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Involving men and boys in family planning is effective in increasing contraceptive use
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Most family planning interventions involving men and/or boys are effective at increasing contraceptive use. Effective types of interventions include community-based educational programmes targeting males as well as females of all ages, and programmes delivered by professionals, trained facilitators or peers.
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Engaging men and boys in enhancing gender equality for women and girls as part of family planning programming was highlighted as key, but this remains an under-used strategy.
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What is this review about?
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This systematic review of intervention evaluation studies is about how to enhance future programming with men and boys to meet needs for family planning for women and men in low- and middle-income countries (LMICs).
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Addressing unmet needs for family planning is a major challenge in LMICs. Addressing male involvement in family planning is also a challenge, as it is in these countries where men’s control over family planning decisionmaking for women and girls is known to be greatest. It is important to involve men and boys in ways that support women’s and girls’ choices, as well as men’s own family planning needs.
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We used a novel method called causal chain analysis to focus on the content of interventions that may work better than others. This involved developing a picture of important programming components with stakeholders and testing how these components affect the impact of different interventions on family planning outcomes.
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What is the aim of this systematic review?
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This review assesses the strength of evidence of involving men and boys as users and supporters of family planning. The review also aims to uncover the effective components and critical process- and system-level characteristics of successful interventions.
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What studies are included?
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We included 127 papers which examined the effectiveness of interventions that included men and/or boys in LMICs as programme participants using experimental or quasi-experimental methods.
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We also included 23 qualitative studies and process evaluations which reported why and how some programmes might have been effective.
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The studies were conducted worldwide in LMICs, over half in Africa. A third of the studies were conducted on programmes that made a special effort to engage males. Less than a quarter of the studies addressed gender inequality as part of the programme.
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What are the main findings of this review?
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When considered together, the interventions included in this review were effective in increasing contraceptive use. The most effective interventions are community-based educational programmes offered in schools, communities and homes or community facilities, and interventions involving multiple components, delivered by professionals, trained facilitators or peers to both males and females for over seven months. Brief programmes of less than three months are also effective.
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Added to this, related implementation studies identified the importance of promoting gender-equitable attitudes and social norms for women and girls among men and women at the individual, wider family, community, health service and societal level as part of family planning programming.
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Some studies also emphasised structural factors such as the importance of widening women’s access to education and labour markets.
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What do the findings of this review mean?
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A wide range of family planning interventions which involve men and boys in LMICs have shown efficacy in increasing contraceptive use.
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The success of family planning programmes that involve men and boys is most often measured by contraceptive use to the relative neglect of other outcomes, such as met need for family planning, equitable family planning decisionmaking, or gender equality. Our analysis indicates some promising intervention characteristics, which are more effective in promoting contraceptive use than other characteristics.
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Our qualitative analysis also highlights the under-used strategy of addressing gender equality attitudes and norms, from the individual to the structural level.
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The findings of this review will be of interest to programme designers wanting to increase male engagement in family planning in gender-equitable ways. The review can also help in measuring programme efficacy beyond contraceptive use, to also include gender equality and met family planning needs.
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How up-to-date is this Campbell review?
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The review authors searched for experimental evaluations in August 2020 and ‘connected’ process evaluations and qualitative studies in June 2021.
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