Sex differences in family planning knowledge, attitudes, and use in Uganda

Abstract Background Literature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda. Methods This study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the uptake and unmet need of FP services. Results Data from 4,352 respondents in the ratios of 70% female and 30% of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44%) than females (36%). Low percent (16%) of females reported having no child compared to 38% in males. Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96%) and females (98%). Significant differences were further seen in specific FP methods. A small proportion agreed that community health workers (CHWs) were always available to offer FP services and no sex variations were observed. The proportion of married females using a modern FP method was 39% compared to 45% for married males. Condom use as a dual protection method potentially overstated FP use among males by 16%. Significant differences were revealed in total unmet need between males (19%) and females (24%). Males, young adults, the more educated and those in marriage or active relationship were more likely to use modern FP services. Conclusions Our study found significant sex differences in knowledge, attitudes and use of FP services. Initiatives to create demand for FP services for both males and females should study sex differences in FP knowledge, attitudes, and methods choice. Findings also revealed low involvement of CHWs in delivery of FP services to both males and females. More research is needed on how CHWs can be leveraged to reach both males and females with appropriate FP services and follow up to improve uptake and retention