Profiling Determinant Factors for Contraceptive Use among Married Men in a State in Southwest Nigeria. (2025)

Author(s): Samuel Oluwasogo Dada (corresponding author) [1]; Great Oluwamayokun Adebodun [2]; Oluwatobi James Hussain [3]; Oluwatoni Adediwura Tayo [4]

INTRODUCTION

Contraceptive use is vital in preventing unwanted pregnancies, minimising mother and child mortality, and enhancing women's lives and those of their families.[sup.[1]] The contraceptive prevalence rate among Nigerian women in 2022 was 18% while among males was 2%.[sup.[2]] Globally, the contraceptive prevalence rate among females has been reported to be higher than among males.[sup.[2]] There are various contraceptive methods, namely oral contraceptives, condoms, implants, tubal litigation, intrauterine devices, and vasectomy for males. The most commonly used male contraceptive methods in developed countries are vasectomy, withdrawal, and condoms.[sup.[3]] These modern contraceptives, when properly used, are effective for birth control.

In Nigeria, there is a high level of awareness and knowledge about contraceptive use among women, but there has been a low level of usage of contraceptives in the country.[sup.[4]] Females are more receptive to the use of contraceptives because they are the ones faced with pregnancy and childbirth risks. This is in addition to the fact that most contraceptive methods are female-controlled, hence giving them higher control over fertility.[sup.[5]] Males can also significantly influence fertility options.[sup.[6]] According to Thummalachetty et al., the involvement of men in family planning is a strategic means of increasing contraceptive use because men play a significant role in deciding to use contraceptives at the couple level.[sup.[7]] However, some of the factors that affect men's participation in reproductive health have been reported to include fear of side effects for their female partners, dissatisfaction, the belief that it is solely a woman's responsibility, lack of knowledge, fear of vasectomy affecting their physiological well-being and reducing their masculinity, and love for many children which is believed to be a source of respect.[sup.[8-10]] In a study among males in Saudi Arabia, vasectomy and male hormonal contraception were believed to be linked to several complications, thereby affecting men's involvement in contraceptive use. The same study found that contraceptive use is associated with educational level, monthly income, size of family, and being employed by the government and not necessarily with marriage duration, love for polygamy, and marital status.[sup.[11]]

The report from a Nigerian survey stated that men were more interested in reversible male contraceptives or contraceptive pills with no side effects which is also similar to a study carried out among Mozambican men.[sup.[12,13]] Some unwanted pregnancies occur because of men's opposition to the use of contraceptives.[sup.[14]] In some parts of Africa, particularly Ethiopia, 90% of men support and approve of the use of contraceptives for family planning, with about 36% not knowing male contraceptive methods. Studies in Pakistan and Ethiopia reported that discussions with family planning experts, level of education, fertility preferences, area of residence, and exposure to media such as TV, newspapers, and radio are linked with male contraceptive use.[sup.[6]] In previous research, barriers to the use of contraceptives include inadequate knowledge of female reproductive anatomy and physiology among men, concerns from men about adverse effects of contraceptives such as irregular periods, reduced sex drive, increased bleeding, and a lack of knowledge of the mechanism of action of the contraceptives.[sup.[7]] According to Msovela et al., access to family planning experts and the cost of visiting an expert influence men's attitudes toward contraceptive use.[sup.[15]] In general, men's knowledge of contraceptives is low, and the level of utilization has been reported to also be significantly low in developing countries.

Many previous studies have focused on women's views and knowledge on contraceptive use, with less attention given to assessing the knowledge and factors affecting contraceptive use among men despite their involvement in sex and reproduction.[sup.[16]] Therefore, this study was designed to investigate the determinant factors affecting the use of contraceptives among married men in a southwestern state (Oyo) of Nigeria. The PRECEED-PROCEED Model guided this study.[sup.[17]] with emphasis on the predisposing, reinforcing, and enabling factors for contraceptive use which can guide adequate educational and behavioral change interventions. The findings from this research aim to enhance knowledge, understanding, and thinking about how to improve contraceptive usage among men in Nigeria and other African sub-regions.

METHODS

Study design

This study adopted a descriptive cross-sectional survey design. A self-administered questionnaire was used to gather data. The population was comprised community members, particularly married men who live in Ibadan Metropolis and who provided informed consent to participate in the study.

Study site

The study was carried out in the Ibadan metropolis [Figure 1]. Ibadan is the capital city of Oyo State in southwestern Nigeria with over 3 million people living in the metropolis. Within the Metropolis, there are five local governments, namely, Ibadan North, Ibadan South-west, Ibadan South-east, Ibadan North-west, and Ibadan North-east, which are headed by elected executive chairmen. It is a metropolitan city with several professionals and artisans.

Figure 1: Map of Ibadan metropolis[sup.[18]] [see PDF for image]

Sampling and recruitment

A total of 402 male participants were systematically and randomly sampled across the five local government areas within the Ibadan metropolis. This was done at multiple stages; each local government in the metropolis was purposefully selected, and then a community in each local government was selected using simple random sampling by balloting. Households were systematically selected in each community, and actual participants were randomly selected based on willingness to provide informed consent to participate in the study.

Sample sizes were calculated using the Lesli-kish[sup.[19]] formula for sample size determination using a prevalence of 0.5 for contraceptive use, and a level of significance of 0.05

n = z[sup.2]pq/d[sup.2]

n = 1.96[sup.2] x 0.5 x 0.5/0.05

n = 384.16

Adding a 10% nonresponse rate, the estimated sample size for this study was 422.

Participants were recruited based on the sampling procedure, and a total of 402 persons who provided informed consent were given structured questionnaires to fill and these questionnaires were retrieved from them after they had been filled.

Inclusion and exclusion criteria

Men who could read and write in the English language, irrespective of level of education, those who were 18 years old and above at the time of data collection, and men who could provide consent were included in this study. Those who could not read or write and those who were <18 years old and could not provide informed consent were excluded from this study.

The instrument for data collection

Validated self-administered questionnaires were used for data collection. The instrument was validated through a review by peers and experts in the field of family planning and reproductive health and also by a review of relevant literature. The instrument consisted of four sections that elicited information on respondents' sociodemographics, knowledge of contraceptives, barriers, and factors influencing contraceptive use among men.

Data collection, management, and analysis

The researchers were involved in the process of data collection. Retrieved questionnaires were checked for completeness and errors before they were carefully coded and entered into statistical software (IBM Statistical Package for the Social Sciences, Version 24.0), and analyzed using descriptive statistics such as frequencies and means and inferential statistics such as binary logistic regression. Data were kept in a secured, password-protected computer system to prevent access by any third party.

The factors influencing contraceptive use, as presented in Table 1 were the frequencies of reported factors for contraceptives by the participants. Most of the participants listed at least more than one factor that influenced the use of contraceptives, and multiple response analysis was done to get the frequencies and the percentage and factor analysis was done to get the significant values.

Table 1: Factors influencing contraceptive use (n=402) [see PDF for image]

Each correct knowledge item was scored 1 point, making it a total score of 16. Knowledge score (KS) 5 (5 and =10 (41%-69%) was categorized as fair, and a score >10 (70%) above were categorized as good knowledge for contraceptives.

Ethical considerations

This study received ethical clearance from the Health Research Ethics Committee of the Ministry of Health, Oyo State, Nigeria, to ensure the study complies with national and international ethical guidelines in research involving human participants. Anonymity and privacy were ensured at every stage of the research. The principles of beneficence and justice were upheld. Participants were at liberty to decline participation at any research stage without any consequence. All participants provided written informed consent.

RESULTS

Sociodemographic characteristics of respondents

Overall, a total of 402 married men in Oyo State, Nigeria, participated in this study. The mean respondents' age was 33 ± 3.6 years, the majority (50.0%) were Christians, while 55.5% had a tertiary level of education. The family size of respondents was mostly (74.1%) nuclear and 25.9% had an extended family. Most (88.1%) of the participants in this study were gainfully employed, with the majority (49.3%) having an average family income of less than N50,000 per month. Many (58.7%) of the respondents have a current household number of >4, with slightly more than half (51.5%) of the participants currently using a contraceptive method [Table 2].

Table 2: Respondent's sociodemographic profile (n=402) [see PDF for image]

Knowledge of contraceptive use

Knowledge of participants on contraceptive use is presented in Table 3. Most (93.8%) of the participants had heard of contraceptives before, 74.8% knew contraceptives were effective for birth control, and 64.2% knew contraceptives would prevent unplanned pregnancy. Many participants knew about different contraceptive methods, including vasectomy, intrauterine devices, condoms, withdrawal methods, abstinence, implants, and oral pills. Slightly more than average (52.5%) of the participants knew they could get contraceptives from hospitals, and 85.3% knew they could buy contraceptives from a pharmacy store. While participants knew contraceptives have some side effects, 75.4% knew contraceptives could help to effectively space children. The majority (76.9%) of the respondents have a good KS on a 16-point knowledge scale on contraceptives; 10.4% had fair knowledge, while 12.7% had poor knowledge of contraceptives [Table 4].

Table 3: Knowledge of contraceptive use (n=402) [see PDF for image]

Table 4: Total knowledge score (n=402) [see PDF for image]

The factors influencing contraceptive use among the study population are presented in Table 1, while barriers to contraceptive use are presented in Table 5. The significant influencing factors for contraceptive use reported in this study include education level, availability and access to contraceptives, cost of contraceptives, and the influence of peers. The barriers to contraceptive use include cultural, religious, and traditional beliefs, fear of side effects, partner disapproval, and the desire to have more children.

Table 5: Barriers to contraceptive use (n=377) [see PDF for image]

In profiling predictors for contraceptive use, a binary logistic regression analysis of the significant factors influencing contraceptive use among men indicated that level of education, access to contraceptives, and the cost of contraceptives could be predictors for contraceptive use among the study population [Table 6].

Table 6: Logistic regression analysis between significant influencing factors for contraceptive use and current use of contraceptive [see PDF for image]

DISCUSSION

This study contributes significantly to married men's knowledge, influencing factors, and barriers in their utilization of contraceptives. The mean age for participants in this study was 33 ± 3.6 years in comparison to 37 ± 5.7 years reported in a previous study[sup.[20]] among married men in Indonesia and 34 ± 6.1 years among married men in Ethiopia.[sup.[21]] This finding revealed that more than half of the sampled population are currently on contraceptives; this is higher than the 30% reported in an assessment of Contraceptive Use by Marriage Type Among Sexually Active Men in Nigeria in a previous study[sup.[22]] while a higher prevalence of 69.7% and 75% were reported by Sultan et al.[sup.[20]] in Pakistan and Ethiopia,[sup.[21]] respectively. The differences in these studies may be due to sociodemographic variation between the countries and access to family planning methods. This disparity in the finding could also be a result of 58.7% of the men having a minimum of two children with a likelihood of not desiring more children, which also supports the findings where a higher odd of contraceptive use was seen among men with a household number of four and above compared to their counterpart who had less and desired more children.[sup.[20,21]] It also supported the fact that as age increases, there is more likelihood to use contraceptives. Level of income is a strong determinant in contraceptive use[sup.[20]] as almost all the respondents in this study being gainfully employed could also be adduced to the comparatively high prevalence of contraceptive use.

Moreover, it was revealed in this study that many of the respondents have good knowledge of contraceptives, indicating that most of the respondents have heard of contraceptives and this supports previous findings where the respondents had good knowledge of contraceptives.[sup.[21,23]] Most of the participants in this study knew contraceptives were effective for birth control and preventing unplanned pregnancy. This high level of knowledge displayed by the respondents could be because of the high level of education reported among the sampled population. Having knowledge of where to get contraceptives could necessitate the use, as this study revealed that more than half of the participants knew they could get contraceptives from hospitals, and 85.3% knew they could buy contraceptives from a pharmacy store. It was revealed that 26.4% of the respondents did not know where to source contraceptives, and despite knowing contraceptives could have side effects, the majority knew it could effectively enhance birth spacing.

One's level of education is a major and influential factor in utilizing family planning. The significant influencing factors for contraceptive use reported in this study include education level, which is similar to previous findings[sup.[22]] where the educational level has a strong positive influence on contraceptive use, as well as availability and access to contraceptives, cost of contraceptives, and the influence of peers. In line with the study among Indonesian married men, education is the most dominant factor affecting family planning utilization, and men with high levels of education have a 2.8 times higher chance of utilizing family planning than men with low levels of education.[sup.[20]] Meanwhile, this finding revealed that the barriers to contraceptive use include cultural, religious, and traditional beliefs, fear of side effects, partner disapproval, and desire to have more children, which is similar to the reports revealed by Asa et al. and Okunola et al.,[sup.[22,24]] even though religion was not a barrier to contraceptive use among married men in the study by Asa et al.[sup.[22]]

A binary logistic regression analysis of the significant factors influencing contraceptive use among men indicated that level of education, access to contraceptives, and the cost of purchasing contraceptives could be predictors for contraceptive use among the study population. The use of modern contraceptives requires some financial commitment from the users, especially when such services are inaccessible, or service providers are at locations far from the users' abode. It was revealed that men with a high economic/richest status have a 3.1 times higher chance of utilizing family planning than their counterparts. A similar study conducted in the United States of America showed that one of the key barriers to contraception for low-income men and men of color is financial accessibility.[sup.[25]] A study conducted in Uganda similar to this study setting revealed that economic status is one factor that influences contraceptive use in men.[sup.[26]] This study has further added to the literature that many factors contribute to contraceptive use among men in developing countries.

Although contraceptive use is generally low among married men in Nigeria, this study concludes that the knowledge of contraceptives among married men is good. However, the knowledge did not translate into utilization as only about half of the participants in this study were currently using contraceptives. Level of education, income, and access to contraceptives are the major factors influencing the use of contraceptives. The barriers to the use of contraceptives among men were cultural, religious, and traditional beliefs, fear of side effects, partner disapproval, and the desire to have more children, which should guide and inform necessary health education and behavioral change intervention programs.

CONCLUSION

This study documented good knowledge and identified the determinant factors for contraceptive use among married men. Therefore, it becomes imperative for a holistic public health intervention to be designed to address the barriers to contraceptive use among men in Nigeria. Efforts to peg the barriers to contraceptive use should be the central focus. The government should make efforts to ensure that contraceptives are accessible and affordable. There is also a need to intensify the implementation of the policy on family planning where couples can be encouraged to discuss and jointly decide on the adoption of family planning services.

Authors' contributions

All authors were involved actively in the conceptualization and implementation of the research. All authors participated in data collection, coding, and analysis. The manuscript was drafted and approved by all the authors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The authors acknowledge all the research participants for their willing participation in the research.

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Author Affiliation(s):

[1] Department of Public Health, Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, United Kingdom

[2] Department of Physiology, School of Basic Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria

[3] Department of Health and Promotion Education, Faculty of Public Health, University of Ibadan, Ibadan, Oyo State, Nigeria

[4] Department of Clinical Research, University Hospital Plymouth NHS Trust, Plymouth, United Kingdom

DOI: 10.4103/jphpc.jphpc_28_24