Introduction

Like in most African countries, family planning programmes in Ghana had, until recently, focused on women as the main target group. Thus men, who in the Ghanaian traditional social system play a critical role as the heads of the family responsible for making important decisions on a wide range of issues including those affecting the fertility of women and family size, were unfortunately neglected in these programmes.

The fact that Ghanaian men are the primary decision-makers in the family was not exploited until 1980 when the Planned Parenthood Association of Ghana (PPAG), recognizing men's critical role in the social and traditional settings, initiated a pioneering project involving men in family planning and reproductive health issues.

Other governmental and non-governmental organizations (NGOs) and agencies in the country such as the Ghana Social Marketing Foundation (GSMF) and the Ministry of Health (MOH) organize IEC (information, education and communications) activities and provide some services to men on an ad hoc basis. However, the PPAG is the only organization in Ghana that runs a solely male-oriented project on family planning, and sexual and reproductive health issues.

The project titled "Male involvement in family planning" was implemented in 1980 and, therefore, started well before the 'discovery' of HIV/AIDS which later provoked many countries to focus on men. The strategy adopted was to increase awareness, acceptance and practice of family planning among selected groups, especially in rural areas, through IEC activities, and to provide services to men as a special target group.

 

Reaching Men Through Daddies Clubs  Workplaces  Industrial Institutions  Vocational groups  Trade unions

The Male Involvement in Family Planning Project
 

Goal and Objectives

• To increase the number of males using family planning methods; and
• To motivate men to encourage and support their spouses/partners to practise family planning

Male groups were identified at work places such as industrialestablishments and institutions including the National Vocational Training Institute (NVTI), taxi drivers unions and functional literacy groups. One strategy adopted was the formation of 'Daddies Clubs'. In 1995, PPAG worked with twelve Daddies Clubs, nine industrial establishments, two NVTIs and ten functional literacy groups.

Activities

Educational and recreational activities were organized to motivate men to get involved in family planning and sexual/reproductive health issues. These activities include:

• Lecturers
• Group discussions
• Film shows
• Condom-wearing competitions
• Clean-up campaigns
• Other educational topics involving topics related to current affairs.

The "Daddies' Club" strategy was pioneered at an oil palm plantation ((Pretsea oil palm plantation in the Western region) for about 150 male workers aged between 17-45 years. The project was conceived by the PPAG field workers who observed during visits to the plantation that workers would gather to chat, drink or play cards to while away the leisure hours.

The PPAG field workers reasoned that such leisure periods could be used in providing family planning education and services to a captive audience. Thus, an innovative strategy adopted was to provide indoor recreational activities such as playing cards and games like Ludo and Monopoly as an entry point for rallying the target group towards family planning and reproductive health activities.

Needs Assessment

Prior to the implementation of the project, group discussions with the target group conducted by the field workers provided information on the level of awareness and knowledge as well as attitudes and use of modern contraceptive methods among these men.

The discussions revealed that even though these men were aware of family planning and some methods of contraception (especially traditional methods like periodic abstinence and withdrawal), little was known about modern methods. Many of these men felt that contraception, as an issue, was more the domain of women. Even the few men who had awareness of family planning had little access to such services because they were, at the time, designed exclusively for women.

It was, therefore, necessary to bridge the gap through the provision of the needed information, education and services to improve the situation, and, to motivate men towards greater involvement in family planning and reproductive health activities.

Since January 1996, the project has been extended to the four other regions through USAID support. In all, a total of 16 Daddies Clubs are currently in operation consisting of groups such as the commercial drivers' unions, the police force, and men in various industrial establishments, mines and plantations.

Baseline Survey

Prior to the expansion of the project to five other regions, a baseline survey was conducted in 1995. The following were the major recommendations of the survey:

1. Men in sexual unions should be motivated to move from the state of family planning awareness and acceptance into actual practice.
2. Efforts should be directed at creating awareness and generating demand for long-term and permanent methods of family planning, especially vasectomy.
3. Efforts should be made to expand the scope of the activities under this project to include issues of sexuality, relationships, communication skills for couples, sexual satisfaction of both partners, impotency, etc. which are equally important elements of building up the self-esteem of the individuals and improving the family relationships.
4. Further motivation is needed for couples' adoption of the smaller family size norm.
5. Additional attention should be placed on educating men on the prevention of HIV/AIDS and STDs.

From 1980 to 1995, the International Planned Parenthood Federation (IPPF) provided funding for the project. However, since the expansion of the project in 1996, the USAID Ghana mission contributes 90 percent of project funds.

Process

The project uses the participatory approach which puts a premium on the involvement of the target group at all stages of project implementation, design, implementation and evaluation.

Before developing the workplan, PPAG initiates discussions with the selected target groups. Discussions generally focus on the rationale for establishing the Daddies Club, the roles and responsibilities of club members and PPAG, and the administrative and logistic arrangements. The PPAG field workers first collected information on various institutions, industries and companies where Daddies' Clubs could be formed. In this way, rapport is thus established with formal and informal leaders as well as with the management of the selected groups.

The PPAG staff and Daddies Club members collectively draw up a workplan for the programme year. The PPAG allows great flexibility in choosing relevant sexual/reproductive health topics for discussion. The number of topics, the duration of discussion groups, and availability of PPAG resources (human, financial and logistic) are considered in drawing up a time-table for each group. The PPAG field staff would then collaborate with the club leaders appointed by each group to organize the activities. Good management of these clubs ensures that the tasks of assigning schedules and meeting places for programme activities are easily implemented.

Even though activities are organized primarily for Daddies Club members, other interested individuals such as co-workers and the public can also join in and benefit from these activities. The clubs have been used as entry point for reaching out to the wider communities.

Implementation

The project has three major activity areas.

1. IEC Actitivities

The IEC activities including lectures, group discussions, counselling, debates, symposia and film/video shows feature prominently in the activities of the clubs. More recently, workshops for artists and musicians have been organized to provide them with adequate and precise information on family planning, and reproductive and sexual health issues. The purpose is to enable them to produce films, plays and music that will address the benefits and importance of male involvement in family planning.

A locally-made film "Dangerous Numbers" has made some impact on the public's attitude towards men's involvement in family planning and reproductive health.

2. Service Delivery

Contraceptive distribution is done by both the PPAG field staff and the trained community-based distribution agents selected from among club members. Referrals are made to other health facilities when necessary.

3. Recreational Activities

Club members participate in recreational activities such as football matches, table tennis, playing cards,and so on. Each club's executive committee supervises the these activities. These committee leaders schedule meeting days/time, and sometimes lead group discussions on family planning and reproductive health issues.

Process Evaluation

The Daddies' Club project uses a pre-activity-test and post-activity-test design. Before the commencement of educational activities, the research unit of PPAG develops indicators for measuring knowledge on the various topics chosen. The questionnaire developed is used to collect data from a sample of club members.

Findings serve as the benchmark against which programme activities could be planned and evaluated. Field staff also monitor achievement of set targets.

Impact

During the 1994 programme year, Daddies' Club activities in the three pilot regions were evaluated. It was found that, generally, activities have provided the needed education and motivation for more acceptance and support for family planning among the target groups.

In 1995, the three regions together contacted 16,678 men, 2,260 of whom were referred to various clinics and health centres for family planning, STD/HIV/AIDS counselling and treatment. Three thousand five hundred and forty-six men accepted and practised family planning in 1995, and, of these, 1,251 of these were new acceptors.

This achievement was found to be a function of two major factors:

• Motivation received by the men through Daddies Club; and
• Accessibility of family planning and reproductive health services.

The evaluation results show that regular meetings and face-to-face interactions with the PPAG staff offer a useful forum for in-depth discussions about the benefits, side effects, and fears associated with the use of family planning methods.
 

The sense of belonging has been identified as very crucial in keeping the motivation going. Cohesiveness is ensured through peer pressure and has also been an important factor in motivating the men. Peers are the most important term of reference, especially in discussions and advice regarding social and reproductive health. Thus, the Daddies' Clubs approach creates the opportunity and forum for sharing family problems and reinforce the use of family planning methods by members.

The activities of the Daddies' Clubs, especially group discussions and lectures on sexual/reproductive health were seen by respondents as offering "enlightenment" to members. Interviews with a number of spouses of club members show that targeting the male partner for family planning education actually enhances the acceptance and practice of contraception. It also has a very positive effect on improving communication between spouses and partners on all issues including sexual and reproductive health.

The majority of club members also noted that the membership enabled them to gain insights into other health-related issues. Mention was often made of the knowledge acquired with respect to symptoms and prevention measures of STDs, including HIV/AIDS. Members also acknowledge that the educational activities have had great influence on their attitude and behaviour generally.

Recreational activities offer a strong incentive for regular meeting by members. To some of the members interviewed, involvement in these recreational activities offers them an alternative to idleness after work.

2. Accessibility of Services

The training of some group members as community-based distribution (CBD) agents ensure easy accessibility to contraceptive supplies. Reports from PPAG clinics show that it is also gradually becoming common place for men (who are the club members) to accompany their wives or partners to clinics for family planning services. Some men also call at PPAG clinics to collect contraceptives (e.g. pill re-supply) for their partners.

The records further show that it is also becoming common for men with infertility or sub-fertility problems to attend clinics for counselling and management.

Some Erroneous Assumptions

Most programmes assumed that men have a negative attitude towards family planning and reproductive health issues, and this has been a major barrier to family planning acceptance in Ghana and, perhaps, Africa in general.

The PPAG's Daddies' Clubs project has proved that men or husbands can have positive attitude towards family planning and reproductive /sexuality issues. It has emphasized more communication between partners which can be achieved through disseminating the relevant and necessary information on family planning and reproductive health to the men. A result of this is enabling couples to make mutual and shared decisions on issues relating to their lives.

Set Backs

As a result of the above erroneous assumptions most family planning programmes have been designed to serve only women. Most family planning clinics are located within maternal child health (MCH) centres, and men do not feel comfortable going to these centres. Furthermore, most trained service providers and counsellors are females who are basically trained to talk to women.

Most of the modern contraceptive methods available are also designed for women, thus leading to a general emphasis on female methods. In short, family planning clinics are not men-friendly. They generally do not provide services or information directed towards men.

A lot more effort needs to be made in providing education and motivation to men on long-term methods. Vasectomy seems to have a negative value in the minds of the average man who links it to castration. People are highly protective of their personal image and virility, particularly men. It will be necessary, therefore, for the project to work to change these perceptions and attitudes, beginning with the Daddies Club members.

The evaluation results also show that the programme is quite limited to promoting knowledge and use of modern contraceptives, and the prevention and control of STDs, including HIV/AIDS. Findings, however, show that club members also have other concerns. For example, people have concerns and questions about human sexuality such as roles, relationships, perceptions and expectations. The project staff would need some further training in sexuality counselling to equip them adequately to address these concerns.

The Future

With the recommendations of the evaluation exercise, PPAG will implement the following innovative activities for the 1997 programme year:

• Expanding its programme activities to cover education on human sexuality including roles, relationships, perceptions, expectations, self-esteem, gender, and so on.
• Forming Young Men's Clubs to expose young men to family planning, reproductive health and sexual health issues. Three of such clubs will be formed in three zones.
• Establishing three male clinics in Ashanti, Central and Greater Accra regions to meet the demand for male-oriented services such as contraception, counselling, and management of STDs, and fertility concerns.
• Reviewing and developing a standardized curriculum on male involvement in family planning and reproductive health activities.
• Continuing with the distribution of contraceptives through hotel outlets, industrial centres and male groups.
• Forming new Daddies Clubs in all regions. In 1997, five such clubs will be formed in five different regions.
• Continuing the motivation of men through condom-wearing competitions and indoor games competitions.

The male involvement project has shown that the best approach is the participatory approach of involving men in family planning and reproductive health. Education and motivation begin when people are willing to share and discuss their concerns freely and collectively work out action plans to address these concerns.

By conducting a needs assessment before the implementation of the project, PPAG was able to design interventions to address specific issues such as gaps in awareness and practice of family planning, provision of appropriate information, and so on. The sense of belonging that Daddies Clubs' members feel, and carefully nurtured by PPAG, is crucial to sustaining the motivation factor.

Men, when provided with adequate and appropriate information on family planning, sexual/reproductive health issues in a supportive environment, will act positively to ensure the success of these programmes.