Encouraging Contraceptive Uptake by Motivating Men to Communicate About Family Planning: The Malawi Male Motivator Project

"Male involvement in family planning matters. The challenge of increasing men's involvement in family planning is to identify the messaging that will most effectively encourage their involvement."

There is a substantial need to improve family planning (FP) uptake in Malawi. Men in sub-Saharan Africa are often the primary decision-makers about family size and use of FP, and researchers have identified a link between male involvement and increases in contraceptive use. This paper examines the effect of the peer-delivered Malawi Male Motivator intervention on couples' contraceptive uptake.

The structure of the educational intervention was based on the information-motivation-behavioural skills (IMB) model, which as applied here involved these fundamental determinants of couples' uptake of modern contraceptive use: (i) information on modern FP methods and locally available resources, a prerequisite of behaviour change; (ii) motivation to act on knowledge and implement FP practices, where motivation is a function of attitudes about contraception, perceived social norms, and personal expectations about family size; and (iii) FP-related behaviour skills, such as communication skills and self-efficacy around correct condom use.

In line with the IMB approach, participants were provided with information on modern FP options and local facilities offering these methods, and they were instructed on correct condom use. Male motivators - married men aged 30 and over chosen for their use of and enthusiasm for modern contraception - sought to positively influence participants' attitudes toward FP and their motivation to adopt it. They did this by sharing their own experiences, engaging participants in discussions exploring how rigid gender roles and norms can lead to negative outcomes, and challenging the notion that a large family is a sign of virility. Motivators also encouraged participants to become involved in decisions related to FP and family size and helped them practice discussing fertility and contraceptive desires with their wives or girlfriends, with an emphasis on joint decision-making power.

In 2008, researchers recruited 400 men from 257 villages across Malawi's Mangochi province who reported not using any method of contraception. They randomised them into an intervention arm and a control arm and administered surveys on contraceptive use at baseline and after the intervention. They conducted in-depth interviews with a subset of intervention participants.

After the intervention, contraceptive use increased significantly within both arms (P < .01), and this increase was significantly greater in the intervention arm than it was in the control arm (P < .01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P < .01). For example, many interview participants said overall communication with their wives or girlfriends was enhanced by their increased comfort with discussing FP, which some attributed directly to their interactions with the male motivator.

The Male Motivator curriculum incorporated lessons and activities emphasising the financial benefits of FP. Thirteen of the 14 men interviewed indicated they found such arguments for FP more persuasive than other arguments. Several participants explicitly linked the financial benefits associated with practicing FP to their children's and wives' or girlfriends' improved health outcomes.

In conclusion, the "results indicate that male-focused peer-led interventions can effectively increase contraceptive use. Such interventions should incorporate the transfer of communication skills to facilitate men's role as partners in reproductive health. Although the IMB model did not fully explain the success of the intervention in this case, research should continue to test theoretical models to advance understanding of complex health behaviors and relationship dynamics."