As Betsy Hartmann has pointed out, "It is difficult to meet unmet need for contraception when male authority and violence prevent women from exercising control over sexuality and reproduction" (84). The ICPD Programme of Action, noting that "men exercise preponderant power in nearly every sphere of life," called for more male participation and sharing of responsibility in family planning (217).

While addressing men as obstacles to women's contraceptive use is difficult for family planning programs and might be counterproductive, programs can find ways to help men understand and respect women's concerns and to help women express their needs (124). For example, informational campaigns can depict new role models for women and men, training programs can build women's skills, and counselors can encourage men's cooperation (see Population Reports, Opportunities for Women Through Reproductive Choice, Series M, Number 12, July 1994).

It is unlikely that women's needs will be met until men's needs also are addressed. Programs can make men a high-priority audience and clientele for family planning information and services and encourage better communication between wives and husbands about reproductive matters.

Involving men as an audience and clientele. Survey findings, although limited, suggest that many men are interested in contraception, even when they and their partners are not using it. In 8 of 13 countries studied on the basis of DHS data, the percentage of married men who do not want to have any more children exceeds the percentage using contraception (including use by their wives) (61). In another study using DHS data from six countries, between one-quarter and two-thirds of husbands did not want any more children but neither they nor their spouses were using contraception (157). In Kenya, while most women interviewed in-depth believed that men are generally opposed to family planning, in fact many men said that they support family planning or else were unsure (184). Many men want to know more about family planning (77, 156). In Bendel State, Nigeria, for example, among men who were not using any contraceptive method, over 90% of unmarried men and 75% of married men wanted family planning information (171).

While men may not be as much an obstacle to family planning as often thought, many still need to be convinced both that family planning is socially acceptable and that male involvement is desirable. According to DHS data from 15 countries, most in Africa, men are more likely than women in the same country to report knowledge and use of contraception but less likely to say that they approve of contraception or, if not using, that they intend to use it (61). Research in the Philippines found that men are less likely than women to think that their relatives and friends approve of contraception (20).

Most family planning methods and program efforts are focused on women (157, 172, 226), and men often feel uncomfortable and unwelcome in family planning clinics that are oriented to women (49). Increasingly, however, programs are focusing more on men and addressing their interests and needs (77, 157). Involving men in family planning has increased their contraceptive use, encouraged women's use of contraception, and improved continuation rates (64, 104, 111, 211). In Bangladesh, for example, addressing the interests of husbands and village opinion leaders through village-level discussion groups, or jiggasha, has helped to increase contraceptive use (105).

Husband-wife communication. Reproductive decision-making is a complex process that differs from one setting to the next and from one couple to the next. While men often have more say than women in the decision to use contraception, in some places women have more responsibility for family planning decisions than they do for other decisions (124). Sometimes women use contraception without telling their husbands. There is some evidence that things are changing. For example, in Tanzania a study found that younger husbands and wives increasingly agree that family interests and responsibilities should be shared (112).

Little is known about how husbands' views of family planning differ from those of their wives. Only a few large-scale surveys, most in Africa, have interviewed both husbands and wives. In these surveys some wives report that their husbands disapprove of family planning when in fact the husbands themselves report that they approve. For example, among couples surveyed in the 1991-92 Tanzania DHS, 63% of wives reported that their husbands disapproved of family planning when this was not so (141). In fact, in 59% of the cases both husband and wife approved. The 1988 Ghana DHS found that 77% of couples had the same opinion about family planning, but 39% of the wives either did not know their husbands' attitudes or mistook them (185). It is likely that if more couples talked to each other about family planning, many would find that they agree about it and thus would be more likely to meet their shared reproductive goals. In seven African DHS, women who had discussed family planning with their husbands in the preceding 12 months were on average almost four times more likely to be using contraception than those who had not discussed family planning (124).