By Michelle Priya Sahai, Monitoring, Evaluation, Learning and Communications Fellow, PSI Cambodia
“Learning about contraception helps eliminate misunderstandings [about contraception] between men and women,” said Chhorn Srieng, a resident of Cambodia’s Battambang Province. “And it encourages us to discuss both the traditional and modern methods of family planning.”
Because most modern family planning methods are primarily designed for women to use and reproductive health programs predominantly engage women, the responsibility of family planning too often falls to women alone.
The research shows: it’s time to get men actively involved. While maintaining women’s autonomy over their bodies and lives, including men in family planning programs can improve couples’ communication and increase both partners’ understanding of and comfort with various contraception options throughout the life-course. This improved communication among couples supports joint decision-making when choosing modern family planning methods.
With the USAID-funded Promoting Healthy Behaviors (PHB) project in Cambodia, we are bringing men into the conversation. In collaboration with the Royal Government of Cambodia, PSI and partner 17-Triggers used social and behavior change (SBC) techniques, including human-centered design, to understand the needs of rural couples and co-develop the “Heart Protector” and “Loving Relationship” interventions. These programs were designed to increase uptake of modern methods of family planning, support joint decision-making among couples, and give Cambodian men the tools and information to help make more informed choices about family planning. Both interventions are powered by partnerships with community-based organizations including Partners in Compassion, Khemara, and Action for Health Development (AHEAD).
What have we done? What learnings apply beyond the Cambodian context? We share, below.
Reframing the traditional role of protector
“I received some information about modern contraception methods from a doctor at the health center after we had our first child, 13 years ago,” said Chhum Pohn, a resident of Cambodia’s Chak Village in Kampong Chhnang.
Today, Pohn partakes in PHB’s Heart Protector program.
Also known as the “Men’s Session,” Heart Protector is named after men’s traditional roles as protectors of their families. It includes engaging, participatory activities and materials through which groups of men learn and discuss, many for the first time, about modern methods of family planning and how to discuss the topic with their partners or wives. Through the sessions, men are encouraged to consult with trained health providers, have informed, open discussions with their partners about contraception, and support their partner to use family planning.
The power of SBC rests in understanding the needs and context of the target population and strategically tailoring the intervention accordingly. As an example, the Men’s Session’s introductory “Goalkeeper” activity uses football (soccer) to teach men about contraception. It involves a participant who plays goalkeeper as another participant kicks a ball towards them. Next, a banner is added to cover the goal to represent sex with contraception. After the activity, participants are asked to reflect on how much more difficult it was to score a goal with the barrier in place and how this is also true of using contraception to prevent pregnancy. This exercise is an example of how we can cater family planning interventions to men in a way that is both educational and memorable.
“I learned about details of each contraception option after joining the men’s session,” said Pohn. “Together with my wife, we decided to switch [from condoms] to daily contraception pills.”
From July 2020 to April 2024, PHB and implementing partners led 4,307 “Heart Protector” sessions, reaching 41,933 men. In a 2022 assessment with participants from Battambang and Pailin provinces, 99% said they were more likely to adopt or use MM after the IPC session(n=80) . Prior to attending the men’s session, 4% of men surveyed reported they were MM users, 89% were non-users, and 7% were traditional method (TM) users (n=100). In the post-assessment, 76% reported current use of MMs (n=80).
Bridging the communication gap
While Heart Protector focuses on men, the Loving Relationship program works with couples to help them communicate openly about family planning. Alongside an interpersonal communication agent, partners talk about fears and misconceptions of modern methods, see real contraception product samples, and play games to have fun and build trust as well as ease the discomfort many couples feel talking about taboo topics, such as family planning.
From July 2020 to April 2024, PSI Cambodia hosted 7,563 Loving Relationship sessions, reaching 34,709 couples. In a survey of 121 participants, 87 percent of respondents said they were more likely to adopt or use modern contraception after the sessions. For couples, at pre-assessment 1% used MM, 72% were non-users, and 27% used TMs. At post-assessment, for couple session attendees, 48% currently use MM and 52% do not.
Community events through both programs have reached over 120,000 individuals, including 76,642 men. Based on a 2023 post-assessment with 1197 participants from all five implementation provinces, 60 percent of participants, the majority of whom were men, reported having a conversation with their partner about family planning.
Applicable Learnings
- According to qualitative interviews, when couples receive and discuss information from trusted sources, including testimonials from their peers, they are more likely to choose contraception.
- Critical barriers to the use of modern contraception among men that the program addressed include myths or misconceptions about side effects or fertility effects; lack of quality, reliable information; perceived cost barriers; and concerns about whether contraception interferes with sexual pleasure.
- Real contraceptive product samples were helpful aids during education sessions and they were the educational tool with the highest recall (83 percent) among participants of the family planning sessions.
- Men preferred group sessions instead of one-on-one sessions and they are effective. In an assessment from 2022, 99 percent of men said they were more likely to adopt or use modern methods after the men’s group session.
- Partnerships with health centers and village health support groups before, during, and after the intervention is essential to support program sustainability.
Men can and should be active participants in family planning decisions, helping to build the best lives for their family members. By addressing key contextual barriers to modern methods of family planning for Khmer men and their partners, couples in Cambodia demonstrate how other couples around the world can be prepared to take control of their health and choose whether, when, and how they have a family.
The Promoting Healthy Behaviors (PHB) Activity is a five-year Social and Behavior Change project funded by USAID and implemented by PSI Cambodia, with partners 17 Triggers and Pact, in collaboration with the Royal Government of Cambodia. PHB works to improve health behaviors among Cambodians and ensure that Cambodians seek and receive quality, accessible health care. Learn more here.
This blog post is made possible by the generous support of USAID. The contents are the responsibility of Population Services International and do not necessarily reflect the views of USAID or the United States Government.
Feature photo: A “Heart Protector” participant poses in front of a banner depicting real contraceptive product samples.
