Abstract
Research suggests that men should be included in reproductive health decision making to help enhance positive health outcomes for their partners. Men affect the use of contraception and what method is used. Men’s decisions may be affected by different factors such as gender, education, and the nature of their sexual relationship. A qualitative study was conducted to explore males’ experiences and perceptions about emergency contraception (EC), and the meanings males assign to EC. Semistructured in-depth focus groups were held with 15 men who engage in heterosexual activity recruited from a university setting in the United States. Participants expressed egalitarian views of the contraception decision-making processes, a sense of responsibility regarding reproductive decision making, and that society has a negative stigma toward those who use EC. However, there was a lack of knowledge regarding the copper intrauterine device, which was not viewed as a method of EC. Exploring the role and needs of men in reproductive health care discussions and research is an important and growing area. Recommendations are provided for health care practitioners, policy, and future research around men and EC.
Background
Men and women in the United States are presented with numerous contraceptive method choices. Issues including personal preference, access, cost, and the impact of sexual partners influence method selection. While most sexually active adults have utilized a method of contraception at one point, consistent use is affected by numerous factors. Barriers such as a dislike of method side effects, lack of information, and the high cost of contraceptive methods inhibit the consistent use of a method of contraception (Ayoola, Nettleman, & Brewer, 2007; Campo, Askelson, Spies, & Losch, 2010; Homco, Peipert, Secura, Lewis, & Allsworth, 2009; Mills & Barclay, 2006). These findings indicate that many couples may face periods of unprotected intercourse and risk unintended pregnancy in times of method discontinuation.
To reach gender equality, and ultimately a healthy society, the 1994 International Conference on Population and Development called for men’s involvement in reproductive health matters. To attain this goal, reproductive health frameworks must be shifted to include men (Bustamante-Forest & Giarratano, 2004). Methods, such as emergency contraception (EC), are available to decrease the likelihood of unintended pregnancy due to method discontinuation or failure, yet little EC research has been conducted involving males
Literature Review
The Role and Influence of Male Partners on Contraceptive Use
Men affect the use of contraception, as well as which method is selected for use. However, men’s expected roles in contraceptive decision making may be influenced by their gender. An exploratory study conducted with 30 opposite-sex couples indicates that both men and women learn about contraception through socialization, yet what they learn is markedly different. Men reported receiving information solely around condoms, while none reported receiving information on female-centered methods, such as hormonal contraceptives. Participants expressed beliefs that men held responsibility for male methods, such as condoms, while females held responsibility for the use of female-centered methods (Fennell, 2011). Male-centered values can be a strong element in contraceptive behavior. Male participants in a qualitative study reported that being married was a deterrent for condoms use, because condoms are used to prevent sexually transmitted infections (Sable, Campbell, Schwarz, Brandt, & Dannerbeck, 2006).
A growing body of literature examines reproductive decision making among couples. A U.S. study of Latino men and women in heterosexual relationships revealed that the majority of men reported having more power in the relationship than their female partner, but believed reproductive decision making to be a shared process (Zukoski, Harvey, Oakley, & Branch, 2011). The nature of specific sexual relationships further influences a couple’s contraceptive use. Research demonstrates that little to no method discussion occurs between partners in casual relationships, limiting the use of effective contraception (Raine et al., 2010). Long-term methods of contraception have been reported to be associated with long-term relationships (Wright, Frost, & Turok, 2012). Long-term relationship status may not result in consistent contraceptive use. A longitudinal study on the associations between low-income women’s relationship characteristics and contraceptive use suggests that couples in established sexual relationships may have less motivation to avoid pregnancy, and therefore be less likely to use a contraceptive method (Wilson & Koo, 2008).
A male’s knowledge of contraceptive methods affects their ability to negotiate contraceptive use with their partners. Men often overestimate their reproductive health knowledge, highlighting the need for male-friendly and male-inclusive health services (Makenzius, Gåden, Tydén, Romild, & Larsson, 2009). Men may want to increase involvement in contraceptive use and decision making. Socialization, policies, and health care providers help alleviate them from responsibility through focusing programs and services primarily on women (Ringheim, 1996). Patriarchal countries with social constructs of masculinity and gender norms have excluded men from actively participating in reproductive health issues (Mullany, Becker, & Hindin, 2007; Mumtaz & Salway, 2009). A qualitative study conducted in the United States exploring attitudes toward family planning identified that larger societal values were barriers for men to participate in the family-planning process (Sable et al., 2006). A more recent study in the United States exploring family planning among men with lower social economic status reported that men had an unclear understanding of family planning largely due to barriers with their social class such as access to health care (Jackson, Karasz, & Gold, 2011). These studies expose problems within larger social structures influencing the lack of involvement from men in family planning and contraceptive understanding.
EC Methods
When taken within 120 hours following a method failure or unprotected intercourse, EC is highly effective in reducing the risk of unintended pregnancy. The most common method of EC in the United States is progestin-containing pills available either behind the counter to women and men or through health care clinics. EC pill use is considered safe for nearly all women and decreases the risk of pregnancy by 75% by delaying or preventing ovulation. Furthermore, the use of EC pills has no effect on an established pregnancy (Trussell, Raymond, & Cleland, 2015).
As an alternative, a copper intrauterine device (IUD) may be inserted as a form of EC up to 5 days following unprotected intercourse (Cleland, Raymond, Westley, & Trussell, 2014). The copper IUD is a small, T-shaped device wrapped in copper wire inserted into the uterus, which prevents fertilization by copper’s cytotoxic effect on sperm and the increased inflammatory activity within the uterine cavity. The precise mechanism of action for the copper IUD used in the EC setting is not known. However, it is extremely effective at preventing pregnancy after unprotected intercourse with zero pregnancies in nearly 2,000 women using the copper T380 IUD for EC (Wu, Godfrey, Wojdyla, Dong, Cong, Wang, & von Hertzen, 2010). Recent studies indicate that approximately 10% of women accessing EC in health clinic settings are interested in the copper IUD as EC (Schwarz, Kavanaugh, Douglas, Dubowitz, & Creinin, 2009; Turok et al., 2011). Despite increased access to EC, the rates of both unintended pregnancy and abortion have not decreased (Trussell et al., 2015). Gaining deeper understanding of males’ perceptions of EC may help address existing barriers among men and women to EC use.
Men’s Knowledge of EC Methods
Accurate knowledge of EC remains startlingly low. A study of knowledge, attitudes, and behaviors around EC among a university population revealed that 87% of the sample believed EC pills to be mifepristone, a pill that acts as an abortifacient in the first 9 weeks of pregnancy (Corbett, Mitchell, Taylor, & Kemppainen, 2006). These misperceptions may be influenced by U.S. men’s cultural context and the messages they receive around EC and reproductive health. For example, EC and abortion are often erroneously used interchangeably in public discourse, leading to continued confusion around EC’s purpose and how it functions (Pruitt & Mullen, 2005). Access to accurate and sufficient reproductive health information is additionally limited. Only 26 states require information on communication skills around healthy sexuality and decision making and avoiding coerced sex be included in school-based sex education programs. A mere 18 states currently require information on contraceptives, including EC, be also included in sex education (Guttmacher Institute, 2015).
Research appears to be restricted to males’ experiences and perceptions of EC pills rather than the copper IUD as a form of EC. A study investigating the perceptions and barriers of male access to EC in the United States reports that 78% of both male and female respondents believe men should always be able to purchase EC. However, half of male participants did not know where to obtain EC, and nearly 20% of males were unaware of EC (Nguyen & Zaller, 2009). Men may in fact play crucial roles in decisions to use EC following unprotected sexual intercourse or a method failure. Women interviewed about their decisions whether to include their male partners in accessing EC report that it was often their male partners who initiated discussions around the use of EC (Daugherty, 2011). However, men’s perceptions about EC are not known.
Notably, studies reporting EC discussions between patients and health care providers limit findings to conversations with female patients (Corbett et al., 2006; Kavanaugh & Schwarz, 2008; Lawrence, Rasinski, Yoon, & Curlin, 2010; Vahratian, Patel, Wolff, & Xu, 2008). Although males may be interested in accessing it, EC continues to be predominantly viewed as a female issue. There is little research investigating males’ conceptualization of EC and experiences accessing it. Policy makers and practitioners are therefore limited in their abilities to increase male involvement with EC. The purpose of this study is to explore the experiences with and perceptions about EC among heterosexually active men.
Theoretical Frameworks
This study utilized two systems-focused theoretical frameworks to explore the perceptions and experiences around EC in a heterosexually active male population. Ecological systems theory (EST) asserts that an individual’s development and behavior are shaped through processes and interactions between the individual and his or her environments (Bronfenbrenner, 1979). EST attempts to explain how different levels of environments influence an individual and how individuals will respond differently to their environments. Environments are organized into four levels of systems: the micro, meso, exo, and macro systems. This study emphasizes the influences of the micro and macro systems and how they affect how a male perceives EC and his role and responsibility around its use. The micro system comprises the beliefs, roles, activities, and interpersonal relations that an individual experiences within a particular face-to-face setting. Belief systems are built and influenced by the socialization done with others such as peers and sexual partners, and further define the ways through which an individual will interact with others within a particular context, or around a specific issue such as EC. A male’s belief system may influence how he approaches the topic of EC individually and with a partner, and influence his decision on whether or not to support its use. Macro systems refer to the consistency observed within a given culture or subculture in the form and content of micro, meso, and exo systems, as well as any belief systems. The stigmatization of EC by U.S. society through policies, political rhetoric, or individual moral beliefs may be a macro-system influence on a male who is contemplating the use of EC.
The second systems-theory framework used to guide this study is gender systems theory (GST; Ridgeway & Correll, 2004). Gender is described as a system of hegemonic social practices within society. The gender system is supported by current cultural beliefs, or rules, which define characteristics of males and females and further guide how they are expected to behave. GST assumes individuals define themselves in relation to others, and expect that others will treat them according to existing gender beliefs, even if these beliefs are not personally supported.
These beliefs further influence the distribution of resources, such as contraception education, support, and conversations between health care providers and patients based on a patient’s gender. The current gender system is further supported by social relational contexts. These contexts influence the maintenance or change within an existing gender system. Gender is heavily involved in reproductive and heterosexual behaviors, and the roles men and women are expected to play within these contexts (Ridgeway & Correll, 2004). For example, men and women’s roles and responsibilities around EC, and expected knowledge and access to EC are based on gender. How men and women are expected to behave following unprotected sexual intercourse, and the consequences of unprotected intercourse are situated within a gendered system.
These theories guided the study design by framing the purpose and questions posed to participants within the context of systems and the participants’ interactions within these systems. The study was analyzed through the lenses of systemic and gender influences, and provided a framework for understanding the findings within a systems context. These helped explain how a heterosexually active male defined his role in accessing EC, his perceptions and knowledge of EC, and how the topic of EC was navigated within his sexual relationship.
Method
Qualitative research methods allow for examining complex social interactions within an individual’s social and cultural settings, and additionally explore the individual meanings assigned to those experiences. In addition, qualitative research designs are emergent, naturalistic, and interpretive approaches to investigate processes and the socially constructed nature of reality (Denzin & Lincoln, 2005). Qualitative research is situated within the social, political, and cultural settings of the participants and researcher, thus allowing for understanding of study findings within these specific contexts (Creswell, 2013). Qualitative methods fit this study due to the nature of social and political parameters around the use of EC. Little current research has explored males’ perceptions and experiences around EC, and the meanings males assign to EC.
Recruitment and Data Collection
Heterosexually active males aged 18 to 40 years were recruited from a university setting in the Western United States. Purposive and snowball sampling techniques were utilized. Informational fliers were displayed in the lobbies of a college of social work with study details and contact information. Female students were also asked to refer interested male friends or partners. Announcements were made in bachelor- and graduate-level social work and business administration classes and interested students were given researcher contact information.
The authors anticipated participants to have little experience accessing or discussing EC with female partners and health care providers due to EC’s predominate definition of being a female-specific method. Focus groups were consequently selected as the most appropriate method of data collection for this study. The interactive and process-oriented nature of focus group data collection allows for participants with limited knowledge or experience of a particular topic to develop perceptions throughout the data collection process based on responses elicited from other participants (Krueger & Casey, 2000). Self-contained focus groups allow for efficient gathering of a large amount of qualitative data when the research interest is placed on not only what participants think about the topic but also how and why they think the ways they do (Krueger & Casey, 2000; Morgan, 1997). Smaller focus groups were used to increase participants’ ability to share experiences and insights, and to allow for more in-depth individual responses and participation (Morgan, 1997).
Four focus groups were conducted in a university setting and were all facilitated by a male moderator. Due to gender role socialization, males may experience difficulties in expressing feelings and thoughts (Norwinski, 1993). Because of limited and gendered socialization around EC, a male facilitator was selected as more appropriate than a female-only facilitator in assisting male research participants to share their feelings, beliefs, and perceptions regarding EC. Focus groups were audio-recorded and transcribed. The moderator took notes during each focus group to capture reactions, thoughts, and perceptions of group interactions. These notes were also used in the analysis process.
Phenomenology
This study utilized a phenomenological approach to data gathering and analysis as described by Moustakas (1994). Phenomenology is the exploration of an individual’s lived experiences and the meanings they create about a particular phenomenon. A phenomenological approach allows for an examination of common experiences and perceptions of a phenomenon from multiple individuals (Creswell, 2013). This study explored the phenomenon of EC among heterosexually males, and examined participant perceptions and experiences around EC. Broad questions were posed to participants to gather information on perceptions of the phenomenon and their experiences with the phenomenon (EC use), and what situations or factors influenced their perceptions and experiences. Males’ perceptions of and experiences with EC were explored, as well as the relationships between their perceptions and experiences. This allowed for gaining an understanding of the common experiences and perceptions of the participants around EC use. Rather than attempting to explain participant experiences, this study provides descriptions of participants’ thoughts, feelings, and ideas constituting their experiences and perceptions.
Analysis
Phenomenological methods were used in analyzing the data (Moustakas, 1994). The audio recordings of the focus groups were transcribed and the transcripts of the focus groups were read and reread by the authors for clarity and familiarity. Individual participant responses were analyzed within each focus group. Data, relevant to the research question (what are heterosexually active men’s perceptions and experiences around EC?) were identified, and participant’s repetitive and vague expressions were eliminated. The remaining data relevant to the study were organized into thematic categories and organized by descriptions of experience with and perceptions about EC. Significant statements were identified and grouped into meaning units and themes (Moustakas, 1994). Similar codes and categories were identified within and between each participant and organized into themes. Recruitment for focus groups ceased when no new themes emerged from the analysis process.
A component of phenomenological research is epoche, wherein researchers actively attempt to set aside personal understandings, experiences, and judgments related to the phenomenon. Epoche occurs throughout the research process, and allows for an open and naive approach to the phenomenon under study (Moustakas, 1994). To minimize subjective interpretations of the findings, the researchers first explored their own perceptions of men’s roles in accessing and using EC. The researchers additionally met regularly to discuss initial findings and interpretations of the findings. Member checking also occurred throughout the analysis process to ensure accurate interpretation of participant responses and meanings. Each participant was invited to provide feedback on the accuracy of their focus group transcription and on thematic findings. Three participants reviewed the thematic findings and provided feedback.
The results are presented in a thematic portrayal of participants’ experiences and perceptions rather than a composite description of all focus groups. Participant quotes are included to provide further illustration of the analysis. Institutional Review Board approval was obtained from the University of Utah for all study procedures.
Results
Participant Demographics
Four focus groups were held with 3 to 5 participants in each group for a total of 15 participants. Focus groups lasted between 40 and 50 minutes. Participants had a mean age of 31.6 years and reported an income range of less than $20,000 to $70,000. See Table 1 for further demographic information, including primary methods of contraception currently used and relationship status. Participants were given pseudonyms.
Demographics.
Note. HCP = health care professional; EC = emergency contraception; IUD = intrauterine device.
Thematic Findings
The results from the study are presented in four thematic findings illustrating the phenomenon of how the participants perceived and experienced EC: meaning of unprotected intercourse/method failure, the meaning of EC, woman’s body/woman’s decision, and sense of responsibility.
Meaning of Unprotected Intercourse/Method Failure
Participants did not discuss personal experiences of unprotected sexual intercourse unless it related to attempting to impregnate their partner. Unprotected intercourse was described as “irresponsible” and being “caught up in the moment.”
The use of a contraceptive method was identified as important and a preventative measure against pregnancy, as well as sexually transmitted infections among participants who were single. Furthermore, a method failure was not described similarly to unprotected sex because participants took action to engage in protected sexual intercourse. Method failure, including a condom breaking and the female partner forgetting to take the pill, were described as being recognized after sexual intercourse.
And contraception, like that includes like oral contraception, yeah, where that [method failure] happened, the conversation happened after the fact and it’s like oh my God, okay. All right. Well I’m glad that there was at least some form, but that wasn’t necessarily me being proactive. It’s reactive. (Mark, single)
Participants reported feelings of anxiety and stress to describe the period of waiting to find out the result of a method failure. The possibility of an unintended pregnancy was viewed negatively, but not something that would be necessarily terminated. Possible actions following method failure were identified as “overreacting” included abortion and utilizing EC.
The scare for us wasn’t that we would have overreacted in our minds and let’s say aborted the baby or did a day after pill. The anxiety and the panic came from now we’re going to have a kid and the expenses with the kid, the responsibility. (Alex, married) In my opinion, with my wife and I, it’s our belief system that it’s not okay ever [EC], but I can’t speak for someone who is raped or it’s something that is just out of their control so I can’t speak for them, but in our family it’s we’ve decided that it’s not okay. (Samuel, married)
Meaning of Emergency Contraception
Participants defined the meaning they assigned to EC based on personal or moral beliefs around pregnancy. While not necessarily personally viewing EC as reckless, participants believed others perceive EC as irresponsible and a result of being unprepared. Participants believed there still exists stigma toward those who access it.
Like on one level I see it as a responsible alternative to coat hanger methods so, but at the same time it’s like reactionary instead of planning for the future. So it’s hard to say like putting an over-arcing label or theme or saying that someone is one way or another because people wear so many different hats at so many different times. (Patrick, in a relationship) If it’s just go out and do whatever and then the next day go get the pill, that is definitely a more negative opinion of that because it’s just less responsible, but if it’s just kind of something happened, we’ve got to do something. Yeah, the guy with a glove box full of morning after pills is a little bit different than the guy with a glove box full of condoms. (Matthew, married)
EC is defined as a backup method after an initial or primary method has failed to avoid an unintended pregnancy.
Like something after the fact where best laid plans didn’t wind up working out and now there’s a potential for pregnancy. (Richard, married) You have sexual intercourse and there is a risk of pregnancy, an unwanted pregnancy, so you use Plan B. That’s the reason they named it that. Something to fall back on. Something that if all else falls through, there’s the best laid plans. (Mark, single)
Participants did not think of the copper IUD as EC because they viewed it as “planned,” preventative method, not fitting within their definition of EC:
I thought an IUD was more of a planned thing. I didn’t know that was an emergency [method]. (Patrick, in a relationship) Yeah, I did too, and I thought it was, because that is actually inserted in the woman, right, so I didn’t think that that actually, I didn’t think that stopped the process. Maybe it does, maybe. I thought the morning after pill was Plan B. I thought the copper IUD is preventative, not emergency. (Brian, married)
Sense of Responsibility
Participants described feeling a sense of responsibility toward the use of contraception and EC, and described experiences of “both being in it together.”
It’s both of our decision. I mean, we both definitely play a role in that and it’s not any one person’s decision. (Samuel, married)
However, participants did not know how their partners perceived EC. Most participants reported no previous experience accessing EC and had not discussed the possibility of EC use with their partners.
We’ve never had that conversation and so I guess I can’t entirely speak for her and what her opinion would be. I’ve never been put in that situation to have to. (Brian, married)
Participants believed they should take active part in knowing what method of contraception a partner is using, in accessing EC, and a further role if a pregnancy occurred. Participants described feelings of having financial and emotional responsibility to their partner if EC was used.
I didn’t even know that was an option [EC] and so she told me about it and I felt that she shouldn’t just do it by herself so I went with her and helped to pay for like half the cost, because it’s something like (inaudible) bucks or something. (Patrick, in a relationship)
Woman’s Body, Woman’s Decision
Participants described the choice to use EC as their female partners’ decision and noted that while they have a say in the use of contraception and EC, yet the choice whether to use it was their female partner’s choice.
I think it’s like you have these 50/50 decisions, like 50/50 we want to get a gym membership, but the 1% is going to be mine, because I’m probably going to spend more time and that’s my interest. A baby is 50/50 too, but it’s kind of 51/49 for me and my partner because it’s her body. She’s the one that’s going to go through a lot of it and I’ll support her in that. (Luke, married)
Participants defined their roles related to EC as being a support and financially involved. Cultural expectations, such as men and women’s individual roles related to a potential pregnancy, were considered.
I think ideally it should be the couple that decides what to do about emergency contraception, not, but I think realistically, our culture has just kind of defaulted to the woman because, like they were saying, she’s the one that deals with it. (Patrick, in a relationship).
Conversations around which method to use, and information around EC take place between their female partner and their female supports, such as family members or friends, participants describe conversations and decisions around EC and contraceptive use as occurring outside of their relationship with their partner, or in partnership with another individual.
I mean it [contraceptive use] wasn’t really a discussion between us before marriage, but she discussed it with her mom and sister, I think, and she got started on the pill and so it was kind of a planned pre-marriage kind of a thing. (Brian, married)
Participants report discussing contraception together with their female partner and health care provider, but not solely between themselves and their health care provider. This is explained by the impact of pregnancy on women versus men.
I would assume it’s because it’s the woman being impregnated and I mean that’s where the focus is. That’s where the attention goes because men, I would assume, have this perception that they can just walk away and they are unaffected from conception, so, I don’t know. (Eddy, married).
Feelings of powerlessness and frustration were used in describing an instance of their partner not choosing to use EC if the participant wanted to and the potential of unintended pregnancy.
It hasn’t really happened to me either, but I could definitely appreciate those feelings of frustration. I mean that is a lifetime of commitment and for someone else to make that decision for you, that would be extremely frustrating. (Paul, married) And then also emotionally you’ve got a child that’s yours that’s out there running around that you feel like you’re responsible for. I mean, I think that’s, I don’t know, I would be a little bit more forceful, I think probably. Like look, I really don’t want this to happen, but then again, it is her body and I don’t know if legally you can make someone do that [EC]. (Mark, single)
Discussion
The findings from this study may in part be explained by the gender of the participants, and the roles males are expected to fulfill related to contraception. Participants voiced the general attitudes of both males and females around men’s social roles around contraception and EC access and use. Similar to past studies about males and contraceptive use, participants noted a desire for both male and female input in contraception decision-making processes. Data from the National Survey of Men reveal that 78% of men in heterosexual relationships reported a move to more egalitarian views around contraception decision making (Grady, Tanfer, Billy, & Lincoln-Hanson, 1996). Although they posit that study responses may in reality reflect ideology more than behaviors, the authors note that a woman’s partner nevertheless greatly influences contraceptive behavior while contraception-related policies and programs continue to exclude men. Participants from the current study expressed a desire to be a part of the decision-making process around EC use. However, their understanding of EC and ability to effectively make informed decisions were limited due to being excluded from the discussion in multiple systems based on their gender.
Notably, few participants had experiences accessing EC. The results are largely reflective of perceptions rather than experiences. This reflection may, in part, be explained by wide-held beliefs that the decision to use EC is the woman’s, thus limiting the male participants’ experiences accessing it. Participants may be unaware of their partner’s previous use of EC. A study exploring the knowledge and use of EC among a university population reported 12% of female participants had previously used EC, while only 8% of male participants reported their female partners had used it (Corbett et al., 2006). This discrepancy may be the result of limited conversations between partners around EC use. These findings support GST regarding gender playing a role in reproductive behavior due to perceived gender responsibilities in a heterosexual relationship. As “Eddy” noted, many men may have the perception that they can walk away from a pregnancy and remain relatively unaffected by its occurrence. This reflects the wider societal focus on females when discussing reproduction and contraception.
While participants believed men and women hold equal responsibility for deciding to use EC and accessing it, the decision was ultimately seen as the woman’s responsibility. Participants further reported having little to no discussion around EC with health care providers unless they were with their female partner. This finding illustrates a continued lack of involving males in reproductive health discussions with health care providers. Increasing conversations between providers and male patients may positively affect both males’ knowledge and comfort in discussing EC with their partners. These findings support both EST and GST by highlighting an impact of societal norms and U.S. culture regarding males’ expected communication with their female partner, particularly regarding EC. These barriers may also illustrate the negative impact of men being excluded from the conversation regarding EC. Discussing sex is often taboo in the United States, let alone discussing current and future planning of EC use.
Participants held definite views of EC and how they believed it functioned. Specific situations, such as rape, sexual assault, and method failure were perceived as acceptable situations for EC use. The possibility of pregnancy in instances of method failure, while not ideal, was described as something that would be carried through and not terminated. Although many participants described instances of method failure, few reported actually utilizing EC. This limited use of EC may be partly explained by low levels of accurate knowledge of EC and the fear that EC caused an abortion. A systematic review evaluating the effects of increased access to EC on pregnancy rates reveals that common reasons for not taking EC include misconception about EC and how it functions (Raymond, Trussell, & Polis, 2007). The current study finding supports EST’s emphasis on the role of macro systems because participants refer to the larger societal influences on a male’s moral decision-making process. Participants’ moral decision-making process around EC focused on accepting only extreme instances wherein EC use would be acceptable, which align with many U.S. societal moral values. The participants fail to recognize, or lack the understanding of, how EC functions and its uses in less extreme circumstances. Increasing accurate knowledge around how EC functions may increase its use, and consequently its effectiveness. These erroneous beliefs may ultimately further inhibit a woman’s ability to control her fertility.
The copper IUD was not viewed as a method of EC due to the planning needed to access the IUD, therefore falling outside of the bounds of what EC meant to participants. Previous studies about the copper IUD as EC report limited participant knowledge about the copper IUD’s ability to function as EC (Bharadwaj, Saxton, Mann, Jungmann, & Stephenson, 2011; Schwarz et al., 2009). Additionally, educating both men and women regarding the importance of health care for the family has been reported to increase support of female partners and their reproductive health. A randomized control trial yielded results that educating women and their male partners had a greater impact on reproductive health behaviors than educating women alone (Mullany, Becker, & Hindin, 2007). Therefore, increasing education for men about EC and expanding discussions around EC to include both oral EC and the copper IUD may address this barrier.
Although most participants did not have previous experience accessing EC, the majority did hold some knowledge of EC. Participants also viewed the decision whether or not use EC as a shared process between both partners, rather than as the responsibility of their female partner. These findings are in contrast to some existing literature around men and contraceptive use. It is likely that the relationship status, higher education level, and predominantly White and older sample influenced this finding.
Limitations
The results of this qualitative study were gleaned from a predominately White sample with high levels of education within a university setting in a Western U.S. city, and should not be generalized to the broader male population. Most participants in the study were in married or cohabitating relationships. Relationship status may have affected participant’s perceptions and experiences around EC. The perceptions and experiences of males in casual sexual relationships may be significantly different than those in long-term sexual relationships. Over half of participants reported that they currently desired a child, or would desire one in the future, and therefore may not view an unintended pregnancy as a catastrophe. A difference in perceptions toward EC between men who did and did not desire a child was not indicated in the results of this study, but differences of EC perceptions may indeed exist among other male populations and could be an additional influence on attitudes toward EC. As previously noted, not every participant had experiences accessing EC or had knowledge of a partner who had utilized it, therefore the results are based primarily on participant perceptions.
Conclusion
The results provide rich descriptions of the complex perceptions of heterosexual men around EC. The move to include men in reproductive health care discussions and research is an important and growing area. This study provides insight into heterosexually active men’s perceptions of and experiences with EC, and the meanings they assign them. The participants perceived EC within the contexts and experiences around personal meaning of unprotected intercourse/method failure, feeling unprepared or irresponsible, their female partner’s body and decision, and personal sense of responsibility.
Reproductive health education should expand to provide further information on how EC functions, and include information on the copper IUD’s ability to function as both EC and a long-term method of contraception. Health care providers should expand conversations around EC to male clients, and frame EC and contraceptive methods as both male and female issues. Expanding clinic policies around health care provider conversations with male clients will increase knowledge around EC and address issues of its use, available methods, and implications. Future research should explore the experiences of health care providers in providing information on EC to patients and the impact of a patient’s gender on EC discussion. Research should also address the experiences around accessing EC with younger men in causal relationships and couples’ experiences and perceptions of EC from both the male’s and female’s perspectives. These continued explorations will hopefully result in greater understanding of how EC is viewed and will expand the involvement of males in reproductive health care.
Footnotes
Declaration of Conflicting Interests
Dr. Turok serves on advisory boards for Actavis, Bayer, and Teva. The Department of Obstetrics and Gynecology, University of Utah, receives contraceptive clinical trials research funding from Bayer, Bioceptive, Medicines 360, and Teva The author(s) declared no other potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received financial support from Award Number R21HD063028 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development for the research of this article.