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ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
5,
N
o
.
1
,
M
a
rch
2
0
1
6
,
pp
.
46
~
50
I
S
SN
: 225
2-8
8
0
6
46
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urn
a
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h
o
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: h
ttp
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e
x.ph
p
/
IJPHS
Barriers to Males Involvement in
Family Planning Services in
Arba Minch Town, Southern Ethi
opia: Qualitative Case Study
Alemu T
a
mis
o
1
, Adm
a
su
T
a
ssew
2
,
Heno
k Bek
e
le
3
, Z
a
le Z
emede
1
, Ad
masu
D
u
lla
1
1
Departm
e
nt
of
Public h
eal
th/Un
it of
epid
em
iolo
g
y
and b
i
ostat
i
st
ics, Co
lleg
e
of
Medicin
e
and
H
eal
th Sci
e
nc
es,
Arba Minch
University
,
Arba Minch,
Ethiop
ia
2
Department
of
Biolog
y
,
Colleg
e of N
a
tural scien
ce,
Arba
M
i
nch
Univers
i
t
y
, Arb
a
Minch
,
Ethiop
ia
3
Department of Planning,
Adare
Hospital, Southern Region
H
e
a
l
t
h
Bureau
, H
a
w
a
s
s
a
, Eth
i
opia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Nov 22, 2015
Rev
i
sed
D
ec 21
, 20
15
Accepte
d
Ja
n 16, 2016
Effective utilization of family
planni
ng services are major contributors of
improved mater
n
al health
. Th
is,
in turn
, n
eeds ad
equate involv
e
ment of male
partners throug
h direct uptak
e the se
rvices and approva
l of
the spouses’
usage. Yet
the family
p
l
ann
i
ng me
thod utilization as well as male
involvement is
indicated to
be low
in
Eth
i
opia.
Qualitativ
e case stud
y
w
a
s
conducted in August 2015 in Ar
ba Minch town to identif
y
b
a
rriers to male
involvement
in
uptake of fam
i
ly
pl
anning services. Open ended, semi-
structured
questionnaire was used to
in
terv
iew
th
e par
ticipan
ts. F
our men and
four women are purposively
selected. Interview
s
we
re conducted in audib
l
y
private location
after
verb
al cons
ent was obtained from th
e recruited
individuals. All interviews were reco
rd
ed and
trans
c
rib
e
d ver
b
atim
. T
h
e
narratives were then translated to
Eng
lish and the responses
are aggregated in
to nine
concepts. The
fina
l aggr
egat
ed dat
a
wer
e
ana
l
yz
ed us
in
g OpenCode
3.4 softwar
e
b
a
sed on
thematic fra
m
e
work
ana
l
y
s
is. To
t
a
l of
eigh
t
participan
ts (fou
r
men and four
wome
n) were in
terviewed wher
e seven
are
m
a
rried and on
e
is
s
i
ngle.
P
a
rti
c
i
p
ants
iden
tified that, Percep
tion (
o
r opinion
)
towards family
planning as
wom
e
n’s
is
s
u
e, S
e
x preferen
ce for
inherit
a
nc
e
and considering
childr
e
n as measure of
blessing of and Fear of partner sexual
prom
iscuit
y
and
to reduce wo
m
e
n’s attrac
tive
n
ess were barri
ers for m
a
le
involvement in modern
fa
mily
planning method
. Fu
ture interven
tions
aimed
at im
proving fa
m
i
l
y
pl
anning se
rvices and m
e
th
ods utiliz
at
ion in
Arba Minch
town and similar settings need to
cons
ider
t
h
es
e bot
tlen
eck
s
for m
a
le
involvement.
Keyword:
Ar
ba M
i
nc
h
Barriers
Fam
i
l
y
pl
anni
n
g
Male in
vo
lv
emen
t
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Alem
u Tam
i
so,
Dep
a
rtm
e
n
t
Pub
lic Health,
C
o
l
l
e
ge
of M
e
di
ci
ne a
n
d
He
a
l
t
h
Sci
e
nces
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
, So
ut
her
n
Et
hi
o
p
i
a
.
Em
a
il: ale
m
u
t
a
m
iso
@
yah
o
o
.
co
m
1.
INTRODUCTION
Fam
i
l
y
pl
anni
n
g
se
rvi
ces a
r
e i
n
t
e
g
r
al
i
n
t
h
e
pre
v
e
n
t
i
o
n
o
f
un
wa
nt
ed
pr
eg
nancy
,
re
d
u
ct
i
o
n
o
f
uns
afe
abo
r
t
i
o
ns, an
d
pr
om
ot
i
on of c
h
i
l
dbi
rt
h spaci
ng
. The ser
v
i
c
es, i
n
t
u
r
n
, nee
d
t
o
assu
re eff
ect
i
v
e i
nvol
ve
m
e
nt
of
men
to
b
e
tter ach
i
ev
e th
ei
r in
t
e
n
d
e
d
g
o
a
ls. Sev
e
ral stud
ies
sh
ow th
at m
e
n
’
s inv
o
l
v
e
m
e
n
t
h
a
s po
sitiv
e i
m
p
a
c
t
on
u
p
t
a
ke o
f
fam
i
l
y
pl
anni
n
g
ser
v
i
ces [
1
]
-
[
4
]
.
H
o
we
ve
r
,
fam
i
l
y
pl
ann
i
ng se
rvi
ces t
r
adi
t
i
onal
l
y
t
a
rget
ed
wo
m
e
n
reg
a
rd
l
e
ss of th
e fact th
at
m
e
n
’
s invo
lv
em
en
t is eq
u
a
lly i
m
p
o
r
tant an
d
ch
ildb
earin
g
h
a
s an
im
p
act on
m
e
n’s l
i
f
e t
o
o.
A re
vi
ew
o
f
m
a
l
e
i
nvol
vem
e
nt
i
n
deci
si
o
n
m
a
ki
ng i
n
fa
m
i
ly
pl
anni
ng
i
n
Su
b
-
Sa
hara
n A
fri
c
a
reflected
l
o
w
in
vo
lv
em
en
t of m
e
n
in
family p
l
an
n
i
ng
pr
o
g
ram
s
[5]
.
A resea
r
c
h
r
e
po
rt f
r
om
Muslim
com
m
unities
in Ghana s
u
ggested furthe
r low m
a
le invol
vem
e
nt in fam
ily planning uptake a
nd
higher non-
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
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6
Ba
rriers t
o
Males In
vo
lvement in
Fa
mily Pl
an
n
i
n
g
S
e
rvices
in Ar
ba Minc
h
Town ..
..
(
A
lem
u
T
a
miso)
47
approval
of for spouses c
ont
rary to
perfect
knowledge a
n
d awar
eness
to cont
raceptive
op
tions [6].
Si
milarly,
low m
a
les’ in
v
o
lvem
ent was
rep
o
rte
d
fr
om
ru
ral distri
ct
s
of
U
g
a
nda
,
De
brem
arko
s t
o
w
n
a
n
d
B
a
hi
r
D
a
r ci
t
y
in
Eth
i
o
p
i
a
[7
]-
[9
].
Barriers t
o
males’ inv
o
l
v
e
men
t
to
ok
v
a
ryin
g
form
s b
a
sed
o
n
th
e con
t
ex
t
o
f
t
h
e co
mm
u
n
ities
con
s
i
d
ere
d
.
P
r
og
ram
for
A
p
pr
o
p
ri
at
e Tec
h
nol
ogy
i
n
Hea
l
t
h
(P
AT
H)
[
1
0]
d
o
c
u
m
e
nt
ed n
u
m
b
er o
f
fa
ct
ors.
Wom
e
n and c
h
ildren ta
rgete
d
nature of t
h
e s
e
rvices, li
m
ite
d
num
ber
of m
a
le cont
racepti
ves a
v
ailable,
rum
o
rs
and m
i
si
nform
a
t
i
on co
ncer
ni
ng t
h
e ef
fect
s of t
h
e avai
l
a
bl
e opt
i
o
ns an
d u
n
fa
v
o
ra
bl
e soci
al
or rel
i
g
i
o
us cl
im
ate
are t
o
m
e
nt
i
on som
e
. In In
di
a and
Nepal
,
m
a
ny
m
e
n resi
st
vasect
om
y
due t
o
m
y
t
h
s t
h
at
the p
r
oce
d
ure c
a
use
s
p
h
y
sical weakn
e
ss
o
r
im
p
o
t
en
ce an
d red
u
c
es a m
a
n
’
s cap
a
b
ility
to
prov
id
e for h
i
s ho
u
s
eho
l
d.
In
parts
of
Nepal,
on the
othe
r ha
nd, m
e
n disa
pp
rove t
h
eir wi
ves to use cont
raceptives
because the
y
believe that it
m
a
y
m
a
ke t
h
e wom
e
n p
r
om
i
s
cuo
u
s
[3]
.
A st
udy
i
n
Ke
ny
a i
d
ent
i
fi
ed m
e
re at
ti
t
ude o
r
ne
gat
i
v
e
perce
p
t
i
o
ns t
o
war
d
s
fam
i
l
y
pl
anni
n
g
by
m
e
n and t
h
e bel
i
e
f t
h
at
i
t
’
s wom
a
n’s affai
r
as m
a
in ba
rri
ers
[1]
.
An
ot
he
r st
ud
y
from
Nyan
za Prov
ince in
Ken
y
a o
n
HIV-Po
sitiv
e
Men
in
d
i
cated
th
at co
n
c
ern
s
ab
ou
t sid
e
effects o
f
co
n
t
raceptiv
es,
lack of knowle
dge a
b
out c
ont
raceptive m
e
thods
, m
y
ths an
d m
i
sconceptions i
n
cluding
fear of infe
rtility, and
lack
of m
a
le focu
s i
n
fam
ily p
l
an
n
i
ng
m
e
th
od
s and
serv
ice
d
e
liv
ery as k
e
y
b
a
rriers to
m
a
le in
vo
lv
em
en
t
[11
]
.
Barriers t
o
m
a
le invol
vem
e
nt in fa
m
i
ly planni
ng i
n
Ethi
opia ha
ve
sim
ilarities to the reports from
el
sewhe
r
e.
H
o
weve
r, l
a
c
k
o
f
i
n
fo
rm
at
i
on an
d l
o
w l
e
v
e
l
of e
d
ucat
i
o
n
got
c
o
nsi
d
e
r
abl
e
s
h
ar
e. S
t
udi
es
conducted in
the north, no
r
t
h-
west
, so
ut
h
-
west
an
d s
o
u
t
h cent
r
al
pa
r
t
s of t
h
e co
u
n
t
r
y
im
pl
y
l
a
ck o
f
ap
pro
p
riate in
form
at
io
n
,
in
accessib
ility o
f
fa
m
ily
p
l
an
nin
g
serv
ices,
attitu
d
e
s o
f
men
to
ward
s
fam
i
l
y
p
l
ann
i
ng
, p
e
rceiv
e
d
fear o
f
sid
e
-effects,
cu
l
t
u
r
al o
r
relig
i
o
u
s
op
po
sitio
ns and
d
e
sire for m
o
re ch
ild
ren
are
am
ong
m
a
i
n
b
a
rri
ers
o
f
m
a
l
e
i
n
v
o
l
v
em
ent
i
n
fam
i
ly
pl
anni
n
g
i
n
Et
hi
opi
a
[
2
]
,
[
8
]
,
[
9
]
,
[
12]
,
[
1
3
]
.
Desp
ite few qu
an
titativ
e research
work
s
und
ertak
e
n
on
male in
vo
lv
em
en
t in fam
ily p
l
an
n
i
n
g
in th
e
cou
n
t
r
y
as
af
o
r
em
ent
i
oned,
i
n
-
d
e
p
t
h
u
nde
r
s
t
a
ndi
ng
o
f
the ration
a
le fo
r m
e
n
’
s lo
w particip
atio
n
h
a
s b
een
un
de
rex
p
l
o
red
.
Ocha
ko et
al
. [1
4]
and
Kaba
geny
i
et
al
. [7]
sho
w
ed t
h
at
aware
n
ess a
nd
kn
o
w
l
e
d
g
e t
o
f
a
m
i
ly
p
l
ann
i
ng
serv
ices often do
n
o
t
translate to
u
s
e,
h
e
n
c
e it n
ecessitates
u
n
d
e
rtak
ing
an
i
n
-d
ep
t
h
qualitativ
e
i
nvest
i
g
at
i
o
n t
o
com
e
up wi
t
h
w
o
r
k
i
n
g s
o
l
u
t
i
on t
o
i
m
prov
e
m
a
l
e
i
nvol
ve
m
e
nt
. To ad
d
r
e
ss t
h
i
s
ga
p, t
h
i
s
st
udy
exam
ines level of m
a
le involvem
e
nt in fam
i
ly plan
ning se
rvices
utilizatio
n
a
n
d ass
o
ciated
factors.
2.
R
E
SEARC
H M
ETHOD
2.
1.
Stud
y are
a
The st
udy
a
r
ea
was
Ar
ba M
i
c
n
h
t
o
wn
, Gam
o
Go
fa Z
one
S
out
her
n
Et
hi
o
p
i
a 50
5
km
sout
h
west
o
f
t
h
e
cou
n
t
r
y
’
s ca
pi
t
a
l
Ad
di
s
A
b
ab
a an
d
27
3
km
so
ut
h
o
f
t
h
e
regi
onal
ca
pi
t
a
l
Hawa
ssa.
Ac
cor
d
i
n
g t
o
nat
i
ona
l
p
opu
latio
n
an
d h
o
u
s
ing
census in
2
007
, th
e
to
wn
w
a
s inh
a
b
ited
b
y
74
,843
p
e
o
p
l
e
(
3
9
,
19
2
m
a
le an
d
35
, 651
fem
a
l
e
)
[15]
. The
c
u
r
r
ent
p
r
oject
e
d
po
p
u
l
a
t
i
on of
est
i
m
at
ed
to
b
e
ov
er 10
0,000
r
e
si
den
t
s. Th
er
e are on
e
g
e
n
e
ral
h
o
s
p
ital, two pub
lic health
cen
ters an
d nu
m
b
er
o
f
p
r
i
v
ate clin
ics
o
f
v
a
ryin
g ra
nk
r
e
nd
er
i
n
g serv
ices t
o
t
h
e heal
t
h
nee
d
s o
f
t
h
e re
si
dent
s
.
Fam
i
l
y
pl
an
ni
n
g
ser
v
i
ces are m
a
i
n
ly
obt
ai
ne
d fr
o
m
t
h
e publ
i
c
heal
t
h
in
stitu
tio
n
s
.
2.
2.
Stud
y design
A
q
u
a
litativ
e
ph
eno
m
en
o
l
og
y stud
y was con
d
u
c
ted
u
s
ing
in
-d
ep
t
h
in
terview
wit
h
fou
r
wo
m
e
n
and
fo
ur m
e
n o
f
r
e
pr
o
duct
i
v
e a
g
e i
n
A
r
ba
M
i
n
c
h t
o
wn
, S
o
ut
her
n
Et
hi
o
p
i
a
.
Sem
i
-st
r
uct
u
r
e
d q
u
est
i
o
n
n
ai
re wa
s
u
s
ed
fo
r th
e i
n
terv
iew with
em
p
h
a
sis o
n
preferred
fam
i
ly
s
i
ze, th
e ro
le
o
f
h
u
s
b
a
n
d
s in
the family with
reg
a
rd
to
fam
ily p
l
an
nin
g
,
kno
wled
ge abo
u
t
con
t
racep
tiv
es and
m
a
le in
vo
lv
em
en
t in
fam
i
ly p
l
an
n
i
ng
.
2.
3.
Pa
rticipa
n
t selectio
n
St
udy
pa
rt
i
c
i
p
ant
s
were p
u
r
posi
v
el
y
sel
ected of
wh
om
seven
were m
a
rri
ed a
nd o
n
e
i
s
unm
arri
ed
who
were liv
ing
in
Arb
a
Minch
town
at th
e
ti
m
e
o
f
th
e stu
d
y
. Th
e
p
a
rtici
p
an
ts
were com
p
o
s
ed
of fiv
e
family
pl
an
ni
n
g
ser
v
i
ce cl
i
e
nt
s (t
wo
m
e
n and t
h
ree
wom
e
n) l
i
v
i
n
g i
n
t
h
e t
o
wn a
nd t
h
ree ser
v
i
c
e pr
ovi
di
n
g
pe
rso
n
n
el
(t
w
o
m
e
n and
a wom
a
n) i
n
Ar
ba M
i
nch
gene
ral
h
o
s
p
i
t
a
l
.
In
fo
rm
ed verbal
co
nse
n
t
was t
a
ke
n f
r
o
m
t
h
e
p
a
r
ticip
an
ts
p
r
i
o
r to
d
a
ta co
llectio
n
w
h
er
e t
h
ey ar
e elig
ib
le
to
jo
in th
e
study.
2.
4.
Data co
llection
Ope
n
en
de
d, s
e
m
i
-st
r
uct
u
r
e
d
que
st
i
on
gui
de
s were u
s
ed t
o
expl
ore
perce
p
t
i
ons re
gar
d
i
n
g
barri
e
r
s t
o
m
a
le involvem
e
nt in fam
i
ly planning
se
rvice
utilization. Int
e
rvie
ws we
re
c
o
nducted in
Am
haric langua
ge and
in audibly pri
v
ate areas until saturatio
n wa
s reache
d
.
All of the study
parti
c
ipants we
re e
n
courage
d
to
openly
d
i
scu
s
s th
eir op
in
ion
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 5
,
N
o
. 1
,
Mar
c
h
20
16
:
46
–
50
48
2.
5.
Da
ta
a
n
al
ysi
s
All
intervie
ws were recorded and
t
r
ansc
ribe
d
ve
rbat
i
m
. After v
a
li
d
a
tin
g
th
e tran
scrip
tion
,
th
e ty
ped
narratives we
re then transl
at
ed into E
nglis
h and ve
rified
for accur
acy. The English translated na
rrat
i
ve per
i
ndi
vi
dual
res
p
on
de
nt
s
was a
g
gre
g
at
ed
i
n
t
o
2
2
c
o
ncept
s
,
l
a
t
e
r
po
ol
ed
t
o
9
bef
o
re
fe
d
i
n
t
o
so
ft
wa
re.
Dat
a
we
re
anal
y
zed usi
n
g Op
enC
ode
3
.
4 so
ft
wa
re. Fi
nal
l
y
, t
h
em
at
i
c
anal
y
s
i
s
wi
t
h
qu
ot
at
i
on wa
s used t
o
re
po
rt
t
h
e
out
put
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
In
-de
p
t
h
i
n
t
e
r
v
i
e
w was c
o
n
d
u
ct
ed
on ei
ght
i
ndi
vi
dual
s
, f
o
u
r
fem
a
l
e
s and
fo
u
r
m
a
l
e
s of
whi
c
h al
l
were m
a
rri
ed,
but
o
n
e. Fi
ve o
f
t
h
e pa
rt
i
c
i
p
ant
s
were
pr
ot
e
s
t
a
nt
, t
w
o
wer
e
ort
h
o
d
o
x
,
on
e was Isl
a
m
fol
l
o
wer
s
and thei
r age
interval ra
nge
s
from
21 to 38 years.
The avera
g
e
durati
on of
th
e in
terv
iew was abo
u
t
27
m
i
nut
es. R
e
d
u
nda
ncy
of i
d
ea
was c
h
ec
ked
a
n
d
o
n
l
y
t
h
re
e t
h
e
part
i
c
i
p
a
n
t
s
’ res
p
on
ses
we
re c
onsi
d
ere
d
f
o
r t
h
e
final analysis.
Analysis of the final selected data
usi
n
g
Ope
n
C
o
de s
o
ft
ware y
i
el
de
d
ei
ght
cat
eg
ori
e
s and
twen
ty-two
cod
e
s
wh
ich
were relev
a
n
t
wi
th
p
a
rticip
an
t’s in
form
at
io
n
.
Acco
rd
ing
l
y,
fou
r
m
a
in
categ
ories
were ide
n
tifie
d as a barrier to
m
a
le’s involvem
e
nt in
cont
raceptive
utilization: i)
Infl
uence
of culture &
relig
ion
,
ii) Percep
tion
(or o
p
i
n
i
on
)
t
o
ward
s
fam
ily
p
l
a
n
n
i
n
g
as
wo
m
e
n
’
s issu
e, iii) Sex
preference for
i
nhe
ri
t
a
nce an
d co
nsi
d
e
r
i
n
g c
h
i
l
d
re
n as m
e
asure
of
bl
essi
n
g
o
f
an
d i
v
) Fe
ar o
f
pa
rt
ne
r se
xual
pr
om
i
s
cuit
y
an
d
to re
duce
wom
e
n’s
attractiveness.
3.
1.
Influence of culture & religio
n
All p
a
rticip
an
t
s
b
e
liev
e
t
h
at relig
io
n
h
a
s an
ad
v
e
rse i
n
flu
e
n
ce on
fam
i
l
y
p
l
ann
i
ng
serv
i
ce u
tilizatio
n
.
Relig
io
u
s
hu
sban
ds are said t
o
less lik
ely utilize fa
m
i
l
y
p
l
an
n
i
n
g
serv
ices th
em
selv
es an
d th
ey
d
i
sapprov
e
u
tilizatio
n
b
y
th
eir
wiv
e
s as well. Th
e
und
erlying
cau
s
e of th
ei
r
d
ecisio
n
is th
e
b
e
li
ef th
at
h
a
v
i
ng m
a
n
y
ch
ild
ren
is t
h
e Go
d’s
b
l
essing
.
A 38
years o
l
d p
a
rticip
an
t who
is
fath
er o
f
fou
r
ch
ildren
states th
is fact as
fo
llows:
“Yes, relig
io
n
a
d
v
ersely in
flu
en
ces fa
mily p
l
a
n
n
i
ng u
tiliza
tio
n
.
For in
sta
n
c
e, in
my relig
ion
ch
i
l
d
r
en
are co
nsi
d
ere
d
as G
o
d’s gi
f
t
and t
h
ey di
sco
u
ra
ge co
nt
race
pt
i
ve usa
g
e
f
o
r f
a
mi
l
y
pl
an
ni
n
g
. Eve
n
t
hou
g
h
maj
o
ri
t
y
of
be
l
i
evers do
n
o
t
ag
ree w
i
t
h
t
h
i
s
i
d
e
a
, s
o
me
ext
remi
st
bel
i
evers d
o
not
use f
a
mi
l
y
pl
a
nni
ng
servi
ces. T
h
ey
si
mpl
y
bea
r
8
,
9
or
up t
o
12
.
The
ast
o
ni
s
h
i
n
g f
a
ct
i
s
t
hat
e
ven t
h
ose w
h
o
sust
ai
n t
h
ei
r l
i
f
e
by
fire wo
od
co
llectio
n
b
e
a
r
10
or 12
.
S
o
metimes I try to
ch
a
llen
g
e
t
h
em to
u
s
e th
e family p
l
a
n
n
i
ng
services, bu
t
th
ey refu
se cla
i
ming
th
eir ch
il
d
r
en
a
r
e
God’s g
ifts and
He w
ill su
sta
i
n
t
h
em”.
Cu
ltu
ral no
rm
s are also
stated
to
p
l
ay si
mila
r n
e
g
a
ti
v
e
ro
le in
fa
m
i
l
y
p
l
an
n
i
ng
serv
ice u
tilizatio
n
as
in
d
i
cated b
y
a
p
a
rticip
an
t who
is m
o
th
er of
th
ree ch
ild
ren.
She
blam
ed the cultural c
u
stom
s of t
h
e are
a
where
she was
br
o
u
g
h
t
up as a
n
o
b
st
acl
e t
o
upt
a
k
e fam
i
ly
pl
anni
n
g
i
n
ge
nera
l
and pe
rm
anent
fam
i
l
y
pl
anni
n
g
m
e
t
hods i
n
par
t
i
c
ul
ar.
“F
or i
n
st
a
n
ce, i
n
r
u
r
a
l
are
a
s
i
f
a w
o
me
n t
a
kes c
o
nt
race
pt
i
ves s
o
me t
i
m
e
bef
o
re
gi
vi
n
g
first b
i
rth
,
h
e
r
h
u
s
ba
nd
will f
o
llo
w an
o
t
h
e
r
yo
ung
er g
i
rl. Th
is is b
ecau
s
e
it is cu
sto
m
in
so
me
p
l
a
c
es to h
a
v
e
mo
re than
on
e wife. Th
a
t
is
a
ba
d
in
flu
en
ce o
f
cu
ltu
re. Th
erefo
r
e, th
e wife p
r
efers to
b
e
a
r
ch
ild
with
ou
t h
e
r
choi
ce j
u
st
f
o
r
t
h
e sake of
securi
n
g
her
hus
ba
n
d
. C
h
i
l
d
be
ari
n
g w
o
men
are
even res
p
e
c
ted in some
areas
.
Thi
s
c
a
n
be
an
ot
her
rea
s
o
n
w
h
y w
o
me
n
m
a
y
n
o
t
co
nsi
d
er
p
e
rma
n
e
n
t
f
a
mi
l
y
pl
a
n
n
i
n
g
met
h
o
d
s.
”
Accordingly, the cust
om
allo
ws a m
a
n can marry
t
o
m
o
re t
h
an
one
wo
m
a
n fo
r t
h
e sa
ke o
f
ha
vi
n
g
childre
n a
n
d
wom
e
n who
bear m
o
re c
h
ildren are
res
p
ec
te
d
.
Th
is
frees th
e m
a
n
to lo
o
s
ely atten
d
fam
i
ly
planning m
a
tte
rs and
forces t
h
e wi
ves to
be
ar m
o
re ch
ild
ren
to
stab
ilize th
eir fam
ily an
d
claim
b
e
tter
so
cial
st
at
us i
n
t
h
e c
o
m
m
uni
t
y
. As t
hos
e r
u
ral
area
s m
e
nt
i
oned
b
y
t
h
e pa
rt
i
c
i
p
a
n
t
are
i
n
t
h
e
vi
ci
ni
t
y
of
Ar
ba
M
i
nch
t
o
w
n
, t
h
e
opi
ni
on
o
f
t
h
ose
res
i
dent
s m
i
grat
ed t
o
t
h
e t
o
w
n
f
r
om
t
h
e nea
r
by
ru
ral
a
r
eas
do
not
va
ry
fr
om
peo
p
l
e
w
h
o
ar
e
bo
und to
th
e custo
m
s
afo
r
em
en
tio
n
e
d
.
3.
2.
Perception of family
planni
ng as
w
o
men’s
issue
Three
of t
h
e p
a
rt
i
c
i
p
ant
s
bel
i
eved t
h
at
i
t
i
s
onl
y
w
o
m
e
n’s busi
n
ess t
o
use
fam
i
l
y
pl
anni
ng m
e
t
hods
because of s
o
cial norm
s
and im
pact
of fa
m
i
ly planni
ng on m
e
n. Some
of them
merely participate in
di
scussi
o
n
.
Al
t
h
o
u
gh
som
e
husb
a
n
d
s al
l
o
w
t
h
ei
r wi
ves t
o
use c
ontrac
e
pti
v
es, t
h
ey themselves are m
u
ch less
willing to
use
fam
i
ly planning m
e
thods
for m
e
n.
T
h
e perc
eption
that only
fem
a
le shoul
d
use
fam
i
ly planni
ng
services is
com
posed of i
n
tricate
r
eason
ing in
clud
ing
lack o
f
kno
w
l
ed
g
e
, r
e
fu
sal
o
f
w
i
ves fo
r
m
e
n
cond
o
m
,
and m
i
sconcep
t
i
on t
h
at
vasec
t
om
y
m
a
y
t
e
r
m
i
n
at
e t
h
e
m
a
nl
y nature
of t
h
e hus
b
and at
all. One pa
rticipant
cl
aim
s
t
h
at
m
e
n ha
ve t
o
use
f
a
m
i
ly
pl
anni
n
g
servi
ces as w
o
m
e
n di
d, b
u
t
he hi
m
s
el
f doe
s not
act
ual
l
y
use.
“I
know
t
hat
,
b
u
t
I d
o
n
’
t
us
e i
t
.
I
have
a st
ory a
gai
n. T
h
ere w
a
s a nei
g
hb
or w
ho i
s
f
a
t
h
er
of
f
i
ve dau
g
h
t
e
rs
an
d
t
h
ree so
ns. T
h
ey have n
o
kn
ow
l
e
d
g
e of
ot
her f
a
mi
l
y
pl
a
nni
ng
opt
i
o
ns
.
The pers
o
n
b
e
i
ng en
o
u
g
h
w
i
t
h
t
h
e
ch
ild
ren
h
e
has p
r
o
p
o
s
ed
to
h
i
s wife to
u
s
e
co
ndo
m. Ho
wever, th
e wife refu
sed
t
h
in
king
it ma
y slip
ou
t
in
sid
e
h
e
r bo
dy. Th
ey q
u
a
rreled
much
un
til I wa
s ca
lled
to
med
i
a
t
e th
em on
the issu
e. Co
ncern
i
ng
th
e o
t
h
e
r o
p
tion
(
v
asect
omy)
,
I hea
r
d a
not
her st
ory. There
w
a
s a boy
resi
di
ng
w
i
t
h
a
w
h
i
t
e
(
f
orei
gner)
. He used
t
o
me
et
t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
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SN
:
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2-8
8
0
6
Ba
rriers t
o
Males In
vo
lvement in
Fa
mily Pl
an
n
i
n
g
S
e
rvices
in Ar
ba Minc
h
Town ..
..
(
A
lem
u
T
a
miso)
49
ho
use
m
ai
d res
i
di
ng
t
o
get
h
er
a
nd
m
a
ke
her
pre
g
n
a
n
t
f
r
eq
uent
l
y
.
Lear
ni
ng
t
h
i
s
eve
nt
t
h
e w
h
i
t
e
ma
n
mi
g
h
t
have injected
him somethi
n
g. Now the
guy
is employee in our university,
but pe
ople talk of him as
he has
been c
a
strate
d by that white
man. He
curre
ntly has no chi
l
d at all. Peop
le even talk of him that he has no
ma
nl
y
f
eel
i
n
gs t
o
w
o
me
n. The
r
ef
ore, I d
o
n
’
t
w
ant
t
o
use
t
h
a
t
.”
3.
3.
Sex
prefere
nc
e for inheritance and c
o
nsi
d
eri
ng c
h
i
l
d
ren as
me
asure
of
bl
essi
n
g
Because of cultural and s
o
ci
al values m
o
st people
pre
f
er son to
daughter to lead the fam
i
ly and
inhe
rit their possessions in ca
se whe
n
the fa
mily head dies. Accordi
ngly,
o
n
e
m
a
le p
a
rti
c
ip
an
t und
erlined
th
at
sex
p
r
eferen
ce was th
e m
a
in
b
a
rrier to m
a
le’s inv
o
l
v
e
m
e
n
t
in
con
t
racep
tiv
e u
tilizatio
n
.
He exp
l
ain
e
d
the
expe
rience
he
cam
e across
as follows:
“
I
h
a
d
a nei
g
h
bor
w
h
o
al
re
ady
f
a
t
h
ered
7 d
a
u
g
h
t
e
rs. He
w
a
s
prot
est
ant
ext
r
e
mi
st
. B
u
t
w
h
e
n
he t
h
o
u
g
h
t
i
t
as i
f
hi
s
w
i
f
e
’s
pro
b
l
e
m
,
he
ch
an
ge
d
hi
s r
e
l
i
g
i
on t
o
ma
r
r
y t
o
a
n
o
t
h
e
r woman
in
sea
r
ch
o
f
b
e
aring
a bab
y bo
y. Ho
wever, th
e
n
e
w
wife g
a
ve
b
i
rth
to
ad
d
ition
a
l two
da
u
ght
ers
.
N
o
w
w
i
t
h
advi
ce f
r
om f
r
i
e
nds i
n
c
l
udi
n
g
mysel
f
he retu
rn
ed
b
a
c
k to
h
i
s family a
n
d
fa
ith. Th
is sto
r
y
I’m telling y
o
u
is very rece
nt one”.
Ot
he
rs
cl
ai
m
e
d
t
h
at
peo
p
l
e
pa
rt
i
c
ul
arl
y
t
h
e p
a
rent
s o
f
the
married c
o
uples
belief that
chil
dre
n
a
r
e m
easure
of
bl
essi
n
g
of
G
o
d
.
T
h
ree
o
f
t
h
e
fo
ur
cl
i
e
nt
wom
e
n t
o
fam
i
l
y
pl
anni
ng
s
e
rvi
ces t
o
l
d
t
h
at
pare
nt
s e
x
t
r
em
el
y
discoura
ge c
o
ntraceptive
utili
zation at
all. Whe
n
this
disa
pproval c
o
m
e
s
w
ith religi
ous
husba
nds it is i
m
pl
ie
d
as o
n
e i
m
port
a
nt
o
b
st
acl
e t
o
m
a
l
e
i
nvol
vem
e
nt
i
n
fam
i
ly
pl
anni
ng
ser
v
i
c
e
s
.
3.
4.
Fear
of partner sexual
promiscuity
and
to red
uce wom
e
n’s
attr
acti
ve
ness
M
e
n pe
rcei
ve
t
h
at
wi
ves
bec
o
m
e
calm
and
su
bm
it
to
th
eir hu
sb
and
s
wh
en
t
h
ey
bea
r
childre
n. A
yo
un
g wo
m
a
n
p
a
rticip
an
t
wh
o regu
larly fo
llo
ws fam
ily
p
l
ann
i
ng
serv
i
ces pu
t th
is
fact o
n
h
e
r
o
w
n wo
rd
s.
“Some
husbands believe that a wife
become calm and subm
its to her husband. They bel
i
eve a woman
settles
w
h
en
she
be
ar
s a
chi
l
d
.”
Wo
m
e
n
’
s
u
tilizatio
n
o
f
fam
i
l
y
p
l
ann
i
ng
serv
ices is also
p
e
rceiv
e
d
to
lead th
em
to
b
ecome u
n
f
aithfu
l
and
refl
ect
w
o
m
e
n’s i
n
t
e
nt
i
ons t
o
a
voi
d
pre
g
nancy
wi
t
h
i
n
e
x
t
r
am
ari
t
al
sexual
r
e
l
a
t
i
ons
hi
ps
. T
h
er
efo
r
e,
p
e
rcei
v
e
d sex
u
al p
r
o
m
iscu
ity
is on
e im
p
o
r
t
a
n
t
b
a
rriers m
a
le in
vo
lv
em
en
t in allo
wi
n
g
th
eir
wiv
e
s to
u
tilize
fam
i
l
y
pl
anni
n
g
m
e
t
hods
.
Fam
i
l
y
pl
anni
ng
m
e
t
hods
w
e
re al
so
de
scri
bed
as e
n
hanc
i
ng
w
o
m
e
n’s
phy
si
cal
at
t
r
ac
t
i
v
eness
by
delaying or preventing chil
dbeari
n
g,
which
m
a
de
m
e
n rel
u
ctant to s
upport wom
e
n’s cont
raceptive
use. A
wo
m
a
n
p
a
rticip
an
t
exp
l
ain
s
ho
w th
is
p
e
rceptio
n
affects famil
y
p
l
ann
i
ng
serv
ice u
tilizatio
n
:
“T
here ar
e
so
m
e
ru
de hu
sban
ds wh
o
are en
vi
o
u
s
on
th
e b
e
a
u
t
y
o
f
th
eir wives. They think their wives beauty won’t drag
a
tten
tio
n o
f
o
t
h
e
r
men
a
s
it fa
d
e
s if th
ey b
e
a
r
ch
ild
ren
freq
u
e
n
tly. Beca
use o
f
th
is silly rea
s
o
n
t
h
ey let t
h
em
si
mpl
y
be
ar ch
i
l
d
ren. B
u
t
I d
o
n
’
t
ag
ree w
i
th t
hat
; i
t
’
s ch
a
r
act
e
r t
hat
di
ct
at
es t
h
e l
o
yal
t
y
of
a w
o
m
an
not
t
h
e
nu
m
b
er
of
c
h
i
l
d
re
n s
h
e
bea
r
s
”
.
4.
DIS
C
USSI
ON
The fi
ndi
ngs
of t
h
i
s
st
u
d
y
sho
w
t
h
at
m
a
le i
n
v
o
l
v
em
ent
i
n
fam
i
l
y
pl
anni
ng m
e
t
hod
and se
rvi
c
e
u
tilizatio
n
is lo
w. Moreo
v
e
r, t
h
ey o
f
te
n
d
i
sap
p
ro
v
e
t
h
e u
tilizatio
n
of fam
i
ly p
l
an
n
i
ng
serv
ices b
y
th
eir
wiv
e
s
base
d
on
se
ver
a
l
bar
r
i
e
rs
. T
h
ese fi
n
d
i
ngs
ar
e i
n
l
i
n
e
wi
t
h
t
h
e re
p
o
rt
s
by
ot
he
rs
researc
h
ers
wh
o
co
n
d
u
c
t
e
d
cross
-
sect
i
o
nal
su
rvey
i
n
di
ffe
rent
part
s
o
f
Et
hi
o
p
i
a
[
8
]
,
[
9
]
,
[
13]
.
The l
o
w m
a
le i
nvol
vem
e
nt
was at
t
r
i
but
ed t
o
m
e
n’s rel
u
ct
ance t
o
su
p
p
o
r
t
us
e of m
oder
n
cont
raceptive
m
e
thods for
t
h
eir
s
p
ouse
s
or
t
h
em
selves
. This is i
n
turn
base
d
on c
u
ltural a
n
d re
ligion
i
n
fl
ue
nce,
Sex
pre
f
ere
n
ce f
o
r i
nhe
ri
t
a
nce an
d co
nsi
d
e
r
i
n
g
chi
l
d
re
n as m
e
asure
of
bl
essi
ng
of
G
o
d
,
pe
r
cept
i
o
n
t
h
at
fam
i
l
y
pl
anni
ng i
s
a wo
m
e
n’s i
ssue, l
ack o
f
k
n
o
w
l
e
dge a
nd
fear s
e
xual
p
r
om
i
s
cui
t
y
by
cont
ra
cept
i
v
e
u
s
ing
wiv
e
s.
Qu
alitativ
e stud
y u
s
i
n
g
fo
cu
sed
gro
u
p
d
i
scu
ssion
in
t
w
o
rural d
i
stricts
an
d
a
sep
a
rate stu
d
y
usi
n
g
key
i
n
fo
rm
ant
s
i
n
Ki
y
e
y
i
of T
o
ro
ro
di
st
ri
ct
i
n
Uga
nda
cam
e up
wi
t
h
si
m
i
l
a
r fi
ndi
ng
s [
7
]
,
[
1
6]
. T
w
o
i
nde
pen
d
e
n
t
re
searche
s
i
n
di
f
f
ere
n
t
part
s
of
Keny
a al
so
re
po
rt
ed si
m
i
l
a
r
out
c
o
m
e
s [11]
,
[
1
4
]
.
The a
w
ar
eness
and
kn
o
w
l
e
d
g
e
t
o
fam
i
ly
pl
anni
n
g
ser
v
i
ces and m
e
t
hods wa
s not
so p
o
o
r a
m
ong t
h
e part
i
c
i
p
ant
m
a
l
e
s i
n
t
h
i
s
st
udy
.
Thei
r
pr
act
i
cal
i
nvol
ve
m
e
nt
d
o
es
not
t
r
ansl
at
e t
h
ei
r
aware
n
ess
i
n
t
h
e c
ont
rary
as
i
ndi
cat
ed
i
n
si
m
i
l
a
r
st
udy
by
Ocha
ko
[
1
4]
.
H
o
we
ve
r, t
h
er
e are s
o
m
e
poi
nt
s s
p
eci
fi
c t
o
t
h
i
s
st
u
d
y
w
h
i
c
h a
r
e
not
wel
l
ex
pl
o
r
ed
by
o
t
her st
udi
es
su
ch
as th
e in
t
e
n
tio
n
of atte
mp
t to
d
e
grad
e t
h
e b
e
au
ty
o
f
w
i
ves t
h
r
o
ug
h c
h
i
l
dbea
r
i
n
g t
o
secure l
o
y
a
l
t
y
, and t
h
e
fact that bearing m
o
re children gi
ve
s a be
tter social status. T
h
e effect
of pare
nt
s o
f
m
a
rri
ed cou
p
l
es i
n
rel
i
g
i
o
us
fam
ily
set
t
i
ngs ca
n a
l
so
be
poi
nt
ed
out
a
s
part
i
c
ul
a
r
t
o
t
h
e c
u
r
r
e
n
t
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 5
,
N
o
. 1
,
Mar
c
h
20
16
:
46
–
50
50
5.
CO
NCL
USI
O
N
Th
e cu
rren
t stud
y id
en
tified
i
n
fl
u
e
n
c
e of cu
ltu
re an
d relig
i
o
n,
p
e
rcep
tion
to
ward
s fam
ily
p
l
ann
i
ng
as
wom
e
n’s i
s
s
u
e
,
sex
pre
f
ere
n
c
e
fo
r i
n
heri
t
a
n
ce and c
o
nsi
d
e
r
i
n
g chi
l
d
ren a
s
m
easure o
f
b
l
essi
ng
of
Go
d
,
an
d
fear o
f
pa
rt
ne
r sex
u
al
pr
om
i
s
cui
t
y
as
m
a
jor ba
rri
e
r
s t
o
m
a
l
e
i
nvol
ve
m
e
nt
i
n
fam
i
ly
pl
anni
n
g
se
rvi
ces
u
tilizatio
n
.
Fu
t
u
re in
terv
en
tion
s
aim
e
d
at imp
r
ov
ing
fam
ily
p
l
ann
i
n
g
serv
i
ces and
m
e
th
od
s
u
tilizatio
n
i
n
Arb
a
Min
c
h
t
o
wn
an
d sim
i
lar settin
g
s
n
e
ed
t
o
co
nsid
er th
ese po
in
ts i
d
en
tified
as m
a
in
bo
ttlen
eck
s fo
r m
a
le
i
n
v
o
l
v
em
ent
.
C
r
eat
i
ng a
w
ar
eness
o
n
be
ne
f
i
t
s
of
fam
i
l
y
pl
anni
ng
an
d
fos
t
eri
ng
fam
i
ly
pl
anni
n
g
o
p
t
i
o
n
s
wi
t
h
detail m
e
rits
and dem
e
rits of each is al
so
of cr
ucial im
porta
nce.
Em
phasis
m
u
st be
give
n t
o
m
a
le
cont
raceptive m
e
thods
a
nd m
a
les
friendl
y
fam
ily planning se
rvices wi
th
appropriate counseling.
We also
reco
mm
en
d
furth
e
r
q
u
a
litativ
e research
especially
th
rou
g
h
fo
cu
sed
grou
p
d
i
scu
ssi
o
n
to
weed
ou
t po
ssib
l
e
i
ndi
vi
dual
i
s
t
i
c
vi
ews a
nd t
o
a
ssess t
h
e wi
de
r
pers
pect
i
v
e o
f
the comm
unity at large. As
on
e of th
e p
a
rticip
an
ts
indicated that
rural bas
e
d
pare
nting of t
h
e m
a
rried
couples is still
evide
n
t in their perce
p
tion
furthe
r
q
u
a
litativ
e study
m
u
st b
e
con
d
u
c
ted
i
n
the rural settin
g
s
i
n
the v
i
cin
ity of the to
wn
.
ACKNOWLE
DGE
M
ENTS
We
wou
l
d lik
e to
ex
press
ou
r k
i
nd
g
r
atitud
e
to
all th
e
p
a
rticip
an
ts
who
acti
v
ely d
e
v
o
t
ed
t
h
eir tim
e to
co
m
e
u
p
with
su
ch
an
inv
a
luab
le d
a
ta. We wou
l
d
lik
e
also
to g
i
v
e
ou
r g
r
atitud
e
to Arb
a
Min
c
h
Un
iv
ersity
,
co
lleg
e
o
f
Medicin
e
and
Health
Scien
ce, fo
r g
i
v
i
ng
op
portun
ity to
cond
uct th
is
q
u
a
litativ
e research.
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NC
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M
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F
actors Influen
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