Literature is replete with studies focusing on knowledge, attitude and use of FP services among the female population, conversely, the disaggregation of results by males and females has been less of a focus and not emphasized in reporting (9). This paper’s findings add to a growing body of literature on FP, in particular, male involvement, and use of FP services. The results from study revealed significant sex differences in the knowledge, attitudes, and use of FP services in selected districts in Uganda.
The finding that knowledge of FP was equally high for both males and females, despite the small differences is an indication that males and females have been equally targeted and engaged with information on FP in Uganda. It is not surprising that men were more aware of condoms as an FP method than any other method while women were more aware of the longer-term FP methods. It may be argued that whereas men may be more focused on the dual protection they can get from condoms, women are usually more concerned about prevention of unplanned pregnancy and this explains why men may be more informed more about condom use. These findings contradict those found in Mwanza region Tanzania (7), Mpigi district Uganda(6), Mbeya region Tanzania (12) and Nigeria (13) which all found that men had little knowledge on the subject.
Whereas females had more knowledge on FP and its availability within their communities, their attitudes and fears about the possible side effects were significantly different from those of males. The study found out that more males were worried that modern FP methods can result in infertility while females were on the other hand more concerned about reduced sexual pleasure or their partners being angry if they found out. Whenever such fears exist, it becomes difficult for people to embrace FP methods. The mismatch in fears between men and women related to FP may also affect couples’ communication on FP matters and result in lower uptake of FP and or discontinuation. The negative effect of fear of side effects on FP uptake have been reported by previous research studies (6, 7, 14–17).
Findings revealed that half of the males used condom use for dual protection compared to a third of the females resulting in 16% differentiated effect as a potential overestimation utilization among males. Whereas almost half of the males in this study commonly reported condoms as their FP method of use, other studies have associated condom use with HIV prevention and protection efforts (18) or casual sexual relationships rather than as a FP method (19). Future research should establish the primary use of condoms whenever they are reported as the FP method to avoid overstating it’s use as a FP method. While our study revealed that the use of permanent methods was higher than long term methods, this does not appear to be a knowledge problem as knowledge of long-term methods was very high. Further investigation into this may be needed. The findings further suggested that the use of short-term modern FP methods accounted for more than three quarters of the total modern FP methods in this study and recent studies associated short term methods use with high odds of discontinuation and switching affecting uptake and retention of clients on FP (2, 17). Our study findings from the regression model suggested that males, the young adults, the highly educated and those in marriage or active relationship were more likely to use modern FP services. These findings are consistent with other research studies that reported high FP among the educated (8), and the married (20). Contrary to a recent study, our study finding revealed no significant variations in uptake of modern FP among respondents with no child and those with increasing number of children (8, 21). Although findings revealed no significant differences, there is substantial evidence that increasing number of children was associated with increased FP use. Respondents with two or three children were approximately 30% more likely to use modern FP compared to those with no child.
Our study findings revealed that the total unmet need for FP among the marrieds was higher in females (24.5%) than males (18.9%), and in the same group, more females reported high unmet need for limiting whereas males reported high unmet need for spacing. These findings speak to the fertility desires of both males and females, but also to who experiences the highest burden of having a pregnancy. Compared to the 2016 UDHS, there is a 4% reduction in unmet need among the married females and this may indicative of the effect of increased funding and programmatic efforts around FP in Uganda in the past 3 years. Study findings from the logistic regression model suggested that the female respondents, those aged 35–49 years in reference to those aged 15–19 years, no/lower education level were associated with high probability of unmet need. The factors associated with high FP use were associated with lower unmet need and this is deemed to be consistent.
Results from a recent randomized controlled trial study found that where CHWs were active in provision of low-cost health products and basic child health services to low income families, there were improved health outcomes among the community members like reduced morbidity and mortality (4). Our study findings revealed low involvement of CHWs in delivery of family planning services. Learning from findings on the RCT study (4), we think that there is a potential opportunity for research on how CHWs can be leveraged to provide FP services and follow up of clients.
Our findings are not indicative of the national picture and should not be decisively used to generalize the entire country’s situation since they are largely biased to a few selected districts where Living Goods Uganda has presence. Albeit, the findings provide important sex-disaggregated insights in the knowledge, attitudes, beliefs and use of FP and are thus important for improving programing of future FP interventions.