New Game for Ugandan Men Uncovers Behavioral Barriers to Family Planning

By Irene Mirembe,
Knowledge management manager, IntraHealth International ; Susan Tino,
Project manager, IntraHealth International
Photo by Ely McElwee.

Men play Together We Decide during a user test in one of the districts. Photo by Ely McElwee.

September 26, 2019
Uganda has a high fertility rate and a declining mortality rate, resulting in rapid population growth. This has led to a dependent population that is not conducive to economic production, savings, investment, or development.
Uganda also has a high unmet need for family planning— according to the 2016 Uganda Demographic Health Survey, an estimated 28-32% of women do not intend to have more children but are not using any contraception. High teenage pregnancy rates and myths around the use of modern contraceptive methods put the lives of mothers and children at risk.
Women who have given birth within two years make up 19% of the population and 69% have an unmet contraception need.
A fresh behavioral science approach engages men in reproductive health matters.

In general, there is low male involvement in reproductive health services across the region, even though men greatly influence the lives of mothers and children in Uganda. Most intervention programs target only women. But this is changing with a fresh behavioral science approach that seeks to engage men in reproductive health matters.  
With funding from the Hewlett Foundation and in partnership with ideas42, IntraHealth International conducted a preliminary behavioral study in the RHITES-E-supported districts of Serere, Kibuku, and Kapchorwa to identify the behavioral barriers to contraception that postpartum women and their male partners face. The study found that:

  • Couples typically do not discuss how many children to have or when to have them.
  • Couples typically do not discuss whether to use modern contraceptive methods.
  • Couples decide to have another child because they either underestimate the cost or overweigh specific benefits of having a child.
  • Couples do not consider modern contraceptive methods because they think their current actions to avoid children are enough.
  • Men and women do not have a “moment of choice” during visits to health facilities to consider modern contraceptive methods because health workers do not consistently discuss them with clients.
  • Couples choose not to use modern contraceptive methods because they are afraid of the side effects, including actual side effects (such as heavy bleeding) and perceived side effects (such as cancer).

One of the interventions we designed to address these behavioral barriers is called Together We Decide, an interactive game specifically for men, since they can be either enablers or inhibiters of contraceptive use. The game teaches men ways to keep their families healthy and how to discuss health topics with their partners.