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The changing attitude and practice of menregarding family planning in Lagos, Nigeria
Publ. Hlth, Lond. (1985) 99, 349-355
The Changing Attitude and Practice of Men Regarding Family Planning in Lagos,,Nigeria Adepeju A. Olukoya* B.S., M.D., M.Ed.
Senior Medica/ Officer, /nstitute of Chi/d /-/ea/th & Primary Care, Co//ege of Medicine of the University of Lagos, Nigena
Men's role in family planning is often neglected. This is unfortunate, especially since men's attitudes often influence their partner's use of family planning and since there is evidence that many men favour family planning. A study done in Lagos, Nigeria indicates that men's knowledge and use has increased over the years, and that attitudes towards male sterilization are not all negative. Some defects in male knowledge of family planning were identified, and suggestions made for health education. Though the sample was a small one, the findings may help others to deliver appropriate family planning services. Introduction
The male's role in family planning is often neglected. M a n y reasons can be attributed to this, especially in Africa?, ~ Men are often assumed to have negative attitudes toward birth control. One study reported men discouraging modern contraceptives because they fear it will encourage promiscuity in their w o m e n ) This lack of encouragement is reflected in the fact that the reported use of modern methods by females is three times that of m e n ) implying that women using these methods may have been doing so without their husband's knowledge. O n the other hand, there is evidence that m a n y men know about the use of modern contraceptives, and have practised it? Some reports, have underestimated the effective role of men in family planning in Africa. Preliminary reports of the D a n f a Comprehensive Rural Health and Family Planning Project in Ghana, showed that 54% of those adopting contraceptives were men. More men than women had tried to persuade others to use contraceptives. Men who chose contraception for themselves or their partners reported fewer pregnancies than women who adopted a method, and the contraceptive continuation rates were higher for male acceptors and their partners (69%) than for female acceptors (46%). 5 Another report from Jamaica indicated that 75% of the men in the study favoured family planning, 40% practised it, and among those disapproving, (24%), more than one-third expressed willingness to allow their partner to use it. Married men in the target population of the Family Health Clinic of the Institute of Child Health and Primary Care of the College of Medicine, Lagos, Nigeria, were therefore studied. Method
An interview survey of 52 married men was carried out in the population served by the clinic in Shomolu. Shomolu is an area in Lagos, the capital city of Nigeria. It is mainly thickly populated, and can be said to be "semi u r b a n " . The inhabitants are mostly * P.M.B. 21178,
0033-3506/85/060349+07 $02.00/0
Ikeja, Nigeria. © 1985 The Society of Community Medicine
350
A. A. Olukoya
lower/middle class. The target population consists of about 30,000 people residing around the clinic. The clinic provides daily health educational talks, which include family planning once a week. This is directed mainly at the women attending. The men were chosen using cluster sampling. The target population is divided into six areas and the sample was chosen from among men permanently resident in each of the areas. The interviews were carried out by trained and experienced field health workers, using an interview schedule. The study was carried out in September, 1982. The data was hand tabulated and analyzed. Results
The biggest proportion of the men fall in the age group 31-40 years (48.1%) with the ages ranging from 21-70 years. All the men were married, with 77 % in m o n o g a m o u s and 23.1% in polygamous marriages. All but two belonged to the Yoruba tribe, which is the predominant tribe of the study area. Ten per cent of the men had two or less children, 33 % had three to four children, 23 % had five to six children and 25 ~o had more than six children. M a n y of the men (57%) were in skilled labour, 12% in professional/office work, and 10% were unskilled. This is shown in Table 1. When they were asked about their support for family planning for spacing children, 79 % answered in the affirmative, 17% said No, and 4% D o n ' t know. When asked if they supported family planning for stopping children after having all that one wants, 65% said Yes, and 35 % said No. Regarding male participation in family planning, 77 % s a i d " Yes", men should participate, and 19% said No. Fifty-nine per cent of the men said they would encourage their women to come for family planning (Table 2). Regarding knowledge of family planning, all of the men had heard of and practised abstinence. About 60% of them had heard of using charms and herbs from native doctors. About 28% had heard of or used the rhythm method and 75% had heard of or used TABLE1. Characteristics of the sample N Age (years) < 30 31-40 41-50 > 50 Type of marriage Monogamous Polygamous Number of children 0 2 3-4 5-6 >6 Occupation Professional Office Skilled Unskilled Trader Other
Percentage
4 25 11 12
7.7 48.1 21.2 23.0
40 12
76.9 23.1
10 17 12 13
19.2 32.7 23.1 24.8
3 3 29 5 7 4
5.9 5.9 56'9 9.8 13.8 7.8
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TABLE2. Men's attitudes to familyplanning Response Yes
Support the idea of F.P. for spacing children Support the idea of F.P. for stopping children after having all desired Think men need to participate in F.P. Would encouragetheir women to come to the clinic for F.P.
No
Don't know
N
Percentage
N
Percentage
N
Percentage
41
78.8
9
17.3
2
3.8
34
65.4
18
34.6
0
--
40
76.9
10
19.2
2
3.8
30
58.8
19
37.3
2
3-9
withdrawal. Over 90~o had heard of or used the condom, 40~o had heard of the foam, about 59 ~o had heard of the pill and the partners of 12 ~ had used it. Thirty-one per cent had heard of the I.U.D., and the partners of 2 ~ used it. Only 17~o knew about male sterilization, and 48~o have heard of female sterilization. N o b o d y had used any of the sterilization methods. These findings are summarized in Table 3. Tables 4-5 show that the knowledge of, and use of the various methods of contraception have increased over the years, when data from previous years 1968 and 1975 were compared. The current use of contraceptives is shown in Table 6; 71 ~o of the couples were currently abstaining, 14~ were currently practising withdrawal, 1 4 ~ were currently using the condom, 4~o were using the pill, 2 ~ using I.U.D., and 2~o the injection method (DepoProvera). It is obvious from this, that some were currently practising more than one method. These findings when compared to data from 1968 also show an increase in current use. This is illustrated in Table 7. It should be noted however that only 11 of the respondents (21 ~ ) currently use any modern form of contraception. The men were asked why they use condoms. 5 4 ~ said that condoms are used for preventing pregnancy, 6 ~ said they are useful for preventing both infection and pregnancy. It is interesting to note that most of the men in this sample, do not have an idea about the time in the menstrual cycle when ovulation occurs. When asked about the best time of the month to have sex with the partner, if pregnancy is not desired, 83 ~o did not know, 8 ~ said midway between menstruations, and 6 ~ said immediately before menstruation. Because of the widespread practice of abstinence, some information was sought about the men's feelings about it. The results show this practice to be still favoured: 87~o of the men believe in stopping sex with their partner after child-birth, and 63~o believe that the abstinence period should last at least 1 year. During this time, 53 ~o of the men claim total abstinence, whereas 4 7 ~ said they turn to other wives, or girl friends for satisfaction of their sexual urge. Almost 9 0 ~ of the men do not want the custom changed. It is interesting to note that in this sample, 1 2 ~ of the men would favour a programme of voluntary male sterilization after having all the desired children.
A. A. Olukoya
352
TABLE3. Men's knowledge and previous practice of some contraceptive methods. Not used but heard
Used N Postponing pregnancy after birth by woman not having sex Woman using charms sold by native doctor Woman using medicine sold by native doctor Man & woman having sex only at certain time of the month (rhythm) Man using withdrawal Man using condoms Woman using foam Woman taking tablets (pill) Woman using IUD Male sterilization Female sterilization Woman having special injections (Depo-Provera)
Percentage
51
100
Never heard
N
Percentage
N
Percentage
0
0
0
0
1
1.9
32
61-5
19
36.5
1
1,9
31
59.6
20
38.5
3
5,8
13
25
36
69.2
11 18 0 6
21,2 34,6 0 11.8
28 31 20 30
53.8 59.6 39-2 58.8
13 3 31 15
25 5.8 60-8 29.4
1 0 0 1
1.9 0 0 2-0
16 9 25 19
30.8 17.3 48.1 37.3
35 43 27 31
67.3 82.7 51-9 60.8
TABLE4. Men's knowledge about modern contraceptives: comparison of data from 1968 and 1982 Heard of method (%) Method Condom Diaphragm Pill IUD Depo-Provera Jelly/Foam
19687 61-2 17.6 37.16 5.1 -5.5
1982 59.6 21.2 58.8 30-8 37.3 39-2
--, Not asked.
Discussion T h e c h a r a c t e r i s t i c s o f this s a m p l e v a r y slightly f r o m t h a t o f B a m i s a i y e . 8 She f o u n d t h a t the m e n in her s a m p l e , a g e d less t h a n 30 years, m a d e u p 3 0 % as o p p o s e d to 7 . 7 % in this study. O n l y 9 % o f h e r s t u d y were o v e r 50 years, w h e r e a s in this s t u d y t h e r e w e r e 2 3 % . I n spite o f this, h o w e v e r , s o m e o f the f i n d i n g s s u p p o r t p r e v i o u s o b s e r v a t i o n s . M o r g a n f o u n d t h a t 7 8 % o f the m e n s a m p l e d s u p p o r t e d f a m i l y p l a n n i n g Y I n this study, 7 9 % o f m e n s u p p o r t family planning. It is e n c o u r a g i n g t h a t 7 7 % & t h e m e n saw the n e e d to p a r t i c i p a t e in f a m i l y p l a n n i n g a n d t h a t 59 % w o u l d e n c o u r a g e their w o m e n to c o m e to t h e clinic.
Men and Family Planning in Lagos
353
TABLE 5. Past practice of modern contraception: comparison of three sets of data from 1968, 1975, and 1982 No. who have ever used method ( ~ ) Method Condom Pill Diaphragm IUD Depo-Pravera Jelly/foam
19687
1975s
1982
17.8 5.9 1.0 0.7 -0.7
8 5 0 1 -1
34-6 11.8 0 1.9 2-0 1.9
- - , Not asked. TABLE 6. Current use of contraception
Method Abstinence Charms by native doctor Rhythm Withdrawal Condom Foam Pill IUD Depo-Provera Breast-feeding Male sterilization Female sterilization
N
Responses for method (~o)
37 1 2 7 7 0 2 1 1 3 0 0
71.2 1.9 3.8 13' 5 13-5 0 3.8 1.9 1.9 5.8 0 0
TABLE 7. Current use of modern contraception: comparison of data from 19687 and 1982 Percentage use Method Condom Diaphragm Pill IUD Depo-Pravera Jelly/Foam
1968
1982
2.3 0-1 1.0 0.1 -0
13.5 0 3.8 1.9 1-9 0
- - , Not asked.
This study shows an increasing awareness of modern contraceptives, compared with s t u d i e s i n 1968, 1975 a n d 1982, e v e n t h o u g h o n l y 11 o f t h e m e n (21 ~o) c u r r e n t l y u s e a n y m o d e r n f o r m o f f a m i l y p l a n n i n g . T h e c o n d o m is u s e d n e a r l y five t i m e s m o r e o f t e n t h a n a n y o t h e r f o r m o f m o d e r n f a m i l y p l a n n i n g . I t is n o t h o w e v e r c l e a r i f t h e c o n d o m s w e r e b e i n g u s e d w i t h a wife o r a girl f r i e n d o r p r o s t i t u t e . I t is a l s o o f n o t e t h a t a n u m b e r o f t h e
354
A. A. Olukoya
men in this study have heard of sterilization both male and female, and 1 2 ~ said that they would favour a programme of voluntary male sterilization. This role of men in family planning needs to be encouraged. Too often health education about family planning is directed at women who form a captive audience for a " h e a l t h t a l k " in maternal/child health clinics. New ways of reaching men should be sought. The family health clinic of the Institute of Child Health and Primary Care of the University of Lagos, has a father's club as one of its strategies for gaining support for family planning and child health programmes. TM This meets once a m o n t h and it is hoped that a diffusion effect of information gathered benefits the community. The increased awareness between 1975 and 1982, shown in Table 5, may be due to this. Other ways of reaching the men m a y be through their places of work in factories, offices, etc. or through the men's clubs. The reasons for focusing on the men are many, a male method (the condom) as shown by this study is the most widely used modern contraceptive, the men favour contraception, and they can influence the behaviour of their partners. This study also shows that over the years, the attitude of the men towards postpartum abstinence has not changed. This attitude can be linked to the traditional beliefs that intercourse during the breast-feeding period can be harmful and make the baby sick. The abstinence period is felt to be necessary to enable the mother to regain her strength. 8 The duration of abstinence suggested by most of the men was more than 1 and up to 3 years. Various authors have written about the incidence of venereal diseases in Nigeria and other parts of Africa. n Some men in this sample resorted to prostitutes during the period of abstinence from their wives post-partum.
Conclusion This study suggests an increase in awareness and use of modern contraceptives among men in Lagos, Nigeria. It shows that a male method (the condom) is the most commonly used modern contraceptive. It is suggested that Health Education Programmes should include knowledge of the beneficial effects of modern contraceptives, and information about the fertile period.
Acknowledgements The author is grateful to Dr (Mrs) A. Bamisaiye and the staff of the Evaluation and Research Unit of the Institute of Child Health and Primary Care for their help in carrying out this study.
References 1. Ok@e, X. & Montague, J. (1975). Hospitals based family planning in rural Africa" Some lessons from the mid Western State of Nigeria Transactions of the Royal Society of Tropical Medicine and Hygiene 69, 189-97. 2. Olusanya, P. O. (1969). "Nigeria: Cultural barriers to family planning among the Yorubas" Studies in Family Planning, 1, 13-6. 3. Caldwell, J. C. (ed). (1975). Population Growth and Socio-economic change in West Africa. New York: Columbia University Press. p. 223. 4. Ibid., p. 76. 5. Anonymous. (1979). "Ghana: Half the fertility reduction in a rural area is due to acception by men of family planning". International Family Planning perspectives 5, 31-2. 6. Morgan, B. I. & Stratmann, C. J. (1971). The Jamaican male and Family Planning. West Indian Medical Journal, 20, 5-11.
Men and Family Planning in Lagos
355
7. Caldwell, J. C. op. eit. p. 221. 8. Bamisaiye, A. Desweemer, C. & Ransome-Kuti, O. (1978). Developing a clinic strategy appropriate to community family planning needs and practices! An experience in Lagos, Nigeria. Studies in Family Planning 9, 44-8. 9. Morgan, R. W., in Caldwell, J. C. op. cit., p. 227. 10. Bamisaiye, A. Ransome-Kuti, O. & Ojo, M. A. Y., (1981). Health Education directed towards the father." A new approach within Maternal and Child Health Services. Paper delivered to 1st International All Africa Conference on Health Education, Lagos, Nigeria, August 1981. 11. Adadevoh, B. K., (ed) (1974). Sub-fertility and Infertility in Africa. Ibadan: Caxton Press. pp. 78, 81, 85.
The Changing Attitude and Practice of Men Regarding Family Planning in Lagos,,Nigeria Adepeju A. Olukoya* B.S., M.D., M.Ed.
Senior Medica/ Officer, /nstitute of Chi/d /-/ea/th & Primary Care, Co//ege of Medicine of the University of Lagos, Nigena
Men's role in family planning is often neglected. This is unfortunate, especially since men's attitudes often influence their partner's use of family planning and since there is evidence that many men favour family planning. A study done in Lagos, Nigeria indicates that men's knowledge and use has increased over the years, and that attitudes towards male sterilization are not all negative. Some defects in male knowledge of family planning were identified, and suggestions made for health education. Though the sample was a small one, the findings may help others to deliver appropriate family planning services. Introduction
The male's role in family planning is often neglected. M a n y reasons can be attributed to this, especially in Africa?, ~ Men are often assumed to have negative attitudes toward birth control. One study reported men discouraging modern contraceptives because they fear it will encourage promiscuity in their w o m e n ) This lack of encouragement is reflected in the fact that the reported use of modern methods by females is three times that of m e n ) implying that women using these methods may have been doing so without their husband's knowledge. O n the other hand, there is evidence that m a n y men know about the use of modern contraceptives, and have practised it? Some reports, have underestimated the effective role of men in family planning in Africa. Preliminary reports of the D a n f a Comprehensive Rural Health and Family Planning Project in Ghana, showed that 54% of those adopting contraceptives were men. More men than women had tried to persuade others to use contraceptives. Men who chose contraception for themselves or their partners reported fewer pregnancies than women who adopted a method, and the contraceptive continuation rates were higher for male acceptors and their partners (69%) than for female acceptors (46%). 5 Another report from Jamaica indicated that 75% of the men in the study favoured family planning, 40% practised it, and among those disapproving, (24%), more than one-third expressed willingness to allow their partner to use it. Married men in the target population of the Family Health Clinic of the Institute of Child Health and Primary Care of the College of Medicine, Lagos, Nigeria, were therefore studied. Method
An interview survey of 52 married men was carried out in the population served by the clinic in Shomolu. Shomolu is an area in Lagos, the capital city of Nigeria. It is mainly thickly populated, and can be said to be "semi u r b a n " . The inhabitants are mostly * P.M.B. 21178,
0033-3506/85/060349+07 $02.00/0
Ikeja, Nigeria. © 1985 The Society of Community Medicine
350
A. A. Olukoya
lower/middle class. The target population consists of about 30,000 people residing around the clinic. The clinic provides daily health educational talks, which include family planning once a week. This is directed mainly at the women attending. The men were chosen using cluster sampling. The target population is divided into six areas and the sample was chosen from among men permanently resident in each of the areas. The interviews were carried out by trained and experienced field health workers, using an interview schedule. The study was carried out in September, 1982. The data was hand tabulated and analyzed. Results
The biggest proportion of the men fall in the age group 31-40 years (48.1%) with the ages ranging from 21-70 years. All the men were married, with 77 % in m o n o g a m o u s and 23.1% in polygamous marriages. All but two belonged to the Yoruba tribe, which is the predominant tribe of the study area. Ten per cent of the men had two or less children, 33 % had three to four children, 23 % had five to six children and 25 ~o had more than six children. M a n y of the men (57%) were in skilled labour, 12% in professional/office work, and 10% were unskilled. This is shown in Table 1. When they were asked about their support for family planning for spacing children, 79 % answered in the affirmative, 17% said No, and 4% D o n ' t know. When asked if they supported family planning for stopping children after having all that one wants, 65% said Yes, and 35 % said No. Regarding male participation in family planning, 77 % s a i d " Yes", men should participate, and 19% said No. Fifty-nine per cent of the men said they would encourage their women to come for family planning (Table 2). Regarding knowledge of family planning, all of the men had heard of and practised abstinence. About 60% of them had heard of using charms and herbs from native doctors. About 28% had heard of or used the rhythm method and 75% had heard of or used TABLE1. Characteristics of the sample N Age (years) < 30 31-40 41-50 > 50 Type of marriage Monogamous Polygamous Number of children 0 2 3-4 5-6 >6 Occupation Professional Office Skilled Unskilled Trader Other
Percentage
4 25 11 12
7.7 48.1 21.2 23.0
40 12
76.9 23.1
10 17 12 13
19.2 32.7 23.1 24.8
3 3 29 5 7 4
5.9 5.9 56'9 9.8 13.8 7.8
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TABLE2. Men's attitudes to familyplanning Response Yes
Support the idea of F.P. for spacing children Support the idea of F.P. for stopping children after having all desired Think men need to participate in F.P. Would encouragetheir women to come to the clinic for F.P.
No
Don't know
N
Percentage
N
Percentage
N
Percentage
41
78.8
9
17.3
2
3.8
34
65.4
18
34.6
0
--
40
76.9
10
19.2
2
3.8
30
58.8
19
37.3
2
3-9
withdrawal. Over 90~o had heard of or used the condom, 40~o had heard of the foam, about 59 ~o had heard of the pill and the partners of 12 ~ had used it. Thirty-one per cent had heard of the I.U.D., and the partners of 2 ~ used it. Only 17~o knew about male sterilization, and 48~o have heard of female sterilization. N o b o d y had used any of the sterilization methods. These findings are summarized in Table 3. Tables 4-5 show that the knowledge of, and use of the various methods of contraception have increased over the years, when data from previous years 1968 and 1975 were compared. The current use of contraceptives is shown in Table 6; 71 ~o of the couples were currently abstaining, 14~ were currently practising withdrawal, 1 4 ~ were currently using the condom, 4~o were using the pill, 2 ~ using I.U.D., and 2~o the injection method (DepoProvera). It is obvious from this, that some were currently practising more than one method. These findings when compared to data from 1968 also show an increase in current use. This is illustrated in Table 7. It should be noted however that only 11 of the respondents (21 ~ ) currently use any modern form of contraception. The men were asked why they use condoms. 5 4 ~ said that condoms are used for preventing pregnancy, 6 ~ said they are useful for preventing both infection and pregnancy. It is interesting to note that most of the men in this sample, do not have an idea about the time in the menstrual cycle when ovulation occurs. When asked about the best time of the month to have sex with the partner, if pregnancy is not desired, 83 ~o did not know, 8 ~ said midway between menstruations, and 6 ~ said immediately before menstruation. Because of the widespread practice of abstinence, some information was sought about the men's feelings about it. The results show this practice to be still favoured: 87~o of the men believe in stopping sex with their partner after child-birth, and 63~o believe that the abstinence period should last at least 1 year. During this time, 53 ~o of the men claim total abstinence, whereas 4 7 ~ said they turn to other wives, or girl friends for satisfaction of their sexual urge. Almost 9 0 ~ of the men do not want the custom changed. It is interesting to note that in this sample, 1 2 ~ of the men would favour a programme of voluntary male sterilization after having all the desired children.
A. A. Olukoya
352
TABLE3. Men's knowledge and previous practice of some contraceptive methods. Not used but heard
Used N Postponing pregnancy after birth by woman not having sex Woman using charms sold by native doctor Woman using medicine sold by native doctor Man & woman having sex only at certain time of the month (rhythm) Man using withdrawal Man using condoms Woman using foam Woman taking tablets (pill) Woman using IUD Male sterilization Female sterilization Woman having special injections (Depo-Provera)
Percentage
51
100
Never heard
N
Percentage
N
Percentage
0
0
0
0
1
1.9
32
61-5
19
36.5
1
1,9
31
59.6
20
38.5
3
5,8
13
25
36
69.2
11 18 0 6
21,2 34,6 0 11.8
28 31 20 30
53.8 59.6 39-2 58.8
13 3 31 15
25 5.8 60-8 29.4
1 0 0 1
1.9 0 0 2-0
16 9 25 19
30.8 17.3 48.1 37.3
35 43 27 31
67.3 82.7 51-9 60.8
TABLE4. Men's knowledge about modern contraceptives: comparison of data from 1968 and 1982 Heard of method (%) Method Condom Diaphragm Pill IUD Depo-Provera Jelly/Foam
19687 61-2 17.6 37.16 5.1 -5.5
1982 59.6 21.2 58.8 30-8 37.3 39-2
--, Not asked.
Discussion T h e c h a r a c t e r i s t i c s o f this s a m p l e v a r y slightly f r o m t h a t o f B a m i s a i y e . 8 She f o u n d t h a t the m e n in her s a m p l e , a g e d less t h a n 30 years, m a d e u p 3 0 % as o p p o s e d to 7 . 7 % in this study. O n l y 9 % o f h e r s t u d y were o v e r 50 years, w h e r e a s in this s t u d y t h e r e w e r e 2 3 % . I n spite o f this, h o w e v e r , s o m e o f the f i n d i n g s s u p p o r t p r e v i o u s o b s e r v a t i o n s . M o r g a n f o u n d t h a t 7 8 % o f the m e n s a m p l e d s u p p o r t e d f a m i l y p l a n n i n g Y I n this study, 7 9 % o f m e n s u p p o r t family planning. It is e n c o u r a g i n g t h a t 7 7 % & t h e m e n saw the n e e d to p a r t i c i p a t e in f a m i l y p l a n n i n g a n d t h a t 59 % w o u l d e n c o u r a g e their w o m e n to c o m e to t h e clinic.
Men and Family Planning in Lagos
353
TABLE 5. Past practice of modern contraception: comparison of three sets of data from 1968, 1975, and 1982 No. who have ever used method ( ~ ) Method Condom Pill Diaphragm IUD Depo-Pravera Jelly/foam
19687
1975s
1982
17.8 5.9 1.0 0.7 -0.7
8 5 0 1 -1
34-6 11.8 0 1.9 2-0 1.9
- - , Not asked. TABLE 6. Current use of contraception
Method Abstinence Charms by native doctor Rhythm Withdrawal Condom Foam Pill IUD Depo-Provera Breast-feeding Male sterilization Female sterilization
N
Responses for method (~o)
37 1 2 7 7 0 2 1 1 3 0 0
71.2 1.9 3.8 13' 5 13-5 0 3.8 1.9 1.9 5.8 0 0
TABLE 7. Current use of modern contraception: comparison of data from 19687 and 1982 Percentage use Method Condom Diaphragm Pill IUD Depo-Pravera Jelly/Foam
1968
1982
2.3 0-1 1.0 0.1 -0
13.5 0 3.8 1.9 1-9 0
- - , Not asked.
This study shows an increasing awareness of modern contraceptives, compared with s t u d i e s i n 1968, 1975 a n d 1982, e v e n t h o u g h o n l y 11 o f t h e m e n (21 ~o) c u r r e n t l y u s e a n y m o d e r n f o r m o f f a m i l y p l a n n i n g . T h e c o n d o m is u s e d n e a r l y five t i m e s m o r e o f t e n t h a n a n y o t h e r f o r m o f m o d e r n f a m i l y p l a n n i n g . I t is n o t h o w e v e r c l e a r i f t h e c o n d o m s w e r e b e i n g u s e d w i t h a wife o r a girl f r i e n d o r p r o s t i t u t e . I t is a l s o o f n o t e t h a t a n u m b e r o f t h e
354
A. A. Olukoya
men in this study have heard of sterilization both male and female, and 1 2 ~ said that they would favour a programme of voluntary male sterilization. This role of men in family planning needs to be encouraged. Too often health education about family planning is directed at women who form a captive audience for a " h e a l t h t a l k " in maternal/child health clinics. New ways of reaching men should be sought. The family health clinic of the Institute of Child Health and Primary Care of the University of Lagos, has a father's club as one of its strategies for gaining support for family planning and child health programmes. TM This meets once a m o n t h and it is hoped that a diffusion effect of information gathered benefits the community. The increased awareness between 1975 and 1982, shown in Table 5, may be due to this. Other ways of reaching the men m a y be through their places of work in factories, offices, etc. or through the men's clubs. The reasons for focusing on the men are many, a male method (the condom) as shown by this study is the most widely used modern contraceptive, the men favour contraception, and they can influence the behaviour of their partners. This study also shows that over the years, the attitude of the men towards postpartum abstinence has not changed. This attitude can be linked to the traditional beliefs that intercourse during the breast-feeding period can be harmful and make the baby sick. The abstinence period is felt to be necessary to enable the mother to regain her strength. 8 The duration of abstinence suggested by most of the men was more than 1 and up to 3 years. Various authors have written about the incidence of venereal diseases in Nigeria and other parts of Africa. n Some men in this sample resorted to prostitutes during the period of abstinence from their wives post-partum.
Conclusion This study suggests an increase in awareness and use of modern contraceptives among men in Lagos, Nigeria. It shows that a male method (the condom) is the most commonly used modern contraceptive. It is suggested that Health Education Programmes should include knowledge of the beneficial effects of modern contraceptives, and information about the fertile period.
Acknowledgements The author is grateful to Dr (Mrs) A. Bamisaiye and the staff of the Evaluation and Research Unit of the Institute of Child Health and Primary Care for their help in carrying out this study.
References 1. Ok@e, X. & Montague, J. (1975). Hospitals based family planning in rural Africa" Some lessons from the mid Western State of Nigeria Transactions of the Royal Society of Tropical Medicine and Hygiene 69, 189-97. 2. Olusanya, P. O. (1969). "Nigeria: Cultural barriers to family planning among the Yorubas" Studies in Family Planning, 1, 13-6. 3. Caldwell, J. C. (ed). (1975). Population Growth and Socio-economic change in West Africa. New York: Columbia University Press. p. 223. 4. Ibid., p. 76. 5. Anonymous. (1979). "Ghana: Half the fertility reduction in a rural area is due to acception by men of family planning". International Family Planning perspectives 5, 31-2. 6. Morgan, B. I. & Stratmann, C. J. (1971). The Jamaican male and Family Planning. West Indian Medical Journal, 20, 5-11.
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7. Caldwell, J. C. op. eit. p. 221. 8. Bamisaiye, A. Desweemer, C. & Ransome-Kuti, O. (1978). Developing a clinic strategy appropriate to community family planning needs and practices! An experience in Lagos, Nigeria. Studies in Family Planning 9, 44-8. 9. Morgan, R. W., in Caldwell, J. C. op. cit., p. 227. 10. Bamisaiye, A. Ransome-Kuti, O. & Ojo, M. A. Y., (1981). Health Education directed towards the father." A new approach within Maternal and Child Health Services. Paper delivered to 1st International All Africa Conference on Health Education, Lagos, Nigeria, August 1981. 11. Adadevoh, B. K., (ed) (1974). Sub-fertility and Infertility in Africa. Ibadan: Caxton Press. pp. 78, 81, 85.