Hylkema, Renske

Ilozumba, Onaedo

English

Sustainable Development Goal 3 aims to improve access to modern contraceptives and inform and educate people on family planning (FP). However, contraceptive use among women of reproductive age in West Africa is low at approximately 20%. One related factor is the limited engagement of males in FP decision-making. Addressing this issue requires a multiplicity of approaches, including the engagement of faith leaders. Faith leaders are often trusted by their congregants and could be an avenue to promoting male involvement in FP. In this report, we discuss the role of faith leaders in two West African countries, Nigeria and Ghana. We conducted 11 in-depth interviews with faith leaders in Nigeria and Ghana. Our exploratory findings indicate that faith leaders seem to have adequate knowledge and a positive perspective on male engagement and FP. In addition, the relationship of trust faith leaders maintain with their congregants is valuable in educating or counselling congregants on male engagement and FP

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  University of BirminghamMale engagement in family planningHylkema, Renske; Ilozumba, OnaedoDOI:10.1093/pubmed/fdad112License:Creative Commons: Attribution (CC BY)Document VersionPublisher's PDF, also known as Version of recordCitation for published version (Harvard):Hylkema, R & Ilozumba, O 2023, 'Male engagement in family planning: the role of faith leaders in urban WestAfrica', Journal of Public Health. https://doi.org/10.1093/pubmed/fdad112Link to publication on Research at Birmingham portalGeneral rightsUnless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or thecopyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposespermitted by law.•Users may freely distribute the URL that is used to identify this publication.•Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of privatestudy or non-commercial research.•User may use extracts from the document in line with the concept of ‘fair dealing’ under the Copyright, Designs and Patents Act 1988 (?)•Users may not further distribute the material nor use it for the purposes of commercial gain.Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document.When citing, please reference the published version.Take down policyWhile the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has beenuploaded in error or has been deemed to be commercially or otherwise sensitive.If you believe that this is the case for this document, please contact UBIRA@lists.bham.ac.uk providing details and we will remove access tothe work immediately and investigate.Download date: 26. Aug. 20231© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse,distribution, and reproduction in any medium, provided the original work is properly cited.Renske Hylkema, Researcher, MscOnadeo Ilozumba, Research Fellow, PhDJournal of Public Health | pp. 1–4 | https://doi.org/10.1093/pubmed/fdad112Male engagement in family planning: the role of faith leadersin urban West AfricaRenske Hylkema1, Onaedo Ilozumba21Athena Institute, Vrije Universiteit, Amsterdam, 1081 HV, the Netherlands2Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UKAddress correspondence to Onaedo Ilozumba, E-mail: u.ilozumba@bham.ac.ukABSTRACTSustainable Development Goal 3 aims to improve access to modern contraceptives and inform and educate people on family planning (FP).However, contraceptive use among women of reproductive age in West Africa is low at approximately 20%. One related factor is the limitedengagement of males in FP decision-making. Addressing this issue requires a multiplicity of approaches, including the engagement of faithleaders. Faith leaders are often trusted by their congregants and could be an avenue to promoting male involvement in FP. In this report, wediscuss the role of faith leaders in two West African countries, Nigeria and Ghana. We conducted 11 in-depth interviews with faith leaders inNigeria and Ghana. Our exploratory findings indicate that faith leaders seem to have adequate knowledge and a positive perspective on maleengagement and FP. In addition, the relationship of trust faith leaders maintain with their congregants is valuable in educating or counsellingcongregants on male engagement and FP.Keywords health promotion, public health, researchIntroductionThe Sustainable Development Goal 3 aims to improve accessto modern contraceptives and inform and educate people onfamily planning (FP).1,2 FP is a way for individuals or couplesto monitor their pregnancies by using modern contracep-tives .2 However, modern contraceptive use among womenof reproductive age in West Africa is low at approximately20%.3 Reasons for the low utilization include men’s desirefor a large family,4 their disapproval of FP,5 and limited maleengagement in FP decisions.6 Male engagement in FP couldencourage couples’ use of contraception.7–9A potential avenue to reach males is through faith leaderssince there is extensive trust in them in West Africa.10,11 Theirinvolvement in providing information on FP contributesto males’ perception of their engagement and communaldecision-making in FP and increases modern contraceptiveuse.12,13 Furthermore, estimates project that by 2050 twothirds of the world’s population will live in urban areas.14Given the long-term urbanization projections, low FPuptake in urban West Africa, and limited FP engagementof males in Ghana and Nigeria, we discuss the role faithleaders can play in male engagement in FP in urban WestAfrica.The current situation in Ghana and NigeriaGhana and Nigeria report high religion rates with over 85%of the population identifying as Christian or Muslim.15,16In 2011 and 2012, Ghana’s and Nigeria’s governmentimplemented policies, which provides FP services free ofcharge.17,18 As a result, the prevalence of contraceptive useraised to approximately 23% and 26% and the number ofunintended pregnancies decreased.19 However, in Nigeria14% (2012), and in Ghana 23% (2017) of pregnancies endin induced abortion. Both countries only permit abortionsunder strict circumstances, therefore illegal abortion ratesremain high.20–22MethodsThe first author conducted in-depth interviews on zoomwith 11 faith leaders from Ghana and Nigeria (Table 1). Allinterviews were transcribed and analysed thematically usingATLAS.ti.23 We identified three themes related to our specificobjective: 1) the trust relationship between faith leaders andtheir congregation; 2) faith leaders’ adequate knowledge andpositive perspective on male engagement and FP; 3) faithDownloaded from https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdad112/7225143 by University of Birmingham user on 21 August 20232 JOURNAL OF PUBLIC HEALTHTable 1 Participant detailsParticipant Age Gender Marital status Church denomination Country of residence1 60 Male Married Restorationism Ghana2 42 Male Married Pentecostalism/Charismatic Nigeria3 38 Male Married Pentecostalism/Charismatic Ghana4 32 Male Single Roman Catholic Church Nigeria5 Unknown Male Married Pentecostal Nigeria6 38 Male Married Reformed Churches Ghana7 Unknown Male Married Pentecostalism/Charismatic Nigeria8 40 Male Married Pentecostalism/Charismatic Nigeria9 38 Male Married Pentecostalism/Charismatic Ghana10 54 Female Married Non-denominational Ghana11 50 Male Single Reformed Churches GhanaTable 2 Participant quotesQuote 1 ‘ . . . . . . they share almost everything: marital issues, health issues, social challenges, yes, almost everything’ (Male, 50, Reformed Church).Quote 2 So, in Africa, we have also gotten to the point where people listen to spiritual leaders, religious leaders. . . . . . . If you tell them somethingthey try to do it. . . . . . . And I think religious leaders and other leaders in different circles are going to be great people, great tools, thatcan be used to change the mindset of people in order to live a good life (Male, 38, Pentecostal/Charismatic church).Quote 3 ‘ . . . . . . for me, the man is the head of the house. He must be responsible for the outcome of whatever happens. So, as a man, you needto sit down with your partner and agree on what you want. Both of you need agreement on how many children you will have, based onyour budget and your plan for the future. I think men are critically responsible for family planning’ (Male, age unknown, Pentecostal).Quote 4 We have something we call ‘home, health, education’. . . . . . . Home is all about family planning. . . . . . . So, it is a program that we do.We do it online, on air, we do it on TV, radio, everywhere. So, that we educate, not only attract one mass but the general public as well(Male, 60, Restoration church).leaders’ role as educators and counsellors in male engagementand FP.ResultsThe relationship between faith leaders andcongregantsFaith leaders are highly trusted by their congregants (Table 2quote 1). However, a few faith leaders acknowledged thatsome of their congregants are reluctant to discuss sensitivetopics such as abortions since most faith leaders see that as asin. A few faith leaders perceived having authority over theircongregants. They see that as an opportunity to influencecongregants’ decision-making and mindsets (Table 2 quote 1).Faith leaders’ knowledge and perspectiveFaith leaders considered themselves knowledgeable aboutmethods like birth spacing and, or limiting the number ofbirths by using contraceptives, such as condoms. Their knowl-edge might be attributable to governmental investments in FPprogrammes in both countries for more than ten years.17,18Furthermore, faith leaders unanimously agreed that FP hasreligiously been approved and encouraged within their con-gregation. Besides, most faith leaders were in favour of mod-ern contraceptives. In contradiction, research found that faithleaders are against the use of modern methods and pre-fer traditional methods or abstinence instead.24 However,their study was based on interviews mainly conducted withCatholic, and Muslim faith leaders, while our findings werebased on interviews of which 91% of participants wereprotestant. This could explain the differences in their per-ceptions since the adoption of modern contraceptives couldbe influenced by faith. This aligns with a qualitative studyin Uganda, which found that Catholics are more hesitant toadopt modern contraceptives.25Additionally, faith leaders unanimously agreed that menneed to be engaged in FP decision-making and reach a con-sensus by mutual decision-making. However, a few faith lead-ers particularly stressed men’s responsibility for FP. There-fore, in their narratives an underlying assumption remainsDownloaded from https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdad112/7225143 by University of Birmingham user on 21 August 2023FAITH LEADERS ROLE IN FAMILY PLANNING 3that, due to the patriarchal society, the final decision in FPshould rely on the men (Table 2 quote 3).Faith leaders’ role as educators and counsellorsFaith leaders stress the importance of FP and male engage-ment in counselling sessions, and FP education, sometimesin collaboration with health care professionals. This is showneffective in a previous study, where health care workers wereused as promoters in faith-based health interventions.26 Inaddition, few faith leaders also spread FP messages outsideof the church setting (Table 2 quote 4). Some faith leaders areinstitutionalizing FP and joint decision-making in FP throughdeveloping materials for health education as part of churchpractices.ConclusionFaith leaders have opportunities to play an essential role inmale engagement in FP. Their trust relationship with congre-gants is evident. Besides, their knowledge and positive attitudetowards male engagement in FP have the potential to increasethe knowledge and behaviour/mindsets of congregants andthe general public. Their role could be substantive as coun-sellors and educators through promoting mutual decision-making in FP, and institutionalising male engagement in FP,which could back up their messages. However, barriers needto be taken into consideration, such as high fertility desiresamong men, and gendered dynamics, which could challengefaith leaders’ influence. The conclusions of this report shouldbe made with caution considering the limited number ofparticipants in our study. However, our findings show thatby strengthening faith leaders’ role through collaboration withhealthcare workers and broadening their target group outsideof the church setting, they can contribute to increasing maleengagement and improving FP uptake, which decreases child-and maternal mortality rates.FundingNot applicable.Conflict of interestThe authors have declared that no competing interests exist.Data availabilityThe data presented in this study are available on request fromthe corresponding author. The data are not publicly availabledue to ethical and privacy reasons.References1. United Nations. (n.d.). Ensure healthy lives and promote well-being for allat all ages. 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Male engagement in family planning:the role of faith leaders in urban West Africa

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Male engagement in family planning:the role of faith leaders in urban West Africa

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