Who uses condoms, 'male cut', pills most in Africa?

Here's why everything

Archbishop Kaigama thinks he knows is wrong

Data hints it is men, not women, who are avoiding babies, and Swaziland, Burkina Faso,
Zimbabwe. Namibia, Uganda, Lesotho, Kenya are the condom kings.

JUST over a week ago, The National Catholic Reporter, reported that Nigerian Archbishop
Ignatius Kaigama who was attending the Bishops Synod, issued a statement saying that
Africans have come of age and believe that contraception is wrong.

Is he right? And, equally, are the popular perceptions that African men hate contraception,
and that contraception is womens business - putting the burden of avoiding pregnancy on
the woman, while leaving the man free to sow his wild oats, true?

You will be surprised what the data says.

The numbers from the latest Demographic and Health Surveys from 31 African countries,
compiled by USAID, tells a completely different story, indicating that more men than women
are using at least one contraceptive method - suggesting that it is men, not women, who are
actively avoiding babies.

Among single, sexually active young people, most of the countries surveyed showed that
more men than women are using at least one method, and fewer men report using no
method at all than women do.

Unexpectedly, the biggest gaps are in some of the most conservative countries, the top five
being Eritrea, Senegal, Chad, Mauritania and Burundi.

Upturning conventional wisdom

Here, many more sexually active men report using contraception than sexually active women
suggesting one of two things, either the single women who are having sex want babies
(perhaps in order to lead to marriage?) or they are powerless to suggest contraception and
fear even to use it behind the mans back.

But it could also suggest something else perhaps men who are sexually active have many
more partners than women, thus there is a bigger need to protect oneself from diseases and
unintended pregnancies. So it is likely that single women are having sex with one steady
partner, but men are more adventurous.

Condoms remain the most common contraceptive that unmarried men in Africa use to avoid
pregnancy, HIV and sexually transmitted infections, with up to 78% in Swaziland of single,
sexually active men saying they regularly use a condom, followed by 76% in Burkina Faso,
and 66% in Zimbabwe.

The lowest condom use among unmarried men is reported in Madagascar at just 9.4%, and
Madagascan men report very low use of contraceptives in general a staggering 82% of
single, sexually active men say they are not using any contraceptive method at all.

In Madagascar, contraception seems to really be womens business, with more women than
men using at least one method.

Alternative methods
So how do the women in Madagascar avoid pregnancy? The most common method is
abstaining from sex from time to time, which is what 15% of single women say is their main
contraception. Periodic abstinence seems to be the main method reported in much of Central
Africa too, with Congo-Brazzaville topping the list at 41.4%, Togo at 28.2%, DRC at 20.5%
and Cameroon at 20.1%. Madagascar comes in at fifth place.

But as for the modern methods, Southern African women lead the pack in using the pill, with
Zimbabwe, Botswana, Cape Verde and South Africa reporting more than 15% usage of the
pill among single women, in the case of Botswana, it goes as high as 35%.

Condom use in Africa plummets with marriage, except in countries with high HIV rates and
discordant couples, where one partner is HIV positive while the other is negative - including
Swaziland, Lesotho and Namibia, where more than one in five married men still uses a
condom; in Swaziland the rate is 42.6%.

In marriage, the data shows that the contraception dynamics change, there seems to be
more collaboration about family planning decisions in most countries, the gap in use is
much narrower than among the singles.

But still, contraceptive use in men outnumbers the women in many countries, the top five
being Chad, Togo, Swaziland, Eritrea and Comoros.

Might polygamy have something to do with it? Perhaps, particularly in a country like Chad,
reporting the biggest gap between contraceptive use in married men and women.

As patriarch, the power to decide the number of children to have rests with the man, so its
not surprising that women in many of these marriages have no say on the number of children
they want to have.

But condoms arent the only way for men to get involved in family planning. Just over 7% of
men in the Comoros rely on the withdrawal method to avoid getting his partner pregnant, the
highest rate reported in Africa. Other countries reporting a relatively high use of the
withdrawal method are Rwanda (3.6%), Nigeria (2.7%), Zambia (2.5%) and Ghana (2.2%).

Giving up on it

And then there are men who consciously give up sex from time to time. Chad, even though it
has one of the highest fertility rates in the world, reports the highest level of men practicing
periodic abstinence as a family planning method, at 14.3% - suggesting that those big
families are not because men are sex-crazed but because they deliberately decide to have
the number of children that they do.

Frequent periodic abstinence is also reported in Togo (9.9%) and Eritrea (7.7%) although
in Eritreas case, the widespread forced conscription into the army may have a role to play in
narrowing sexual opportunities for men.

But what about men who are looking for a more permanent solution?

Vastectomies are taboo in most of Africa for cultural reasons some men say they can only
be cut once (circumcision), and it is feared that vasectomy leads to impotence but where
are we likely to find men who have broken these barriers and have adopted a permanent
solution?
Namibia leads Africa in the rate of vasectomies, where 2.4% of married men say they have
undergone sterilisation, followed by Sierra Leone (1.2%), Malawi (1.1%) and Swaziland
(1.1%). In the rest of Africa for the countries reported the rate is less than 1%.

It seems then that if Kaigama were a betting Archbishop, he would lose his money on this
one.