1. Conception or Contraception Men‘s Role in the decision making process in Minya, Egypt Adel Takruri PhD Candidate Johns Hopkins Bloomberg School of Public Health October, 2010

3. Fertility in Egypt TFR in Egypt was 3.1 in 2005 In Southern rural Egypt: 3.8 Contraceptive use in Egypt in 2005: 57% In Southern rural Egypt: 41% Unmet need for contraception in 2005: 7% in Northern Egypt 17% in Southern Egypt Decelerating fertility Decrease unwanted fertility or wanted fertility? Source: EDHS, 2005

4. The benefits of reducing fertility At the household level Educational opportunity Lower maternal mortality Better nutrition At the economic level Better job opportunities Poverty reduction At the environmental level Better sanitation Less strain on natural resources Less environmental degradation Source: Greene & Merrick, 2005

5. Reproductive Interventions The missing actor? Family planning programs mostly target women Reproductive health studies rarely include men Most family planning surveys collect data from women Reproductive health services mainly focus on women The question? Do men matter?

6. Study Objectives To determine the effects of husbands desire for more children on contraceptive use To determine factors that empower women to use contraception To determine the influence of husbands attitudes towards family planning on wives attitudes and subsequent use of contraception

7. Study data A panel survey of three years: 2004, 2005, and 2007 Included 1927 couples Based on the questions asked in DHS

9. Preliminary Results Use of contraception in relation to men-related factors OR95% CI Heard about FP past 6 months1.3(1.08-1.55) Staff talked about FP2.06(1.2-3.4) Staff talked about side effects FP0.56(0.21-1.5) Thought most people use FP1.3(1.08-1.55)

10. Desire for a future child 86% of couple are concordant in their desire for a future child 14% are discordant

11. Contraception among couples in which the woman wants to stop childbirth and the man want more children Woman's SchoolingPercent contraceptingNot contracepting Attended School80.319.7 No Schooloing76.623.4 Number of children Less than 48119 4 or more7327 Age 30 or less8515 Above 306139 Discussed FP with husband Yes8317 No7426

12. Pending hypothesis? Spouses influence each other Wife’s desire Husband’s desire Wife’s desire Husband’s desire

13. Policy Implications Including men men in reproductive and family planning services Empowering women to take control of their fertility Encouraging communication between spouses

14. Further Research How to define or refine the concept of unmet need to include husbands, wives or couples (Becker 1999) How do couples negotiate their fertility and contraceptive desires Who initiates the discussion Verbal or nonverbal expressions How to include men in reproductive health With wives Separately Men groups Men’s attitudes towards involvement? Childbearing and rearing are women’s issues? What is the value of children for men and for women? Unwanted fertility versus wanted fertility Informed Free from influence