What Does Your Partner Want? Using a Gender Equality Lens to Assess Partner Support and Involvement in Family Planning in Uganda

"Study findings improve the current understanding of partner support for family planning and offer insights on how social support can be leveraged in partnerships to improve health and well-being, particularly related to family planning."



There is unmet need and inequitable gender norms related to family planning in Uganda. However, male partner support is associated with a threefold increase in a woman's subsequent uptake of family planning. This study explores male and female differences in partner support preference in Uganda. Conducted by the United States Agency for International Development (USAID)-funded Social and Behavior Change Activity (SBCA) in Uganda, the study aims to (i) investigate preferred measures of partner support related to family planning among males versus females and (ii) assess male versus female priorities in family planning decision-making considerations. This understanding can inform the design of tailored interventions to improve contraceptive use at multiple levels, including men, women, community, and facility.



A theoretical underpinning for this study is social support theory, which refers to resources that people have access to based on their relationships and social ties. Within the context of family planning, women may receive support from their partners such as advice and information, emotional support, and services. The exchange of such social support within couples can influence their family planning decisions or actions. The present research investigates how social support among couples can be better quantified and leveraged in the design of relevant family planning programmes for Ugandan men, women, and couples.



Data were from a cross-sectional, nationally representative telephone survey (December 1-12 2020) of 1,177 men and women aged 18-49 years old in sexual partnerships. Key measures included current family planning use (Are you or your partner currently doing anything to prevent or delay becoming pregnant?); family planning decision-making considerations (In your experience, which of the following are the three most important considerations as you make family planning decisions?); and preferred partner support (What level of involvement would you like to see from your partner in your family planning decisions?). Multivariable logistic regressions explored factors associated with decision-making priorities and preferred partner support, adjusting for sociodemographic confounders.



About 74% of the study population (similar proportions among men and women) reported currently using family planning. Most common reasons noted by non-users of family planning (N = 309) included the fear of side effects (38%), disapproval from partner, family, or friends (23%), lack of knowledge of the appropriate method to use (11%), and cultural or religious concerns (9%), as well as the cost/inaccessibility of family planning services.



Two-thirds (66%) of men and women wanted a high level of involvement from their partner, which was associated with higher odds of using family planning (adjusted odds ratio (aOR): 2.46, 95% confidence interval (CI): 1.87-3.24). Specific ways partners could be involved included accompanying them to health services (39%), permitting them to get family planning services (26%), and jointly discussing family planning options (23%). Of note, more women wanted their partner to accompany them (45%) than men (33%), while more men (29%) wanted to jointly discuss options than women (15%).



Most (85% each, men and women) respondents considered discussion with their partners to be the biggest consideration for deciding to use family planning. Adults who viewed discussing family planning with their partners (aOR: 5.11, 95% CI: 3.58-7.30), choosing a right method (aOR:3.38; 95% CI: 2.54-4.51), or knowing where to get a method planning (aOR: 1.98; 95% CI: 1.51-2.59) as important decision-making considerations were more likely to be current family planning users. Conversely, those who viewed partner approval as an important consideration for family planning were less likely to be family planning users (aOR: 0.30; 95% CI: 0.19-0.47).



Thus, this study found similar trends among men and women related to family planning use, reasons for non-use, decision-making priorities, and preferred level of partner involvement. However, notable sex differences were seen in some specific ways that men and women operationalised partner support. "The findings suggest the need for interventions that push the narrative of partner support for family planning in Uganda using approaches that are sensitive to existing gender-based power imbalances among couples while seeking to encourage equitable partner communication..."



USAID SBCA used these insights to inform a newly designed national multimedia umbrella family health campaign called "Happiness". In brief, the campaign:

• Was developed using human-centered design processes leveraging the views of community members, leaders, and health providers in the programme design and implementation;
• Infuses behavioural science and economic approaches, such as narrative storytelling and nudges like special invitations or personalised messages to male partners, respectively;
• Incorporates messages that explicitly encourage partner dialogue and communication across the various life stages (during courtship, pregnancy, childbirth, and rearing) and that aim to empower women with knowledge and skills to have honest conversations with their partners about when to have children and how many to have and share their preferences related to family planning; and
• Engages community gatekeepers and influencers to address negative gender norms and to position family planning as not just a woman's responsibility but a couple's responsibility, as well as highlighting the fact that women have a right to use family planning regardless of partner approval.

Additional opportunities to improve partner support, male involvement in family planning, and the participation of men in decision-making could include mobilising community leaders, highlighting the economic benefit of family planning, packaging the focus of family planning interventions  beyond family planning alone, and providing small incentives.



The study findings also suggest that appropriate policies that operationalise partner support are needed for increased family planning uptake. For example, the researchers assert that, at the community level, further efforts are needed to explore how existing by-laws such as those enforcing male attendance for antenatal visits can also accommodate joint decision-making and gender equity related to family planning.



Additional research could, for instance, investigate power dynamics and gender equity within relationships and the degree to which women feel empowered to have conversations about family planning. Such research findings could be used to empower women to have conversations about family planning.