In the Democratic Republic of Congo, women are typically the target of most family planning interventions, as health providers try to educate them about the benefits of modern contraceptive methods and access. Pregnancy is considered a woman’s responsibility.
But social norms in DRC often dictate that men are the final decision makers of whether and when a couple wants to have another child. Men tend to be swayed by the choices made by other men in the community, by what is deemed acceptable and what is seen as taboo by their peers. Men often worry that allowing their wife to use a family planning method makes them look weak or infertile. At the same time, men are typically left out of contraception education, meaning these decisions are made without full context.
New research conducted under the Johns Hopkins Center for Communication Programs-led Breakthrough ACTION project (which closed this spring) suggests that family planning programs should focus more on men and couples’ communication, shifting the emphasis to contraception as a tool for birth spacing rather than framing it as something that limits family size. The findings appear online in the journal Reproductive Health.
“When we engage men not just as gatekeepers but as partners who care deeply about the health and well-being of their families, we create opportunities for real change,” says Salomine Ekambi, a research associate at the Johns Hopkins Bloomberg School of Public Health who worked on the CCP research. “By reframing family planning as a way to build a stronger, healthier family we can break down misconceptions and make birth spacing a shared goal.”
Birth spacing, which encourages families to wait at least two years between giving birth to each child, can both improve the health of mother and child, giving the mother more time to recover post-delivery, and making it easier to financially support all children in the family.
Engaging men as a group of peers, as opposed to individually, Sugg says, can reduce stigma and create a sense of community acceptance. It can be a positive type of peer pressure.
“If you speak to men together and engage them in a dialogue so that they know that the other men in their community have heard the same information and have some of the same feelings about it, then they’re more likely to practice family planning,” says Kathryn Sugg, who worked on the research at CCP.
“We shouldn’t focus all of our family planning efforts on increasing knowledge among women, because while they’re the ones who are accepting a family planning method, they’re not actually doing that in a vacuum.”
Sugg says that working with men and promoting communication within couples is important to dispel misconceptions about family planning, misconceptions that often prevent men from permitting their wives to wait between pregnancies.
Across sub-Saharan Africa, modern contraceptive method prevalence is estimated at 23.4 percent, up 6.4 percent from 2012. In the DRC, however, modern contraceptive method prevalence is much lower, with only 10.7 percent of married women on a modern method as of 2024, compared to 7.8 percent of married women in 2013.
One third of married women surveyed for the 2023–2024 Demographic and Health Survey (DHS) expressed an unmet need for family planning, stating that they did not want to become pregnant at the time of the survey but were not using a modern method to prevent pregnancy.
The lack of knowledge around different modern contraceptive methods and how to obtain them has historically been a barrier, but social norms also play a significant role.
The research was conducted in the spring of 2022 over a series of 24 interviews and focus groups with 144 community members from three DRC provinces: Kasai Central, Lualaba, and Sankuru. The conversations explored norms and attitudes with married and unmarried men.
“We found that while social norms oppose the use of modern contraceptive methods and advocate for larger family size, there is notable social support for birth spacing,” the authors write. “Some men reported they would support their wives in learning about contraceptive methods if they were able to make the final decision. However, other men felt that allowing their wives to seek a method would undermine their authority or their virility.”
The study makes recommendations for how three groups – healthcare providers, religious leaders, and male peer groups – can help birth spacing more of a community norm.
Among them: Engage health providers to talk to men, individually as well as in groups, about the benefits of contraception for postpartum family planning and birth spacing, and engage religious leaders to speak in favor of birth spacing as a means of improving the health of the mother, newborn, and family (and reinforce that it is not a sin to take effective action to protect the health of your family).
“It’s me who supports. How are you going to refuse to have a child?”: the social norms and gender dynamics of men’s engagement in family planning practices in the Democratic Republic of the Congo” was written by Salomine Ekambi, Kathryn Sugg, Florence Mpata, Dédé Marachto Aliango and Peter J. Winch.
