Conception or ContraceptionMen‘s Role in the decision making process in Minya, Egypt

Adel TakruriPhD Candidate

Johns Hopkins Bloomberg School of Public Health

October, 2010

Fertility in Egypt

•TFR in Egypt was 3.1 in 2005•In Southern rural Egypt: 3.8

•Contraceptive use in Egypt in 2005: 57%•In Southern rural Egypt: 41%

•Unmet need for contraception in 2005: 7% in Northern Egypt

•17% in Southern Egypt•Decelerating fertility•Decrease unwanted fertility or wanted fertility?

Source: EDHS, 2005

The benefits of reducing fertility

•At the household level•Educational opportunity•Lower maternal mortality•Better nutrition

•At the economic level•Better job opportunities•Poverty reduction

•At the environmental level•Better sanitation•Less strain on natural resources•Less environmental degradation

Source: Greene & Merrick, 2005

Reproductive InterventionsThe missing actor?

•Family planning programs mostly target women•Reproductive health studies rarely include men•Most family planning surveys collect data from women•Reproductive health services mainly focus on women

The question?

•Do men matter?

Study Objectives

•To determine the effects of husbands desire for more children on contraceptive use•To determine factors that empower women to use contraception•To determine the influence of husbands attitudes towards family planning on wives attitudes and subsequent use of contraception

Study data

•A panel survey of three years: 2004, 2005, and 2007

•Included 1927 couples

•Based on the questions asked in DHS

Conceptual framework of the influences of community, couple, and individual level factors on fertility intentions and behaviors

Husband’s Knowledge and

Attitudes

Wife’s Knowledge and

Attitudes

Contraceptive use or nonuse

Fertility outcome

Partners’ age

Partners’ schooling

Partners’ employment

Parity

Residence

Son preference

Couplecommunication

CultureModernityPatriarchy Fatalism

Religion

Policies

FP servicesavailability

Media

Socialnetworks

CoupleCommunity

Husband’sIntentions

Wife’sIntentions

Proximate/Individual Outcomes

Adapted from Becker 1996

Background Variables

A BC

D

E

F

G

H I

Shaded variables will not be included in the analysis

Preliminary ResultsUse of contraception in relation to men-related factors

OR 95% CI

Heard about FP past 6 months 1.3 (1.08-1.55)

Staff talked about FP 2.06 (1.2-3.4)

Staff talked about side effects FP 0.56 (0.21-1.5)

Thought most people use FP 1.3 (1.08-1.55)

Desire for a future child•86% of couple are concordant in their desire for a future child•14% are discordant

Contraception among couples in which the woman wants to stop childbirth and the man want more children

Woman's Schooling Percent contracepting Not contracepting

Attended School 80.3 19.7

No Schooloing 76.6 23.4

Number of children

Less than 4 81 19

4 or more 73 27

Age

30 or less 85 15

Above 30 61 39

Discussed FP with husband

Yes 83 17

No 74 26

Pending hypothesis?Spouses influence each other

Wife’s desire

Husband’s desire

Wife’s desire

Husband’s desire

Policy Implications

•Including men men in reproductive and family planning services•Empowering women to take control of their fertility•Encouraging communication between spouses

Further Research•How to define or refine the concept of unmet need to include husbands, wives or couples (Becker 1999)•How do couples negotiate their fertility and contraceptive desires

•Who initiates the discussion•Verbal or nonverbal expressions

•How to include men in reproductive health•With wives•Separately •Men groups

•Men’s attitudes towards involvement? Childbearing and rearing are women’s issues?•What is the value of children for men and for women?•Unwanted fertility versus wanted fertility

•Informed •Free from influence