Family Planning

Cultural Norms and Decision Making

Research from Sierra Leone, conducted by the International Planned Parenthood Federation (IPPF), found that although many girls do not have accurate information on sexual and reproductive health matters, some are aware that modern family planning methods prevent pregnancy. Some say that condoms can protect against STIs including HIV. However, many sexually-active girls were not using any reliable form of contraception, due to myths, traditions, religion and/or not being able to ask their partners to use contraception. There also is a lot of shame associated with buying condoms as well as pressure from men not to use them. For some girls not using condoms was due to their partners’ preference for ‘body to body’ sex. Many girls mentioned that having ‘flesh to flesh’ sex not only feels better but it is also a way to show your partner how much you care about them and that you trust them.

There are 6.96 billion people on the planet. Of this, it is estimated by researchers at the 2011 Family Planning Conference89 that only 900 million women and their partners practice family planning. Family planning is a key intervention for improving the health and well-being of women and their families. It provides couples and individuals the means to prevent unwanted pregnancies and control the formation of their families. Family planning has wide-ranging benefits for sexual and reproductive health, including enabling women to exercise choice and control over their fertility, reducing maternal morbidity and mortality, reducing the risk of STIs, including HIV transmission, advancing gender equality, and increasing women’s opportunities for education, employment and full participation in society.90

It is not that men and women around the world do not want to control their fertility; it is that contraceptives remain out of reach of most of the world’s couples. Condoms, birth control pills, IUDs, diaphragms, implants, hormone patches and injections may be unknown, unavailable or too expensive for many. This may be due to the direct costs of contraceptives themselves or associated costs such as transport to health clinics and time taken to seek information and services.

Evidence also suggests that gender power inequities, politics, cultural norms and beliefs, lack of accurate information,91 lack of routine supplies of commodities, and unavailability of comprehensive family planning services in the lowest (most accessible) levels of health care systems are some of the most common barriers to accessing family planning services. In many contexts these barriers are amplified for adolescent girls, for whom family planning is often deemed – incorrectly – to be inappropriate or unnecessary.

The cultural norms that place decision making authority regarding reproduction on the man, and in some cases the mother-in-law, were also cited to greatly deny women the right to access family planning services. Some research shows that it is the man who decides whether or not the woman should use family planning. Similar authority can be vested with the mother-in-law, where she determines if and when their daughters-in-law can use contraception. The mother-in-law also makes decisions as to where the daughter-in-law can obtain health care services.

Barriers in Accessing Contraception
Multiple barriers impede girls’ access to contraception. These include:

  • Laws prohibiting or restricting young and/or unmarried girls’ contraceptive access or requiring permission from parents or husbands
  • Beliefs that exposure to family planning information increases the propensity for young people to engage in sex
  • Gender-based violence
  • Misleading, inaccurate or incomplete information
  • Economic constraints
  • Restrictions to access, both geographical and rights-based
  • Cultural and traditional practices and norms

Sport programmes can create safe spaces where girls are educated about the importance of family planning (whether they themselves are mothers, starting families, or plan to some day). Coaches can help participants understand the importance of using contraception if they want to have control over the amount and spacing of their children. Girls and young women also can use this space to discuss freely issues related to family planning without the social stigma they might experience in their homes. In addition, sport programmes can help girls and young women learn and share ideas on how to negotiate condom use and control over their bodies.

Useful Example – Youth Peer-to-Peer Training
In Kenya, Planned Parenthood Global (PPG) works with several local soccer leagues to integrate sexual and reproductive health education and services into their programmes. Using their Youth Peer Provider model, PPG partners, like Moving the Goalposts, train young people to become health educators and contraceptive counsellors in their own right. Youth Peer Providers work closely with local clinics and are trained by public health experts to teach their peers how to avoid unwanted pregnancy and STIs, and to provide contraception to young people who need it. This peer-to-peer model circumvents the stigma and barriers that surround adolescent sexual and reproductive health services. In countries where talking to young people about sex remains taboo, Youth Peer Providers help their counterparts delay pregnancy, stay healthy and stay in school.

Useful Example – Football Tournament
On the remote volcanic island of Ometepe in Lake Nicaragua, gender roles are strictly dominated by the machismo culture. For 11 years and running, AMOJO (a youth empowerment organisation) has held a girls’ football tournament to educate, raise awareness and support for SRHR. In 2011, 14 teams participated and hundreds in the community came to watch, officiate and provide support. The directors name two winning teams – one that wins the most games and one that answers the most questions correctly about sexual health and gender-based violence. The prize for winning is a t-shirt that says “I Always Wear Condoms.”

Adolescent Girl Life Skills:

Practical Ideas: Goal Programme Sessions