Men are from Mars...Survey results

As our regular readers might recall, a few weeks ago we were reviewing the quarterly statistics with the staff when it was noted that family planning (FP) services in our clinic fell below Kenyan goals. Paul asked if male patients were being asked about FP too which led to hoots of laughter. We joined the staff in a lively discussion about the FP beliefs of African men and sharp differences in opinions were expressed along gender lines. I suggested that we construct a survey to determine just what men do believe and if and how they practice FP.

Four of the staff, 2 men and 2 women, came up with initial questions to ask men. Some of the women’s questions had an in borne bias. For example, one question asked “Why don’t you men use condoms?” The men’s questions were less biased but were phrased in a way to lead the respondent to the ideal or desired answer. After a week, they gave me all the questions they had amassed and asked me to choose the best questions. I reminded them of the survey’s goal, added some guidance on writing unbiased questions and then sent them back to work on it some more.

The final questionnaire isn’t prefect but it did result in some interesting data. It starts with asking basic demographics, allowing us to look for differences or similarities amongst men of different ages, marital statuses and educational levels.

It then asks questions regarding the number of wives they have and the number they desire; the number of children they currently have and the number they desire; and if they know about family planning, what they use if anything and whether their partners are happy with the method. The final question asked the man if his wife were to become pregnant, would he accompany her to the clinic visits.

They distributed the surveys to men who came to our clinic and also to men in other communities. They got 115 responses, the majority of which were men in the 18-30 year old group (48%). Only 8% were over 45 years of age. A full 66% reported being married with the majority stating they had only one wife (though a few had 3-4 wives).

90% of all men reported they had heard about FP and 84% thought it was good. But how many reported practicing some form of FP? Across all groups the number was similar- about 53%. That was true for all ages, all educational levels, all marital groups. Why did so many think FP was good and yet barely half of them use it? The answer may be in how they answered the questions about desired children. In all age groups, the majority of married men (47%) reported having 4 or more children. And when asked how many more children they wanted, 42% said they’d like 4 or more additional children. One man said he’d like 20.

Are their partners happy with the method? 77% thought they were. Would they accompany their wives to clinic if they were pregnant? Yes, said 85%.

Now came the really interesting part. As we began to dissect and discuss the data people’s interpretation of it split the group along gender lines once more. The men proclaimed the results clearly demonstrated that things are changing, men are marrying fewer women and are being more responsible in helping prevent HIV by using condoms. They claimed this in spite of facts and data to the contrary.

Only 53% use any form of FP and of those only 60% were using condoms. A few stated they use oral contraceptives, a few use Depo and a few use withdrawal. The numbers didn’t add up. How to explain the discrepancy? Much discussion again ensued until Dr. Jeevan walked to the board and wrote “men are worthless liars”.

This outrageous statement had the desired effect. First, it broke the tension in the room and got everyone to laugh and second, it allowed them to acknowledge the possibility that what men said they did and what they actually did in their lives may be 2 distinctly different things.

The women believed this to be the case all along whereas the men still didn’t believe it (damn the statistics!). The female staff embraced the beliefs that women have more children than is healthy because their husbands want too many children. In days past, having many children meant one was wealthy. Men still brag about their father having 7 wives and 46 sons. Although the younger men on the staff believed the times were changing, in practice men may be closer to their grandfather’s generation in beliefs than they think.

They also strongly believe that prevention of HIV hinges on women having more rights and choices in FP matters. As one clinician stated “they must be empowered”. They shouldn’t have to be exposed to HIV because their husband refuses to use a condom, but they often are.

By the end of the discussion we had three suggestions on the table. One, create a survey to determine women's FP beliefs and practices; two, provide more FP counseling to men at the time they are seen in the clinic and with HIV counseling and testing and three, invite men to accompany their wives to antenatal appointments so they are more intimately involved.

So gentle readers, stay tuned and we will give the women their own voice in an upcoming blog.