Family Planning and the Pressures South Asian Men Face

Youth aged 15 to 18 years from the Mahadalit community attending a training about sexual and reproductive health at the village. Photo credit: Paula Bronstein/Images of Empowerment

By Aishwarya Sahay and Kuhika Seth

Norms around masculinity impose certain expectations around how men think and behave, particularly in the South Asian context. Masculinity is a product of socially-constructed, well-defined roles which govern men’s understanding of themselves vis-à-vis the society they inhabit. On one hand, masculine expectations accord men superior status; on the other, that status pressures men to fulfill a range of expectations.

With the rapid increase in information technology, digital media has penetrated into some of the most remote areas of India where young men and boys are among its most consistent consumers. This phenomenon has opened up a wide range of aspirations for men and broadened their outlook on how they envision their lives, research in the Indian states of Uttar Pradesh and Bihar has revealed.

According to India’s fourth National Family Health Survey, only 46 percent of the population uses modern contraceptive methods—and female sterilization accounts for 36 percent! Male-controlled methods such as condoms (for spacing) and male sterilization (for limiting) remain at 3.9 and 0.3 percent, respectively. Further, three in eight men believe that contraception is “women’s business” and that men should not have to worry about it.

Masculinity is embodied through four key roles: provider, protector, procreator and pleasure giver. All spheres of men’s lives, including the dynamic they share with their partners, are guided by these roles. They shape spousal communication as well as decision-making on matters related to health, reproduction, contraception and sex.

Reproductive Health Session with young men.
Photo credit: Paula Bronstein/Images of Empowerment

Within the intimate space, men are driven by their need to fulfill their role of procreators and “pleasure givers.” They perceive sex as a performance where to prove their sexual prowess they perform to satisfy their need and provide pleasure to their partners. In addition, men feel the need to show their ability to control during sex and gain their partner’s trust by way of using traditional methods such as withdrawal or standard days method, a fertility awareness based family planning method that identifies a woman’s fertility window. Failure of these “traditional” contraceptive methods often occurs and leads to unintended pregnancies and abortions.

“I withdraw and ejaculate outside but once I had to give her a pill because she conceived, and I didn’t know what to do.” – A man with one child in Bihar

Among some younger men, such risky expressions of masculinity may be offset by the desire to be a responsible procreator, potentially providing key opportunities to encourage men to challenge the status quo and reframe their notions of masculinity.

“My husband wanted to give a gap of two years minimum because I am quite young (20 years). Also he thought that I am physically weak and we decided we will not do it.”

“My wife and I spoke to each other and decided.” – A couple in Bihar

This level of communication has the potential to facilitate more gender-equitable relationships. Through short video clips inserted as advertisements promoting positive messages about sex, contraception and consent, men can be nudged toward perceiving the “smart man” as one who practices safe sex and seeks pleasure through consensual sex. This approach would enable men to recognize the pitfalls of existing (conventional) notions of masculinity and promote the idea that using modern contraceptives is the marker of a responsible man.
Newly married men and women have both individual and shared aspirations for their future lives. Early on in their marriages, men often feel “burdened” by the provider role with little or no ability to pursue their own ambitions. Achieving social mobility, financial prosperity or spending more time with one’s partner are among the key motivations couples cite in delaying starting a family. These aspirations are amplified with increased access to technology providing men with avenues to seek better jobs, pursue education, in addition to spending more time at home.

“I want to pursue my business and open my own dairy farm. I have also spoken to my father about it already.” – A man with three children in Uttar Pradesh

Financial planning is key to couples achieving their goals, particularly as it can help couples to visualize the financial implications of an unintended pregnancy or the health risks of not practicing family planning. Considering the implications of their financial future encourages men and couples to use modern contraception to efficaciously space their families.

Reproductive Health counseling for couples.
Photo credit: Paula Bronstein/Images of Empowerment

The acute economic pressures and uncertainties brought on by the COVID-19 pandemic has further exposed the challenges men face in an economic and health crisis. When India announced a nationwide lockdown, a large proportion of men lost their jobs and had to return to their villages, especially in the states of Uttar Pradesh and Bihar, which have large, migrant male populations. The pressures to provide for the family triggered considerable psychological distress among men and affected couples’ dynamics. Reports of a rise in domestic violence and an increase in men’s alcohol consumption were widespread, as were accounts of women being coerced into non-consensual sex and experiencing emotional, verbal and physical abuse. Some men claimed that the increased pressures they felt to protect and provide for the family were released through sex, an act where they could assert their manhood.

As a result of the pandemic-induced financial crisis, many men described themselves as “responsible procreators” advocating for delaying, but not abandoning starting a family, or adding to it. As the frequency of sex increased, it was matched with a demand for using modern contraception methods, including condoms. While this could be attributed to a higher risk aversion during a difficult period (where personal aspirations were taking a back seat), men still wanted to be seen as being educated and “responsible”—using modern contraception to plan and space their families.

Transforming the values attached to each of these masculine roles is an important step toward creating an equitable environment where both men and women can lead healthier lives. It may provide men with the safe spaces they need to experience some relief from the pressures they feel, and to collaborate with their spouses on family planning. It also facilitates transforming longstanding inequitable power dynamics between men and women into equitable ones by helping men become family planning advocates, and supportive and equal partners on a couple’s contraceptive journey.

The pandemic has highlighted the need for men to see masculinity without the pressure to provide for their families and to prove their sexual prowess. Rather, it points to the need to encourage behaviors where men view themselves as well-informed, responsible users of family planning. It also nudges men, especially younger men, to fulfill their aspirations and to collaboratively embark on a healthy marital life with their partners.

Aishwarya Sahay is a research and program associate at the International Center for Research on Women (ICRW Asia) working on public health issues, particularly family planning and sexual and reproductive health. She previously worked on adolescent empowerment efforts at ICRW and domestic violence at the Tata Institute of Social Sciences in Mumbai.

Kuhika Seth is a technical specialist at ICRW Asia, also working on family planning and sexual and reproductive health and rights. Both work on “Couple Engage,” a human-centered design project to engage men in family planning in the Indian states of Uttar Pradesh and Bihar. Prior to joining ICRW, Kuhika worked with Sambodhi Research and Communications Pvt. Ltd., Population Council, and George Mason University in Virginia.

The authors acknowledge the contribution of the ICRW Couple Engage team, Pranita Achyut, Sharmishtha Nanda, and Sneha Sharma. They also thank Vihara Innovation Network, and the Bill & Melinda Gates Foundation for their support.