Examining the Association between Men's Gender Equitable Attitudes and Contraceptive Outcomes in Rural Maharashtra, India

"...findings reinforce the value of couple-level and gender-synchronized interventions to ensure that women's engagement and control remain central in gender-transformative FP [family planning] programming."

Researchers have long recognised the importance of engaging men in family planning (FP) in ways that are supportive and respectful of their female partners. Interventions that aim to improve gender-related norms and attitudes are one key strategy for male engagement. This study seeks to examine the association between men's gender norm ideologies and contraceptive behaviour outcomes among young husbands in the context of rural India, where spacing contraceptive use and male engagement in FP remain low. Specifically, the study tests the hypothesis that men reporting more gender-equitable attitudes (i) will be more likely to engage in contraceptive communication with their wives and (ii) that they and/or their wives will be more likely to use all forms of FP, compared to men with less equitable attitudes.

This study uses a cross-sectional analysis of baseline survey data from married young couples (N = 989) participating in the CHARM2 [Counselling Husbands and wives to Achieve Reproductive health and Marital equity] FP evaluation trial, conducted in the rural Junnar district of Maharashtra, India. The researchers examined the associations between men's gender role attitudes, which were assessed using the 24-item Gender-Equitable Men Scale (GEMS), and a) spousal contraceptive communication and b) contraceptive use by type (none, traditional, condoms, oral contraceptive pills (OCPs), or intrauterine device, or IUD). The contraceptive use outcome was based on wives' report. The researchers assessed these associations via bivariate t-test (communication outcome) or ANOVA test (contraceptive type outcome), as well as unadjusted and adjusted logistic (communication outcome) and multinomial logistic (contraceptive type outcome) regression models. Adjusted models included sociodemographic factors selected a priori based on established associations with gender-equitable attitudes and/or the assessed outcomes. Data were collected between September 2018 and June 2019.

In this sample, the majority of women (61%, n = 604) reported currently using an FP method, comprised of 23% (n = 231) reporting traditional methods (withdrawal and rhythm), 25% (n = 252) condoms, 9% (n = 89) IUD, and 3% (n = 32) OCPs. The majority of men (61%, n = 605) reported having a discussion with their wives on what to use or do to prevent/stop a pregnancy within the past three months. Mean GEMS score was 54.3 (within a range of 24-72, with a higher score indicating greater support of gender-equitable norms in the sample).

Men with more gender-equitable attitudes were more likely to discuss FP with their wives (adjusted odds ratio (AOR) = 1.05, 95% confidence interval (CI) 1.03-1.07, p < 0.001) and to use condoms (adjusted relative risk ratio (ARRR) = 1.03, 95% CI 1.00-1.06, p = 0.07). There was no association between gender-equitable attitudes and use of other types of contraception.

Thus, this study shows that men who hold more equitable gender ideologies are significantly more likely to discuss contraceptive use and use condoms with their wives. However, gender-equitable attitudes do not appear to be linked with greater likelihood of use of more effective types of contraceptive use. That is, men supportive of gender equity may take greater responsibility for FP vis-à-vis a less effective contraceptive, condoms, in the absence of more effective short-acting contraceptives for men.

These findings reinforce calls for better male contraceptive options, while suggesting that gender-equity-focused programmes to engage males in FP may best support effective FP use by including female partners as well. Such findings are consistent with the Can-Act-Resist framework, which centralises women's agency for reproductive decision-making even while supporting engagement of men in FP. Thus, male engagement that avoids reinforcing dominant gender roles in decision-making is needed, and programmes that directly address gender attitudes and norms may be one way to achieve this aim.

"Ultimately, men's gender-equitable attitudes may contribute to discussion and utilization of FP, but full realization of these outcomes may be hindered by availability of male-controlled methods and lack of female agency in contraceptive decision-making and control."