Strategies for Male Involvement in Reproductive Health in western Kenya: A qualitative Study

Monica Adhiambo Onyango; Sam Owoko and Monica Oguttu

Funded by: IPPF
August 2009

The Context

Traditional reproductive health programs almost exclusively focused on women. The popular view about men's participation and involvement in family planning for example has been that men know little about contraception and do not want their partners to use it.
As a Kenyan nongovernmental organization, Kisumu Medical and Education Trust (K-MET) has been implementing community based reproductive health programs for over 13 years in five provinces of Kenya. One of K-MET’s objectives is to enhance the involvement of up to 400 male partners in sexual and reproductive health (SRH) services by 2010 in western Kenya.

Study Objectives:

Methodology:

The study was conducted using qualitative descriptive (QD) design. Stratified purposive and snowball sampling techniques were used. Data was collected from December 2008 to February 2009 at three provinces of western Kenya: Nyanza, North Rift and Western. Study locations were mapped around five health facilities run by private health providers within the post-abortion care network (PACNET) of western Kenya. Using an interview guide, in-depth interviews with individual participants and focus group discussions (FGDs) were used to collect data. A total of 12 in-depth interviews and eight FGDs were conducted. All interviews were tape recorded verbatim. Initial data coding of typed transcripts was done by hand on the margins. The transcripts were also imported into nvivo8 computer software for qualitative data analysis and coding continued electronically. Categories and emerging patterns were noted while interpreting the findings simultaneously. Relationships between constructs were identified which informed the final report.

Findings:

The study revealed that there was varied understanding of RH by participants. Majority of participants could not provide a comprehensive description of RH. Most answers were related to contraception, family planning and maternal health. Also, the sources which influenced their understanding of RH were the traditional ones like the health care system, educational and work institutions and with the family and/or community. A large majority of study participants were of the opinion that men should be involved in sexual and reproductive health programs (SRH) in western Kenya. Two main patterns emerged from the various factors which participants thought influence male involvement in SRH: 1) gender norms; and 2) the traditional approaches used to implement RH and family planning programs.  Among the gender norms are cultural practices manifested by men which influence male involvement and impact women’s reproductive health negatively. These include polygamy, extra marital sex, preference of children of a certain sex and the general male indifference to SRH issues. Furthermore, in western Kenya men being heads of households are not expected culturally to discuss SRH matters with their wives and female children. This role is for the mother. Men are not under any obligation to practice family planning or worry about limiting the number of children. It is the woman’s responsibility to decide when to stop giving birth.  Men in western Kenya are also not enthusiastic to accompany their wives to the clinics. If they do, this is perceived by their peers as a demonstration of weakness. Remarks from peers like this one drops the wife to the clinic are viewed as insulting and keep men from SRH programs. Women are therefore under a lot of pressure to fulfill their reproductive functions alone most of the time. Never-the-less, if the clinics can be able to address the male SRH needs such as prevention of STIs, access and knowledge of condom use sexual performance, infertility counseling and prostate gland issues, men would consider attending them. The traditional approaches taken by the health systems in SRH interventions discourage male involvement. These programs have been introduced as relevant for women and children. Moreover, men who have attempted to accompany their wives to the clinics are always told to “wait outside”, by the health providers.