Providers' perspectives on male involvement in family planning in the context of a cluster-randomized controlled trial evaluating integrating family planning into HIV care in Nyanza Province, Kenya

Abstract

Integration of family planning (FP) services into HIV care and increasing male partner involvement in FP are being explored as strategies to reduce unmet need for contraception. Providers' views can give valuable insight into current FP care. We evaluated the perspectives of HIV care providers working at HIV clinics in Nyanza Province, Kenya, on male partner involvement in FP. This qualitative study was part of a cluster-randomized controlled trial evaluating the impact of integrating FP into HIV services on contraceptive prevalence among HIV-positive patients in Nyanza Province, Kenya. Thirty individual interviews were conducted among health-care workers at 11 HIV care facilities in Nyanza Province, Kenya. Interviews were conducted from integrated and control sites one year after implementation of FP/HIV integration. Data were transcribed and analyzed using grounded theory methods and ATLAS-ti. Providers supported male partner inclusion when choosing FP and emphasized that decisions should be made collaboratively. Providers believed that men have traditionally played a prohibitive role in FP but identified several benefits to partner involvement in FP decision-making including: reducing relationship conflicts, improving FP knowledge and contraceptive continuation, and increasing partner cohesion. Providers suggested that integrated FP/HIV services facilitate male partner involvement in FP decision-making since HIV-positive men are already established patients in HIV clinics. Some providers stated that women had a right to choose and start FP alone if their partners did not agree with using FP. Integrated FP services may be a useful strategy to help increase male participation to reduce the unmet FP need in sub-Saharan Africa. It is important to determine effective ways to engage male partners in FP, without impinging upon women's autonomy and reproductive rights.

Trial registration: ClinicalTrials.gov identifier: NCT01001507.

Keywords:

• HIV
• family planning services
• delivery of health care
• integrated
• health-care provider
• men
• Kenya

Acknowledgments

We acknowledge the important logistical support of the KEMRI–UCSF Collaborative Group and especially FACES. We gratefully acknowledge the Director of KEMRI, the Director of KEMRI's Centre for Microbiology, and the Nyanza Provincial Ministries of Health for their support in conducting this research. We thank the providers who generously gave their time to participate in this study and Jackline Otieno and Luke Odhiamabo for their important contributions to this research.

Funding

This study was funded by the Bill and Melinda Gates Foundation. Dr Newmann was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI [grant number KL2TR000143]. The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the funders.

Additional information

Funding

Funding: This study was funded by the Bill and Melinda Gates Foundation. Dr Newmann was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI [grant number KL2TR000143]. The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the funders.