Les obstacles à l'implication des hommes dans la planification familiale au sein des ménages au Togo

Cet article examine la faible implication des hommes à la planification familiale (PF) au sein des ménages au Togo. Si des programmes sont élaborés et mis en oeuvre pour améliorer l’utilisation des méthodes contraceptives modernes par les hommes et les femmes, les principaux indicateurs de santé de la reproduction (SR) qui rendent compte du niveau d’utilisation des services de PF restent encore préoccupants. Les données de la dernière enquête démographique et de santé réalisée au Togo en 2014 ont montré que la population masculine sexuellement active s’implique peu dans les services de PF. Ainsi, le présent article a pour objectif de comprendre les logiques sociales qui sous-tendent la faible implication des hommes à la PF au Togo. Il s’appuie sur les données de l’enquête de base du projet « Santé reproductive chez les hommes et les garçons au Togo », réalisée entre 2016 et 2019 par l’Unité de Recherche Démographique de l’Université de Lomé (URD/UL) en collaboration avec l’Association Togolaise pour le Bien-Être Familial (ATBEF). Le recueil de données a été réalisé dans les régions de la Kara, Centrale, des Plateaux et Maritime, auprès des hommes et des femmes en âge de procréer et sexuellement actif.ve.s; de leaders communautaires et de leaders religieux et auprès des prestataires de soins offrant des services de PF par le biais d’entretiens semi-directifs, d’entretiens de groupes et de discussions informelles. Les résultats révèlent que la santé sexuelle et reproductive au sein des ménages togolais est fortement imprégnée des normes et des croyances qui considèrent la planification familiale comme une affaire essentiellement féminine. Ces normes et croyances privilégient également la présence d’un enfant de sexe masculin dans la descendance pour assurer la pérennisation du clan ainsi que le patronyme. La discussion entre conjoints sur les questions relatives à la santé sexuelle est quasi absente. Par ailleurs, la vasectomie, seconde méthode contraceptive masculine au Togo, peine à être acceptée par les hommes et les femmes interviewés. Il ressort également que la faible implication des hommes à l’utilisation de la PF est liée en partie aux rapports sociaux de sexe. Ces rapports influencent les prises de décision des hommes et des femmes en matière de procréation. En outre, le comportement des prestataires de soins de PF vis-à-vis des hommes contribue à cette faible implication des hommes, ce qui remet en question la qualité de la formation reçue par ces prestataires.This paper examines the low involvement of men in family planning (FP) at the household level in Togo. While programs are being developed and implemented to improve modern contraceptive use among men and women, key reproductive health (RH) indicators about the level of FP service utilization remain a concern. Data from the last Demographic and Health Survey conducted in Togo in 2014 showed that the sexually active male population has little involvement in FP services. Thus, this article aims to understand the social logics that underlie the low involvement of men in FP in Togo. Data from the baseline survey of the "Santé reproductive chez les hommes et les garçons au Togo" project, conducted between 2016 and 2019 by the Demographic Research Unit of the University of Lomé (URD/UL) in collaboration with the Togolese Association for Family Welfare, were used. Data collection was conducted in the Kara, Central, Plateaux and Maritime regions, among sexually active men and women of reproductive age; community and religious leaders; and health care providers offering FP services through semi-structured interviews, focus groups and informal discussions. The results indicate that sexual reproductive health in Togolese households is significantly influenced by norms and beliefs that consider FP to be essentially a female affair. These norms and beliefs also favor the presence of a male child in the offspring to ensure the continuity of the clan and the family name. Discussion of sexual health issues between spouses is almost non-existent. In addition, vasectomy, the second male contraceptive method, is difficult to accept by men/women interviewed. The low involvement of men in the use of FP is linked in part to gender relations and the sexual division of domestic and parental labor. These relationships influence men's and women's reproductive decision-making as well as the behavior of FP providers, which contributes to this low involvement of men, thus questioning the quality of the training received by these providers

National optimisation of accessibility to emergency obstetrical and neonatal care in Togo: a geospatial analysis

Objectives : Improving access to emergency obstetrical and neonatal care (EmONC) is a key strategy for reducing maternal and neonatal mortality. Access is shaped by several factors, including service availability and geographical accessibility. In 2013, the Ministry of Health (MoH) of Togo used service availability and other criteria to designate particular facilities as EmONC facilities, facilitating efficient allocation of limited resources. In 2018, the MoH further revised and rationalised this health facility network by applying an innovative methodology using health facility characteristics and geographical accessibility modelling to optimise timely access to EmONC services. This study compares the geographical accessibility of the network established in 2013 and the smaller network developed in 2018. Design: We used data regarding travel modes and speeds, geographical barriers and topographical and urban constraints, to estimate travel times to the nearest EmONC facilities. We compared the EmONC network of 109 facilities established in 2013 with the one composed of 73 facilities established in 2018, using three travel scenarios (walking and motorised, motorcycle-taxi and walking-only). Results: When walking and motorised travel is considered, the 2013 EmONC network covers 81% and 96.6% of the population at the 1-hour and 2-hour limit, respectively. These figures are slightly higher when motorcycle-taxis are considered (82.8% and 98%), and decreased to 34.7% and 52.3% for the walking-only scenario. The 2018 prioritised EmONC network covers 78.3% (1-hour) and 95.5% (2-hour) of the population for the walking and motorised scenario. Conclusions: By factoring in geographical accessibility modelling to our iterative EmONC prioritisation process, the MoH was able to decrease the designated number of EmONC facilities in Togo by about 30%, while still ensuring that a high proportion of the population has timely access to these services. However, the physical access to EmONC for women unable to afford motorised transport remains inequitable

Sexual risk behavior among people living with HIV and AIDS on antiretroviral therapy at the regional hospital of Sokodé, Togo

BACKGROUND: Several studies on the sexual risk behaviors in sub-Saharan Africa have reported that the initiation of antiretroviral therapy leads to safer sexual behaviors. There is however a persistence of risky sexual behavior which is evidenced by a high prevalence of sexually transmitted infections among people living with HIV and AIDS (PLWHA). We sought to determine the factors associated with risky sex among PLWHA on antiretroviral therapy in Togo. METHODS: An analytical cross-sectional survey was conducted from May to July 2013 at regional hospital of Sokodé, Togo, and targeted 291 PLWHA on antiretroviral therapy for at least three months. RESULTS: From May to July 2013, 291 PLWHA on antiretroviral treatment were surveyed. The mean age of PLWHA was 37.3 years and the sex ratio (male/female) was 0.4. Overall, 217 (74.6%) PLWHA were sexually active since initiation of antiretroviral treatment, of which, 74 (34.6%) had risky sexual relations. In multivariate analysis, the factors associated with risky sex were: the duration of antiretroviral treatment (1 to 3 years: aOR = 27.08; p = 0.003; more than 3 years: aOR = 10.87; p = 0.028), adherence of antiretroviral therapy (aOR = 2.56; p = 0.014), alcohol consumption before sex (aOR = 3.59; p = 0.013) and level of education (primary school: aOR = 0.34 p = 0.011; secondary school: aOR = 0.23 p = 0.003; high school: aOR = 0.10; p = 0.006). CONCLUSION: There was a high prevalence of unsafe sex among PLWHA receiving ART at the hospital of Sokodé. Factors associated with sexual risk behaviors were: low education level, non-adherence to ART, alcohol consumption before sex and the duration of ART. It is important to strengthen the implementation of secondary prevention strategies among this population group

Applying a power and gender lens to understanding health care provider experience and behavior: A multicountry qualitative study

A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains—beliefs and perceptions; practices and participation; access to assets; and structures—to explore how these constructs are differentially experienced based on one’s gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs’ power derives from the nature and quality of their relationships with clients and the community. Providers’ power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs’ power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power—and secondarily, gender lenses—can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs

Flow chart of patients included in the study.

<p>Flow chart of patients included in the study.</p