Family planning: Why women need support, not men's permission

Women are more likely to use implants, injections, pills and intrauterine devices. [Courtesy]

For many Kenyan women, deciding to prevent or delay another pregnancy does not end with a conversation with their partner. It can mean visiting a clinic alone, choosing a contraceptive, dealing with side effects and, sometimes, defending that decision at home.

For Janet Nasambu, 32, family planning has meant carrying a responsibility she believes should be shared with her husband.

A mother of three, Janet wanted to delay another pregnancy after the birth of her youngest child. Her children were still young, household expenses were rising and she felt the family needed time before taking on the demands of another baby.

Her husband agreed with the decision, but beyond that, Janet said, he largely left the matter to her.

“I told him I did not want another pregnancy soon, and he agreed. But after that, everything was left to me. I was the one who went to the hospital, chose the method and dealt with whatever happened,” Janet said.

After consulting a health worker, she chose an injectable contraceptive. She later experienced headaches and changes in her menstrual cycle, leaving her to manage the discomfort while still thinking about the possibility of an unintended pregnancy.

“I was the one experiencing the side effects, but life continued normally for him,” she said.

Janet’s experience reflects a wider reality in which men can agree that a couple should delay or stop having children without necessarily becoming involved in the work required to make that decision possible.

Family planning may be described as a shared responsibility, but contraception often remains largely a woman’s burden.

Women are more likely to use implants, injections, pills and intrauterine devices, methods that place the physical consequences of preventing pregnancy on them. Even when a couple agrees on the number of children they want, the responsibility for ensuring they reach that goal can fall almost entirely on the woman.

Dr. Walter Obita, country director of Marie Stopes Reproductive Choices Kenya, cautions against viewing the issue simply as men taking a back seat. He said women often take greater charge of reproductive choices because they bear most of the consequences when decisions are not made or pregnancies are unintended.

“If a woman does not take a family planning option or a contraceptive option, then she is the one who will bear the burden of having babies which are unplanned for,” Obita said.

But Obita notes that male attitudes towards contraception vary. Some men are indifferent and leave their partners to make the decision, while others actively discourage their wives or partners from using contraception. In other cases, men encourage their partners to seek family planning.

“There are also men who say, ‘Let the woman make her choice,’ or in some cases, they will be the ones who say, ‘My wife, go and take a family planning option,’” he said.

For some women, however, opposition is much stronger. Obita explained that Marie Stopes  Reproductive Choices has encountered situations where women seek contraception secretly because their partners do not want them to use family planning methods.

“We have found that women would go to a health facility for a family planning option in secret, without the husband knowing, because the man would not want them to take a family planning option,” he said.

A woman experiencing side effects may have to return to a clinic, change methods or tolerate discomfort, while a man who has agreed that they should not have another child can continue with his daily life without experiencing the physical effects of the method.

For some women, the decision becomes even more complicated when contraception causes disagreement within relationships.

A woman may want to delay another pregnancy because she has young children, is working or feels her family is complete. Her partner may want another child, distrust contraceptives or object to the method she has chosen.

What should be a joint reproductive decision can therefore become a negotiation that women are expected to manage.

Kenya has made progress in expanding access to modern contraception, but access does not necessarily mean women have control over reproductive decisions.

A woman can walk into a health facility and receive contraception yet still lack the freedom to use it without fear of conflict at home.

Male participation in family planning is therefore critical, but participation should mean more than allowing women to use contraception.

Men have contraceptive options of their own. Condoms protect against pregnancy while also reducing the risk of sexually transmitted infections.

Vasectomy offers men a permanent option when they have decided they do not want more children.

Obita said misinformation remains one of the biggest barriers to greater male involvement.

Men need accurate information about short-acting, long-acting and permanent contraceptive methods so they can make decisions with their partners based on their reproductive plans.

“It’s first an access to information solution. The misconceptions about different contraceptive options make also men fear their wives or girlfriends or the women in their lives taking a family planning option,” Obita said.

One of the persistent misconceptions surrounds vasectomy. Some men associate the procedure with loss of sexual strength or masculinity, despite it not being intended to remove sexual function.

He explained that men who undergo vasectomy can continue to have erections and engage in sexual activity, although the procedure prevents sperm from being present in semen.

The misconception is particularly important in a society where masculinity can be closely tied to sexual ability. For some men, fear of losing sexual strength can outweigh the potential benefit of taking responsibility for permanent contraception.

Marie stops is also working with county governments to increase access to vasectomy in public health facilities, according to Obita. The organisation is supporting training and competency assessments for public-sector healthcare providers so men do not have to rely only on specialised centres.

“It’s a matter of how many men want to come for them. If men come for them, we carry them out, they come back for reviews, and everything is okay,” Obita said.

For women, meanwhile, contraceptive choices can come with their own challenges. Some experience side effects and discontinue methods.

Others move from one method to another in search of something that works for them. Some face pressure from partners or relatives who believe contraception encourages promiscuity or causes infertility.

Janet said the hardest part is not necessarily that her husband refuses contraception, but that he does not appear to see it as something requiring his active participation.

“He is not against family planning. He just feels that if I do not want another baby, I should be the one to prevent it,” she said.

It is the man who agrees that the family is complete but leaves his partner to choose the method. It is the man who knows she is experiencing side effects but does not ask whether she wants to change methods. It is the man who assumes contraception is being handled because his partner has taken responsibility for it.

Because pregnancy happens in a woman’s body, the consequences of failing to plan are also largely borne by her.

An unintended pregnancy can affect a woman’s health, employment, education and income. It can also increase financial demands on a household already struggling with food, housing, healthcare and school fees.

Changing this reality requires more than encouraging men to accompany their partners to health facilities. It requires challenging the idea that contraception is inherently women’s work and confronting the assumption that a woman will simply handle it.

Men need accurate information about the methods available to them. Couples need spaces where they can discuss fertility intentions without judgment.

Healthcare workers also need to engage men as partners in reproductive health rather than treating family planning as a service primarily meant for women.

Obita said couples should make decisions based on their circumstances, including whether they want to use a temporary or permanent method.

There is no single age or stage of marriage at which a man or woman should automatically choose a permanent method. The decision should instead be based on informed choice and the couple’s reproductive intentions.

Most importantly, men need to understand that being involved does not mean controlling what their partners do with their bodies.

It means showing up, asking questions, understanding side effects, considering male contraceptive options and recognising that deciding not to have another child is not the same thing as deciding that the woman should prevent the pregnancy alone.

“I don’t want him to choose the method for me. I just want him to understand that this affects both of us,” Janet said.

The question is not whether women should continue having access to contraception. They should. The question is why men can remain largely unbothered by the physical, emotional and economic consequences of a decision that affects both partners.

Family planning is ultimately about decisions that affect two people and, often, an entire family. Until men are expected to participate rather than simply approve, Kenya’s family-planning conversation will remain incomplete.

For women like Janet, shared responsibility should mean more than a man saying he supports family planning. It should mean asking himself what he is willing to do, too, for their family.