussions were recorded, translated, transcribed 
and analysed manually by the team. Analysis o f the in depth interviews were treated 
similarly.
3.11 Ethical Consideration
No equipment, like tape recorder was used without the consent and knowledge of 
respondents. Respondents were assured that maximum confidentiality would be kept 
throughout the study and after.
3.12 Limitations
(1) Problems o f finance, logistics and transport constituted limitations to the study: 
such as DHMT computers got broken down due to electrical faults.
(2) Family planning and for that matter contraception is a subject matter which most 
people would not discuss openly. This could therefore affect the quality of 
responses.
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CHAPTER FOUR
STUDY FINDINGS
4.1 Survey Findings
4.1.1 Socio -  demographic Characteristics of Respondents
A total o f 252 respondents were interviewed consisting mainly of the youth, adolescents 
and men. with ages ranging from 15 to 60 years. About thirty -  one percent o f 
respondents were between 40 -  60 years; the mean age was 38.04 years. 19.8% 
respondents were between the ages 26 -  30 years; 6.7% between 16 20 years: 14.3% 
between 21 25 years: 13.5% between 13 and 35 years and 14.3% between 36 and 
40years.
65.5% of the respondents were married; 25.4% were single and the rest were divorced 
4.4%. separated 2.8% and widowed 2.0%.
The majority o f respondents were Christians (72.6%); 25.8% traditionalists. 1.2% 
Moslems and others constitute 0.4%.
As shown in table 1 about (24.2%) of the respondents were not-having children. Those 
with 1.2.3.4.5. or more children were about (15.1%) ( 15.1%) (14.7%) (8.3%) and 
(22.6%) respectively.
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Table: 1 Distribution o f  Respondents by number o f  living children they had.
No. of living children Frequency Percentage
Nil 61 24.2
1 38 15.1
2 38 15.1
"5 37 14.7
4 21 8.3
5 57 22.6
Total 252 100.0
As shown in table 2. 9.9% o f the respondents were unemployed: the rest had the 
following occupations; 40.9% farmers. 0.4% fishermen. 12.7% salary workers. 23.8% 
Artisans, and others formed 12.3%.
Table 2: Occupation of Respondents
Occupation Number of respondents Percentage
Unemployed 25 9.9
Farmers 102 40.4
Fishermen 1 0.4
Salary workers 32 12.7
Artisans 60 23.8
Others 32 12.7
Total 252 100.0
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Table 3: Educational Level o f  respondents'.
Educational level Number of Percentage
respondents
Nil 28 11.1
Primary 41 16.3
Middle/Jss 121 48.0
Tec./Com./Voc/Sec. 40 15.9
Poly< Post Sec. 14 5.6
Higher 8 3.2
Total 252 100.0
As shown in table 3. 11.1% o f respondents have had no education 64.3% had had basic 
education, i.e. Primary. Middle/JSS; and the rest (24.7%) Technical. Secondary and 
Higher education.
4.1.2. Knowledge of Family Planning
When respondents were asked whether they had heard about family planning, 92.5% said 
Yes and only 7.5% had not, with the source o f information being the radio (34.5%); a 
combination o f radio and health workers (23.0%), while the church. Television, and wife 
as sources of information form 0.4% each.
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A fewer urban men had heard o f  family planning (50.6%) than rural men (49.3%). Men 
with basic education who had heard o f  family planning form 64.8%; those with higher 
education form 26.2% and with no education form 9.0%
The difference is significant at 95% confidence level. (P = 0 .0 1).
Men with 5 children and more had heard o f  family planning 24.03% than men with no 
children 22.3%. followed bv men with 2 children, 1 child, 3 children and 4 children in 
that order.
When respondents were asked whether they know o f  any family planning method 73.0% 
answered yes while 27.0% has not.
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Table 4: Selected background characteristically o f  men having knowledge o f  any 
fam ily  planning method
C h a ra c te r i s t i c s N u m b e r  o f  men having Pe rcen tag e
know ledge  a b o u t  any  family 
p lan n in g  m ethod
Age
< 40 134 72.8
40+ 50 27.2
Educational level
Nil 12 6.5
Elementary 151 62.0
Higher 21 31.5
Religion
Christians 145 78.8
Moslems 3 1.6
Traditionalist 36 19.6
Residence
Rural 89 48.5
Urban 95 51.6
No. o f  living children
Nil 41 22.3
1. Child 30 16.3
2. Children 34 18.5
3. Children 28 15.2
4. Children 12 6.5
5. or more children 39 21.2
As shown in table 4: Younger men 134 (72.8%), m en with some basic form o f  education. 
151 (62.0%). Christian 145 (78.8%) and urban men 95 (51.6%) lnve  a better knowledge 
o f  family planning method, than older men, men with no education, M oslems and 
traditional men and men in the rural community in Akatsi.
Men with no children knew more about family planning methods than men with 
5 children or more; followed by 2 children, 1 child, 3 children and 4 children.
Respondents were asked to spontaneously mention all the family planning methods they 
had heard of. Then respondents were probed, for further knowledge o f  other methods not 
mentioned spontaneously.
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Table 5 shows the distribution o f  respondents by knowledge o f  specific methods both 
unprompted and prompted.
T a b le  5: Male knowledge o f  fam ily planning methods.
M E T H O D K N O W L E D G E K N O W L E D G E
U N P R O M P T E D P R O M P T E D
Pill 43.1 18.6
Male Condom 59.5 11.5
Female Condom 12.7 31.0
Injection 37.2 24.3
IU D 4.4 10.7
Vaginal tablets 11.9 28.2
Norplant 3.9 25.1
Female sterilisation 7.2 26.5
Male sterilisation 2.8 18.2
Diaphragm 4.3 12.0
Rhythm/A b sti ne nc e 8.3 37.5
Withdrawal 8.3 41.7
The method known by most respondents was the male condom. This was mentioned by 
71.0% o f  men when unprompted and prompted responses were combined. The methods 
known the least were the IUD, Diaphragm, male sterilization, Norplant. Vaginal Tablets.
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Female sterilisation and female condom. Rhythm/ Abstinence, withdrawal, injection and 
the Pill in that order.
The level of knowledge about family planning was confirmed during the Focus Group 
Discussion, in the following statements made by discussants:
•  I f  you have too many children “ Asiwo Mateju -  atuwo o " literally meaning 
your hand cannot meet them. This will make them i f  not all became thieves
,others will involve themselves in disgraceful acts. Secondly i f y ou space your 
children the woman will be healthy (m).
• Our birth rate is to high there is scarcity o f  food and also because presently 
school fees are high. So there is a need to give birth to the number you can 
care for (m)
The above were mainly based on economic hardships, health o f  family and education for 
children. But there was a negative response from Ave -  Dakpa, as shown below
• It is good you have many children as some will go to school to become soldiers 
and teachers. I f  the children come to you, you will be happy. That is why in the 
past our grandfathers had may children. In this town people who have many
4.1.3 Approval of  Family Planning
Ninety one percent o f  the respondents approved o f  family planning, while 9.0% o f  them 
disapproved o f  family planning.
6 8 .7 %  o f  m e n  b e l o w  ag e  41 y e a rs  a p p r o v e d  o f  fa m i ly  p la n n in g ,  w h i l e  3 1 . 3 %  o f  m e n  
a b o v e  4 0  y e a r s  d i s a p p r o v e d  o f  fa m i ly  p l a n n in g  th is  d i f f e r e n c e  is s i g n i f i c a n t  at 9 5 %
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confidence level. ( P = 0.006 ). 65.7% o f  men with basic education approved o f  family 
planning, followed by 24.7 % men with higher education and 9.6% with no education. 
24.3% o f  men with no children approved o f  family planning followed by men with 5 or 
more children, 23.5% 1 child, 3 children, 2 children and 4 children respectively.
50.4% o f  rural men approved o f  family planning while urban men form 49.6%. this 
difference is significant at 95% confidence level, ( P= 0 .0 1 1).
Majority o f  Christians 73.0% approved o f  family planning followed by traditionalist 
25.2%. M oslem 1.3% and other 0.5%.
4 1.3.1 Ever use o f  family planing methods
59.1% o f  men in the Akatsi district had ever used family planning whiles 40.9%  had not. 
Out o f  the total men who had ever used family planning method with their partners. 
76.5% are below 40 years and 23.5% above 40 years.
61.7% o f  men with basic education had ever used family planning method with their 
partners. Those with higher education formed 32.8%, and without education 5.4%. This 
is significant at 95% confidence level ( P = 0.00).
Men with 5 children or more 21.5% had ever used family planning method with their 
partners; 21.5% o f  men with No children had ever used family planning method with 
their partners, with the rest being men with less than 5 children. 55.0% urban men had
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ever used family planning method as against 45.0% o f  rural men. This difference is 
significant at 95% confidence level, ( p = 0.04) ( Table 6).
Table 6 S elected background characteristics o f  men approving o f  and ever using 
fam ily planning,
Characteristics Percent
Approval o f  family Ever used a family 
planning [ N  = 230 ] planning m ethod [ N  =  149 ]
Age
<40 68.7 76.5
40+ 31.3 23.5
Educational Level
Nil 9.6 5.4
Elementary 65.7% 61.7
Higher. 24.7 32.8
No of children living
5 > 24.3 21.5
Nil 23.5 21.5
< 5 52.2 57.0
Residence.
Rural 50.4 45.0
Urban 49.6 55.0
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4.1.3.2 Reasons for using Contraceptives
Reasons given by respondents for ever using contraceptives were: to limit the number of  
children. (41.8%); limit number o f  children with economic liability (11.6%); to limit and 
space children (10.3%). while space children and economic liability were each mentioned 
by 9.6% of respondents. Health o f  wife; to avoid unwanted pregnancies and S T D ’s by 
using condoms are the other reasons, given by respondents, for using contraceptives.
4.1.3 .3 Current use of  Family Planning.
50.8% o f  respondents were not using contraceptives at the time o f  the study while 49.2% 
were using contraceptives. O f  those using contraceptives 46.8% w'ere using condom: 
12.1% the Pill. 12.1% injection, followed by Rhythm/Periodic method (8.9%). vaginal 
foam 1.6% Diaphragm 1.6%.
Abstinence 1.6%. withdraw;al 1.6%, Norplant 0.8%, and others form the rest (Table 7)
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Table 7: C urrent use o f  fam ily p lanning m ethods in the Akatsi District.
M ETH O D Frequency distribution o f  Percentage
contraceptive methods used by 
partners
Condons 58 46.8
Pill 15 12.1
Injection 15 12.1
Rhythm/Period 11 8.9
Vaginal foam 2 1.6
Diaphragm 2 1.6
Abstinence 2 1.6
Withdrawal 2 1.6
Female 3 2.4
sterilisation
Herbs 2 1.6
Norplant 1 0.8
Others 11 8.8
Total 124 100.0
Current contraceptive use am ong men in the Akatsi District is as follows:
Single men 28.2%. married 66.1%. Divorced 1.6%, separated 2.4%. widowed 1.6%. 
Christians form the majority o f  men currently using contraceptives (77.4%). 
Traditionalists 2.1% and Moslems 1.6%
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Men with basic education (primary and middle/ JSS) form 59.6% currently using 
contraceptives: men with higher education form 35.5%, with no education 4.8%. The 
difference is significant at 95% confidence level. ( P =0.000).
Urban men currently using contraceptives form 53.2% as against Rural men 46.8%
Some o f  the statements that come out when respondents were asked how they were 
protecting themselves now  are as follows: -
•  I don ' t  have any children, but I wish to have 4 . 1 am using condom which is normally 
called -PASSPORT” (m)
• I have two (2) children with two (2) wives, the wom an w h o ’s child is younger is 
going for the injectable (Depo), the wom an with the older child is not practicing any 
family planning method as she need to be pregnant this time (m)
When the women were asked o f  the current family planning method and whether their 
husbands are in favour, the following issues came out:
•  1 u se  th e  n a tu ra l  m e th o d  b y  c a lc u l a t i n g  th e  t im e  I w il l  o v u la te .  I k n o w  it m y  h u s b a n d  is in 
f a v o u r  (w )
•  I w a s  u s in g  th e  i n je c ta b le  ( D e p o ) .  M y  h u s b a n d  w a s  n o t  in f a v o u r  an d  m o re  so  h e  w a s  n o t  
a w a r e  th a t  I a m  d o i n g  it. N o w  I h a v e  s to p p e d  an d  w a n te d  to  be  p r e g n a n t
4.1.3.4 Unmet Need for Contraception
About 116(46.0%) o f  the men will like to have children after two years. However, only
72 (62.1%) o f  those who wanted to have children after two years, were using 
contraceptives. The rest (37.9%) were not using contraceptives. Thirty five percent o f  the
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respondents said they d o n ’t know when they intend to have their next children, while the 
rest gave reasons like my wife had divorced me; I had stopped having children and 
menopause, when asked the same question.
Men not using contraceptives give the following reasons: 16.4% no partner, 12.5% 
because my partner has stopped giving birth, 10.9% not interested, 6.5% against my 
religion. 6 .3% will start after their last children, with other reasons being; wom an is 
already sterilised, old and has stopped having children, because o f  side effects o f  
contracepti\es: partners not staying to g e th e r . more children to take care o f  me in future.
During the FGD the following reasons were given for Non -  use o f  contraceptives
• Lack o f  understanding especially those o f  our rural folk i f  people explain what is 
family planning to them, they have been saying that you want them to be sick e.g 
with the Depo that is why you want them to do it (m)
•  The religion in which the person may be, do not allow him to use family planning 
method (m)
• In our culture family planning method are not right. If  the wom an with you 
delivered up to a certain number and she connot bear it again then you go in for 
another wom an (m)
Reduction in sexual feeling and expensive family planning devices were some additional 
reasons given, for non use o f  contraceptives.
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4.1.3.5 Future use of  Contraceptives
Majority o f  the respondents will like to use contraceptives in future (78.2%). The 
com m on methods they intend to use were; female sterilisation (7.7%), injection (37.2%), 
Pill (6.1%). Condom (22.4%), Norplant (1.5%), Rhythm (4.6%), Foaming tablet. (1.0%), 
Yet to seek for medical advice (3.1%). Abstinence (0.5%), Herbs (0.5%) and 
others.
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4.1.4 A ttitude towards Fam ily Planning
M e n 's  attitude toward and ever use o f  family planning is presented in table 8.
Table 8: M en ’s attitude towards and practice o f  family planning in Akatsi District.
Item E v er  used family p lanning  P ercen tage
method  [N = 149]
In a relationship who should have a 
major sa> in FP?
Man 109 73.1
Woman 14 9.4
Both 23 15.4
Don't know 3 2.1
Total 149 100.0
Who makes the decision to use FP in 
your relationship?
Respondent 99 66.5
Wife/Partner 10 6.5
Both 40 26.8
Total 149 100.0
Who should decide on the number of 
children a man/wife should have? 
Man 102 68.5
Woman 2 1.3
Both 45 30.2
Total 149 100.0
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W hen men who had ever used family planning were asked who should have a major say 
in family planning, the majority (73.1%) mentioned the man.
As to who makes the decision to use family planning, the majority was for the man 
(66.5%). The majority (68.5%) answered that the man should decide on the number of  
children a man and wife should have. In all, decision by both partners was second 
favoured.
When attitudes were viewed against background factors such as Age. Education and 
residence, younger men. men with basic education and men in the rural community said 
the man should have a major say in family planning issues.
As to who should decide on the number o f  children a man and his wife should have: men 
w ith basic education, younger and living in the rural community were in favour o f  the 
woman. As to who makes the decision to use family planning in a relationship the 
decision was for the man or woman.
4.1.5 Initiation o f  Family Planning
Twenty three percent o f  men, would like a woman to initiate family planning after the 
third child. A m ong men who approved o f  family planning only 11.3% said family 
planning should be initiated before the first birth.
And a large proportion o f  respondents who approve o f  family planning would only use 
family planning methods after the woman has had at least one child.
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fable 9 : M en ’s attitude toward initiation o f  contraception by parity.
W hen should a wom an use Percentage
family planning Total sample [N = 252 ] Respondents approving o f  
famil) planning [N = 230]
Before her first child 10.3 11.3
After first child 15.9 15.2
2nd child 9.1 9.6
3rd child 23.0 23.9
4th child 21.0 22.2
5th child 3.6 3.0
6th child 6.3 6.5
shouldn 't  use FP. 6.0 4.4
D on 't  know 2.8 2.2
It depends on the wom an 0.8 0.4
Others 1.2 1.3
Total 100.0 100.0
As shown in table 9. about 1 in 9 (10.3%) o f  the total respondents said a wom an should 
use family planning, for postponing onset o f  child bearing.
Age was found to be a dominant factor in deciding i f  family planning should be initiated 
before the first childbirth, with men over forty years being more in favour. The
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relationship between age o f  respondents and attitude towards when family planning 
should be initiated, is significant at 95% confidence level, (p = 0.045).
4.1.6 Partner Communication
As many as 178 o f  the respondents (70.6%) had ever talked to their partners about family 
planning, while 74 (29.4%) had never talked to their partners about family planning. O f  
those who had talked to their partners about family planning. 61.2% did so about 6 
months ago. while 37.6% did the same one year and above, ago.
Reasons for never talking to partners about family planning are as follow:
• No partners (25.7%).
• Do not know how to use family planning methods (12.2%).
• No knowledge or awareness o f  family planning (10.8%).
• I want my wife to be pregnant (9.5%).
• Against my religion and can’t advice anybody (8.1%).
• Had stopped giving birth (8.1%).
• Rhythm/natural method (4.1%).
• Side affects (2.7%).
• Will do family planning after last child (2.7%).
• Contraceptives can fail (1.4%).
• Unfaithfulness o f  women these days (1.4%).
• Presently important and financial problems (1.4%).
•  Not obtained the desired number ol children (4.1 %).
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Table 10: Partner communication about family planning by selected  
background characteristics
Sta tu s  o f  C h a r a c te r i s t i c s E v er  ta lk ed  to p a r tn e r  a b o u t  D o n ’t ta lk  to p a r tn e r  a b o u t  
A p p r o v a l  o f  fam ily  p lan n in g fam ily  p la n n in g
fam ily  
p la n n in g
Frequency Percentage Frequency Percentage
Approval  o f Age
family
planning < 4 0 125 79.1 33 20.940+
49 68.1 23 31.9
Education
Nil
11
Elementary 50.0 11
50
143 76.0 45 24Higher
20 100.0
Residence
Rural
88 75.8 28 24.2
Urban
86 75.4 28 24.6
Religion
Christians
135 80.4 33 19.6
Moslems
3 100.0
Traditionalist
36 62.0 22 38.0
Others
1 100.0
Age
Do not 
<40
Approve o f  2 14 13 86.0
40+
Family 1 16.6 5 83.4
planning
Education
Nil
1 16.6 5 83.4
Elementary
1 8.3 12 91.7
Higher
1 50 1 50.0
Residence
Rural
3 25.0 9 75.0
Urban
9 100.0
Religion
*Christians
3 21.4 11 78.6
“T rad i t iona l is t
7 100
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As shown from table 10: most o f  the men in Akatsi district who do communicate with 
their partners approved o f  family planning (3 to about 143 respondents), while only a 
minimal number o f  men who communicated with their partners did not approve o f  family 
planning (1 to 3 respondents). Younger men, men with at least some basic education and 
Christians who approved o f  family planning have a better partner communication.
It is also significant to note that three respondents from the rural community and three 
Christians w ho communicated with their partners do not approve o f  family planning. 
Therefore partner communication has a positive impact o f  family planning.
Some issues that came out when discussants were asked about family planning methods 
and whether spousal consent is necessary were as follows: -
• The men decide but th ;  wom en should be involved i f  not you will fail (m)
• The m an had to decide because some women feel shy to approach the man 
(m)
It appeared most o f  the men were in favour o f  spousal consent but one man from Ave -
Dakpa had a negative attitude:-
• From the man; the wom an has no authority over him when the m an says we 
have to bring forth, the w om an has no say, ners is ju s t  to obligate. I f  she refuses 
then she has to leave for him to find another wom an (m).
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The FGD  for women showed that most women were in disagreement with spousal 
consent in family planning. Some o f  the statements are as shown below: -
•  We don 't  discuss family planning in the house, the pregnancy will not come. You 
will no more have you menses i f  you use family planning (w).
• We d o n ’t discuss anything on family planning because looking at things he will 
not agree on the issue. So 1 hide and go for the injection (w)
4.1 .7 Perception o f  the Role of  Men in Family Planning  
Tablel 1: Perception o f  the role o f  men in family planning
C h a r a c te r i s t i c s
W H O  S H O U L D  T A K E  A C T I V E  R O L E  IN F A M I L Y  P L A N N I N G
M E N W O M E N B O T H N O N E
F r e q u e n c y  % F r e q u e n c y  % F r e q u e n c y  % F r e q u e n c y  %
Age
<40 118 68.2 13 7.5 42 24.3
40+ 45 56.9 4 5.1 28 35.4 2 2.5
Education
Nil 14 50 4 14.5 9 32.1 1 3.6
Elementary 137 67.8 11 5.4 53 26.2 1 0.5
Higher 12 54.5 2 7.1 8 36.4
Residence
Rural 79 61.2 10 7.7 39 30.2 1 0.8
Urban 84 68.3 7 5.6 31 25.2 1 0.8
As shown in table 11: Greater number o f  men in Akatsi think men should take an a c th e  
role in family planning (12 to 137 respondents) while a reasonable proportion o f  men 
think both men and wom en should take active role in family planning (8 to 53 
respondents). Men who think is should be the women are minimal. (2 to 13 respondents). 
Again younger men. men with some basic education and urban men dominated in the 
perception that men should take active role in family planning.
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4.1.8 Reasons for Men Taking Part in Family Planning
Almost all the respondents agreed that it is important for men to take part in family 
planning, the reasons given being as follows:
•  Because the man takes every financial responsibility in the house (45.2%).
• Bccausc men lake decision and face every problem (13.1 %).
•  Limit and space the number o f  children (11.9%).
•  Protection from S T D 's  and HIV/AIDS (3.2%).
•  Men have higher sex drive than women (2.8%).
•  For a health) life (1.6%).
• Avoid unwanted pregnancy (2.8%).
• Because men cann 't  trust women (0.4%).
• Others (15.2%).
4.1.9. Use of  the Health Centre or Hospital for Family Planning.
Some o f  the feelings about the above were-.
• I d o n ’t feel shy because the long life that you want to live may be short lived -  for 
prevention o f  HIV/AIDS (m).
• Financial difficulties because may be the devices are expensive (m).
During the refreshment time the participants from Akatsi -  sub -  district said they only 
knew Akatsi health centre, is for treatment and even for family planning methods they 
only knew o f  injectables. They don 't  know- that condoms are sold at the Akatsi health 
centre.
•  I hey  say if  y ou  are p rac tic in g  fam ily  p la n n in g  tlien  you  becam e a m an (N e zu Ju tsu ) m ean in g  you  w ill nol 
m en stru a te  aga in  (on ly  m en d o n ’t m enstruate) so 1 am  afraid  (w )
• I have  th e  in teres t to  p rac tice  it but w hat peop le  are  say ing  is searing . T hey  say  it can  spo il o r  dam ag e  yo u r
rerviv ( w \
In the female FGD. fear o f  the side -  effects o f  family planning methods was expressed:
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4.1.10 Findings From the Health Facilities
Table 12: Family Planning acceptors in the Akatsi District by methods and by year  
1999 and 2000.
1999 2000
METHODS N E W / %  OF A CCEPTORS NEW / %  A C C EPTO R
CO NTINUING BY M ETH OD CONTINUING B Y  M ETH O D S
A CC EPTO RS A CC EPTO RS
ORAL PILL 601 3.04 854 4.86
CONDOM 839 4.25 1017 5.79
FOAMING TABLETS 187 0.94 422 2.40
IUCD 35 0.18 29 0.16
INJECTABLE 2430 12.32 3504 19.95
STERILIZATION NIL NIL 4 0.02
TOTAL 4092 20.73 5830 33.2
WIFA 19727 17559.
As shown in table 12; the highest acceptable contraceptive is the injectable -  depo for
women and for men is the condom. According to the health worker condom s are
available at the Akatsi health centre and even some men send their wives to buy for them.
But there were no condoms at Ave -  Dakpa. at the time o f  the study: -
•  We d o n ’t have condoms in the Akatsi district we are short o f  
condoms. Not available at our centres as at now (Ave -  Dakpa 
Health centre).
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Additional deductions made from the in -  depth — interviews with the health workers aie 
as follow s:-
•  Our messages are targetted for men. We meet them at the ANC. post -  Natal 
clinic and church meetings, funeral and drumming gatherings but they d o n ’t 
want to hear about vasectomy.
•  The opening times are not suitable, some o f  the men come to us in the 
house. Some health workers are kind to the m en but some are harsh to them.
•  The m en in the district are not interested. The m en want to have many 
children -  polygamy and they need farm -  helps. They beat and force the 
wom en for sex.
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CHAPTER FIVE
5.1 DISCUSSION O F FINDINGS
5.1.1 Family Planning Knowledge.
From this study, at least. 92.5% o f  respondents had heard o f  family planning in the Akatsi 
district. Their com monest source o f  information was the radio (34.5%) and a 
combination o f  health workers and the radio (23%).
Urban men and men with basic education had more knowledge about family planning 
than those in rural community and those with no education. At least 73.0% o f  
respondents knev\ about a family planning method. Again urban men in Akatsi township 
had more knowledge about family planning methods, (51.6%) as against men from Ave -  
Dakpa. the rural community (48.5%). This difference is significant at 95%  confidence 
level, (p = 0.00). Also, men with basic education (62.0%) knew  o f  family planning 
methods better than those with no education (6.5%). This difference is significant at 95% 
confidence level ( p =0.00)
Younger men had better knowledge (72.8%) than older men (27.2%).
It is worth mentioning that the level o f  knowledge for Christians (78.8%) is higher than 
that o f  respondents o f  other religions e.g Traditionalists and Moslems.
Moreover men with no children know about family planning more than men with 5 
children or more. This may be due to the fact that men in Akatsi who had attained their
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desired family size and might be older than those without children show little interest in 
family planning ; educational level may also be a contributing factor.
Similar findings have been elicited in studies by AHADZIE and KO RKOR. (1997). 
In Ahadzie and k o rk o r 's  study, level o f  knowledge was found to be higher am ong men in 
the Greater Accra Region (the most Urbanized region), than in all other regions. 
However, this urban feature does not explain the relatively high proportion o f  men in 
upper east Region, who have knowledge o f  family planning.
Studies in Egypt. Morocco. Kenya, Zimbabwe and Ghana, had shown that the best 
known family planning methods are the condom and periodic abstinence. Knowledge and 
use o f  condom is on the rise, due to the AIDS epidemic.
5.1.2 Approval, Ever Use o f  Family Planning
Men's approval and ever use o f  family planning were viewed against the following 
characteristics: Age. Educational level. Residence and number o f  living children, younger 
men. men with basic education and men in the urban area were more likely to approx al 
family planning method, than other men. Which clearly depicts that men who h a \e  
attained their desired family size, older and without education show little interest in 
family planning in the Akatsi District.
Studies in Mali (1997) and Kenya (1997), based on DHS findings had also shown 
education to be the strongest predictor o f  m en’s attitude towards family planning. Better-
educated men are more likely to approve o f  family planning, as are men in monogamous
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marriage. In most countries, men who live in urban areas are more likely to approve of 
family planning than their counterparts in rural areas.
5.1.3 Reasons for using contraceptives , current use, concept of  unmet need and 
future use o f  contraceptives
Majority' o f  men in the Akatsi district will use contraceptives to limit the number of  
children they have. Spacing and economic liability were also some o f  the factors. Health 
o f  wife and the use o f  condom s to prevent unwanted pregnancies and S T D 's  were also 
mentioned.
O f  the 92.5% respondents who had heard o f  family planning, 50.8% o f  them are not 
using contraceptives at the time o f  this study. Only 49.2%  were using contraceptives, the 
most prefered to use being the condom, pill and injection. Norplant was the least prefered 
method, followed by Herbs.
In this study, married men. men with basic education and Christians were in the majority 
o f  current users o f  contraceptives. The relationship between educational level and 
current use o f  contraceptives, is significant at 95%  confidence level (P = 0.000).
Similar findings were recorded by studies in Tanzania, 1994 and Morocco, 1992. where 
the percentage o f  educated men practicing family planning was 52.0% as against 7% men 
without education. In Morocco. 60% o f  educated men were practicing family planning as 
against 31.0% with no education. Forty six percent o f  respondents, in the Akatsi district
will like to have children after 2 years. However, only 6 2 .1 % o f  those who wanted to
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have children after two years were using contraceptives. The rest (37.9%) were not using 
contracepti\es.  thus indicating level o f  Unmet need.
Ngom (1997. p. 192) using DHS data from Ghana and Kenya, estimated unmet need to 
be 24 .3V  for married men in Ghana and 23.5% for married men in Kenya. When 
corrected for men whose wives were pregnant, menopausal, or infecund. the unmet 
need for contraceptives was 53.3%, which is relatively higher than found by Ngom. 
There is. therefore, the need for innovative and male friendly approaches to convert this 
potential non-users into users.
The com m onest reason why men in the Akatsi district were not using contraceptives are; 
no partner, d o n ’t know how  to use any method, not interested, religion, will start after last 
child, side effects. Bangaarts and Bruce (1995, p. 72.73), in a study o f  causes o f  unmet 
need for contraceptives and the social context o f  services, concluded that the principal 
reasons for non use o f  contraceptives were lack o f  knowledge, fear o f  side effects, social 
and familial disapproval. Men in Nigeria would not use family planning because they 
believe that contraception makes it easier for their wives to engage in extramarital sexual 
relationships. (Bankole. 1994, p 10).
5.1.4 Attitude toward family planning
In this study, most men who had ever used family planning methods believe that the man 
should dominate in family planning issues (Table 6).
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However, when their attitudes were viewed against the background ot Age. Education 
and residence: younger men. men with basic education and men in the rural community 
said men should have a major say, in family planning issues. As to who should decide on 
the number ot children a man and his wife should have, men with basic education, 
younger and men living in the rural community were in favour o f  the woman making 
such a decision. As to who makes the decision to use family planning in a relationships 
the decision was for either the man or the woman.
Studies in other African countries like Nigeria and Kenya had shown that the perception 
that men will necessarily have more influence in reproductive decision making because 
they control the family assets and are accepted as heads o f  the house hold, may be an 
exaggeration.
Bankole (1995. p.320) observed that among the Yoruba o f  Nigeria, the fertility desire o f  
both partners were important predictors o f  the couples fertility.
Gage -  Brandon and her colleagues (1994, p.6) also reported that wom en in Kenya had 
greater control over reproductive decision -  making than their Ghanaian counterparts
Generally, as to when a woman should initiate family planning, most o f  the respondents 
in Akatsi district will initiate family planning after the third child (23%). Only 11.3% 
will want their women to initiate family planning, before the first birth.
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Younger men were more in favour o f  initiating family planning, before the first 
childbirth.
5.1.5. Partner Communication
Most ot the respondents (70.6%) in this study had ever talked to their partners about 
family planning. \ \  liile 29.4% had never talked to their partners about family planning. 
61.2% had talked about family planning 6 months prior to the study.
The reasons given for not talking to partners about family planning were similar to those 
given for Non -  use o f  family planning methods. When partner communication is viewed 
against status o f  approval o f  family planning, age. educational level, religion and 
residence: \o u n g e r  men. men with basic education and Christians who approved o f  
family planning had better communication with their partners. (Table 10).
Many analysts consider communication between husbands and wives as one o f  the most 
important factors associated with family planning practice. A study in Ghana carried out 
by John Hopkins University showed that communication between spouses was the most 
significant pathway to family planning adoption following on IEC campaign.
Similar results were also obtained in Egypt and Niger ( DHS comparative studies No I 8 )
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5.1.6 Perceptions o f  the Role o f  Men in Family Planning and Use o f  Health  
Centres for Family Planning
The reasons men gave for taking part in family planning were sinvlar to their reasons for 
using family planning methods e.g. economic hardship; to limit and space birth; men 
have higher sex dr i \e .  and for protection from S T D 's  and HIV/AIDS, am ong others.
From the FGDS. the main reason why men in the Akatsi district will not attend family 
planning clinics are. perceived cost o f  family planning devices, side effects, shyness and 
lack o f  information about family planning methods. For the women their main 
problem was the side effects.
5.1.7 Findings from the Health Facilities
In -  depth -  interviews with the health workers show that men. in the district, are not 
interested in family planning, because they want to have many wives and children -  (to 
help them on their farms). They also do not encourage their w om en  to com e for family 
planning.
Apart from the above, the opening times are not suitable for the men. Some health 
workers are kind to the men whilst others are harsh.
Family planning programmes are targetted at men in the district at ANC. post -  Natal 
clinics, church meetings, funerals and drumming gatherings. But men do not want to hear 
about vasectomy. Data from the Akatsi Health centre shows that the most acceptable 
contraceptive is the injectable ("depo") for women and the condom for men. On the other
hand, there is no equity in the distribution o f  these contraceptives, in the district.
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CHAPTER SIX
6.0 C O N C L U SIO N S AND R E C O M M EN D A TIO N S
6.1 Conclusions
The level ol knowledge about family planning in the Akatsi district was about 92.5%, and 
level o f  education and residence were found to be the most significant variables as far as 
knowledge level is concerned. Religion was also a significant factor since 78.8% of  
Christians had higher knowledge than Traditionalists and Moslems. It is important to 
mention that men with no children knew more about family planning than men with 5 
children or more.
For specific methods o f  family planning, the one known by most respondents, was the 
male condom and the least known methods were IUD, Diaphragm and male sterilization.
Appro\al and ever use o f  family planning methods was influenced by education, 
residence and number o f  living children and age. but education and place o f  residence 
were the most significant factors.
Majority o f  the men in the Akatsi district will use contraceptives to limit and space birth 
and because o f  economic reasons and for the prevention o f  STD'S ' including HIV/AIDS.
There was a big gap between knowledge o f  family planning 92.5%, compared to 49.2% 
o f  men using contraceptives, at the time o f  the study: with condoms, pill and injection
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being the most commonly used methods. Norplant and herbs were the least, Norplant is 
not available in the Akatsi district.
62.1% o t men who wanted to delay having children for two years were using 
contraceptives, the rest 37.9% were not using contraceptives -  showing the Level o f  
unmet need in the district. In this study, the causes o f  unmet need for contraception were 
lack o f  knowledge, fear o f  side effects and socio-cultural and familial disapproval.
The majority o f  the men in Akatsi district will like to use contraceptive in future but 
prefer their women to go in for the injectables than they using condoms. It is important to 
note here that no respondent made mention o f  vasectomy.
As to who should decide on whether or not family planning should be practiced, it was 
either the man or the woman, with men in the rural community more in favour o f  male 
dominance in family planning issues.
Most o f  the men in the district will like to start family planning after the third child, but 
younger men w ere in favour o f  starting family planning before the first child.
This study show's that partner communication has a positive impact on the use o f  
contraceptives, with 62.4% o f  men who had talked to their partners using contraceptives. 
Younger men, men with basic education and Christians had better inter -  spousal 
communication.
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The qualitative study however showed a negative attitude o f  both men and women 
towards partner communication. While men in the Akatsi district will divorce their wives 
for want ol more children, the women after reaching their desired family size will go in 
tor the injectables without informing their husbands.
From the tocus group discussions, the main reasons why men in the district will not 
attend family planning clinics are:-
Cost o f  family planning devices, side effects, shyness and lack o f  information about 
family planning methods.
Health workers deductions about male involvement in the Akatsi district, are:
• They target men at ANC, post -  Natal clinics, churches, funerals and drumming 
gatherings, but they are afraid o f  vasectomy.
• The opening hours o f  family planning clinics are not convenient to men.
• Male im o lvem en t is low in the Akatsi district because the men do not encourage their 
women to come for family planning. The women sneek to have the depo (injectables) 
so they would not like their men to accompany them.
•  The men in the district are not interested. The men want to have many wives and 
children. Information from the health centre shows that there is on equity in the 
distribution o f  contraceptives, in the district.
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Recommendations
Based on the findings o f  the survey, the FGD and the in-depth interviews with 
health personnel, as well as the existing literature, the following recommendations 
are made:
There should be promotion o f  male involvement themes and especially the use 
o f  male contraceptives on the local Radio, Radio Volta, in the Local 
language to explain the use o f  various methods, so as to correct the various 
misconceptions about side -  effects.
Male im o lvem en t  programmes should be in-corporated into the primary health 
care outreach activities o f  the district to save potential clients the problem of 
travelling to far o f f  places for family planning services.
Family planning Information. Education and Com munication activities must 
target men so as to facilitate the conversion o f  the large pool o f  potential 
acceptors into users o f  contraceptives. The programmes should use teaching aids 
like posters, illustrations and video -  films in the local language.
Collaboration o f  the D H M T with chemical sellers, male TB A 's .  Hotel and bar 
keepers and other agencies to spread the message o f  male involvement in the 
district and social marketing o f  male contraception on the whole.
Encouraging wom en to accompany their partners for counselling and services, 
and sensitization on gender dynamics should be intensified at such sessions. 
Promoting joint decision making can lead to sustained use. IEC messages must 
aim at promoting joint decision -  making for family planning, in the district.
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(7) School health programmes must help to explain male involvement initiatives to 
the youth and contraception and counselling services must be made available to 
the youth.
(8) I he DH M T should ensure equity and availability o f  male contraceptives at the 
health centres, and hold sessions to explain misconception o f  the side effects o f  
male contraception.
(9) To discourage polygamy and large family size by the introduction o f  community 
based health financing and agricultural technical assistance in the communities.
(10) Christianity to be promoted to enhance knowledge o f  family planning in the 
District
(11) The D H M T  through the C H N 'S  should help modify social norms that govern 
male behaviour in sexual relationships and parenthood in the district.
(12) The District Assembly should collaborate with N G O 's  to help with family 
planning activities in the Akatsi District.
(13) CHPS should be introduced into the primary health care in the Akatsi district.
(14) The D HM T should try to merge male involvement programmes with em powerment
o f  w om en 's  projects.
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REFERENCES
1. AHADIZIE L. E. K. and KORKOR A. S. 1997 “ contraceptive knowledge and 
use. agreement between spouses on use o f  contraceptive among Ghanaian men." 
Macro international inc. December 1997. Pp. 20
2. Addo. Nii 1997, Case studies in communication and m en 's  participation.
In Better Together: A report on the African Regional Conference on M e n ’s 
Participation on Reproductive Health Eds. Robert J. Riccio and Kristina A. 
Samson. Baltimore. Centre Publications pp. 1 4 - 1 5
3. Bankole Akinrinole. 1994. " the Role o f  Mass Media in family planning 
promotion in Nigeria" Demographic and Health survey Working Papers. No. 11 
Calverton, MD, USA: Macro International.
4. Bankole Akinrinole. 1995. ” Desired fertility and fertility behavior am ong the 
Yuroba o f  Nigeria: A study o f  couples ' preferences and subsequent fertility ' 
Population studies 49(2) : 317 -  328.
5. Batse Z.M.K. and Kumakpor Tom. 1989; A critical review o f  the Ghana 
Population Policy. RIP In Development in family planning Policies and 
programmes in Africa pp. 62 Africa pp. 62,80
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Dela Afenyadu, Mercy Amevor. August 1994, Collaborative Research on FP in 
the Volta Region o f  Ghana pp 36-37
Ezeh. Alex C. Serousii Michka and Rogers Hendrik 1996. " M en 's  fertility. 
Contraceptive and Reproductive Preferences" Demographic and Health Survey 
Comparative Studies NO. 18 Calverten, MD, USA Macro International.
Farzaned Roudi and Lori Ashford: men and family planning in Africa, DHS 
comparative studies No. 18. Macro international pp. 1 0 - 1 1 :  pp. 1 2 — 13; pp — 16 
-  17
Gage Brandon, Anastasia. Njogu 10. and Naguib N.G./ 1994. " Roles. 
Resources and Responsibilities: comparative Perspective" Papers presented and 
the population council symposium on family Gender and Population Policy: 
International Debates and Middle eastern Realities, Cairo, 7 - 9  February 2.
Government o f  Ghana (1999) National Population Policy (Revised Edition) the 
advert Press. Accra. Pp. 22 pp. 22-4
Gov ernment o f  Ghana. Ministry o f  Flealth. (1993) Annual MCH/'FP 
report: pp. 19-14
Green. CP 1990 “ male involvement in Family planning Lessons Learnt and 
Implications lor AIDS prevention" Global programs in AIDS/WHO: PP..5
University of Ghana          http://ugspace.ug.edu.gh
13. Khaifa M A. “Characteristics and attitudes o f  family planners in khartoum, 
Sudan Journal o f  Biosocial Science. 1 4 ,1 :7 -  16
14. Khailfa. M A. 1988. “ Attitudes o f  Urban Sudanese men Toward Family 
Planning". Studies in Family Planning. 19:14. 1988.
15. Knodal. J. and V. Prachuabmoh (1976). " Preferial for Sex at children in 
Thailand. A comparison o f  Husbands and Wives' Attitudes” in Studies in Family 
Planning. Vol. 7, No. 5.
16. Lai la Toure MD. MPH, Nov. 1996. M A LE IN V O LV EM EN T IN FP. A Review 
o f  Literature and selected programmes Initiatives in Africa. Pp. 1 -  15
17. Lyman. P. Dwyer, J. Wilkinson. D. Landry. E. (1993). Vasectomy in Kenya: the 
first Steps. AVSC. working paper. No 4.
18. Odjiambo Eunice A. Ajode, 1995. Male involvement in family planning 
(Dissertation). Studies in Family Planing. 19:14, 1988
19. Omondi -O dh iam bo  (1997) “ M en’s Participation in family planning Decisions in 
Kenya” Population Studies 51. Printed on Great Britain, pp. 29 -  40.
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Opia Mensah Kumah. et al. June 1994 "‘Changing the Attitudes and Behaviour o f  
African Men Towards Contraception: Myths, Facts, Obstacles and Opportunities" 
(Paper Presented” at the SARA Project seminar, Washington, DC)
Sabina Mensah, male participation in family planing in Ghana 1992. p .60.
Simonetti. C. et al 1996: Listening to boys: A talk with Ecol Staff. In 
Zeichenstain. S. and Moore, K. eds. Leaving About Sexuality A Practical 
Beginning New York pp. 324 -  332.
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APPENDIX 1
Q U E S T IO N N A IR E  FOR M A L E USE O F FAM ILY PLANN ING  IN TH E  
AKATSI DISTR ICT  
Data Collection Tools:
QUESTIONNAIRE FOR QU ANTITA TIVE A NALSYSIS -  A KATSI DISTRICT 
Interview's identity number [ ] (please enter your I.D. num ber here).
SUBDISTRICT [ ] (please enter subdistrict codes as follows)
A k a t s i  D is t r i c t  01
A n y  o th e r  su b  -  d i s t r ic t  02
B a c k g r o u n d  c h a ra c te r i s t i c s
1. A g e  o f  r e s p o n d e n t  [ ] (E n te r  a g e  in y e a r s  a s  a t  b i r th  d ay  )
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(For questions 2 - 7  mark most appropriate with an ) I  X
2. Marital Status
Single [
Married [
Divorced [
Separated 
Widowed
3. Religion
Christian [
Moslem 
Traditionalist 
Other [ (please specify)
Num ber o f  living children (please tick most appropriate answer) 
Nil [
1 child [
2 children [
3 children [
4 children [
5 or more children 
3 Level o f  education
Primary 1
Middle/JSS [
Tech/C'om/Voc./Sec. I
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Poly/Post Sec.
Higher 
Nil
6. Occupation
Unemployed 
Farmer 
Fisherman 
Salary Worker 
Other (please specify)
7. Usual place o f  Residence
Rural 
Urban
B. Knowledge
8. Have you heard o f  family planning? Yes [ ] No [ ]
If yes, source o f  information.
If  No, go to question (9)
(More than one response allowed) 
Radio
Health care worker 
Newspaper 
Friend 
Other (p le a se  sp e c ify )  . 
9. Do you know o f  any FP methods? Y e s  | ] N o  | 1
If No, go to question 11
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] 0. W h a t  f a m i l y  p l a n n i n g  m e t h o d s  d o  y o u  k n o w  o f  
Unprompted response Prompted response
Pill [ ] I I
Male condom [ ] I I
Female condom [ ] f |
Injection [ ] f )
IUD [ ] [ I
Vaginal foam [ ] [ J
Norplant [ ] [ )
Female sterilization [ ] [
Male sterilization [ ] [
Diaphragm [ ] [ ]
Rhythm/periodic [ ] [
Abstinence [ ] [
Withdrawal [ ] [ ]
11. Do you approve o f  family planning? Yes f ] No | ]
Please give reasons for your answ er .................................................
C. Use o f  Family Planning
12. Have you or your partner(s) ever used family planning methods'?
Yes [ ] No [ j
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If  Yes, why did you or your partner use the FP methods?
If No. go to question 13.
REASONS FOR USE
Limit number o f  children [ J
Space children [ ]
Limit and space children [ ]
Health o f  wife [ ]
Economic liability [ ]
Other (please specify) [ ] ............................
13 When do you plan to have your next child?
Less than two years [ ]
Two years or more [ ]
14. Are you or your partners using a contraceptive now ? Yes [ ] No[
If [ Yes ] what method are u s i n g ................................................................
I f  [ No ] what is the reason for n o n - u s e ? ................................................
15. Would you like to use a family planning method in future '?
Yes [ ] No [ ]
If  Yes what method would you like to u s e .........................................
If No, go to question 16.
Attitude toward Family Planning
16. In a relationship who should have a major say in deciding to use
family planning. (Not applicable to Non -  user)
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Man [ ] 
Woman I I 
Both [ I 
D on 't  know [ ]
17. Who makes the decision to use family planning in your 
relationship?
Respondent [ ]
Wife/partner | ]
Both [ ]
Other (please specify w h o ) ...............................
18. Who should decide in the number o f  children a man and his w ife 
should have?
Man [ ]
Woman [ ]
Both [ ]
Other (please specify w h o ) ....................................
19. when should a woman use FP?
Before her 1sl child [ ] 
After 1st child [ I 
2nd child [ 1 
3rd child I ] 
4 lh child I I 
5lh child I 1 
6 child I ]
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Should not use family planning [ ]
E Partner Communication
20 Have you ever talked to your partner(s) about family planning? 
Yes [ ] N o [ ]
If (Yes), when was the last time you talked to your partner about 
family planning?.............................................................................................
If  (No), w h y ? ...................................................................................................
21 How often have you talked about family planning with your 
partner(s)
Rarely [
Regular [ ]
Very often [ ]
Never [ 1
(F) PERCEPTION OF THF. ROLE OF M EN IN FAM ILY PLANNING
22. Is it important that men take part in FP? ( W h y ? ) .....................
23. Who should take an active role in FP?
(a) Men [ ]
(b) Women [ ]
( c) Both [ ]
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APPENDIX 2
AKATSI DISTRICT C O M M U N IT Y  S U R V E Y  
GUIDE FOR ROLE PLAY AND FIELD PR AC T ICE FGD/IDI
To Men
1. Can you please tell me what you know  about family planning?
2. What is your desired family size. Do you really care whether they are boys 
or girls? Some wants boys, others girls, which is your choice and why?
3. H ow  do you protect yourself  from having children now?
4. W hy do people refuse to use FP or contraception 's even after achieving 
the desired family size?
5. W ho decides whey FP methods should be used? And whether spousal 
concern is necessary.
To women:
1. What is your desired family size? W hat role do sou play in arri\ ing at this 
decision?
2. Are you obliged to reach this family size? Yes/ No
3. What efforts do you make to protect yourself? Is your husband in favour?
If he is not. how do you overcome that obstacle ?
4. Do you usually discuss FP in the home, who initiates the discussion? And 
What is the outcome o f  such discussions?
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Health Workers:
1. Are your messages o f  FP targeted for men? If so, how do you go about it?
2. What forums do you use to target them (al work, churches, meetings)?
3. Whether men discuss their concerns and fear with them?
4. What category o f  men do you deal with (young or old or married, 
students)?
5. What are general impressions, perceptions about the role o f  men in FP?
6. Is the FP service delivery user friendly to men (opening hours, services, 
o p e n  during child welfare clinics or post -  natal clinics)?
D o  y o u  have male methods o f  contraceptions? Are they often available at 
the health centers?
THANK YOU.