Family Planning: Not just a woman’s business, By Fatimah Bisola Lawal

Even as government agencies and international organisations continue to create awareness on the need to eliminate gender-based violence in Nigeria, one unexpected way that discrimination against women manifests in the country, but which we seldom discuss, is in the use of contraception among partners.

Family planning – via contraceptive use – allows women to be in control of their fertility and lets them decide if and when to have children. It also remains one of the best ways for couples or families to jointly have control over their social and economic lives, because it helps to properly space pregnancies according to the family’s needs, reduces unwanted pregnancies, and as a result, lowers pregnancy-related morbidity and mortality. 

However, in my work studying the use of contraception across the world, and particularly in Nigeria, I found that too many men outsource the burden of family planning and contraception to their female partners, due to a wrong perception that it is a female-only issue. This is despite contraception providing both partners with greater opportunities to pursue their education or career goals, remain in the workforce, and contribute to economic growth and advancement.

Not many men even know that they, rather than their wives, can choose to use contraceptives. In one study that analysed data from the 2018 Nigeria Demographic and Health Survey, researchers found that 71 per cent of Nigerian men (15-59 years) who participated in the study do not use any modern contraceptive. Additionally, about 20 per cent of the study participants – nearly 2000 men – opined that contraception is “a woman’s business.”

A Woman’s Business?

So why does this happen? It’s because of a false, deeply ingrained sense that contraception, or anything to do with childbearing, is to be left to the woman to shoulder and that men have nothing to contribute.

That thinking can be dangerous to men, and detrimental to both the family and society at large. At the family level, leaving contraception to one person limits shared-making between couples and shrinks opportunities for couples to make choices that align with their family’s goals and needs. Just as it overly burdens women, it also steals men’s decision-making power. 

Even male condoms, which are so readily available, are not seeing a good enough uptake. The prevalence of male condom use is only about 21 per cent worldwide, according to UNDESA, despite it being 87 per cent effective. These numbers further corroborate the fact that women disproportionately bear the burden of contraceptive use. 

At the societal level, the ideology wrongly perpetuates negative gender norms and undermines efforts towards gender equity in reproductive health. Such thinking also often sneaks into other family roles, such as child care and upbringing, reinforcing negative practices that tend to unequally burden the woman with raising a child.

Biases against women are evident and are reinforced by one-sided efforts in research and product development. Contraceptive research and programmes have largely focused on women’s role in the practice, as though it only takes a woman to create life. In addition, most of the existing contraceptive options are only available for women, leaving just male condoms and vasectomy available to men. 

According to a report by the United Nations Department of Economic and Social Affairs (UNDESA), less than one per cent of men globally (42 million) have undergone a vasectomy. This method is 99 per cent effective with little to no side effects. Compare that to the 180 million women who have undergone tubal ligation, a similar permanent procedure specifically for women.

Even male condoms, which are so readily available, are not seeing a good enough uptake. The prevalence of male condom use is only about 21 per cent worldwide, according to UNDESA, despite it being 87 per cent effective. These numbers further corroborate the fact that women disproportionately bear the burden of contraceptive use. 

Although highly recommended, contraceptive use is accompanied by downsides. In addition to the cost implications, and the logistic barriers that women have to overcome to renew female-centered contraceptive options, several side effects accompany contraceptive use, ranging from bleeding irregularities to weight gain, fatigue, mood changes, and depression. 

On the other hand, we don’t fully know how men might be affected because research on male contraceptive options has been rather slow to emerge, despite the numerous breakthroughs in science, medicine, and technology. One study on male birth control was discontinued due to the  side effects that the study participants experienced, such as mood changes, depression, and injection site pain. These are some of the same side effects that women have had to endure for years. It seems as though society is saying, it is only the woman, simply under her gender, who must undergo the challenges of contraceptive use. 

While there are numerous efforts by the international community to ensure health equity for all, the current contraceptive landscape in Nigeria, and many other countries globally, indicates we are far from achieving it. There is a critical need for holistic education and advocacy to change the existing beliefs that contraception – and reproduction more broadly – is a woman’s business. 

Time for Change Is Now

Involving both men and women in family planning efforts and education is critical, as it offers opportunities for couples to become empowered to make informed choices. It additionally directly helps to target and eliminate myths and misconceptions about contraceptive use, as well as cultural biases towards childcare in general, bringing us, as a society, to an ideal state of health equity.

The idea is for all individuals to have a fair opportunity to achieve their highest health potential and for no one to be disadvantaged from achieving their best because of their gender, race, ethnicity, or socio-economic status. Unfortunately, the equity field is not level for women, as they have to choose one of two evils: Either contraception and its associated burdens or no contraceptives and the loss of bodily autonomy. 

For many women, it’s rarely a win-win situation because either option comes at a cost. 

While there are numerous efforts by the international community to ensure health equity for all, the current contraceptive landscape in Nigeria, and many other countries globally, indicates we are far from achieving it. There is a critical need for holistic education and advocacy to change the existing beliefs that contraception – and reproduction more broadly – is a woman’s business. 

So, how can things change? We need to ask ourselves: When will the male pill or other long-acting methods for males finally become available? When will vasectomy be normalised in our society? When will science and medicine prioritise contraceptive options, devoid of side effects for women, as it has for men? 

Concerted efforts are urgently needed from researchers, advocates, and donors to push for more contraceptive options for men and to encourage their uptake. Contraceptive development efforts should also prioritise creating contraceptive options devoid of side effects for women, so that they can have a fair opportunity to achieve their full health potential. We can’t expect to achieve sexual and reproductive health equity within couples or family units, while our actions as a society indicate otherwise. 

Fatimah Bisola Lawal is a public health practitioner.