Assessment of men involvement in family planning services use and associated factors in rural Upper West Region of Ghana

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The study assessed factors which promote or hinder the uptake of FP services among partners in a rural setting of northern Ghana. Methods A cross-sectional descriptive study design was used to collect data from 200 respondents. Study respondents were selected through random cluster sampling. Results The findings showed that men partners’ knowledge (95.5%) and approval (72.8%) of FP services were high. Approval of services was also confirmed by their men partners (75%). Mass media was the commonest source of contraception information (48.1%) with the radio (29.4%) being the most popular source. The findings also indicated that men had a higher propensity (X 2 = 4.5534, p = 0.033) of supporting a FP method use. Women who reported that their spouse supported FP method use were more likely to use a contraceptive method (X 2 = 9.5223, P = 0.002) if their spouse supported FP method use (X2 = 9.5223, P = 0.002) and if their partners had some education (X2 = 14.1133, P = 0.000). Reasons for low contraceptive use were health risks, side-effects and socio-cultural norms. Conclusion Family planning programs need to include men at all levels of health promotion and education of FP programs to help reduce misconceptions about contraceptive Architecture, Design and Planning Public Relations Family planning services men partners Upper West Region Ghana Background Family planning services are critical to improving maternal and child health and reducing maternal and infant mortality [1]. Expanding the availability of FP services and working on the utilization of services in LMICs could avert up to 42% of maternal deaths [1, 2] . Men are also recognized to be responsible for the large proportion of reproductive ill health suffered by their partners’ use of FP methods [3]. Although contraceptive methods and services are frequently geared towards women, men are often the primary decision makers on family size and their partners’ use of FP methods [4]. It is well documented that men's general knowledge and attitude about the ideal family size, gender preference of children, ideal spacing between child births, and contraceptive methods use greatly influence women's preferences and opinions[3, 5, 6]. The 1994 Cairo International Conference on Population and Development recognized that men involvement in reproductive health issues is required and further work with men is needed for effective change [7]. The effects of men and the socio-cultural construction of masculinities on women’s reproductive health outcomes are also recognized [8]. The World Fertility Survey showed that utilization of FP methods varied widely from 69% in south-east Asia to 11% in Africa 9. Evidence showed that there is high unmet need for contraceptive use in most developing countries and even higher In sub-Saharan African countries where the number of women with unmet need for modern contraception increased from 31 million in 2008 to 36 million in 2012 [9]. In Ghana, the focus of this study, knowledge of any contraceptive method is almost universal, with 98% of all women and 99% of all men knowing at least one method of contraception 10 and where 50% of all women reported having used a method contraception before [10]. However, according to the 2014 Ghana Demographic and Health Survey, only 27% of married women use FP with 22% using a modern method and 5% using traditional method [11]. Family planning in Ghana dates as far back as 1956 [12]. However, studies have shown that uptake of FP services in Ghana has not been encouraging and for that matter Tumu in the Sissala East District of the Upper West Region which experienced a decrease from 71.4% in 2011 to 50.7% in 2012 [13]. Family planning research in rural Ghana have been dominated by findings almost exclusively from women studies. Men especially in Ghana are seen to be the head of the home and influence healthcare decisions of the entire household [14]. Studies have also shown an increase in contraceptive use in cases where men partners have been involved [4, 15]. Men involvement helps not only in accepting contraceptives uptake but also its effective use and continuation [4, 5, 15]. However, men partners role in FP services promotion and uptake has often overlooked and neglected in LMICs such as Ghana. To fill this research gap, this study assessed factors that promote or hinder contraceptive uptake among women and their men partners in a rural district of the Upper West Region. Methods Study setting The study took place in Tumu in the Sissala East District in the north-eastern part of the Upper West Region of Ghana. Tumu, the district capital is predominantly rural by nature, with majority (85 %) living in rural settings [16, 17]. A large percentage (84%) of the population live below the poverty line [16, 17]. A greater proportion (76%) of the population are being engaged in agriculture. It is predominantly Islam (88.0%) with Christianity being the largest of the minority (10%) followed by Traditional (1.4%) [16, 17]. A greater proportion of the population (52.4%) has Some level of education [16]. Study Design A cross-sectional descriptive study design was used for this study. An interviewer administered questionnaire consisting of both open and close-ended questions were administered by experienced research assistants to elicit the necessary information from the study population. Sampling technique and sample size The sample size for this study was determined using the Yamane method: p = margin of error (5%). A sample size of 386 was derived from the total population of 11,252. Study population The study population consisted of adult males and females aged 15 years and above who were either married or cohabitating. For this study, we aimed at recruiting 386 respondents but finally recruited 200 respondents due to financial constraints. Data Collection method An interviewer administered questionnaire consisting of both closed and open-ended questions was used to assess the knowledge and use of FP services among partners. The study questionnaire was developed based on the objective of this study by the principal investigator. The questionnaire was administered by the first author and other two experienced research assistants who understand the native dialect. It was administered in English and translated into the local dialect for those who could not understand or speak the English language. The data was administered among households in five communities or clusters out of the ten in Tumu municipality. These communities were chosen using a simple random sampling method. Forty respondents were interviewed from each community. This method gave the individual an equal chance of being selected. Before permission was sought from respondents, the aim of the study was explained to each individual. They were also assured of confidentiality and privacy of information they will give. The questionnaires were pretested in a similar environment in the district. Data management and Analysis To ensure accuracy, data collected was checked and screened for completeness. The completed copies of the questionnaire were serially numbered coded and doubly entered and analyzed using Statistical Package for Social Scientists version 20.0. Bivariate and regression analyses were used to determine the associations between the outcome variables and a host of explanatory variables. Results Background characteristics of respondents Two hundred (200) respondents were interviewed for this study. The study involved 107 men representing 53.5% and 93 women representing 46.6%. Respondents’ age ranged between 15-54 for men and 15-49 for women. In all, over seventy percent (76.5%) had some form of education ranging from primary to tertiary while (23.5%) had no education. All the respondents were involved in some kind of work with over sixty percent (66%) being artisans. Knowledge of Family Planning. Majority of the men respondents (95.5%) had heard of FP. Almost half of the respondents (48.1%) had information about FP via the mass media (Television, Radio and Newspaper) followed by friends (27.5%) and the health facility (23.5%) as indicated in Table 1. Table 1: Source of Information on family planning Source Frequency Percent (%) Television 17 16.7 Radio 30 29.4 Newspaper 2 2.0 Internet 1 0.9 Friends 28 27.5 Health facility 24 23.5 Total 102 100.0 Twenty eight percent (28.0%) of the men interviewed understood FP as avoidance of unintended pregnancy, 25.2% as limiting family size while 19.6% understood it as spacing of childbirth. Others (27.1 %) explained it as two or more of the above definitions as shown in table 2. The most common method known and used was the condom (42.5%) followed by implants (32.0%) and the least known method being the foam tablet (7.0%) among men respondents. Table 2: Men understanding of meaning of family planning. Meaning Frequency Percent (%) Limiting family size 27 25.2 To avoid unintended pregnancy 30 28.0 Spacing childbirth 21 19.6 Others 29 27.1 Total 107 99.9 Men involvement in FP Over fifty percent (52.2%) of the men respondents reported they or their partner were currently using some form of contraceptives to delay or avoid pregnancy. However only 36.4% of women reported they or their partner were currently using contraceptives to delay or avoid pregnancy. Majority of the men respondents (72.8%) approved of the use of FP methods by their partners, 75% of the women respondents also indicated their partners had approved of their use of FP. The findings also indicate that men had a higher propensity of reporting FP use (X 2 =4.5534, p= 0.033). For the couples who did not approve of the FP methods, the reasons included: socio-cultural beliefs (31%), side effects (30.8%) and others (38.5%). Decision making in FP use We wanted to know from the women whether their partners support them in their desire to use contraceptives; 67.0% of the women answered in the affirmative and 33.0% answered in a negative. Those who answered in the affirmative said their partners support them by providing money for transport to facility and/or for FP services, encouraging and accompanying them to the health facility. Women who reported that their spouse support FP use were more likely to use a contraceptive method (X 2 = 9.5223, P=0.002) compared to those who said no. Women who reported their partners had some education were also more likely to use a contraceptive method (X 2 =14.1133, P=0.000). Generally, a greater proportion of men (77.6 %) intend using FP in the future. For those who answered in a negative, 19.1% said most of the contraceptives were designed to suit women and thought it was a woman’s business. Nearly three quarters of women (73.4%) who ever used a FP method indicated their partner had a say in the decision to use. For the women interviewed,70.7% said they would still practice birth control irrespective of their partners’ opinion while 23.9% would not use birth control if their partners were against it, 5.4% were however were not certain. Discussion This study assessed men partners knowledge and factors associated with use of FP services in Tumu in the Sissala East District of the Upper West Region of Ghana. The study identified several factors that influence FP services use among partners in this setting. Our study demonstrated that despite the high knowledge of modern contraceptive methods among couples, use was low due to side effects and socio-cultural norms. Men’s attitude and social practice towards family planning methods also influence the behaviour of their partners using contraceptives [ 18 ]. It is found elsewhere that the decision not to practice FP is men dominated and men are responsible for providing contraceptive decision when FP is practiced [ 19 ]. A major limitation facing low-and-middle come countries family planning promotion programs and population policy development on contraceptive behaviour is that men are always neglected [ 20 ]. Our study identified several factors associated with men’s influence in FP service utilization among their partners. Non-approval of family planning methods by men this study was attributed to perceived risks, side-effects and socio-cultural norms. Focus groups with men and women in rural Uganda have come out with similar findings [ 4 ]. Contraceptive knowledge and use are shaped by the socio-cultural cultural environment as are personal attitudes and feelings about contraception. In rural settings in low-and -middle income countries most men may be unwilling to have their wives adopt family planning, which they themselves have little knowledge about it. Evidence show that some oppose contraceptive use for reasons of tradition and religion which require men to maintain the honour and position of their extended family, village, religious group and social organization [ 21 ]. Studies have come with similar findings in settings in rural northern Ghana [ 22 , 23 ]. The complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them to take their wives to health clinics to discuss family planning issues [ 20 ]. Several interventions can be used to address barriers in the uptake of family planning services in this setting. Family planning programs need to target men at all levels of health promotion and education with their partners to reduce misconceptions about family methods to increase acceptance [ 18 ]. Men’s participation is crucial to help reduce misconception about side effects of contraceptive methods [ 18 ]. Therefore, family planning programs need to target men at all levels of the service. Their involvement will also lead to women’s empowerment to increase effective contraceptive use and continuation to improve better health outcomes in reproductive health [ 24 ]. User experiences indicate that text messages provide a novel way to raise awareness, promote behaviour change and address myths and socio-cultural norms[ 25 ]. Limitations This study has some limitations which need to be taken into consideration. The finding of this study cannot be generalized to the entire region of the Upper West region due to the small sample size. Despite the small sample size, views of groups of our respondents which comprised of married partners and those cohabitating, will not differ significantly from the rest of the entire population in the region. Also, this study provides vital insights for policy makers in Ghana and beyond who are working to improve sexual and reproductive health services for men and women. The need for future study to capture the perspectives of men and women on cultural factors influencing PF services for policy. Conclusions Our study demonstrated high knowledge of FP among partners. However, use of modern contraceptives methods was low due to side effects and socio-cultural norms. Involving men partners in FP programs could give them accurate and complete information on contraceptive methods to help reduce misconception and increase uptake. Reproductive health programme designers, policy makers, and population researchers, health professionals need to incorporate the findings into reproductive health programs to help address barriers to improve health outcomes among couples. Abbreviations FP: Family Planning LMICs: Low- and Middle-Income Countries Declarations Ethics approval and consent to participate Ethics approval was obtained from Institutional Review Board of the Community Health Department of the University for Development Studies in Ghana. Informed consent was obtained from the study participants prior to data collection. Consent for publication All authors read the manuscript and approved it for publication. Availability of data and materials The dataset for this study is available on request from the corresponding author. Competing Interests None to declare Funding The authors received no funding for this work. Authors’ Contributions “SAK conceived the study and conduced field work. SAK and TA designed the study and performed the statistical analysis. ASL drafted the manuscript. SAK and TA reviewed the manuscript. All authors read and approved the final manuscript” Acknowledgements The authors wish to acknowledge all study participants for their cooperation in providing the necessary information and the research assistants for data collection. References Chola, L., et al., Scaling up family planning to reduce maternal and child mortality: the potential costs and benefits of modern contraceptive use in South Africa. PloS one, 2015. 10 (6). Khan, S.A., et al., A comparative trial of copper T 380 and Cu 375 IUCD. Journal of Ayub Medical College Abbottabad, 2010. 22 (3): p. 185-187. Mistik, S., et al., Married men’s opinions and involvement regarding family planning in rural areas. Contraception, 2003. 67 (2): p. 133-137. Kabagenyi, A., et al., Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reproductive health, 2014. 11 (1): p. 21. Vouking, M.Z., C.D. Evina, and C.N. Tadenfok, Male involvement in family planning decision making in sub-Saharan Africa-what the evidence suggests. The Pan African Medical Journal, 2014. 19 . Organization, W.H., Programming for male involvement in reproductive health: Report of the meeting of WHO regional advisers in reproductive health, WHO/PAHO, Washington DC, USA 5-7 September 2001 . 2002, Geneva: World Health Organization. Roth, D.M. and M.T. Mbizvo, Promoting safe motherhood in the community: the case for strategies that include men. African journal of reproductive health, 2001. 5 (2): p. 10-21. Mumtaz, Z. and S. Salway, Understanding gendered influences on women's reproductive health in Pakistan: moving beyond the autonomy paradigm. Social science & medicine, 2009. 68 (7): p. 1349-1356. Darroch, J.E. and S. Singh, Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. The Lancet, 2013. 381 (9879): p. 1756-1762. GSS, G., Ghana statistical service (GSS), Ghana health service (GHS), and ICF macro. Accra: Ghana Demogr Health Surv, 2009. 2008 : p. 79-96. Staveteig, S., Understanding unmet need in Ghana: Results from a follow-up study to the 2014 Ghana Demographic and Health Survey . 2016: ICF International. Adanu, R.M., et al., Contraceptive use by women in Accra, Ghana: results from the 2003 Accra Women’s Health Survey. African journal of reproductive health, 2009. 13 (1). Kuganab-Lem, R.B., R. Dogudugu, and L. Kanton, Birth preparedness and complication readiness: a study of postpartum women in a rural district of Ghana. Public Health Research, 2014. 4 (6): p. 225-233. Apusigah, A.A., The gendered politics of farm household production and the shaping of women’s livelihoods in Northern Ghana. Feminist Africa, 2009. 12 (12): p. 51-67. Williamson, L.M., et al., Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reproductive health, 2009. 6 (1): p. 3. Service, G.S., 2010 Population & Housing Census. District Analytical Report. Sissala East District. October 2014. Report, S.E.D.H.D., Resource Endowment, Investment opportunities and the Attainment of MDGs. 2011. Bayray, A., Assessment of male involvement in family planning use among men in south eastern zone of Tigray, Ethiopia. Scholarly Journal of Medicine, 2012. 2 (2): p. 1-10. Mbizvo, M.T. and D.J. Adamchak, Family planning knowledge, attitudes, and practices of men in Zimbabwe. Studies in family planning, 1991. 22 (1): p. 31-38. Shahjahan, M. and M. Kabir, Why males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions. International Quarterly of community health Education, 2006. 26 (1): p. 45-59. Tuloro, T., et al., The role of men in contraceptive use and fertility preference in Hossana Town, southern Ethiopia. Ethiopian Journal of Health Development, 2006. 20 (3). Apanga, P.A. and M.A. Adam, Factors influencing the uptake of family planning services in the Talensi District, Ghana. Pan African Medical Journal, 2015. 20 (1). Eliason, S., et al., Determinants of unintended pregnancies in rural Ghana. BMC pregnancy and childbirth, 2014. 14 (1): p. 261. Kassa, M., A.A. Abajobir, and M. Gedefaw, Level of male involvement and associated factors in family planning services utilization among married men in Debremarkos town, Northwest Ethiopia. BMC international health and human rights, 2014. 14 (1): p. 33. Riley, P., et al., Mobiles for quality improvement pilot in Uganda. Bethesda (MD): Abt Associates, Strengthening Health Outcomes through the Private Sector Project, 2011. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major Revision 31 Jul, 2021 Review # 2 received at journal 24 Jul, 2021 Reviews received at journal 29 Jun, 2021 Reviewer # 2 agreed at journal 29 Jun, 2021 Review # 1 received at journal 18 May, 2021 Reviewers invited by journal 21 Apr, 2021 Reviewer # 1 agreed at journal 21 Apr, 2021 Editor assigned by journal 07 Apr, 2021 Submission checks completed at journal 07 Apr, 2021 Editor invited by journal 07 Apr, 2021 First submitted to journal 06 Apr, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-412990","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":20811719,"identity":"2deff402-8624-4fcb-bc47-25a7ac8b0fe3","order_by":0,"name":"Abigail Kpekpo Kwawukume","email":"","orcid":"","institution":"Seventh-Day Adventist Hospital Koforidua, Ghana","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"Kpekpo","lastName":"Kwawukume","suffix":""},{"id":20811720,"identity":"278683b0-c039-483a-8a73-f6b651dfe685","order_by":1,"name":"Alexander Suuk Laar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACPghlAeUesAESjI0H8Glhg1ASMC1pIC0NJGk5DKHwamE//OwDQ42EnMEB9mfSPGfO261tPwy0pcYmGqcWnjTjGQzHJIwlG3jMpHlu3E7ediYRqOVYWm4DToclGANJicR+Bh42aZ4Pt5PNDgC1MDYcxq2F//lnBoZ/EvVtDCCHfTiXbHb+IQEtEjnGDIxtEgn8DAwghx2wM7tByBaJN8UMiX0ShjObeYwt55xJTjC7AbQlAY9f+PnTNzN8+GYjb3C8/eGNN8fs7M3Opz988KHGBqcWMEgAEcwQdmIDXIRYYE+K4lEwCkbBKBgZAADsR1h8N8pqwAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-0721-4533","institution":"REJ Institute, Research and Consultancy Services, Tamale, Ghana","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Alexander","middleName":"Suuk","lastName":"Laar","suffix":""},{"id":20811721,"identity":"3b516c5b-44d9-475d-b11e-f9062c11d8db","order_by":2,"name":"Tanko Abdulai","email":"","orcid":"","institution":"University for Development Studies","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tanko","middleName":"","lastName":"Abdulai","suffix":""}],"badges":[],"createdAt":"2021-04-11 19:04:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-412990/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-412990/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13685842,"identity":"fc63bb19-8a86-4a10-8342-34d6af77e3ad","added_by":"auto","created_at":"2021-09-17 12:14:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":338583,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-412990/v1/256d2991-a179-4e68-ac3e-0aee03700635.pdf"}],"financialInterests":"","formattedTitle":"Assessment of men involvement in family planning services use and associated factors in rural Upper West Region of Ghana","fulltext":[{"header":"Background","content":"\u003cp\u003eFamily planning services are critical to improving maternal and child health and reducing maternal and infant mortality [1]. Expanding the availability of FP services and working on the utilization of services in LMICs could avert up to 42% of maternal deaths [1, 2] . Men are also recognized to be responsible for the large proportion of reproductive ill health suffered by their partners\u0026rsquo; use of FP methods [3]. Although contraceptive methods and services are frequently geared towards women, men are often the primary decision makers on family size and their partners\u0026rsquo; use of FP methods [4]. It is well documented that men's general knowledge and attitude about the ideal family size, gender preference of children, ideal spacing between child births, and contraceptive methods use greatly influence women's preferences and opinions[3, 5, 6].\u003c/p\u003e\n\u003cp\u003eThe 1994 Cairo International Conference on Population and Development recognized that men involvement in reproductive health issues is required and further work with men is needed for effective change [7]. The effects of men and the socio-cultural construction of masculinities on women\u0026rsquo;s reproductive health outcomes are also recognized [8]. The World Fertility Survey showed that utilization of FP methods varied widely from 69% in south-east Asia to 11% in Africa 9. Evidence showed that there is high unmet need for contraceptive use in most developing countries and even higher In sub-Saharan African countries where the number of women with unmet need for modern contraception increased from 31 million in 2008 to 36 million in 2012 [9].\u003c/p\u003e\n\u003cp\u003eIn Ghana, the focus of this study, knowledge of any contraceptive method is almost universal, with 98% of all women and 99% of all men knowing at least one method of contraception 10 and where 50% of all women reported having used a method contraception before [10]. However, according to the 2014 Ghana Demographic and Health Survey, only 27% of married women use FP with 22% using a modern method and 5% using traditional method [11].\u003c/p\u003e\n\u003cp\u003eFamily planning in Ghana dates as far back as 1956 [12]. However, studies have shown that uptake of FP services in Ghana has not been encouraging and for that matter Tumu in the Sissala East District of the Upper West Region which experienced a decrease from 71.4% in 2011 to 50.7% in 2012 [13]. Family planning research in rural Ghana have been dominated by findings almost exclusively from women studies.\u003c/p\u003e\n\u003cp\u003eMen especially in Ghana are seen to be the head of the home and influence healthcare decisions of the entire household [14]. Studies have also shown an increase in contraceptive use in cases where men partners have been involved [4, 15]. Men involvement helps not only in accepting contraceptives uptake but also its effective use and continuation [4, 5, 15]. However, men partners role in FP services promotion and uptake has often overlooked and neglected in LMICs such as Ghana. To fill this research gap, this study assessed factors that promote or hinder contraceptive uptake among women and their men partners in a rural district of the Upper West Region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study took place in Tumu in the Sissala East District in the north-eastern part of the Upper West Region of Ghana. Tumu, the district capital is predominantly rural by nature, with majority (85 %) living in rural settings [16, 17]. A large percentage (84%) of the population live below the poverty line [16, 17]. A greater proportion (76%) of the population are being engaged in agriculture. It is predominantly Islam (88.0%) with Christianity being the largest of the minority (10%) followed by Traditional (1.4%) [16, 17]. A greater proportion of the population (52.4%) has Some level of education [16].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional descriptive study design was used for this study. An interviewer administered questionnaire consisting of both open and close-ended questions were administered by experienced research assistants to elicit the necessary information from the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling technique and sample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size for this study was determined using the Yamane method:\u003cimg src=\"data:image/png;base64,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\" alt=\"\" /\u003ep = margin of error (5%). A sample size of 386 was derived from the total population of 11,252.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of adult males and females aged 15 years and above who were either married or cohabitating. For this study, we aimed at recruiting 386 respondents but finally recruited 200 respondents due to financial constraints.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Data Collection method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn interviewer administered questionnaire consisting of both closed and open-ended questions was used to assess the knowledge and use of FP services among partners. The study questionnaire was developed based on the objective of this study by the principal investigator. The questionnaire was administered by the first author and other two experienced research assistants who understand the native dialect. It was administered in English and translated into the local dialect for those who could not understand or speak the English language. The data was administered among households in five communities or clusters out of the ten in Tumu municipality. These communities were chosen using a simple random sampling method. Forty respondents were interviewed from each community. This method gave the individual an equal chance of being selected. Before permission was sought from respondents, the aim of the study was explained to each individual. They were also assured of confidentiality and privacy of information they will give. The questionnaires were pretested in a similar environment in the district.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure accuracy, data collected was checked and screened for completeness. The completed copies of the questionnaire were serially numbered coded and doubly entered and analyzed using Statistical Package for Social Scientists version 20.0. Bivariate and regression analyses were used to determine the associations between the outcome variables and a host of explanatory variables.\u003c/p\u003e"},{"header":"Results","content":" \u003cp\u003e\u003cstrong\u003eBackground characteristics of respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred (200) respondents were interviewed for this study. The study involved 107 men representing 53.5% and 93 women representing 46.6%. Respondents\u0026rsquo; age ranged between 15-54 for men and 15-49 for women. In all, over seventy percent (76.5%) had some form of education ranging from primary to tertiary while (23.5%) had no education. All the respondents were involved in some kind of work with over sixty percent (66%) being artisans.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of Family Planning.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMajority of the men respondents (95.5%) had heard of FP. Almost half of the respondents (48.1%) had information about FP via the mass media (Television, Radio and Newspaper) followed by friends (27.5%) and the health facility (23.5%) as indicated in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;Source of Information on family planning\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eTelevision\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e17\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e16.7\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eRadio\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e29.4\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eNewspaper\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e2.0\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eInternet\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eFriends\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e28\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e27.5\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eHealth facility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e24\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e23.5\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e102\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTwenty eight percent (28.0%) of the men interviewed understood FP as avoidance of unintended pregnancy, 25.2% as limiting family size while 19.6% understood it as spacing of childbirth. Others (27.1 %) explained it as two or more of the above definitions as shown in table 2. The most common method known and used was the condom (42.5%) followed by implants (32.0%) and the least known method being the foam tablet (7.0%) among men respondents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;Men understanding of meaning of family planning.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eMeaning\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eLimiting family size\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e27\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e25.2\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eTo avoid unintended pregnancy\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e30\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;28.0\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eSpacing childbirth\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e21\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e19.6\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e29\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e27.1\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e107\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003e99.9\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e Men involvement in FP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver fifty percent (52.2%) of the men respondents reported they or their partner were\u0026nbsp;currently using some form of contraceptives to delay or avoid pregnancy. However only 36.4% of women reported they or their partner were currently using contraceptives to delay or avoid pregnancy. Majority of the men respondents (72.8%) approved of the use of FP methods by their partners, 75% of the women respondents also indicated their partners had approved of their use of FP. The findings also indicate that men had a higher propensity of reporting FP use (X\u003csup\u003e2\u003c/sup\u003e =4.5534, p= 0.033). For the couples who did not approve of the FP methods, the reasons included: socio-cultural beliefs (31%), side effects (30.8%) and others (38.5%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDecision making in FP use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wanted to know from the women whether their partners support them in their desire to use contraceptives; 67.0% of the women answered in the affirmative and 33.0% answered in a negative. Those who answered in the affirmative said their partners support them by providing money for transport to facility and/or for FP services, encouraging and accompanying them to the health facility. Women who reported that their spouse support FP use were more likely to use a contraceptive method (X\u003csup\u003e2\u003c/sup\u003e = 9.5223, P=0.002) compared to those who said no. Women who reported their partners had some education were also more likely to use a contraceptive\u0026nbsp;method (X\u003csup\u003e2\u003c/sup\u003e=14.1133, P=0.000).\u003c/p\u003e\n\u003cp\u003eGenerally, a greater proportion of men (77.6 %) intend using FP in the future. For those who answered in a negative, 19.1% said most of the contraceptives were designed to suit women and thought it was a woman\u0026rsquo;s business. Nearly three quarters of women (73.4%) who ever used a FP method indicated their partner had a say in the decision to use. For the women interviewed,70.7% said they would still practice birth control irrespective of their partners\u0026rsquo; opinion while 23.9% would not use birth control if their partners were against it, 5.4% were however were not certain.\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eThis study assessed men partners knowledge and factors associated with use of FP services in Tumu in the Sissala East District of the Upper West Region of Ghana. The study identified several factors that influence FP services use among partners in this setting. Our study demonstrated that despite the high knowledge of modern contraceptive methods among couples, use was low due to side effects and socio-cultural norms. Men\u0026rsquo;s attitude and social practice towards family planning methods also influence the behaviour of their partners using contraceptives [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It is found elsewhere that the decision not to practice FP is men dominated and men are responsible for providing contraceptive decision when FP is practiced [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A major limitation facing low-and-middle come countries family planning promotion programs and population policy development on contraceptive behaviour is that men are always neglected [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study identified several factors associated with men\u0026rsquo;s influence in FP service utilization among their partners. Non-approval of family planning methods by men this study was attributed to perceived risks, side-effects and socio-cultural norms. Focus groups with men and women in rural Uganda have come out with similar findings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Contraceptive knowledge and use are shaped by the socio-cultural cultural environment as are personal attitudes and feelings about contraception. In rural settings in low-and -middle income countries most men may be unwilling to have their wives adopt family planning, which they themselves have little knowledge about it. Evidence show that some oppose contraceptive use for reasons of tradition and religion which require men to maintain the honour and position of their extended family, village, religious group and social organization [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Studies have come with similar findings in settings in rural northern Ghana [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them to take their wives to health clinics to discuss family planning issues [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral interventions can be used to address barriers in the uptake of family planning services in this setting. Family planning programs need to target men at all levels of health promotion and education with their partners to reduce misconceptions about family methods to increase acceptance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Men\u0026rsquo;s participation is crucial to help reduce misconception about side effects of contraceptive methods [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, family planning programs need to target men at all levels of the service. Their involvement will also lead to women\u0026rsquo;s empowerment to increase effective contraceptive use and continuation to improve better health outcomes in reproductive health [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. User experiences indicate that text messages provide a novel way to raise awareness, promote behaviour change and address myths and socio-cultural norms[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e "},{"header":"Limitations","content":" \u003cp\u003eThis study has some limitations which need to be taken into consideration. The finding of this study cannot be generalized to the entire region of the Upper West region due to the small sample size. Despite the small sample size, views of groups of our respondents which comprised of married partners and those cohabitating, will not differ significantly from the rest of the entire population in the region. Also, this study provides vital insights for policy makers in Ghana and beyond who are working to improve sexual and reproductive health services for men and women. The need for future study to capture the perspectives of men and women on cultural factors influencing PF services for policy.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eOur study demonstrated high knowledge of FP among partners. However, use of modern contraceptives methods was low due to side effects and socio-cultural norms. Involving men partners in FP programs could give them accurate and complete information on contraceptive methods to help reduce misconception and increase uptake. Reproductive health programme designers, policy makers, and population researchers, health professionals need to incorporate the findings into reproductive health programs to help address barriers to improve health outcomes among couples.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eFP:\u0026nbsp; \u003c/strong\u003eFamily Planning\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMICs:\u003c/strong\u003e \u0026nbsp;Low- and Middle-Income Countries\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from Institutional Review Board of the Community Health Department of the University for Development Studies in Ghana. Informed consent was obtained from the study participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read the manuscript and approved it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset for this study is available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;SAK conceived the study and conduced field work. SAK and TA designed the study and performed the statistical analysis. ASL drafted the manuscript.\u0026nbsp;SAK and TA reviewed the manuscript. All authors read and approved the final manuscript\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to acknowledge all study participants for their cooperation in providing the necessary information and the research assistants for data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChola, L., et al., \u003cem\u003eScaling up family planning to reduce maternal and child mortality: the potential costs and benefits of modern contraceptive use in South Africa.\u003c/em\u003e PloS one, 2015. \u003cstrong\u003e10\u003c/strong\u003e(6).\u003c/li\u003e\n\u003cli\u003eKhan, S.A., et al., \u003cem\u003eA comparative trial of copper T 380 and Cu 375 IUCD.\u003c/em\u003e Journal of Ayub Medical College Abbottabad, 2010. \u003cstrong\u003e22\u003c/strong\u003e(3): p. 185-187.\u003c/li\u003e\n\u003cli\u003eMistik, S., et al., \u003cem\u003eMarried men\u0026rsquo;s opinions and involvement regarding family planning in rural areas.\u003c/em\u003e Contraception, 2003. \u003cstrong\u003e67\u003c/strong\u003e(2): p. 133-137.\u003c/li\u003e\n\u003cli\u003eKabagenyi, A., et al., \u003cem\u003eBarriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women\u0026rsquo;s perceptions in two rural districts in Uganda.\u003c/em\u003e Reproductive health, 2014. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 21.\u003c/li\u003e\n\u003cli\u003eVouking, M.Z., C.D. Evina, and C.N. Tadenfok, \u003cem\u003eMale involvement in family planning decision making in sub-Saharan Africa-what the evidence suggests.\u003c/em\u003e The Pan African Medical Journal, 2014. \u003cstrong\u003e19\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eOrganization, W.H., \u003cem\u003eProgramming for male involvement in reproductive health: Report of the meeting of WHO regional advisers in reproductive health, WHO/PAHO, Washington DC, USA 5-7 September 2001\u003c/em\u003e. 2002, Geneva: World Health Organization.\u003c/li\u003e\n\u003cli\u003eRoth, D.M. and M.T. Mbizvo, \u003cem\u003ePromoting safe motherhood in the community: the case for strategies that include men.\u003c/em\u003e African journal of reproductive health, 2001. \u003cstrong\u003e5\u003c/strong\u003e(2): p. 10-21.\u003c/li\u003e\n\u003cli\u003eMumtaz, Z. and S. Salway, \u003cem\u003eUnderstanding gendered influences on women's reproductive health in Pakistan: moving beyond the autonomy paradigm.\u003c/em\u003e Social science \u0026amp; medicine, 2009. \u003cstrong\u003e68\u003c/strong\u003e(7): p. 1349-1356.\u003c/li\u003e\n\u003cli\u003eDarroch, J.E. and S. Singh, \u003cem\u003eTrends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys.\u003c/em\u003e The Lancet, 2013. \u003cstrong\u003e381\u003c/strong\u003e(9879): p. 1756-1762.\u003c/li\u003e\n\u003cli\u003eGSS, G., \u003cem\u003eGhana statistical service (GSS), Ghana health service (GHS), and ICF macro.\u003c/em\u003e Accra: Ghana Demogr Health Surv, 2009. \u003cstrong\u003e2008\u003c/strong\u003e: p. 79-96.\u003c/li\u003e\n\u003cli\u003eStaveteig, S., \u003cem\u003eUnderstanding unmet need in Ghana: Results from a follow-up study to the 2014 Ghana Demographic and Health Survey\u003c/em\u003e. 2016: ICF International.\u003c/li\u003e\n\u003cli\u003eAdanu, R.M., et al., \u003cem\u003eContraceptive use by women in Accra, Ghana: results from the 2003 Accra Women\u0026rsquo;s Health Survey.\u003c/em\u003e African journal of reproductive health, 2009. \u003cstrong\u003e13\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eKuganab-Lem, R.B., R. Dogudugu, and L. Kanton, \u003cem\u003eBirth preparedness and complication readiness: a study of postpartum women in a rural district of Ghana.\u003c/em\u003e Public Health Research, 2014. \u003cstrong\u003e4\u003c/strong\u003e(6): p. 225-233.\u003c/li\u003e\n\u003cli\u003eApusigah, A.A., \u003cem\u003eThe gendered politics of farm household production and the shaping of women\u0026rsquo;s livelihoods in Northern Ghana.\u003c/em\u003e Feminist Africa, 2009. \u003cstrong\u003e12\u003c/strong\u003e(12): p. 51-67.\u003c/li\u003e\n\u003cli\u003eWilliamson, L.M., et al., \u003cem\u003eLimits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research.\u003c/em\u003e Reproductive health, 2009. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 3.\u003c/li\u003e\n\u003cli\u003eService, G.S., \u003cem\u003e2010 Population \u0026amp; Housing Census. District Analytical Report. Sissala East District.\u003c/em\u003e October 2014.\u003c/li\u003e\n\u003cli\u003eReport, S.E.D.H.D., \u003cem\u003eResource Endowment, Investment opportunities and the Attainment of MDGs.\u003c/em\u003e 2011.\u003c/li\u003e\n\u003cli\u003eBayray, A., \u003cem\u003eAssessment of male involvement in family planning use among men in south eastern zone of Tigray, Ethiopia.\u003c/em\u003e Scholarly Journal of Medicine, 2012. \u003cstrong\u003e2\u003c/strong\u003e(2): p. 1-10.\u003c/li\u003e\n\u003cli\u003eMbizvo, M.T. and D.J. Adamchak, \u003cem\u003eFamily planning knowledge, attitudes, and practices of men in Zimbabwe.\u003c/em\u003e Studies in family planning, 1991. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 31-38.\u003c/li\u003e\n\u003cli\u003eShahjahan, M. and M. Kabir, \u003cem\u003eWhy males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions.\u003c/em\u003e International Quarterly of community health Education, 2006. \u003cstrong\u003e26\u003c/strong\u003e(1): p. 45-59.\u003c/li\u003e\n\u003cli\u003eTuloro, T., et al., \u003cem\u003eThe role of men in contraceptive use and fertility preference in Hossana Town, southern Ethiopia.\u003c/em\u003e Ethiopian Journal of Health Development, 2006. \u003cstrong\u003e20\u003c/strong\u003e(3).\u003c/li\u003e\n\u003cli\u003eApanga, P.A. and M.A. Adam, \u003cem\u003eFactors influencing the uptake of family planning services in the Talensi District, Ghana.\u003c/em\u003e Pan African Medical Journal, 2015. \u003cstrong\u003e20\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eEliason, S., et al., \u003cem\u003eDeterminants of unintended pregnancies in rural Ghana.\u003c/em\u003e BMC pregnancy and childbirth, 2014. \u003cstrong\u003e14\u003c/strong\u003e(1): p. 261.\u003c/li\u003e\n\u003cli\u003eKassa, M., A.A. Abajobir, and M. Gedefaw, \u003cem\u003eLevel of male involvement and associated factors in family planning services utilization among married men in Debremarkos town, Northwest Ethiopia.\u003c/em\u003e BMC international health and human rights, 2014. \u003cstrong\u003e14\u003c/strong\u003e(1): p. 33.\u003c/li\u003e\n\u003cli\u003eRiley, P., et al., \u003cem\u003eMobiles for quality improvement pilot in Uganda.\u003c/em\u003e Bethesda (MD): Abt Associates, Strengthening Health Outcomes through the Private Sector Project, 2011.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Family planning services, men, partners, Upper West Region, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-412990/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-412990/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn low-and-middle come countries (LMICs) less attention is paid to men\u0026rsquo; involvement in Family Planning (FP)programs where public health officials have advocated the involvement of men as a strategy for addressing the dismal performance of FP programs. The study assessed factors which promote or hinder the uptake of FP services among partners in a rural setting of northern Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional descriptive study design was used to collect data from 200 respondents. Study respondents were selected through random cluster sampling.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings showed that men partners\u0026rsquo; knowledge (95.5%) and approval (72.8%) of FP services were high. Approval of services was also confirmed by their men partners (75%). Mass media was the commonest source of contraception information (48.1%) with the radio (29.4%) being the most popular source. The findings also indicated that men had a higher propensity (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.5534, p\u0026thinsp;=\u0026thinsp;0.033) of supporting a FP method use. Women who reported that their spouse supported FP method use were more likely to use a contraceptive method (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.5223, P\u0026thinsp;=\u0026thinsp;0.002) if their spouse supported FP method use (X2\u0026thinsp;=\u0026thinsp;9.5223, P\u0026thinsp;=\u0026thinsp;0.002) and if their partners had some education (X2\u0026thinsp;=\u0026thinsp;14.1133, P\u0026thinsp;=\u0026thinsp;0.000). Reasons for low contraceptive use were health risks, side-effects and socio-cultural norms.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFamily planning programs need to include men at all levels of health promotion and education of FP programs to help reduce misconceptions about contraceptive\u003c/p\u003e","manuscriptTitle":"Assessment of men involvement in family planning services use and associated factors in rural Upper West Region of Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-13 18:10:25","doi":"10.21203/rs.3.rs-412990/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revision","date":"2021-08-01T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-07-25T00:00:00+00:00","index":2,"fulltext":"Recommendation: Major Revision\nForm responses:\n---\n\nComments to Author:\n---\nIn general the article is sufficient. The gap is stated. However, some aspects can be better clarified and related to the results. More visualization may be used to present the percentages in the results for better and ease of reading.\n\n34-36: language or repetition.\n86: how are men responsible for ill reproductive health by their partners use of FB method- this sentence is unclear.\n\nIn the data collection method- were both men and women from the same households interviewed? if yes, were they interviewed separately? as this might have had an impact on the answers.\nYou indicate the communities were selected using random sampling. How were the households selected?\n\nin table 1- is it the source of information for both men and women or only men? add in table title\n\n199- explain how did the findings indicate that men had a higher propensity of reporting FP use? and how does that related to the results given in the previous sentence\n\nThe discussion is weak. It mentions that the study demonstrated low use mainly due to side effects and socio-cultural norms. however the study isn't providing any in-depth information of what type of side-effects or cultural aspects they meant. None of the results demonstrate anything on this either.\nIt is clear from the literature and background that men need to be more involved in FP planning. however, it is unclear how the results section came to this conclusion that it is due to side effects and socio-cultural norms that men are not allowing women to use FP methods.\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final decision on the manuscript has been made. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Level of interest: **An article whose findings are important to those with closely related research interests**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2021-06-30T00:00:00+00:00","index":0,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-06-30T00:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-05-19T00:00:00+00:00","index":1,"fulltext":"Recommendation: Major Revision\nForm responses:\n---\n\nComments to Author:\n---\nThe title of the manuscript is okay but the researchers has to do justice to the work before it could be publisher.\n\nComment: Abstract\n\nThis work should go for proper editing, for instance: first line should be low-and-middle in-come countries. Lines 4-6: the study assed factors which promote or hinder the uptake of FP services among partners in a rural setting of northern Ghana; this is not the title of this work. Therefore the abstract needs total overhauling for other comments to be accommodated. \n\nComment: Background\nFirst paragraph lines 89-90 authors reported men's general knowledge and attitude about family size among others, thereby neglecting the main focus of the study (men's involvement in family planning (FP)). It is also expected that you look at FP globally (developed and developing countries), Ghana inclusive, giving statistics and current citations to back it up. The citation in line 93 is obsolete (1994), therefore should be expunged. Lines 98, 99 and 100 are not necessary since the study is on assessment of men. In line 102, which study are you referring to? Line 104, 2014 Ghana Demographic Health Survey should be written Ghana Demographic Health Survey (2014). Lines 118, 119 and 120 (assessed factors that promote or hinder contraceptives uptake among women and their men partners in rural district of the Upper West Region) is not the title of this work but you assessed men's involvement in family planning services use and associated factors in Upper West Region of Ghana.\n\nComments: Methods\nStudy setting\nThere should be a detailed explanation about what makes this area different from others, creating need for the study, which the gap is to be filled at the end of this investigation.\nStudy design\nThe study design is okay but design should be deleted, that is it should read cross-sectional descriptive study (line 133).\nSampling technique and sample size\nLines 137, 138, 139 and 140 are okay since it is clear enough\nStudy population\nThe authors are supposed to recruit 386 respondents based on the sample size above but finally recruited 200 respondents. Detailed explanation should be given on how and why the respondents were narrowed to that number. How could you convince your readers that the reason is financial constraint? Can you generalize the findings of this study?\n\nComments: Data collection\nLine 149, what the authors stated (to assess knowledge and use of FP services among partners) are not the objectives of this study. Line 152 (administered in English language and translated into local dialect). Instead, the instrument should be in local dialect reason being that the study area is Rural Upper West Region of Ghana, in order to be supplied with accurate information for the study. Line 155, using a simple random sampling method. You have to be specific, that is with replacement or without replacement? Line 155-156, the forty respondents, what are their gender in ratio and what is your criteria? Lines 157 and 158, you mean each respondent was explained to one after the other the aim of the study until the sample size was complete? Or did you brief them generally concerning the study? Where, when and how these were done has to be in place for your readers to comprehend better.\n\nComment: Data management and analysis\nFirst, you have to state how many of the questionnaire was returned, what is the mortality rate?\n\nComments: Results\nLines 173-177, the independent variables for this study were not specified earlier than now, only for them to appear suddenly. Lines 179-182, knowledge of FP is not the focus of this work, even though table is not also fixed. Lines 183-190 Table 1, this is also not part of this study. Table 2, lines 194-200, men's understanding of meaning of FP is as good as knowledge, still not the focus of this investigation. Line 194, men involvement in FP, has no table representation. Line 215, did you only interviewed women, what about men who are the major focus and majority of this investigation? See page 6, lines 173-175. What is the rationale for this? This work has to be reanalysed for its objectives to be achieved.\n\nComments: Discussion\nThis has to be revisited as well\n\nComments: Conclusion\nLine 216, knowledge is an imported word in this study, refer to the title.\n\nComments: References\nAll Ps in each reference should be deleted, number 19 is obsolete, should also be expunged and all journal names should be italicized. \n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. 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I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: **\nI agree to the open peer review policy of the journal**\n"},{"type":"reviewersInvited","content":"","date":"2021-04-22T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-04-22T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-04-08T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-04-07T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-04-07T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2021-04-07T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5bf24742-7526-4316-aa57-54d0dae117a4","owner":[],"postedDate":"April 13th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":3597460,"name":"Architecture, Design and Planning"},{"id":3597461,"name":"Public Relations"}],"tags":[],"updatedAt":"2022-02-04T17:28:18+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-13 18:10:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-412990","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-412990","identity":"rs-412990","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}