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Men's contraceptive practices in France: Evidence of male involvement in family planning

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To describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to explore their involvement in managing contraception within the couple. Data are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010. The study sample comprised 3,373 men aged 15-49, 1,776 of whom of whom were asked about their current contraceptive practices after they reported they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models. Few men aged 15-49 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4% only cooperative methods, such as condoms, withdrawal, and the rhythm method, and 4.5% both. Among contraceptive users, withdrawal (7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive method by 18.9% of men. Its prevalence was higher for those in new and non-cohabiting relationships (36.1%) and lower for those in cohabiting relationships (12.4%), in which STI/HIV prevention is less of a concern. Men's high awareness of contraceptive practices and their use of some cooperative methods reveal their involvement in contraceptive practices within the context of relationships. Condom use is associated with the prevention of STIs/HIV for non-cohabiting men, but men who live with their female partner seem to use condoms mainly as a contraceptive method. Withdrawal appears to be associated with disadvantaged low level of education and financial difficulties. Finally, having engendered a pregnancy that was terminated appears to influence men's contraceptive practices. Studying men's contraceptive practices helps to understand their involvement in contraceptive management within relationships. Copyright © 2015. Published by Elsevier Inc.
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Original research article
Men's contraceptive practices in France: evidence of male involvement in
family planning
Mireille Le Guen
a,
, Cécile Ventola
a
, Aline Bohet
a
, Caroline Moreau
a,c
,
Nathalie Bajos
a,b
for the FECOND group
1
a
Gender, Sexuality, Health, CESP Centre for research in Epidemiology and Population Health, U1018, Inserm, F-94807, Le Kremlin-Bicêtre, France
b
Institut National dEtudes Démographiques, F-75020, Paris, France
c
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Received 24 September 2014; revised 23 February 2015; accepted 24 March 2015
Abstract
Objective: To describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to
explore their involvement in managing contraception within the couple.
Study design: Data are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010.
The study sample comprised 3373 men aged 1549, 1776 of whom were asked about their current contraceptive practices after they reported that
they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models.
Results: Few men aged 1549 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4%
only cooperative methods, such as condoms, withdrawal and the rhythm method and 4.5% both. Among contraceptive users, withdrawal
(7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive method
by 18.9% of men. Its prevalence was higher for those in new and noncohabiting relationships (36.1%) and lower for those in cohabiting
relationships (12.4%), in which STIs/HIV prevention is less of a concern.
Conclusion: Men's high awareness of contraceptive practices and their use of some cooperative methods reveal their involvement in
contraceptive practices within the context of relationships. Condom use is associated with the prevention of STIs/HIV for noncohabiting men,
but men who live with their female partner seem to use condoms mainly as a contraceptive method. Withdrawal appears to be associated with
low level of education and financial difficulties. Finally, having engendered a pregnancy that was terminated appears to influence men's
contraceptive practices.
Implications: Studying men's contraceptive practices helps to understand their involvement in contraceptive management within relationships.
© 2015 Elsevier Inc. All rights reserved.
Keywords: Contraception; Contraceptive practices; Men; Condom; Withdrawal; France
1. Introduction
The decrease in the birth rate observed throughout
the 18th to the 20th century in western countries [13] was
mainly due to the practice of withdrawal (coitus interruptus)
by couples [4]. Although other methods existed [4,5], they
were little used, and induced abortions were both rarely
effective and associated with high rates of mortality [6].In
the 1960s, feminist movements obtained the legalization of
contraception. New contraceptive options, the pill and the
intrauterine device (IUD), became available and replaced
traditional methods that required the involvement of both
partners: withdrawal, the rhythm method and condoms. As
a result, women were able to manage their own fertility,
regardless of men's consent. These changes have led to a
transition from the traditional contraceptive model managed
by couples to a medicalized and female-controlled contra-
ceptive model [7,8]. At the beginning of the 1980s, national
campaigns to prevent HIV led to the reintroduction into the
Contraception 92 (2015) 46 54
Corresponding author at: Gender, Sexuality, Health, Inserm CESP
U1018 - Ined, 82 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre, France.
Tel.: +33-1-45-21-23-35.
E-mail address: mireille.le-guen@inserm.fr (M. Le Guen).
1
The FECOND group, includes N. Bajos and C. Moreau (PIs), A. Bohet
(coordinator), A. Andro, J. Bouyer, G. Charrance, D. Dinova, D. Hassoun,
M. Le Guen, S. Legleye, E. Marsicano, M. Mazuy, H. Panjo, N. Razafindratsima,
A. Régnier-Loilier, V. Ringa, E. de la Rochebrochard, V. Rozée, M. Teboul,
L. Toulemon, C. Ventola.
http://dx.doi.org/10.1016/j.contraception.2015.03.011
0010-7824/© 2015 Elsevier Inc. All rights reserved.
contraceptive repertoire of condoms [9], which until then
were used mostly in the context of premarital intercourse
and prostitution [10]. Since then, condom use as a
contraceptive method has increased notably [11,12].
Nevertheless, the contraceptive landscape in France, as in
most countries in the world (except in sub-Saharan Africa),
remains dominated by highly effective female methods. Thus,
womenarefarmorelikelytotakeresponsibilityforboth
partners' fertility control, and men's interest in contraception is
rarely considered.
Although some studies have investigated men's involve-
ment in family planning decisions [1318], the focus on
women of most analyses of contraceptive practices suggests
that men are not really considered to be part of the
contraceptive story.Men's sexuality is widely explored,
but studies of their contraceptive practices are scarce [1921]
and most often focus on the concordance of men's and
women's descriptions of current contraceptive use [22,23].
Differences in the reporting of condom prevalence between
men and women havebeen explained by the fact that men may
be using them for extramarital intercourse [24],without
considering that men might be more likely to report this
method as their own because it is the only reversible method
labeled as male.Women have many more effective
contraceptive options available than men do [25]; accordingly,
female methods dominate. This situation should not necessar-
ily be interpreted, however, as evidence of men's lack of
interest in birth control. When analyzing men's involvement in
contraception, we need to reconsider the methods used and
broaden the dualistic view of male or female methods to
include partners' awareness of use. In this perspective,
methods such as condoms, withdrawal and the rhythm method,
which require both men and women to consent, can be
considered cooperative methods. Because research on nego-
tiation within couples and on male motivations for using
contraception is very limited in France, we preferred not to
assume that contraceptive decisions are made exclusively by
either women or by men. Men may also have an interest in
managing their own fertility, in terms of limiting and timing
childbearing, and they may therefore want to participate in
managing contraception. In this perspective, we consider that
fertile men who do not currently want a child and have
heterosexual intercourse without using any contraception are
at risk on unintended pregnancy, and so, as for women, their
need for contraception are considered unmet. This paper is a
descriptive analysis of contraceptive practices of men in
relationships in France.
2. Materials and method
Data are drawn from the FECOND study, a national
probability survey conducted in France in 2010. A detailed
description of the survey has been published elsewhere [26].
The telephone survey included a random sample of 3373
men aged 15 to 49 years residing in France. Both landlines
and cell phones were called to avoid the bias associated with
surveying only landlines. Participants agreed orally to
respond to a questionnaire that took a maximum of 41 min
to administer. The refusal rate was estimated at 20.2% [27].
The relevant French government agency (Commission
Nationale de lInformatique et des Libertés, French data
protection authority) approved the study.
Because questions related to current use of contraception
were asked only of men who reported having a female partner at
the time of the survey (the question about current contraception
was: Are you that is, you or your partner doing something
to prevent a pregnancy?),oursamplesizedroppedto2331men.
We restricted the analysis to the 1776 men who were not sterile,
not trying to conceive, had had heterosexual intercourse in the
last 12 months and who had a female partner younger than
50 years who was neither sterile nor pregnant (Fig. 1).
Topics explored in the FECOND survey included social
and demographic status: age, country of birth, highest
diploma, perceived financial situation (defined by response
to the question Today, would you say that your financial
situation is: 1/OK, we're comfortable; 2/Its tight, I need to
be careful; or 3/Difficult, Im not managing), importance of
religion and cohabitation status. The latter indirectly reflects
a degree of stability in a relationship in the French context,
where marriage is no longer an essential step in forming a
family and raising children [28]. The survey collected a
number of sexual and reproductive health indicators
including: duration of the current relationship, age of current
partner, number of children, number of partners lifetime and
during the previous 12 months, frequency of sexual
intercourse (constructed by asking people if they had had
sexual intercourse during the previous year and, if so, how
many times during the past month). Finally, we asked men
about pregnancies they had engendered and if any had been
terminated by induced abortions (summarized hereafter as
history of induced abortions).
We considered four contraceptive methods involving male
participation (or which could not be used without his consent):
vasectomy, (male) condom,
1
withdrawal and the rhythm
method. Only one man reported a vasectomy and was therefore
excluded from the analysis. As withdrawal, rhythm and condom
use depend on the cooperation of both partners, we defined these
methods as cooperative methods. Other methods that do not
require male consent were considered as female-controlled
methods. To analyze men's contraceptive practices, we
distinguished four groups: (a) men with an unmet need for
contraception; (b) men using a cooperative method; (c) men
using at least one cooperative method alongside a female-
controlled method; and (d) men who reported that they used
only a female-controlled method with their current partner.
We first examined the factors associated with men's
unmet need for contraception, defined by the criteria for
analysis above (able but not intending to conceive and whose
1
In this article, condomrefers to the male condom; the female
condom is very rarely used in France.
47M. Le Guen et al. / Contraception 92 (2015) 4654
partner is not pregnant) and not using a contraceptive method
at the time of the survey. Subsequently we analyzed use
of withdrawal and of condoms separately among male
contraceptive users, because condoms are extensively
promoted to prevent sexually transmitted infections (STIs),
whereas health care professionals are unlikely to recommend
withdrawal [29], due to its relatively low effectiveness
compared to other contraceptive methods [30,31]. All but 14
of the men using the rhythm method were also practicing
withdrawal (86%) too few to study.
Only variables significantly associated with the outcome
(that is, unmet need for contraception, condom use and
withdrawal use) at the level of 20% in the bivariate analysis
were considered in the multivariate analyses, together with
the age group variable (which was forced in each model).
Each adjusted odds ratio (OR) was adjusted for the other
variables included in each model. Because level of education
and perceived financial situation were highly correlated, we
ran two different multivariate regression models to assess
the separate effects of each variable. To analyze condom use,
we fitted two logistic regression models stratified by men's
cohabitation status, in view of the difference in condom use
between these two groups. We further considered an
interaction term between history of induced abortion and
level of education (test of interaction pb.01) as the association
between educational level and condom use differed according
to this abortion experience.
Weighted analyses were used to account for the complex
survey design. All analyses were conducted with Stata 13.
3. Results
3.1. Men's contraceptive practices
In 2010, 3.4% of men aged 1549 years in need for
contraception were not using any method (Fig. 2). Three
quarters of the men (71.7%) relied on a female-controlled
method only, 20.4% were using a cooperative method, such
as condoms, withdrawal, or the rhythm method and 4.5%
relied on a female-controlled method alongside a cooperative
method. Cooperative methods were mainly used at sexual
debut; their use decreased as age increased. Use of combined
female-controlled and cooperative methods was also high at
the age of 1819 (20.7%) and then decreased rapidly (8.6%
at 2029), dropping to marginal levels between ages 30 and
49 (less than 2%).
3.2. Unmet need for contraception
In the bivariate analysis, use of contraception was not related
to age (p=.65), level of education (p=.11) or cohabitation status
(p=.11). Men reporting at least two sexual partners in the last
12 months were more likely to be using contraception than men
with a single partner during the past year (respectively, 0.8%
vs. 3.7% were not using contraception, pb.01) (Table 1).
Likewise, men with a history of induced abortion used
contraception more often than those who did not report this
experience (0.6% vs. 3.8% not using contraception, pb.01).
Multivariate analysis showed, however, that men with a
high level of education used contraception more often (that
is, were less likely to have an unmet need for contraception:
OR=0.5 [0.21.0], p=.06). It also confirmed that men with a
history of induced abortion were more likely to use contracep-
tion (OR=0.2 [0.00.9], p=.03).
3.3. Use of withdrawal
Among men using contraception, 7.7% reported using
withdrawal (Table 2): 2.3% withdrawal only, 0.2% in
association with the pill or an IUD, 1.4% with condoms
and 3.8% combined with the rhythm method. Bivariate
analysis indicates that men born abroad were more likely to
practice withdrawal than men born in France (15.3% vs.
7.2%, p=.04). Men who reported financial difficulties at the
time of the survey were also more likely than others to rely
on withdrawal (12.1% vs. 6.7%, pb.01). Similarly, those
with the lowest and highest levels of education relied more
on withdrawal: 9.1% with no diploma, 4.5% with a high
1776
included in the analysis
2116
-340 were sterile (themselves or their partner) or were trying to conceive or whose partner was pregnant
2238
-122 not sexually active in the last 12 months
2331
-93 with a female partner aged 50 and more
3 373 men aged 15-49
-1 042 without partner
Fig. 1. Description of the study sample.
48 M. Le Guen et al. / Contraception 92 (2015) 4654
school diploma, 5.8% with a bachelor's degree and 8.7% of
those with a master's degree, p=.03). Finally, men who
reported that religion was very importantor importantin
their lives were more likely to practice withdrawal (12.8%
vs. 6.5%, pb.01).
The multivariate analysis (Table 2) confirmed that
financial difficulties were associated with a higher OR of
withdrawal use (OR=2.5 [1.34.7], pb.01). In the model
using education level instead of perceived financial situation
as the indicator of social position, our results similarly
indicate that men with less than a high school diploma were
more likely to practice withdrawal (OR=2.1 [1.14.0], p=.02),
as were those with a master's degree (OR=1.8 [0.93.6], p=
.09). Men who reported a religious affiliation were also more
likely to use withdrawal (OR=1.9 [1.13.4], p=.02).
3.4. Use of condom
In our sample, 18.9% of men who reported contraceptive
use were using condoms at the time of the survey, including
4.4% in combination with a female-controlled method. Men
not living with their partners were more likely to report
condom use for contraception than cohabiting men (36.1% vs.
12.4%, pb.01). Correlates of condom use differed by
cohabitation status.
In a subanalysis among noncohabiting men, those
involved in a relationship that began only recently and
those who reported more than one partner during the last year
were more likely to use condoms (Table 3). Moreover,
condoms were more likely to be used by men who reported
fewer acts of intercourse, compared to those reporting
frequent intercourse, defined as 10 acts or more in the past
month (60.0% vs. 24.0%, pb.01). The latter were more likely
to be using more effective female-controlled methods (pill,
IUD, implant, patch, hormonal injection, vaginal ring or
sterilization) as compared to those who had less frequent
sex (78.8% vs. 49.3%, pb.01). Among those who did not
report a history of abortion, condom usage was inversely
related to level of education (30.1% for men with a higher
level of education vs. 39.2% for their less educated
counterparts). The reverse was true among those who reported
engendering a pregnancy that was terminated: 53.2% of the
more educated men reported condom use versus 24.4% of
those less educated.
Multivariate analysis among noncohabiting men
(Table 3)confirmedsomeoftheprevious bivariate results:
men in newer relationships (1 year or less) were more likely
to use condoms (OR=2.3 [1.43.9], pb.01) than those in
longer relationships. The OR of condom use increased as
frequency of sexual intercourse decreased among this
subgroup. Higher education was associated with less
frequent condom use among men with no history of induced
abortion (OR=0.5 [0.30.9], p=.01) but was higher among
those with such a history (OR=3.8 [1.113.0], p=.03).
Condom use was not associated with the number of female
sexual partners in the past 12 months in the multivariate
analysis among noncohabiting males.
In the analysis among cohabiting men (Table 3), younger
men were more likely to use condoms than their older
counterparts. Moreover, higher education was significantly
related to condom use. Again, the effect of education differed
among those who reported a history of induced abortion and
those who did not. Finally, men who reported financial
difficulties were less likely to use condoms (8.2% vs. 13.4%,
p=.04) (data not shown).
48.8
21.7 21.3 18.3
26.6 20.2 19.2 13.9 20.4
8.9
20.7
6.9 10.4 4.5
36.1
55.6
69.9 68.3 67.1 75.7 76.9
77.6
71.7
6.2 6.6 3.4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
15-17 18-19 20-24 25-29 30-34 35-39 40-44 45-49 15-49
Unmet need for contraception Female-controlled only
Female-controlled with cooperative method Cooperative methods (condom, withdrawal and rhythm)
Source: FECOND Survey 2010 (Inserm-Ined)
* among male respondents aged 15-49 years who were not sterile and not trying to conceive, who had not had heterosexual
intercourse in the last 12 months, and who had a female partner younger than 50 years who was not sterile or pregnant.
Fig. 2. Men'scontraceptive use by age groups in France in 2010. Interpretation: 3.4% of men of our sample were not using any contraception.
49M. Le Guen et al. / Contraception 92 (2015) 4654
In the multivariate analysis, the ORs of condom use were
higher among men aged 2534, compared to those aged 35
to 49 years (OR=1.6 [1.12.4], p=.02). Men with higher
education who lived with their partners were more likely to
use condoms than their less-educated peers unless they had a
history of induced abortion (OR=1.8 [1.32.7], pb.01).
When we considered perceived financial situation instead of
level of education, men who declared financial difficulties
were less likely to use condoms (OR=0.6 [0.31.0], p=.04)
(data not shown).
None of the analyses indicated an association between
recent HIV testing and condom use.
These results were similar among men who were not
relying on female methods together with condoms.
4. Discussion
Our results show that a vast majority of men in
partnerships in France report using contraception with their
partner: three quarters relied on female-controlled methods
(pill or the IUD) solely, while the remaining reported using
cooperative methods, that is, condoms, withdrawal or the
rhythm method, alone or in addition with a female-controlled
method. The level of men's unmet need for contraception
was quite low (3.4%) similar to published estimates among
women [26]. Factors related to use of cooperative methods
differ depending on the method, with greater use of
withdrawal among those reporting financial difficulty and
greater use of condoms among men in new relationships.
This finding suggests high levels of male awareness of
contraceptive usage within relationships despite the limited
contraceptive options they can manage themselves [25] and
the absence of specific services for information and prescrip-
tions for men in France [32,33]. Medical gynecologists
provide most contraceptive prescriptions in France [34].
They are considered women's health specialists and do not
advertise themselves as offering health care services to men
[35]. Most family planning/contraceptive provision facilities
are therefore labeled as womens services.
Our study has limitations that need to be discussed. First,
only men who reported being in a relationship were asked
about their contraceptive usage. Among these men, social
desirability bias may affect the responses, but the direction it
might bias towards is unclear. Desire to give the right
answer might lead men to report specific contraceptive use
when they do not actually know or are not certain or,
alternatively, to pretend they do not know about it, as
contraceptive responsibility is socially constructed as a
female concern. Some men may find it more virile to pretend
they are not involved in this woman's activity. Social
desirability could affect responses but most likely not in only
one direction. Nonetheless, most men reported using
contraception, and they reported a cooperative method
more often than women, a pattern previously observed in
studies of the concordance of men and women's reports of
contraceptive practices in developing countries [22,36] and
in the United States [33]. These results suggest that men are
involved in contraceptive decisions. In any case, men's
involvement in contraception should not be reduced to the
couples' use of cooperative methods. Further studies are
Table 1
Bivariate and logistic regression predicting men's
a
unmet need for contraception
n/N% Unadjusted p-value Adjusted OR
b
95% CI
% 3.4
Age 0.650
1525 8/379 2.5 1.25 0.403.87
2534 14/458 3.2 1.02 0.472.18
3549 33/939 3.7 1
Highest diploma 0.113
b=High school 40/1083 3.8 1
NHigh school 14/688 2.2 0.49
+
0.241.03
Living situation 0.106
Cohabiting with partner 45/1226 3.9 1
Not cohabiting with partner 9/547 2.0 0.51 0.161.66
Number of female partners in the last 12 months 0.005
1 partner 49/1498 3.7 1
2 partners or more 3/247 0.8 0.32 0.071.41
History of induced abortion 0.006
No 53/1565 3.8 1
Yes 2/211 0.6 0.19⁎⁎ 0.040.87
N1776 1738
+
pb0.10; pb0.05; ⁎⁎pb0.01; ⁎⁎⁎pb.001.
CI=confidence interval.
a
Among male respondents aged 1549 years who were not sterile and not trying to conceive, who had had heterosexual intercourse in the past 12 months,
and who had a female partner younger than 50 years who was neither sterile nor pregnant.
b
Each adjusted OR is adjusted for the other variables included in the model.
50 M. Le Guen et al. / Contraception 92 (2015) 4654
needed to explore contraceptive negotiations within couples
and men's contribution to male- or female-controlled
contraceptive choice and to their partners' contraceptive
adherence [10,37]. However, the lack of information about
the partner's characteristics further limits the study of male
involvement within the context of a relationship [37]. Finally,
this study, because cross-sectional, could describe associations
but cannot establish causal links.
Men's contraceptive practices in France are deeply rooted
in the country's historical and social context. As in many
countries, condom use here has mainly been promoted
through extensive media campaigns since the mid-1980s to
prevent STIs, especially HIV, in nonstable relationships
[38,39]. For this reason and because health care providers
generally do not recommend condoms as a contraceptive
method [35], their use is more frequent among noncohabit-
ing men. In addition, as we have seen, correlates of condom
use differ by cohabitation status, a difference that suggests
varying reasons for use by men with regular partners. The
association of duration of relationship with condom use
among men who do not live with a partner suggests that its
purpose is to prevent STIs. The fact that men with more
frequent sexual activity report using condoms less often than
men with less frequent intercourse may suggest that people
with more frequent sexual activity rely on more effective
and coitus-independent methods. Among cohabiting men,
however, for whom STI prevention is less of a concern,
condom use is more likely to reflect a contraceptive choice,
among individuals with high social and cultural resources.
Men who had experienced an abortion were more likely
to use contraception, which may reflect their higher
awareness of unwanted pregnancy risks. However, their
contraceptive strategies differed according to their level of
education and their relational context. Specifically, among
men who were in noncohabiting relationships and had
experienced an abortion, those with higher education
privileged cooperative methods over method effectiveness,
choosing condoms rather than more effective female-
controlled methods, while those with lower education
privileged method effectiveness over cooperative methods.
One possible hypothesis is that noncohabiting men with
higher education may be more likely to want to take control
over their own reproductive future by trusting their ability to
use condoms each time they have intercourse, while those
with lower educational level may feel less entitled to
challenge the contraceptive norm privileging female-
controlled methods [7,40] over less effective male-controlled
methods. Otherwise, financial difficulties, found to be related
Table 2
Bivariate and logistic regressions predicting men's
a
use of withdrawal
n/N% Unadjusted
p-value
Model 1 Model 2
Adjusted OR
b
95% CI Adjusted OR
b
95% CI
% 7.7
Age 0.152
1525 16/371 4.6 0.64 0.311.29 0.61 0.301.24
2534 37/444 9.0 1.25 0.762.06 1.37 0.802.33
3549 77/906 8.1 1 1
Nationality 0.035
French 121/1661 7.2 1 1
Other 9/58 15.3 1.65 0.733.76 1.68 0.733.85
Financial situation 0.007
No problem 33/659 4.9 1
Tight 66/789 8.1 1.64
+
1.002.69
Difficult 31/271 12.1 2.48⁎⁎ 1.314.70
Highest diploma 0.032
bHigh school 60/636 9.1 2.121.114.03
High school 20/407 4.5 1
Bachelor's degree 22/357 5.8 1.20 0.592.44
Master's degree 27/317 8.7 1.82
+
0.913.63
Importance of religion 0.004
Not importantNot religious 95/1418 6.5 1 1
Very important/Important 35/298 12.8 1.851.093.14 1.941.113.40
Number of female partners, lifetime 0.085
1 18/214 11.2 1 1
More than one 107/1475 7.0 0.60 0.331.12 0.62 0.331.15
History of induced abortion 0.178
No 116/1512 8.0 1 1
Yes 14/209 5.3 0.62 0.321.21 0.69 0.361.33
N1721 1681 1679
+
pb.10; pb.05; ⁎⁎pb.01; ⁎⁎⁎pb.001.
a
Among male contraceptive users aged 1549 years who were not sterile and not trying to conceive, who had had heterosexual intercourse in the past
12 months, and who had a female partner younger than 50 years who was neither sterile nor pregnant.
b
Each adjusted OR is adjusted for the other variables included in the model.
51M. Le Guen et al. / Contraception 92 (2015) 4654
to lower use of condoms, may inform contraceptive decisions
based on economic considerations and may affect men's
contraceptive options: unlike sterilization, IUDs, hormonal
contraception (except the patch and vaginal ring) and the
diaphragm, condoms are not reimbursed by the national health
care system in France [34].
Men with a higher level of education reported using
contraception more often than their less-educated counter-
parts and were also more likely to use a cooperative method
(withdrawal, condoms). We interpreted these results in the
light of studies about attitudes towards a potential male
hormonal contraceptive. International studies have shown
that more educated men were more likely to state that they
would be interested in using such a method, that is, a male
pill, if it were to become available [41]. This might suggest
that men with higher levels of education might be more
likely to challenge the dominant norm of fertility control as a
female domain [10,19,20] by demonstrating more individual
involvement in using male or cooperative contraceptive
options [42]. Future research exploring male involvement in
contraceptive decisions and their sense of responsibility
regarding fertility control within the context of their
Table 3
Bivariate and logistic regressions predicting men's
a
condom use
Not cohabiting with partner Cohabiting with partner
n/N% Unadjusted
p-value
Adjusted
OR
b
95% CI n/N % Unadjusted
p-value
Adjusted
OR
b
95% CI
% 36.1 12.4
Age 0.428 0.014
1525 98/286 36.7 1.06 0.552.05 16/85 15.7 1.55 0.812.98
2534 52/129 39.6 1.92
+
0.933.93 56/314 16.6 1.611.082.41
3549 39/123 30.4 1 93/782 10.7 1 1
Nationality 0.256 0.108
French 179/521 35.4 1 154/1138 11.9 1
Other 9/16 51.5 2.39 0.777.39 11/42 20.3 2.00
+
0.904.46
Importance of religion 0.290 0.167
Not importantNot religious 154/438 37.5 1 131/980 11.7 1
Very important/Important 35/100 30.8 0.55
+
0.281.06 33/196 15.6 1.41 0.852.33
Age gap between partners 0.395 0.145
Woman is older 12/47 34.6 0.77 0.331.82 28/145 16.8 1.26 0.712.23
Same age 102/270 39.2 1 64/425 13.4 1
Woman is younger 75/220 32.2 0.79 0.451.37 73/610 10.8 0.83 0.551.25
Length of relationship b0.001 0.136
b=1 year 131/299 44.5 2.31⁎⁎ 1.363.94 12/51 19.4 1.22 0.522.89
N1 year 56/235 25.0 1 153/1129 12.2 1
Number of female partners
in the last 12 months
0.022 0.189
1 partner 98/334 31.7 1 154/1114 12.3 1
2 partners or more 87/192 43.8 1.59
+
0.922.76 11/51 20.1 1.98 0.745.30
HIV test during the last year 0.180 0.403
No 148/400 38.1 1 148/1105 12.2 1
Yes 41/138 30.4 0.60
+
0.351.02 17/76 15.3 1.21 0.662.21
Frequency of sexual intercourse b0.001 0.997
04 per month 75/134 60.0 4.93⁎⁎⁎ 2.788.74 43/293 12.5 1.12 0.701.82
59 per month 41/102 40.1 2.39⁎⁎ 1.344.25 50/344 12.5 1.16 0.731.83
10 or more per month 73/301 24.0 1 71/536 12.4 1
Highest diploma and history
of abortion
0.091 b0.001
b=High school, no history
of induced abortion
117/303 39.2 1 76/612 10.3 1
NHigh school, no history
of induced abortion
49/166 30.1 0.480.270.86 76/426 18.3 1.85⁎⁎ 1.262.71
0.040 0.709
b=High school history
of induced abortion
12/47 24.4 1 8/80 9.6 1
NHigh school history
of induced abortion
11/21 53.2 3.801.1113.02 5/60 7.7 0.79 0.222.80
N538 518 1181 1148
+
pb.10; pb.05; ⁎⁎pb.01; ⁎⁎⁎pb.001.
a
Among male contraceptive users aged 1549 years who were not sterile and not trying to conceive, who had had heterosexual intercourse in the past
12 months and who had a female partner younger than 50 years who was neither sterile nor pregnant.
b
Each adjusted OR is adjusted for the other variables included in the model.
52 M. Le Guen et al. / Contraception 92 (2015) 4654
relationships, across the socioeconomic spectrum, would shed
light on these preliminary findings. Likewise, future studies
should investigate men's attitudes towards contraceptive
options in order to improve our understanding of the preference
for traditional methods among highly educated men, which
may reflect a rejection of hormonal contraception as unnatural,
in line with a growing concern about the side effects of
hormones [43] or an aspiration to a greater sharing of
contraceptive responsibilities with their partner [44].These
hypotheses need to be explored in further analyses, including
gender norms as a potential driver of contraceptive negotiations
within relationships.
Acknowledgment
We thank all men who participated in the FECOND study,
Henri Panjo for his help in the statistical analysis and Jo Ann Cahn
and Rachel Scott for their help in English translation. We also
thank Armelle Andro for her advice and suggestions.
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... Although some studies have investigated men's involvement in family planning decisions (Adelekan, Omoregie, & Edoni, 2014;Clark, Yount Mon, & Rochat, 2008;Zakaria & Bhuiyan, 2016), the focus on women of most contraceptive studies suggests that men are not really considered to be part of the contraceptive practice (Balde et al., 2016;Le Guen, Ventola, Bohet, Moreau, & Bajos, 2015). The perspective of men regarding family planning should also be measured not only as women's opinion but also as independent individuals with different reproductive organs, histories, and needs (Le Guen et al., 2015). Family planning surveys should interview both females and males to explore the characteristics, knowledge, attitude, and practices of family planning between two different individuals (Becker & Costenbader, 2001;Becker, Fonseca-Becker, & Schenck-Yglesias, 2006). ...
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... Factors associated with men's support for the future use of the implant by their female intimate partners included: a) men knowing that the intimate partner wishes to have another child in future, b) knowing that the implant is safe for use by women who have not had children yet, c) knowing the timeframe within which the implant can effectively prevent pregnancy, and d) the perception that the implant last long. These findings are not unique, previous studies conducted elsewhere among men on women's contraceptive use also identified a strong association between men's awareness of contraceptive methods and their support for female intimate partner use [21][22][23][24][25][26][27][28]. Furthermore, men's awareness of and support for modern contraceptive use was strongly associated with women's desire to use contraception in Nigeria [21], and in Uganda [26]. ...
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In France in 2010, 50% of women aged 15-49 concerned by contraception used the pill. The slight fall in the proportion of pill users since the early 2000s has been offset by the growing use of new hormonal contraception methods (contraceptive implant, patch and vaginal ring), except among the 20-24 age group. Use of the IUD is continuing its slow decline, while condom use is increasing. Only a small minority of women opt for contraceptive sterilization, which was legalized in 2001. Around 3% of women not wishing to become pregnant do not use any form of contraception. This situation is more frequent among women facing financial difficulties, with a low level of education or living in a rural area.
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The idea of increasing men’s participation in family planning has received periodic attention for the past 20 years, but there is no generally accepted understanding of what men’s involvement actually means. This paper examines the gender implications of ‘male involvement’ for the staff and decision-makers of service delivery programmes, and the gender dynamics surrounding the use of contraceptives, particularly male-dependent methods. It discusses the importance of taking into account the interplay between men’s and women’s roles, rather than focusing on women’s situation (or men’s) alone, with the aim of increasing equality between women and men. Finally, it cautions against forms of ‘male involvement’ which result in men usurping what was formerly women’s territory and thereby worsening existing male dominance. Résumé Depuis 20 ans, on se préoccupe périodiquement de la participation des hommes a la planification familiale, mais il n’existe toujours pas de consensus sur ce qué Yon entend par la. L’auteur étudie les implications de cette “participation masculine” pour le personnel et les décideurs des programmes de prestation de services, ainsi qué la dynamique hommes/femmes de l’emploide la contraception, notamment en ce qui concerne les méthodes dependant des hommes. II discute l’ímportance de prendre en consideration l’intrication des roles masculin et féminin plutôt qué de se focaliser sur la situation des femmes (ou des hommes) seulement, pour une plus grande égalité entre hommes et femmes. Finalement, il met en garde contre les formes de “participation masculine” ayant pour résultat l’annexion par les hommes de ce qui était autrefois un territoire reserve aux femmes, et aggravant de ce fait la domination masculine existante. Resumen La idea de aumentar la participation del hombre en la planificación familiar ha recibido atención periódica durante los últimos 20 anos, pero no existe un consenso general en cuanto a to qué significa realmente la participation masculina. Este ensayo examina las implicaciones a nivel de genero de la “participation masculina” para el personal y los encargados de la toma de decisiones de los programas de prestación de servicios, y las dinámicas de genero qué rodean el use de métodos anticonceptivos, particularmente los qué dependen del hombre. El ensayo discute la importancia de tomar en consideración la interacción entre el papel del hombre y el de la mujer, en lugar de concentrarse exclusivamente en la situation de la mujer (o del hombre), con el objetivo de aumentar la igualdad entre ambos. Finalmente, hace una advertencia en contra de las formes de “participation masculina” qué resultan en la usurpación por parte del hombre de terreno qué pertenecia anteriorente a la mujer, empeorando por tanto el dominio masculino existente.
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Prior to the 19th century, the sources for the study of abortion in the west are not statistical but literary, medical, religious and legal, and give little indication of its demographic weight. It is, however, possible to study the frequency of the contexts in which abortion is mentioned: for example, by marital status of the mother, type of motivation, approval or disapproval of the author of the quotation, probable effectiveness of the methods used. The frequency of references to abortion can also be compared with those regarding alternative practices such as infanticide. Our examination of the very crude sources that are available indicates that there is no compelling reason to conclude that abortion was in the past anything else than an unreliable, dangerous and rare practice, and with no demographic impact. The less dangerous methods were probably ineffective, while the drastic measures were only used by desperate unmarried girls and prostitutes.
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Censuses provide a means to count the population and to describe its main characteristics at all geographical levels. French census data from 1962 to 2006 are available via the IPUMS-I project of the University of Minnesota, and data for the years 2006-2009 are accessible on the INSEE website, so changes in family situations over the last fifty years can be described in detail. With the fertility decline and population ageing, the proportion of "children" has decreased. The other major changes (increasing share of persons living alone or in lone-parent families, fewer situations of co-residence with adult children or other relatives) follow very different patterns by sex and age. The same is often true for disparities between social groups (identified by occupational group, educational level or place of residence) and their evolution. The switch to annual census surveys in France provides new opportunities for analysing annual data, at least at national or regional scale, even though the census is designed to group the data from five successive annual waves.
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The idea of increasing men's participation in family planning has received periodic attention for the past 20 years, but there is no generally accepted understanding of what men's involvement actually means. This paper examines the gender implications of 'male involvement' for the staff and decision-makers of service delivery programmes, and the gender dynamics surrounding the use of contraceptives, particularly male-dependent methods. It discusses the importance of taking into account the interplay between men's and women's roles, rather than focusing on women's situation (or men's) alone, with the aim of increasing equality between women and men. Finally, it cautions against forms of 'male involvement' which result in men usurping what was formerly women's territory and thereby worsening existing male dominance.
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The myth of a 'natural' pattern of fecundity in the past has been explodd; couples behaved according to religious, social and cultural norms. Falling birth rates have been plotted in many Western countries since the baby boom of the late 1940s and the 1950s. In many countries the 1930s were also years of declining demographic development. Different social groups are tending to display rather similar characteristics of family formation.- Hugh Clout
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Unlike most medical research fields, reproductive health has long focused on women. When contraception became a medical issue in France, this further cemented the perception of it as a female issue. Indeed, the promotion of female medical methods went hand in hand with the discrediting of collaborative contraceptive methods involving both partners, such as withdrawal or condom use. This article aims to analyse how the medicalisation of contraception has reinforced the construction of sexually differentiated roles with regard to reproduction, and specifically the role of the medical profession in defining what is possible and desirable in this sphere. It focuses on health professionals’ representations and attitudes, and the role they play in defining contraceptive standards and gender roles. We conducted 16 semi-structured interviews with contraception providers in Paris and its suburbs in 2012 and 2013. Their representations, for the most part, reflect a gendered perception of individuals and their contraceptive skills, men being associated with sexuality and women with reproduction. This gender differentiation is used as a justification for excluding male methods from contraceptive provision.