Shahjahan et al.

Reproductive Health 2013, 10:27

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RESEARCH Open Access

Determinants of male participation in

reproductive healthcare services: a cross-sectional
study
Md Shahjahan1*, Shirin Jahan Mumu2, Afsana Afroz3, Hasina Akhter Chowdhury3, Russell Kabir4 and Kapil Ahmed5

Abstract
Background: The role of male’s participation in reproductive healthcare is now well-recognized. The present study
investigated the role of men in some selected reproductive health issues, characterizing their involvement,
including factors influencing their participation in reproductive healthcare services.
Methods: This study was conducted in the working areas of urban and rural implemented by NGOs. The sample-size
was determined scientifically. The systematic sampling procedure was used for selecting the sample. The study
included 615 men aged 25-45 years. Bivariate analysis was performed between male’s involvement as the dependent
variable with several independent variables. Logistic regression analysis was applied to assess the effects of risk factors
on the participation of men in reproductive health care services.
Results: The mean age of the respondents was little over 34 years while their mean years of schooling was 3.7, and
their mean monthly income was about Tk 3,400 (US$ 1 = Tk 70) at the time of the study. Rickshaw-pulling and driving
was the main occupation of the respondents from the urban while farming were main occupation in the rural area
respectively. About two-thirds of the respondents discussed reproductive health issues with their wives and
accompanied them to healthcare facilities. The current contraceptive-use rate was 63% among the men who attended
the evening clinics. Results of bivariate analysis showed a significant association with education, occupation, income,
access to media, and number of living children. Results of logistic regression analysis showed that secondary to higher
education level, number of living children, paid employment status, long marital duration, and access to media were
important correlates of males’ involvement in reproductive healthcare services.
Conclusions: The results imply that a greater integration of reproductive healthcare matters with the Millennium
Development Goals and increasing perception of men through enrollment in various components of reproductive
activities will produce synergistic effects.
Keywords: Cross-sectional studies, Male participation, Reproductive health, Bangladesh

Background still largely female-oriented. The reproductive health

The Program of Action of the ICPD clearly set a new programmes have traditionally focused on women and the
agendum when it emphasized on male’s responsibilities exclusion of men. However, results of recent studies re-
and participation in reproductive healthcare services [1]. vealed that men might serve as gatekeepers to women’s
Although consensus was reached on involvement of men access to reproductive health services significantly [2].
in reproductive health, and the policy environments gen- The concept of reproductive healthcare is that men,
erally support that notion in many countries including women, and young people have the right to be informed
Bangladesh, healthcare service for reproductive health is and have access to safe, effective, affordable, and accept-
able reproductive healthcare services [3]. Although there
is a tendency to overlook the relevance of men in mat-
* Correspondence: [email protected]
1
Assistant Professor, Department of Biostatistics, 125/1 Darussalam, Mirpur,
ters relating to reproductive healthcare, they have sub-
Dhaka -1216, Bangladesh stantial reproductive health influence. So, reproductive
Full list of author information is available at the end of the article

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health in its broader sense should be a concern for all, the contribution of different factors for increasing the par-
not just that of women. ticipation of men in reproductive activities.
A large number of articles [4-6] and the growing num-
ber of conferences, research projects, and debates on this Methods
subject bear testimony to the importance of this issue, Operational definition
both from the programmatic point of view and as a Male involvement
process for bringing about a gender balance in men’s and Among the spousal communicating men, those who
women’s reproductive rights and responsibilities. This are visiting clinics with their wives, and of them, those
renewed interest in male’s involvement is not unconnected attend delivery care are considered that they partici-
with the HIV/AIDS pandemic that has spurred an intense pate or are involved in reproductive healthcare ser-
interest in the promotion of condom-use. Effective family vices. Towards ensuring an effective participation of
planning is important in spacing childbirth so that both males in reproductive healthcare services, spousal
mother and child can gain the maximum quality of life, es- communication of men, accompanying wives during
pecially the mothers at high -risk. Birth spacing will also visits to clinics, and their delivery care are the essential
give the mother ample time to recuperate from her previ- preconditions of male’s involvement.
ous pregnancy [7].
Men, especially in Africa, are dominant and are the
major decision-makers in family affairs, including repro- Evening clinic
ductive healthcare matters [8]. The dominance of male in Evening clinics are those which are run by Service pro-
this respect is reinforced by the cultural institution of viders and which offer counseling on reproductive health
patriarchy, religion, and the economic power that men issues for males in the evening (from 5 pm to 9 pm).
wield. Ezeh reportedted that, in Ghana, spousal influence
in respect of reproductive goals, rather than being mutual Methods and procedures
or reciprocal, is an exclusive right exercised only by the This cross-sectional study was carried out among males
husband [9]. In Ilorin, Nigeria, one of the major reasons who visited some selected NGOs working in both urban
for not adopting modern contraceptive method by women slums and rural areas of Bangladesh. Married males
is the husband’s resistance [10]. In northern Nigeria, who attended an evening clinic constituted the sam-
women cannot practice family-planning method without pling frame. In total, 615 men were randomly selected
the formal consent of their husbands [11]. for the study.
Reasons for involving men in reproductive health The sample-size* was determined using the statistical
matters are multifaceted. First of all, men have their cluster-sampling technique. The cluster was NGO
own reproductive health concerns and their involve- evening clinics. Six study sites were randomly selected
ment should not be seen only as a means to achieve from NGOs working in urban slums and rural areas lo-
women’s better reproductive healthcare. Second, men’s cated in Agargoan (Dhaka), Narayanganj, Narsingdi,
sexual and reproductive well-being and behaviours Tangail, Narail, and Gaibandha. From each of these six
directly affect their partners. Third, decisions on sites, at least 100 men were interviewed employing a
the matters of reproductive healthcare occur within re- systematic sampling technique. Trained interviewers
lationships that affect both men and women [3]. The and field supervisors were recruited to collect data
involvement of men in reproductive healthcare matters from the health centers. A pre-tested structured ques-
should be seen as an important measure for achieving tionnaire was used for collecting information on socio-
the MDGs that include the reduction of maternal mor- demographic characteristics, cultural factors, and on
tality and reducing the prevalence and impact of HIV/ the use of family-planning methods.
AIDS [12].
In the present context of Bangladesh, involving men and
bringing positive influences in reproductive healthcare ser- Analysis of data
vices are the crucial aspects of enhancement of couples’ Data were analyzed using the SPSS software for
reproductive healthcare services. Therefore, identification Windows (version 17). The associations between the
of demographic variables relating to men’s involvement variables were measured using the appropriate statis-
and the contribution of different influencing factors to tical techniques such as χ2 and logistic regression. Bi-
demographic change would help to formulate future pol- variate analysis was performed between male’s involvement
icies for achieving the demographic target through men’s as the dependent variable and each independent variable.
involvement. In this paper, an attempt has been made to Linear logistic regression analysis was done to determine
assess the relationship between the level of men’s involve- the factors affecting men’s participation in reproductive
ment and the demographic variables in order to measure healthcare services.
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*
Table 1 Socio-demographic characteristics of respondents The sample size was determined using the formula:
(n = 615)
Variable Number Percentage
n ¼ NZ2 pð1−pÞ=Nd2 þ Z2 pð1−pÞ
Age (years)
≤30 231 37.6
31-40 268 43.6
Results
41+ 116 18.8
The distribution of the socioeconomic and demographic
(mean; 34.1 SD = ±7.6) characteristics of the respondents is shown in Table 1.
Education The mean age of the respondents was 34 [standard devi-
No education 272 44.2 ation (SD) ± 7.6)] years. Forty-four percent of the re-
Up to class Five 132 21.5 spondents had no education. The mean years of
schooling of the respondents were 3.7 (SD ± 4.1).
Up to HSC pass 201 32.7
Rickshaw-pulling and driving were the primary occupa-
Graduate and above 10 01.6
tions of the men living in the urban slums, followed by
(mean; 3.7 years, SD = ±4.1) business, monthly salaried job, and day laborer. The
Occupation mean income was Tk 3,438 (US$ 1 = Tk 70), and the
Farming 263 42.7 mean land holding was 37.5 decimals. In the case of ac-
Service 91 14.8 cess to media, around 34% of the men had no access to
any media, 35% had access to one, 21% to any two, and
Business 198 32.2
10% had access to all three media, such as newspapers,
Driving 63 10.3
radio, and television (TV).
Access to media The distribution of respondents’ inter-spousal commu-
Read newspapers nication is shown in Table 2. More than half (58%) of
Yes 118 19.2 the husbands accompanied their wives during visits to
No 497 80.8 clinics. Two-thirds of the husbands discussed about
reproductive healthcare issues with their wives. Most
Listening radio
(95%) couples were approving any family-planning
Yes 315 51.2
methods. The proportion of couple currently using any
No 300 48.8 contraceptive method was 63.1%.
Watching television Table 3 presents the results of bivariate analysis be-
Yes 227 36.9 tween the male’s involvement and the demographic
No 388 63.1 variables. A significant association was found among
education (p < 0.001), occupation (p < 0.001), income
Marital duration (years)
<5 177 28.8 Table 2 Distribution of respondents by their inter-spousal
5-10 183 29.8 communication
11+ 255 41.4 Variable Number Percentage
Wife work outside Visits to clinics with wife

Yes 56 9.1 Yes 354 58.4

No 559 90.9 No 252 41.6

No. of living children (n = 531) Discussing about reproductive health issues

1 158 30.8 Yes 416 66.0

2 154 30.0 No 197 32.0

3 108 21.0 Others 12 2.0

4+ 93 18.2 Currently using family planning methods

(mean = 2; SD ± 1.6) Yes 388 63.1

Results are present as n (%) and mean (±SD). HSC: Higher No
Secondary Certificate.
Approval of family planning 227 39.9
Yes 585 95.1
No 30 4.9
Results are present as n (%).
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Table 3 Bivariate analysis between male’s involvement (p < 0.001), access to media (p < 0.001), and number of
and demographic variables living children (p < 0.003).
Background characteristics Male’s involvement in p Table 4 shows the results of logistic regression ana-
reproductive health value lysis, which was performed for identifying the factors af-
Yes No fecting the involvement of males in reproductive
(n = 152) (n = 463)
healthcare services. The fitness of model was significant;
Age (years)of respondent
≤30 48 183 Table 4 Logistic regression analysis on involvement of
31-40 78 190 0.085 male in reproductive healthcare services
41+ 26 90 Independent variable β p OR 95% CI for
value Exp (β)
Education
Lower Upper
No education 42 222
Age (years)* −0.007 0.764 0.993 0.951 1.058
Primary 27 124 0.001
Educational level
Secondary + 83 117
No education Reference
Occupation
Up to primary -0.039 0.895 0.962 0.541 1.711
Farming 36 227
Secondary+ 0.925 0.001 2.523 1.439 4.424
Service 36 55 0.001
Occupation
Business 67 131
Farming Reference
Driving 13 50
Service 0.912 0.005 2.489 1.3 14 4.714
Monthly income (BDT)
Business 0.814 0.003 2.256 1.3 14 3.875
Up to 2,500 50 180
Driving 0.245 0.521 1.278 .065 2.699
2,501 – 4,000 48 192 0.001
Monthly income (BDT)* 0.000 0.117 1.000 1.000 1.000
4,001 – 5,500 34 45
Access to media
5,501+ 20 46
No Reference
Access to media
Yes 0.647 0.015 1.910 1.136 3.213
No 28 182 0.001
Number of living children
Yes 124 281
≤1 Reference
Number of living children
2 0.659 0.043 1.934 1.021 3.664
<1 57 203
3+ 0.075 0.851 1.078 0.492 2.363
2 54 100 0.003
Duration (years)of marital life
3+ 41 160
<5 Reference
Marital duration (years)
5-10 0.548 0.081 1.730 0.934 3.202
<5 37 140
11+ 0.436 0.292 7.547 0.687 3.481
5 - 10 56 127 0.080
Wife works outside
11+ 59 196
No Reference
Wife work outside
Yes 0.164 0.653 1.179 0.575 2.415
Yes 131 43 0.779
Approval of family planning
No 39 420
No Reference
Approval of family planning
Yes 0.876 0.181 2.402 0.664 8.688
Yes 149 436 0.055
Currently using family- planning
No 3 27 methods
Currently using family-planning methods No Reference
Yes 97 291 0.817 Yes −0.019 0.934 0.981 0.622 1.548
No 55 172 −2log likelihood 604.049 0.000
χ2 test was performed to find the association. BDT: Bangladeshi Taka. Model chi-square 81.472 0.000 0.039
Constant −3.236
*In this model, age and monthly income (BDT) were considered as
continues variables.
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chi-square was 81.472 (p < 0.001), and -2Log likelihood The results of logistic regression analysis again revealed
was 604.049. Men having secondary and higher-level that men having more education, higher income level, and
education were more likely to be involved in reproduct- those who access to media were more likely to be involved
ive healthcare services than men who had no or primary in reproductive healthcare services. The logistic regression
education. Men who were paid employees were more results further documented that men with the marital dur-
likely to be involved in reproductive healthcare services ation of 5–10 years were more likely to be involved in
compared to farming professionals. Men who had two reproductive healthcare services compared to their coun-
children had higher odds of involvement in reproductive terparts. The longer marital duration increases men’s par-
healthcare services than those with no or one children ticipation in reproductive healthcare services.
whereas men having three or more children had lower It is, thus, a very crucial area that needs continuous
odds of involved in reproductive healthcare services. strengthening and increasing male’s participation in repro-
Men with the marital duration of 5–10 years were sig- ductive health services to reduce the maternal pregnancy
nificantly more likely to be involved in reproductive related risks. This male participation in reproductive
healthcare services than those with the marital duration health issues also leads to better understanding between
of less than five years. Men who had access to media were husbands and wives, which would reduce unwanted preg-
more likely to be involved in reproductive healthcare ser- nancies and the unmet needs for family planning. Increas-
vices than their counterparts. ing the perceptions of men through involvement in
various reproductive activities is believed to produce syn-
Discussion ergistic effects that could be a greater integration of repro-
In reproductive health matters, most people viewed ductive health matters with the MDGs. The growing
women as the target group, and little attention is given private sector in Bangladesh will have the greater scope to
to the role of men. However, in patriarchal society where provide men-friendly reproductive health services, which
decisions are largely made by men, the needs to include deserves due attention more. Finally, it could be suggested
them in all matters that require joint spousal decisions that more pragmatic and target-oriented program are be
are crucial to achieving the reproductive health goals. required to increase the involvement of men in reproduct-
This paper aimed to determine the factors that influence ive health matters in Bangladesh.
the involvement of males in reproductive healthcare.
The study results mainly revealed that when men had a Ethical consideration
higher level of education, their involvement in repro- This study was approved by the National Ethics
ductive healthcare was more. The result is comparable Committee of the Bangladesh Medical Research Council.
to the study conducted in Nigeria where men without Written informed consent was obtained from the all par-
formal education are likely to more conservative outlook ticipants. Ethics has been respected throughout the
towards family life [13]. Men are more exposed to radio, whole study period.
TV, newspapers, and diversified personal communica-
tion than women as men generally have more free time,
Competing interests
more education, more disposable income, and, in many
The authors declare that they have no competing interests.
cultures, more freedom of movement than women [14].
Men who have exposure on mass media have effects in Authors’ contributions
changing their attitudes to use of family planning and MS contributed his intellectual ability to conception and design of the
research analysis and interpretation of data; drafting the article and revising
their spousal communications improve. This exposure of it critically for important intellectual content; and final approval of the
men obviously increased contraceptive-use and following version to be published. SJM, AA and HAC participated on drafting the
the use of mass media has other behavioral change [15]. article and revising it critically for important intellectual content; and final
approval of the version to be published. RK revises the manuscript for
The results of the present study showed that the majority important intellectual content. KA works on analysis and interpretation of
66% of the men discussed the reproductive health-related data; and final approval of the version to be published. All authors’ read and
matters with their wives and accompanied their wives for approved the final manuscript.
seeking reproductive healthcare services. The proportion
Acknowledgements
of couples in this study are currently using any contracep- We are grateful to the National Ethics Committee of the Bangladesh Medical
tive methods was 63%. The results also revealed that most Research Council for funding this study under UNFPA research program.
married couples were approving family-planning methods
Author details
(95%) in achieving the reproductive health benefits, which 1
Assistant Professor, Department of Biostatistics, 125/1 Darussalam, Mirpur,
indicates that men knowledge on family planning was Dhaka -1216, Bangladesh. 2Assistant Professor, Department of Epidemiology,
high. A study was conducted in Ethiopia showed that 96% Bangladesh Institute of Health Sciences (BIHS), Darus Salam, Mirpur, Dhaka -1216,
Bangladesh. 3Lecturer, Department of Biostatistics, Bangladesh Institute of Health
of married men approved at least one method of family Sciences (BIHS), Darus Salam, Mirpur, Dhaka -1216, Bangladesh. 4Doctoral Student,
planning [16], which is similar with our study. Economics & Statistics Department, Business School, Middlesex University,
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London, UK. 5Research Manager, Bangladesh Center for Communication

Programs, Dhaka, Bangladesh.

Received: 26 June 2012 Accepted: 13 May 2013

Published: 16 May 2013

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doi:10.1186/1742-4755-10-27
Cite this article as: Shahjahan et al.: Determinants of male participation
in reproductive healthcare services: a cross-sectional study. Reproductive
Health 2013 10:27.

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