Has family planning been left to women?

It’s an issue most men don’t discuss in public. Many will not even allow to be seen seeking family planning services with their spouses hand in hand. But why are men shy when it comes to issues of family planning. Are the men letting the burden of family planning issues to women? Statistics from the Health Monitoring system, a component of the health ministry that crunches numbers and makes sense of them indicate that as of 2013, 58 per cent of the sexually active population was using various family planning methods. This was a 13 per cent increase from 2010. Breaking down the numbers further, 26 per cent of the population under family planning opts for injections, 7 per cent pills, 6 per cent implants, 1 per cent female sterilisation and 6 per cent traditional methods such as withdrawal and safe days. That leaves a mere 3 per cent of family planning methods tailored for men in use. Going by these findings, one should be forgiven for concluding that as things change, they pretty much stay the same. As progress is made in the penetration of family planning services, it seems to have been left to women with low numbers of men participating in family planning. Explaining the possible reasons for the state of affairs, Thomas Nsengiyumva, the in-charge of family planning at the Ministry of Health, cited nature as probable cause. “Naturally we have more methods for women than men, but what we try to explain to the population is that family planning is a duty for all. If a family has to engage in family planning it should not be left to women, they should discuss and agree what services to enroll for. We usually urge them to visit the health facility together for both to be given the available options and for the other partner to be aware of the side effects the other may be going through. It is not the duty of one partner, it is a family decision.”As the findings are shocking to some, others find it pretty normal and no news in it. To some it doesn’t come as a surprise, not only because of nature but also due to society’s perception and mentality.Alice Mazimpaka, a nurse who previously worked with a family health programme in rural areas found out from women the health initiative was trying to reach out to that their partners had little if any knowledge of the family planning method in use. They only cared that the women were safe. “Two years ago I worked with a family health programme; I found out from women that their husbands or boyfriends were not involved in family planning, some of them to the extent of being totally unaware if it was in use. This was mostly the case amongst middle aged married couples. Young sexually active people were concerned probably out of fear of early pregnancy.”Mazimpaka goes on to reveal that lack of men’s involvement in family planning is at times a blessing in disguise for women as it gives them an upper hand to avoid their husband’s demands to have kids. “When men are not involved or out of the picture during family planning, women can use that to their advantage to put out their husbands constant urge to get them pregnant. A lady can get on a long term family planning method like implants without their husband’s knowledge and have an upper hand in decision making.”Mazimpaka also noted that women did not seem to complain of lack of their partner’s involvement in family planning. “Most seemed to have embraced it as a normality and don’t ask to change the status quo.”But not everyone sees family planning as a feminine responsibility. Edwin, Rugumba a 35-year-old father of two, has for long discussed family planning with his wife of nine years and whatever option they have taken has been out of agreement.“Even though we may not necessarily opt for a masculine method like vasectomy or condoms, we have sat down and come to a fair conclusion of whatever method we use. Through this she (his wife) feels that I have not left family planning to her and that I would be understanding in case she experiences side effects that may come as a result of the method in use,” he says looking the other way when asked his family’s method of choice.Rugamba doesn’t see it as being modern as most see it but rather involved and concerned about his future and that of his young family. “How is being involved in family planning modern? I see it as a being concerned about my family and future. Being the main provider I wouldn’t want to have children I have not planned for and end up giving them less than they deserve. I wouldn’t want to get overburdened by my responsibilities as a father. There is talk that it is a woman’s role but no one concerned about their future should see it that way.”Gladys Uwimana, an insurance sales lady and a mother of two, doesn’t see her husband’s lack of involvement in family planning as neglect of duties. “As a woman who considers herself responsible, family planning is my responsibility just as providing for the family is his. I cannot always bother him with such ‘personal’ issues while he still has other bigger responsibilities. A vasectomy is out of the question. I am afraid it would make him less of a man in my eyes. I know which method is best for me so his involvement wouldn’t change a thing.”Out of the 58 per cent of the population under family planning only 1 per cent is under permanent methods meaning that less that 1 per cent of men have undergone a vasectomy. Though vasectomy is one of the services the Ministry of Health provides free of charge, the numbers of men who have undergone a vasectomy seems to be wanting.For Yusuf Ganza a resident of Nyamirambo, if playing part in family planning means undergoing a vasectomy, then he doesn’t pledge his involvement. “Married people don’t use condoms; a vasectomy is out of the question because I am still ‘young’ and no one knows of the future. That means the methods in use will only apply to women.” When he says no one knows about the future, Ganza means that he may want to have another child in future and would want to avoid the chances of it happening.Does he see it as being a chauvinist?He laughs; a laughter that shakes his whole body, and stokes his goatee. “It is just the way things are, it is just nature, nature made it that there are more ways for ladies to get under family planning than men. Though they tell you that a vasectomy will not make you a lesser man, it just might, mentally. The thought that you can never have children again is not very comforting. So I am not surprised that very few men will agree to undergo a vasectomy and end up getting labeled uninvolved.”Family planning being a major determiner of the country’s population which is projected to double by 2030 probably calls for a lot of attention from both partners and not to be delegated to one. However we should probably begin by defining what ‘involvement of both partners’ means; is it by one of them undergoing a procedure or one holding the other’s hand through it?--------------------------------------Is family planning a women’s thing?No, who says it’s only left to women. Actually some men are the ones that do everything to control birth rate and make sure there is a good spacing between their children. I would actually say it’s more of the man’s part to play. Lilian Lancey NakijobaFamily planning is left to women because campaigns insist more on women and make it look like women are the ones to attend these family planning programmes and so on. But it’s supposed to be a joint effort.Aphrodice MutanganaWomen do a lot of work when it comes to family planning and men always want to sit back and just see results. They are the ones that attend the free family planning education sessions and men never want to hear of it. Yet the benefits of proper family planning are for both of them. Christine MuhozaYes, because they have the most ways to control the number of children they want. It’s much harder for a man to do that. Solomon Kyamadde

Insight

Has family planning been left to women?