1. Contraceptive behaviour among men in Nepal Govinda Prasad Dahal, Andrew Hinde and Monique Hennink Division of Social Statistics Prepared for the annual conference of the BSPS, Leicester 13-15 September 2004

2. Structure of Presentation 2 Background 3 Data and methods 4 Results 5 Conclusions 1 Objectives

3. Objectives - the factors associated with the use of contraceptive methods - the reasons why don’t Nepali men use male methods of contraception? -whether Nepali men consent their wives to use female methods of contraception To examine:

4. Background HIV/AIDS and unwanted pregnancies are public health problems Men’s behaviour is reported to be the main reasons for these risk ICPD emphasised the active involvement of men to improve sexual and reproductive health outcomes Nepal’s women focussed FP policy and programmes overlooked men

5. Trend of CPR and TFR, Nepal 1976 - 2001 CPR TFR

6. Female knowledge and use of contraception in Nepal

7. Male knowledge and use of contraception in Nepal

8. Data and methods  This study uses both quantitative and qualitative data  Considers 2,187 currently married men aged 15-59  2001 Nepal DHS Quantitative data:  Included men respondents for the first time

9. continued….  Logistic regression models Two dependent variables:  Overall use of contraception (1= used any method 0 = used no method)  Use of male method (1= male method 0= female method) Male method= Condom, Vasectomy, Withdrawal and Periodic Abstinence Female method=Pill, IUD, Depo, Female sterilization, Foam/Jelly, Norplant

10. Qualitative data: Conducted eight focus groups with Nepali married males aged 15-45 in order to discuss family planning in terai and hill of Nepal during April-May 2004 continued…. Thematic analysis The groups ranged from 6-10 participants

11. Results

14. Summary of Results: Multivariate analysis Men who are less likely to use contraception: are young have no children desire child within two years (of survey) have low knowledge of contraceptive methods are from mountain & are from non-Hindu background

15. Among users, men who use male methods: are highly educated possess professional, technical & managerial job are from mountain and hill ecological regions have no living number of children Among users, men who rely on female methods: posses jobs like clerical, sales and services live in terai have spousal communication only once or twice have low level of contraceptive knowledge Summary of Results (continued …)

16. Why don’t men use male methods? The results from qualitative survey show a range of factors, which are: Young couples desire to have children immediately after marriage because of three reasons: (i) pressure from parents …bride and groom’s parents show their greed to be grandparents as soon as possible and apply force to the newly married couples to have baby soon (FGD 1:35 years married farmer from rural terai) (ii) limited knowledge of family planning and early child bearing Newly married couples may not have proper knowledge of contraceptive use and the likely consequences of child birth in early age (FGD 1:35 years married farmer from terai)

17. Why don’t …….(continued …) (iii) fear of developing sterility If young women used any temporary female contraceptive methods such as pills or depo injection before having the first child, it is believed that they may be infertile for their whole life (FGD 2: 35 years, married NGO worker from hill).  Negative attitudes towards condom use Condom is a tedious method of contraceptive (FGD 2: 30 years, married farmer) ….storage and dumping (after use) is big problems to maintain privacy if one intends to use condoms (FGD 1: 19 years farmer).  Fear of post surgical problems of vasectomy Males do not want to do vasectomy operation because vasectomy makes men weak and they can not support their family economically (FGD 3: 27 years rural man). Why don’t …….(continued …)

18.  Unavailability of suitable male methods …..this is not because male do not want to involve but it is due to unavailability of suitable methods for men. Male has only condom as temporary method. This is annoying to use condoms for a long period of time. How long we keep on using that condom! Instead it is good and easy to rely on female method, depo injection (FGD2: 33 years service men from hill). Why don’t …….(continued …)

19.  Except men of lower caste families, no other men generally object to their wives to use female methods of contraception if wife’s health is normal (FGD 1: 35 years married farmer).  Generally educated couples decide who should adopt permanent method of contraception based on the health and need of the couples. However, in lower caste and uneducated society, some men who want no more children often force women to adopt permanent method (FGD 3: 27 years manual worker) Whether Nepali men consent their wives to use female methods of contraception -The findings suggest that generally Nepali men consent their wives to use female contraceptive methods if wife’s health is good However, uneducated and poor especially, from lower caste do not intend adopting male methods and also do not want their wives to use female contraceptive methods due to the fear of promiscuity.

20. This analysis identified that certain groups of Nepalese men were not using contraception A comprehensive FP programme targeted to their needs should be needed FP programme should deliberate the massage about advantages of using methods (especially use of condom to avoid STIs and AIDS) Changing rooted cultural value takes time to change but efforts should be continued Research on the development of new contraceptive methods for men is needed Conclusions

21. THANK YOU !