Gender Norms and Family Planning Decision-making in Tanzania: A Qualitative Study

This paper examines a qualitative study undertaken by researchers from C-Change, under a cooperative agreement funded by the United States Agency for International Development (USAID), to explore the role of gender norms in reproductive decision-making and contraceptive use among young married men and women in Tanzania. The purpose of the research was to understand the role of gender norms in supporting high fertility, unplanned pregnancies, and unhealthy timing and spacing of births in Tanzania - with the ultimate goal of incorporating this understanding into social and behaviour change communication (SBCC) in specific social contexts.

As the authors explain, gender norms - such as men's dominance in decision-making - often support high fertility, influencing the timing of marriage and childbearing, and aspirations regarding family size and sex composition. "FP [family planning] programs and services have often selectively accommodated rather than challenged prevailing gender norms by targeting FP toward women and have reinforced the idea that reproduction and family welfare are women's responsibilities."

Among 12 sub-Saharan countries for which Demographic and Health Survey (DHS) data exist, Tanzania has the fourth highest fertility rate, at 5.7 children per woman. Nearly a quarter (24%) of sexually active married and unmarried women has an unmet need for FP, according to the 2008 DHS.

The study was conducted among ethnically mixed populations in one urban/peri-urban and two rural sites: Temeke District in Dar es Salaam Region, Mbeya Region, and Mwanza Region. The data were collected through open-ended, in-depth interviews (IDIs) conducted face-to-face by same-sex interviewers of 30 young currently married men, 30 young married women, and 12 older people who influenced FP decisions. Six focus group discussions (FGDs) were also conducted, one with men and one with women in each of the 3 sites, with about 6 participants per group.

The findings showed near universal agreement among women and men users and non-users about the norms related to men's and women's roles in the family and society. In short, men were characterised as being the head of the household, the provider for the family, able to have sex and satisfy a woman, able to have children, and able to participate in society. A woman in Tanzanian society was characterised as the supporter of the husband, a caretaker of the family, and a bearer of children. It was considered disrespectful for a woman to disagree with and disobey her husband. But when asked about recent changes, participants voiced more liberal views about the roles women can play in the family and society. (Table 2 in the document summarises the gender norms that discourage contraceptive use and those that might facilitate it.)

The findings indicate a high level of unmet need for FP, with 21 out of 23 non-users of modern contraceptives expressing a desire for spacing or limiting the number of children. Also, virtually all participants recognised that the condom protects against sexually transmitted infections (STIs) as well as pregnancy, and many said specifically that men should or did use condoms in their extra-marital relationships. As Table 3 in the document illustrates, women were more motivated than men to practice FP - but not overwhelmingly so.

In 14 cases, communication on FP was initiated by women; in 11 cases, men; and in 6, it was unclear who initiated communication. But "Our findings suggest that couple communication alone is not enough to determine that relationships are equitable; equitable discussions and decision-making might be more meaningful indicators."

Both users and non-users often held mixed views of modern FP methods, recognising both the benefits for limiting and spacing children, but also expressing strong fears about the harmful side effects. Out of the 21 respondents desiring birth spacing or limiting, 15 held negative opinions or misconceptions about FP methods and stated that either their fear or their partner's fear was the main reason for not using contraceptives. (To cite one example, some men said they objected to the intrauterine device (IUD) because a doctor would need to touch their wives' "private parts" to insert it.)

Many of the men had made misinformed decisions about contraception, as it is not normative for men to seek information from sources such as health clinics. Three out of the 11 male non-users directly stated that they did not have enough information on contraceptives to make an informed decision, but that did not stop them from deciding that neither they nor their wives would use them, for fear of side effects.

Out of the 12 female non-users, 4 wanted to use FP methods but did not because their husbands would not permit them to do so. Both men and women, users and non-users, said that if a woman was caught using contraceptives secretly a husband would warn, beat, or divorce her. For instance, many said that using contraceptives secretly would create mistrust and cause a husband to think his wife is doing other things in secret, such as having an affair.

"Thus, on balance, despite ample evidence of gender inequality and gender norms that were potential barriers to the use of contraception, fears and misconceptions about side effects appeared to be more powerful deterrents to contraceptive use than non-egalitarian gender norms....In conclusion,...FP messages and interventions should engage both men and women and encourage equitable decision-making. Men should be encouraged both to seek information about modern contraceptive methods from reliable sources and to encourage their wives or partners to do so. In addition, the capacity of clinics and other sources of contraception to provide accurate information might need to be strengthened."