Percent of men who share in the decision making of reproductive health issues with their spouse or sexual partner
The percent of men who report joint decision-making with their wife or sexual partner about various aspects of their sexual and reproductive health (SRH).
This indicator is calculated as:
(Number of men in target population surveyed/interviewed who report that they share in making SRH decisions/ Total number of men surveyed/interviewed) x 100
SRH decision-making can include the areas of contraceptive use, antenatal care, delivery in the presence of a skilled birth attendant, newborn care and breastfeeding, health, nutrition, and sexually transmitted infection/HIV screenings and treatment.
Responses to structured or in-depth interviews. The concept of inter-partner communication is somewhat open-ended and questions on partner communication need to be clear and concrete to foster valid responses. UNFPA (2003) has a list of suggested questions about shared SRH decision-making:
- The extent to which sexual relations are initiated with mutual consent
- The extent to which both partners are able to negotiate and practice safe sex
- The extent to which partners communicate and agree on family size and plan pregnancy together
- The extent to which contraception is negotiated, dual protection is considered and partners support each other in using contraceptives
The Gender-Equitable Men (GEM) scale (Pulerwitz and Barker, 2008) includes related questions on family planning decision-making in the equitable norms subscale: #18. ‘A couple should decide together if they want to have children;’ and #23. ‘A man and a woman should decide together what type of contraceptive to use.’ Where the detail is available, the indicator can be disaggregated by the specific types of SRH practices for which there is shared decisions-making, as well as by age, marital status (all men, currently married men, or sexually active unmarried men), and geographic location (urban/rural residence).
Surveys among the male clients at health facilities, program-based SRH sites, or among men in the general public (population based). Alternative sources are surveys among the spouses and partners of male participants in male-focused programs.
Increased sharing in SRH decision-making by male and female partners is generally associated with beneficial outcomes for the health and well-being of women, children, and the entire family (UNFPA, 2003). Male engagement interventions often are designed to increase male awareness of SRH issues and to increase partner communication on these topics. This indicator measures the extent to which husbands and wives or other sexual partners discuss and share decision-making for specific SRH topics.
Gender-related attitudes held and expressed by men directly affect the health and well-being of women and girls, as well as, the men themselves. In many cases, males in relationships or families hold the decision-making power to deny woman access to their healthcare needs. Male-focused programs can educate men regarding their SRH needs, the needs of women and girls, and can address gender norms. Engaging men in questioning and challenging inequalities between men and women can promote more evenly shared decision-making power and improved access to SRH resources for women and girls (Promundo, UNFPA, MenEngage, 2010).
The answers to this question or subset of questions about specific SRH topics are subject to bias, especially if men or women are aware that their attitudes or behaviors deviate from socially accepted responses. They may try to respond as they expect will please the interviewer and it is best if the interviewers ask these questions in a neutral matter-of-fact way. Follow-up probes and questions with in-depth interviews may be helpful. In addition, respondents may consider shared discussions about SRH topics as shared decision-making, when, in fact, one partner made the actual decision. Again, carefully worded questions, probes, and follow-up questions may assist in clarifying whether the decision-making was ‘shared.’
There may be differences in the types of SRH practices for which men and women are more likely to share decision-making. Male and female partners may find it easier to share in decision-making on antenatal, maternal and newborn care than decision–making on use of modern FP methods, methods requiring male cooperation, or whether to pursue STI/HIV testing or treatment. Including a range of SRH practices in the questionnaires or in-depth interviews is important for examining these differences and interpreting the findings.
women’s status, empowerment, male engagement
UNFPA, 2003, It Takes Two: Partnering with Men in Reproductive and Sexual Health, http://www.unfpa.org/publications/it-takes-2
Pulerwitz, Julie and Gary Barker. 2008. “Measuring attitudes toward gender norms among young men in Brazil: Development and psychometric evaluation of the GEM Scale,” Men and Masculinities 10: 322–338.
Promundo, UNFPA, MenEngage, 2010, Engaging Men and Boys in Gender Equality and Health: A Global Toolkit for Action. http://www.unfpa.org/public/site/global/pid/6815