Indigenous men's perspectives on long-acting reversible contraceptives: a qualitative study of relationship dynamics and infidelity fears

Annually, approximately 74 million women worldwide face unintended pregnancies, which are particularly prevalent in low- and middle-income countries (LMICs), notably Africa. Effective contraception is crucial for mitigating the substantial risks to maternal and child health posed by unintended pregnancies. Long-acting reversible contraceptives (LARCs) play a pivotal role in addressing these risks by facilitating pregnancy spacing and reducing maternal mortality rates. However, challenges persist in their global adoption, particularly in regions such as Uganda, where inadequate male partner support contributes to low usage rates, thereby exacerbating the associated health risks. The objective of this study was to examine how women's use of LARCs affects relationship stability and fears of infidelity among rural Ugandan men in Nyamweru subcounty, Rubanda District, to develop strategies for increasing LARC use. This qualitative study focused on understanding the perspectives of indigenous Bakiga men in the Nyamweru subcounty, Rubanda, Uganda, regarding LARCs. Fifteen participants were purposefully selected from areas characterized by low LARC usage, high fertility rates, and elevated maternal mortality. In-depth focus group discussions and in-depth interviews with men aged 20 – 49 aimed to explore their perceptions of and beliefs about LARCs. Data saturation guided sample size determination to ensure comprehensive exploration of the perceptions. Analysis revealed prevalent misconceptions among indigenous Bakiga men regarding LARCs, including beliefs that their use makes women more attractive to other men and increases the likelihood of extramarital affairs and relationship breakups. These misconceptions reflect men's insecurities about their partners' contraceptive choices. Dispelling misconceptions and addressing insecurities surrounding LARCs among indigenous men are essential for improving the support and acceptability of LARCs by women. Tailored interventions, such as behavior change communication, proper health education, and counseling on LARCs, are crucial for fostering acceptance among men and advancing reproductive health outcomes.