Exploring male involvement and support in long-acting reversible contraceptive decision-making: a mixed-methods cross-sectional study in Kampala, Uganda

Abstract Background Male involvement in family planning is a critical yet underexplored factor influencing contraceptive uptake and decision-making, particularly for long-acting reversible contraceptives (LARCs). In Kampala, Uganda, socio-cultural norms and misconceptions may limit men’s participation in reproductive health services. This study assessed the extent, determinants, and barriers to male involvement in LARC decision-making among couples. Methods A mixed-methods cross-sectional study was conducted between March and September 2025 in Makindye Division and Kisugu Health Centre III. Quantitative data were collected from 362 women using structured questionnaires, while qualitative data were obtained from six focus group discussions (FGDs) with men and women, and five key informant interviews (KIIs) with healthcare providers. Quantitative data were analyzed using SPSS, and qualitative data were thematically analyzed in NVivo. Instruments were pre-tested and assessed for reliability. Results While 96% of women reported that their partners discussed contraception with healthcare providers, only 10% accompanied their partners to clinics. Male support for family planning was mainly financial (60%), and joint decision-making on LARCs occurred in 39% of couples. Key determinants of male involvement included marital status, education level, and number of children. Cultural norms and religious beliefs emerged as significant barriers. Qualitative findings highlighted entrenched gender norms, misconceptions about contraceptives, and the perception that reproductive health services are primarily for women. Participants reported limited couple-focused counseling, with only 44% indicating men’s concerns were adequately addressed during consultations. Conclusions Male involvement in LARC decision-making in Kampala remains low due to socio-cultural barriers and limited male-friendly services. Strengthening male engagement requires inclusive counseling by trained health workers, community and religious leader involvement, and promotion of male-friendly and couple-centered reproductive health services.