Opportunities, challenges and countervailing narratives: Exploring men’s gendered involvement in contraception and family planning in Southern Malawi

Malawi faces challenges regarding increasing its contraceptive use and advancing women’s empowerment. Male involvement, and use of male methods, remain low in Southern Malawi, and little is known about how men’s gendered understandings, attitudes, norms and behaviours influence their approach to contraception and family planning. This study focuses on male involvement to inform a more supportive and equitable environment for the use of contraception. A mixed methods community-based design was employed in urban Blantyre and rural Chiradzulu, including a household survey with 417 men, in-depth interviews with 40 men, six focus group discussions with men and women, 38 interviews with health providers and key stakeholders, secondary male client data and observational techniques. Bivariate and multivariate analyses were carried out, with thematic analysis of qualitative data, before data integration. Analysis was informed by Raewyn Connell's theory of hegemonic masculinities. Gender and contraception were conceptualised and operationalised as female-only. Unmarried men reported greater odds of contraceptive use, using male condoms with their partners, while married men relied exclusively on their wives’ methods. Men reported overall inconsistent condom use and objections to male and female methods, alongside gendered understandings and misconceptions of family planning and contraception. Men’s support for gender equality was associated with increased method use. Men predominately desired to control contraceptive communication flows and decision-making, while women were primarily responsible for preventing pregnancy. Norms of male fertility, breadwinner masculinities, male stoicism, virility, sexual pleasure, multiple sexual partners and ownership of women’s sexuality influenced male involvement in complex and countervailing ways. The health system and government had a limited focus on male involvement and reinforced male hegemony. Programmes and policies require a greater understanding of how the social production of gender and contraception, the enforcement of hegemonic masculinities, and men’s performance of gender norms influence male involvement and undermine women’s reproductive autonomy