The challenge of accessible, affordable, and acceptable healthcare continues to be a major hindrance to reaching the attainment of desired outcomes in public health, family planning, and gender equity in Kenya. Alongside many other important goals, the importance of factoring in men or male involvement in family planning interventions, as well as the exploration of available options in family planning services and commodities is essential for improving outcomes to ensure gender inclusivity. 

Nairobi, as the model city of male involvement in family planning, is the capital city of Kenya and one of Africa’s most diverse cities. It is host to many world-class health facilities including the Aga Khan Hospital, the Nairobi Hospital, and the largest public health facility in the country, Kenyatta National Hospital. Alongside these are non-governmental organizations and partnerships that have heavily invested in making sexual and reproductive health better, including the Johns Hopkins University, Marie Stopes, Pathfinder International, and FHI 360.

Given the rate of urbanization and the mushrooming of new industries in Nairobi, rural-to-urban migration from all parts of the country has exerted a population increase in the city, with a majority of the population strewn across informal settlements. The rural-urban migration draws populations from all corners of the country, resulting in a mixed-community population with a heterogenous perception of contraceptive usage.

With the ballooning population, a strain on resources is expected and family planning emerges as a major need within the city, specifically among young people in the informal settlements. To prevent further resource strains and ensure people have access to the information and services they need to decide when to have children and how many, male involvement was squarely identified as a core pillar of family planning programs, supported by the, supported by the ideology that in many parts of the world Kenya included, men still own major decision-making power.

Nairobi’s Diverse Population

Like any other large metropolitan city, Nairobi has a diverse population and a mixture of different cultures and backgrounds. The 2019 Kenya Population and Housing Census recorded the population of Nairobi County as 4,397,073 persons. The approximate male population is 2,261,277, slightly higher than the female population, accounting for about 51% of the total figure. Of the total population, the youth population between the ages of 15 to 24 is estimated at 1,303,562.

The majority of Nairobi residents live in the informal settlements of Mukuru, Mathare, Korogocho, Githurai, and Kibera. The population in these settlements is estimated to be about 60% of the total population of Nairobi meaning that about 2,638,144 people in Nairobi live in informal settlements. These settlements are often defined by severe and acute absences of reliable services including family planning, healthcare, and security.

According to the Kenya Demographic and Health Survey (KDHS) 2022, Nairobi still grapples with a high unmet need for family planning. Nairobi reports an above-country average where 13% of married women aged 15-49 still have an unmet need for family planning. The unmet need for family planning are among women capable of having children and are also sexually active, who desire to prevent having children for the next two years or more but are not currently using contraception. 

In comparison, the Kenyan national average for the unmet need in family planning services, which is currently at about 14%, translating to an estimated 14% of sexually active married women, want to space or limit their childbearing but are not currently using any methods of contraceptive. The report further shows that, despite notable strides in providing education and services for contraceptives, a significant number of adolescent girls and women are still not able to get the much-needed family planning options to help them prevent or space their childbearing. A separate report shows that, even as the unmet need for family planning in Nairobi remains high, Kenya met most of the FP2020 goals with the uptake of contraceptives for married women noted at about 63%.

Unmet Need and Male Involvement in Family Planning

In Kenya, the trends in family planning are governed by various determinants that may be diluted or enhanced by the heterogeneous population. Some factors that can affect the participation of males in family planning programs and interventions may include religion, large family size, culture, fear of supposed and mostly unverified side effects, relative access and exposure to reliable and correct information, restrictive individual and communal attitudes, norms and self-efficacy, and the different experiences of interaction with health care providers.

In many communities outside the capital city of Nairobi, the profound impact of male participation in family planning overtime has contributed to the reduction of the overall unmet need for contraception. Male involvement in family planning thrives the best when men and women are educated and involved in family planning decision-making together. Male involvement can also help to prevent gender-based violence.

Men play a crucial role as agents of change in achieving desired family planning outcomes and addressing related issues, including gender-based violence. Understanding the importance of contributing to and participating in reproductive rights and choices, men become advocates for family planning best practices. When men participate alongside women, the likelihood of effective contraceptive use increases, leading to healthier families and communities. It is then, extremely important, to normalize the incorporation of men as champions for gender programs that support family planning, which also contribute to the drive for gender equality.

Male involvement encapsulates strategies, mechanisms, and that results in the involvement of men in health-related programs. Notably, male involvement can be achieved through the participation of men exclusively in the uptake of male family planning options including the highly used male condoms, vasectomy, and male contraceptive pills that may join the choices soon. The other major way may be through involving men in spousal decision-making about contraceptive use since men can sometimes stand as obstacles to effective use.

Male involvement extends beyond men offering women emotional support; men can also actively participate in supporting their partners financially and physically in accessing family planning services, and they can dispel misconceptions about family planning methods by being champions. Men can also infuence the behavior of other men to actively take on these roles in their relationships. Furthermore, as gatekeepers of culture in many communities, institutions, and leadership roles, men are often in positions to create policies and laws that are supportive of family planning use, access, and education.

Overcoming Challenges to Increase Male Involvement in Family Planning

The following recommendations will help improve male involvement in family planning programs in Nairobi: 

1. Inclusion of men in family planning conversations:

The inclusion of men in conversations around family planning is important for the general success in the uptake of contraception, especially modern methods. As much as most family planning methods target girls and women, it is essential to educate boys and men about the options available for them as well as the options that are available for females, to support joint decision-making. Informed mutual decisions are also hailed for developing better relationships in courtship and marriage. This inclusion ensures that couples can jointly analyze existing choices about their reproductive health.

2. Addressing concerns and misconceptions about contraception to reduce stigma and taboos:

Myths and misperceptions about contraception are a major barrier to contraceptive uptake among men and women, including young men and women, in certain regions of Kenya including in Nairobi. In educating and addressing misconceptions for men in family planning, the replacement of false and unverified information such as the use of certain contraceptive methods causing infertility may lead to better uptake of family planning.

3. Educational strategies for adolescents:

Age-appropriate comprehensive sexual education (CSE) has been pointed out to bear the potential of steering a breakthrough in reproductive health including family planning for men. Educating adolescents about reproductive health topics, including families and relationships, respect and consent, anatomy and puberty, and contraception and pregnancy, over time  and building on that knowledge as they grow can help young men and women take up correct information into their adulthood and, in the process, challenge unequal gender roles.

Enhancing education for boys and men to promote responsible fatherhood through a family planning perspective would also be important since oppressive and restrictive gender beliefs often set root in childhood. To effectively counter misogynistic beliefs, it is crucial that in educating children as they mature, they are made to understand that parenting is a shared father and mother responsibility, alongside everything else that comes with it including family planning decisions.

4. Government and non-governmental partnerships for initiatives:

The government should enhance partnerships and develop intentional interventions at the national and county levels to expose family planning stakeholders to the different realities making up the conglomeration of communities. Collaboration should be forged between these communities, stakeholders, and the government to address the underlying cultural norms for the effective shaping of targeted initiatives. Through this, they can shape and implement programs specifically tailored for men within family planning interventions.

The government, as well, needs inter-departmental partnerships, for example, through the Ministries of Health and Education, to develop policies and guidelines that support male involvement in targeted interventions.

Through stakeholder partnerships, the government can also train service providers on responsiveness to the demands of male involvement in family planning.

5. Integration of government services and facilities to maximize hospital visits:

Through innovative methods at all levels of health such as couple services, partner notification, and integrated services, health facilities may be able to optimize clinical visits and educate men on the role they have in the success of family planning. Integrating family planning services into essential health services like HIV/AIDS counseling, prevention, and treatment would also be an innovative way of enhancing male involvement.

Lets All Take Action

We may assume that men don’t want to be involved in family planning, but studies have shown that when they are invited to accompany their wives to family planning clinics or to attend community health meetings, many men actively engage with their partners on this issue, leading to positive family planning and reproductive health outcomes.

Family planning interventions must be tailored to adopt a gender-transformative approach that actively involves men to help reduce the unmet need for contraception, prevent gender-based violence, and foster healthier relationships. Through targeted government interventions, stakeholder collaboration, and the acknowledgment of diversity of cultural context, inclusive and effective family planning ecosystems can be achieved.