Not only women’s businessMen need to take equal responsibility in family planning and contraceptive use
Females have the ability to bear children, and so it may seem only logical to relate fertility and ‘anything’ associated with it as ‘women’s business’. The family planning arena, in particular, has been hugely feminised. From assuming the physical responsibility of using contraception to facing its emotional and mental consequences, the role falls almost exclusively on women. But should pregnancy prevention really just be women’s business? What consequences does the feminisation of contraception have?
A wide range of modern contraceptive options are available for women in Nepal. They range from short-acting reversible contraceptives (female condoms, pills and injectables) and long-acting reversible contraceptives (implants and intra-uterine devices or IUDs) to permanent methods (sterilisation). In contrast, condoms and sterilisation (vasectomy) are the only male contraceptives available in the market. Misconceptions that male sterilisation leads to reduced physical strength and that condoms reduce sexual satisfaction discourage the use of contraceptives by men, further curbing the already limited choice.
Over the years, the feminisation of contraception has had two major implications. First, the involvement of men in family planning, in general, has become pacified. The conventional family planning programmes overlooked the active role of men in pregnancy prevention. Consequently, these programmes had woman-centric designs and dissemination. Men ‘actively’ participating in family planning programmes and showing agency over pregnancy prevention stagnated in the aftermath. Ironically, the social perspectives bear a marked disconnect vis-à-vis ‘who seeks’ the information regarding contraception, ‘who ultimately decides’ and ‘who eventually uses’ the method.
Second, the development of reversible contraceptive options for men has become a lesser priority. Years of bio-technological research on contraceptives has been guided by very normative assumptions around fertility control. Hence, such a gendered approach to contraception has constrained the discursive landscape for men to actively partake in contraception over time.
In 2017, the Journal of Sex Research published an article entitled ‘More Than a Physical Burden: Women’s Mental and Emotional Work in Preventing Pregnancy’ which illustrated how health care providers, in different ways, perpetuated the normative expectations about the gendered responsibility of fertility control. Notably, the research showed that counselling visits often marginalised male contraceptive options, undermining their positive aspects and giving more emphasis to their supposed negative sides. Likewise, some insightful findings were yielded in a multi-country analysis regarding the global trend of contraceptive use by males over a period of two decades. Interestingly, the use of male sterilisation significantly dropped (from 3.7 to 1.9 percent) in the developing world and female body-based contraceptive methods continue to predominate the global contraception terrain. The report, thus, reiterated the prominent existence of the feminisation of contraceptive use worldwide.
In Nepal’s case, studies exploring local discourses on the feminisation of contraceptive use are virtually absent. However, the more general narratives do suggest that reproductive health, at large, is established as a gendered social structure in our community. As reflected by the recent household-based survey, the modern contraceptive prevalence rate has stagnated in the country since 2006. And despite the fact that male sterilisation is much simpler than female sterilisation, the latter remains the most popular method in the country, accounting for more than one-third of all current users in the broader method-mix spectrum. In total, female contraceptives hold an 80 percent share of all current users in Nepal.
Family planning is one of the oldest priority health programmes worldwide dating back to the 1960s. In spite of its long history, encouraging men to seek family planning information and utilise services has begun only very recently. So for many years, male involvement in the area was greatly overlooked. Despite the fact that ‘de-feminising’ contraception is constrained by the unavailability of a wide range of modern methods for men, deeply seated gendered normative beliefs regarding fertility work do play a pivotal role in limiting the space for discourses and actions on the matter.
Very profound questions here then are: How much are men ready to take an oral contraceptive pill or have an injectable? Are women ready to accept their men taking pills instead of them? And are societies ready to allow such an amalgamated practice? In countries like Nepal where gender inequality is well entrenched, the process of de-feminisation can be even more challenging.
In recent times, there has been an influx of family planning interventions globally which aim at promoting male participation. This is indeed a starting step towards breaking the age-old norm, and much work is still left to be done. Along with robust dialogues and discourses on the subject, understanding contexts, mapping stakeholders and partners, traversing the global learnings and actively engaging communities are indispensable to bringing about material change. But first, further explorations and researches on the subject matter from diverse perspectives are needed to help guide the de-feminising process.
Rai holds a Master’s degree in Public Health from the Royal Tropical Institute, the Netherlands.