Gender and Family Planning

Lessons from MCSP Mozambique

By Brittany Goetsch

This article summarizes gender and family planning lessons learned from a recent study by the USAID-funded Maternal and Child Survival Program (MCSP), conducted in two provinces in Mozambique. We explore how the MCSP research findings are relevant to our understanding of gender bias, and how it can be addressed in the design of family planning programs.

The USAID-funded Maternal and Child Survival Program (MCSP) recently published findings from a study in two provinces in Mozambique

The two-year study encouraged couple communication through group dialogues (palestras), couple counseling, and training for health workers. The study measured how well the project engaged men in antenatal care, use of modern family planning, and birth preparedness. It also looked at how couples make decisions about family planning. The MCSP Mozambique study was qualitative, meaning that it gathered non-numerical data (no numbers). 

Linking to family planning and reproductive health

Family planning programs benefit everyone, including men. This is why many programs not only include men, but also aim to challenge harmful gender norms. Some gender norms can prevent both women and men from using modern contraception. 

We explore how the MCSP research findings are relevant to our understanding of gender bias, and how it can be addressed in the design of family planning programs. 

“Gender-transformative” programs aim to examine, question, and change gender norms and behavior in a way that supports gender equity and equality.

The main family planning lessons from MCSP Mozambique's study

  • Men still make most decisions about family planning. This includes how many children to have, when to have them, and whether to use contraception. Gender norms limit women’s ability to make decisions about family planning.
  • Couple counseling about family planning could reduce intimate partner violence related to contraceptive use. Women said they wished their male partners participated in counseling. They felt this would reduce the chance that they would face violence for wanting to limit births. The study recommended that providers use counseling to address male partners’ attitudes about family planning and reduce violence.
  • Community dialogue meetings were successful at increasing support for reproductive and maternal care. But they are not enough. The study suggests a need for long-term group education to challenge gender norms. This education should reach community members on an ongoing basis. This would help ensure change continues.
family planning lessons from MCSP Mozambique

After the woman’s first institutional delivery, a couple leave the health center with their newborn – the couple’s twelfth baby.

Credit: Fastel Ramos/MCSP

Looking deeper

How does the MCSP study compare with what we already know? Data from Family Planning 2020 (FP2020) tell us that most women have either sole or joint decision-making power when it comes to contraception. 

  • According to data from 41 countries, 91% percent of married women who use contraception report that they made the decision to use a modern method either on their own or with their husband or partner (Source: FP2020 Progress Report). 
  • According to data from 14 countries, 86% percent of married women who don’t use contraception report that they made this decision either alone or with their husband or partner (Source: FP2020 Progress Report).

Compared to these large data sets, the MCSP study spoke to a small number of people, and only in two provinces. But one particular finding reinforces the idea that when designing a gender aware program, context matters. In the MCSP Mozambique study, community members and health providers had different views about how family planning decisions were made. More than half of men and women in the study reported making decisions together. But providers reported something different: that men alone make decisions about family planning. 

 

Final thoughts

Family planning programs need to have multiple strategies to address gender bias in order to be effective. Large data sets can show global or country-wide trends. Smaller studies, like this one, can show the story behind the numbers– and highlight localized differences.

We can learn a lot from this MCSP study in Mozambique. An important lesson is that perceptions of decision-making can vary. Research needs to examine and account for these differences. Asking a wide range of participants from diverse backgrounds needs to be the standard in community-based research about family planning decision-making. This has time and funding implications for research. But the value of the data obtained is well worth it, as it can help us be more responsive in program design and implementation. 

 

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