Examining men’s attitudes toward family planning in Istanbul, Turkey

Abstract

Background

Family planning (FP) is a vital component of reproductive health and gender equality, particularly in developing countries. Despite the critical role of men in FP decision-making, their involvement remains limited due to sociocultural factors. This study aims to examine men’s attitudes toward FP in Turkey and highlight the need for more inclusive FP strategies.

Methods

A descriptive study was conducted with 400 male participants residing in Istanbul, using the Family Planning Attitude Scale (FPAS), a validated and standardized questionnaire. Stratified sampling was employed to ensure diverse representation of educational backgrounds and sociodemographic factors. The statistical analyses employed descriptive statistics, an independent sample t-test, a one-way ANOVA, and a Pearson correlation analysis.

Results

The mean total score of the Family Planning Attitude Scale was found to be 74.5 ± 30.4, with the mean of the sub-dimensions “attitude towards society” being 31.8 ± 14.3, “attitude towards methods” being 24.8 ± 11.2, and “attitude towards pregnancy” being 17.9 ± 8.0. The total scale score and sub-dimension scores of the participants were found to be at a relatively low level. Significant differences were observed in participants’ attitudes towards family planning according to educational level, spouses’ educational status, age at early marriage, and having children (p < 0.05). The results indicated that individuals who did not utilize contraceptive methods exhibited more negative attitudes than those who did (M = 84.0 vs. M = 71.1). The criteria that men considered when selecting a family planning method were found to significantly influence their attitudes toward pregnancy (F = 7.02; p = 0.001).

Conclusions

The findings underscore the necessity of increasing men’s FP knowledge and access to contraceptive methods. Targeted interventions should focus on improving men’s understanding of FP methods to foster shared decision-making between spouses.

Trial registration

Clinical trial number: not applicable. The data that support the findings of this study are openly available in the National Thesis Center at tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp.

Introduction

Family planning (FP) is a core aspect of health care, promoting sexual and reproductive health by enabling contraceptive use. FP plays a critical role in improving maternal and neonatal health, especially in developing countries, and contributes to social and economic benefits, including gender equality and women’s empowerment [1–4]. FP is a key component of the Sustainable Development Goals (SDGs) set forth by the World Health Organization (WHO) and the United Nations. These goals are designed to ensure the promotion of good health and well-being worldwide. In this context, FP services are regarded as a crucial health concern for both women and men [1, 5].

Men’s involvement in FP significantly impacts women’s contraceptive use and healthcare access, though traditional gender roles and sociocultural norms in Turkey often limit male participation. For instance, Turkish men show low rates of contraceptive use, particularly with modern methods like condoms and vasectomy [6–9]. In Turkey, although women generally possess a high level of knowledge about family planning, the utilization rates of effective contraceptive methods remain inadequate despite this awareness, and method selection varies. Some women still opt for less effective methods, such as coitus interruptus. This indicates that men’s attitudes toward method selection, sociocultural factors within the family, educational attainment, and access to healthcare services play a significant role in influencing contraceptive choices [7, 10–13].

Evidence indicates that male involvement in FP, including using FP methods, supporting partners, and discussing FP options, encourages women’s consistent use of contraceptives [2, 6]. Research has shown that couple communication on FP leads to better family planning and method choice [2, 9, 14], yet most FP programs primarily target women. Men’s involvement benefits family health and couple relationships; however, male hesitance toward methods like vasectomy persists, as does the need for more information on these options [3, 15, 16]. Encouraging men’s understanding and participation in FP can reduce barriers for women and help achieve SDG Goal 3 (Good Health and Wellbeing) [2, 17–19].

FP is a critical component of reproductive health, directly influencing maternal and child well-being, gender equality, and socioeconomic development [1–2]. In Turkey, despite widespread awareness of FP methods, their utilization remains inconsistent, often influenced by sociocultural norms, gender roles, and healthcare accessibility [10–13]. Previous studies on FP in Turkey have predominantly focused on women’s knowledge and utilization of contraceptive methods, with limited emphasis on men’s perspectives and involvement [3, 4, 8, 10]. However, research indicates that men’s attitudes and participation in FP play a crucial role in determining contraceptive use and decision- making within households [11, 13, 15, 16]. The gap in the existing literature lies in the lack of comprehensive data on Turkish men’s perceptions, attitudes, and decision-making processes regarding FP [3, 4, 8, 16]. This study contributes to the field by addressing this gap, offering a nuanced understanding of the factors shaping men’s attitudes toward FP. By examining the sociocultural and demographic determinants influencing these attitudes, this research provides novel insights that can inform targeted interventions and policies to promote male engagement in FP services, ultimately supporting more effective reproductive health strategies in Turkey.

This study aims to explore Turkish men’s attitudes toward family planning and examine the sociocultural and demographic factors influencing these attitudes. By identifying key determinants, the findings will contribute to the development of more targeted and evidence-based strategies to enhance male engagement in family planning initiatives. The study’s results may inform policy recommendations aimed at improving awareness and participation among men, ultimately supporting more effective family planning practices in Turkey.

1. What is the rate of FP method use?

2. What are the participants’ scores on the family planning attitude scale?

3. What factors influence attitudes toward FP?

Materials and methods

This study was designed as a descriptive cross-sectional study.

Setting and population policies in Turkey

Turkey’s population policies have evolved over time, shifting from a pro-natalist approach in the mid-20th century to a more balanced perspective that emphasises reproductive health and FP. While current policies do not explicitly focus on population control, they aim to ensure sustainable demographic growth and improve maternal and child health outcomes [12]. In Turkey, FP is influenced by various sociocultural and economic factors such as education level, religious beliefs, and accessibility to health services. Despite the increasing awareness of FP methods, patriarchal structures prioritize male preferences in reproductive decision-making processes [10–13]. Women in these settings may face barriers such as limited autonomy, lack of communication with partners, and insufficient knowledge about contraceptive methods [8, 10, 11]. Research indicates that men play a decisive role in determining contraceptive use, with traditional norms reinforcing the perception that FP is primarily a woman’s responsibility [2–4]. However, encouraging male involvement in FP decisions has been shown to improve contraceptive adherence, enhance gender equity in reproductive health, and contribute to better maternal and child health outcomes [11–16].

Place and time of the study

This study was conducted between February 2021 and December 2022 with men who applied to the Esenpet Arena Sports Complex Astroturf Field in Gökevler Neighborhood of Esenyurt district of Istanbul. The fact that men are together in the astroturf field, that it is an environment where men feel easily accessible and comfortable, and the high population of the selected astroturf field were effective in the selection of the research location. Additionally, the data collection process was carried out in this setting.

Population and sample of the study

The population of the study consisted of 3.288 married men between the ages of 18–65 who were registered in the Gökevler neighborhood of the Esenyurt district in Istanbul. A stratified random sampling method was used to ensure adequate representation across different educational and socioeconomic backgrounds. The sample size was determined using the G*Power 3.1.9.4 program, with an effect size of d:0.5 (medium), yielding a required minimum sample of 344 participants. To account for an estimated 15% rejection and inaccessibility rate, the final sample size was determined as 400 participants. The selection was made within a 95% Confidence Interval (CI), ensuring the robustness and generalizability of the findings within the studied population.

Inclusion criteria

To be registered in Gökevler neighborhood of Esenyurt district of Istanbul, to volunteer to participate in the study, to be over the age of 18, 65 and under, to speak Turkish, being married, to be male.

Data collection tools

In the study, the via face-to-face interview method was employed. Two data collection instruments were employed in the study.

The personal information form

The Personal Information Form was designed to obtain information about the demographic characteristics of the participants, their spouses, and their use of FP strategies. The 31-question Personal Information Form, developed by the researchers in accordance with the existing literature [4, 15, 16], collected data on various demographic variables and FP method use.

To ensure accurate data collection and minimize potential misunderstandings, the survey and scale were administered through a face-to-face interview method. At this stage, the researcher provided the data collection tools to the participants, who independently filled out the forms. The researcher was available to clarify any questions upon request while ensuring a neutral stance to avoid influencing responses.

This method was chosen allowing for better comprehension of the questions and reducing response bias. Additionally, participants were given sufficient time to complete the questionnaire in a private and comfortable setting to encourage honest and uninfluenced responses. This approach contributed to a higher response rate and improved data reliability.

Family planning attitude scale– FPAS

The Family Planning Attitude Scale (FPAS) was developed by Örsal and Kubilay (2007) to assess attitudes toward family planning in Turkey. The scale underwent a rigorous validity and reliability assessment through a methodological field study. The scale was originally developed in Turkish and is specifically adapted for use among Turkish-speaking populations. It comprises 34 items and employs a 5-point Likert scale, with higher scores indicating a more favourable attitude toward FP. To establish construct validity, confirmatory factor analysis (CFA) was conducted, demonstrating that the scale effectively distinguishes between attitudes toward society, FP methods, and pregnancy. Content validity was ensured through expert evaluation, and criterion validity was examined using internal consistency measures. The scale was found to be highly reliable, with a Cronbach’s alpha coefficient of 0.90, indicating strong internal consistency. Item-total correlations ranged from 0.31 to 0.59, further confirming the scale’s reliability. Additional statistical analyses, such as Hotelling’s T-squared test (T²=1865.06, p = 0.000) and variance analysis (F = 54.93, p = 0.000), validated the scale’s ability to measure FP attitudes effectively.

Given these findings, the FPAS is a valid and reliable instrument for assessing family planning attitudes in Turkish populations. It has been widely used in reproductive health research and is appropriate for evaluating men’s perspectives on FP in this study [20].

The FPAS is comprised of three sub-dimensions: (1) Society’s Attitude towards FP, (2) Attitude towards FP Methods, and (3) Attitude towards Pregnancy. The “Society’s Attitude Towards FP” sub-dimension of the scale is composed of 15 items. The range of possible scores for this sub-dimension is from 15 to 75. The FPAS sub-dimension designated as “Attitude Towards FP Methods” comprises 11 items. The lowest possible score is 11, while the highest is 55. The FPAS sub-dimension “Attitude Towards Pregnancy” is comprised of eight items. A minimum score of 8 and a maximum score of 40 can be obtained from this sub-dimension. In total, the FPAS allows for a minimum of 34 and a maximum of 170 points to be obtained. Higher scores on the scale indicate a more favorable attitude toward FP. The validity and reliability of the FPAS were originally determined by Örsal and Kubilay (2007) [20], who reported a Cronbach’s Alpha reliability coefficient of 0.90 for the total score. In this study, the overall Cronbach alpha value of the scale was found to be 0.969, with the sub-dimensions of the scale exhibiting the following alpha values: 0.935 for the Attitude Towards Society sub-dimension, 0.963 for the Attitude Towards Methods sub-dimension, and 0.909 for the Attitude Towards Pregnancy sub-dimension, respectively. This reliability assessment was conducted across the entire study sample (N = 400) to ensure the consistency and applicability of the FPAS in this research context.

The FPAS was chosen for this study due to its established validity and reliability in assessing FP attitudes in the Turkish population. Given that it was originally developed in Turkish and has been widely used in studies examining reproductive health attitudes in Turkey, it was deemed the most appropriate tool for evaluating men’s perspectives on FP in this context.

Data collection

The data were collected via face-to-face interviews conducted during the interval between the arrival of the subjects at the astroturf field and their commencement of participation in the study. The data were completed by the researcher with the men who met the research criteria and volunteered to participate in the study through the use of the face-to-face data collection method, with an average time commitment of 15 to 20 min.

Data analysis

The data obtained from the study were subjected to analysis using the SPSS 25.0 program at a 95% confidence level. A Cronbach’s Alpha analysis was conducted to determine the reliability of the scale. In order to determine the distribution of the data, the values for kurtosis-skewness and mean-median from the central tendency measures were examined, and parametric tests were employed, given that the data exhibited normal distribution. Prior to this, the suitability of the data used for normal distribution was tested with ‘Kurtosis-Skewness’ and ‘Central Tendency Measurements’. In addition, the normal distribution of the data used depends on the skewness and kurtosis values being between ± 3. When the distribution of the data was examined, it was determined that the distribution was normal since the mean and median of the measures of central tendency were close to each other and the skewness and kurtosis ratios were between − 2 and + 2. Given the normal distribution of the data, the independent sample t-test was employed to compare groups of two, while the one-way ANOVA test was utilized to compare groups of more than two. The Pearson correlation analysis was conducted to examine the relationships between the scale dimensions.

Results

The objective of this study was to determine the factors influencing men’s attitudes toward FP. The findings were collected from a sample of 400 participants. Upon examination of the demographic characteristics of the male participants, it was determined that the mean age was x̄=34.11 ± 7.92, with 39.8% of the participants having obtained an undergraduate degree. The mean age of the participants’ spouses was determined to be 31.53 ± 7.47, the mean age at marriage was 26.71 ± 4.46, the mean duration of marriage was 7.36 ± 2.56, and the mean age at which they had their first child was 28.11 ± 4.28. It was determined that over half of the spouses of the participants were not employed (n = 250; 62.5%), and the majority of them had children (n = 286; 71.5%). The majority of participants (n = 376; 94.0%) indicated that they had decided on the number of children together with their spouses. Additionally, 82.5% of participants perceived FP methods as necessary. Among the methods currently used, 52.5% of participants reported using condoms. Notably, all participants (n = 400; 100.0%) indicated that they made joint decisions with their spouses when using FP methods (Table 1).

Table 1.

Participants’ use of family planning methods (n:400)

Variable	Category	n	Percentage%
Person Deciding the Number of Children	Myself with my spouse	24	6.0
	Myself with my spouse	376	94.0
Status of Finding Family Planning Method Use Necessary	Yes	330	82.5
	No	70	17.5
Receiving Information on Family Planning Methods	Yes	208	52.0
	No	192	48.0
#Sources of Information*	Newspaper. book. magazine	117	44.7
	Friend	20	7.6
	Doctor	69	26.3
	Midwife	25	9.5
	Nurse	31	11.8
Wishing to Receive Information**	Yes	67	34.9
	No	125	65.1
Previous use of contraceptive methods	Yes	296	74.0
	No	104	26.0
Previously Used Method	Condom	191	64.5
	Withdrawal	69	23.3
	Other	36	12.2
Are you currently actively using any family planning method?	No	261	65.5
	Yes	139	34.8
Currently Active Family Planning Method	Condom	73	18.3
	Withdrawal	23	5.8
	Other	43	10.8
Reason for not using family planning methods	Wanting to have children	59	56.7
	Absence of the spouse	14	13.5
	My wife is pregnant	16	15.4
	Not sexually active	15	14.4
Considerations when Choosing a Family Planning Method	Ease of use	144	36.0
	Recommendation from health staff	96	24.0
	Cleanliness	50	12.5
	Economical	37	9.3
	Being religiously appropriate	59	14.8
	Other	14	3.5
Satisfaction with the Method Currently Used***	Yes	135	97.1
	No	4	2.9
Reasons for being satisfied with the current method****	Ease of use	44	32.6
	No side effects	25	18.5
	Being an effective method	54	40.0
	Economical	12	8.9
Joint decision-making with the spouse when deciding on the use of a family planning method	Yes	400	100.0
Talking about family planning methods with a friend	Yes	168	42.0
	No	232	58.0
Opinion about the person who should use family planning methods	Man	55	13.8
	Woman	49	12.3
	Both	296	74.0
Total		400	100.0

^#Since there are multiple answers, the number n may vary

* Answered by those who answered yes to receive information about family planning methods

** Answered by those who answered no to receiving information about family planning methods

*** Answered by those who have currently actively used family planning methods

**** Answered by those who are satisfied with the method currently used

It was observed that the participants exhibited a mean score of 74.46 (SD = 30.42) on the FPAS, a mean score of 31.84 (SD = 14.28) on the attitude toward society, a mean score of 24.77 (SD = 11.15) on the attitude toward methods, and a mean score of 17.85 (SD = 8.00) on the attitude toward pregnancy. It was determined that the participants exhibited low levels of attitudes related to FP and its associated sub-dimensions. A comparison of the participants’ attitudes towards FP with sociodemographic data revealed a significant correlation between FP attitudes and educational status (F = 11.849; p = 0.001). The Scheffe test was conducted to determine which groups exhibited significant differences in attitudes. The results indicated that individuals with a primary school education exhibited the highest level of FP attitudes, with a mean score of 100.19. This was followed by those with an associate degree (69.44), undergraduate degree (66.81), and graduate degree (64.98). Similarly, the data revealed a significant correlation between education and the sub-dimensions of the scale (Table 2). These findings support the study’s goal of identifying key sociodemographic determinants affecting FP attitudes.

Table 2.

Comparison of family planning attitude scale total score and sub-dimensions results with sociodemographic variables

		Family Planning Attitude Scale Total Score			Attitude Towards Society Subdimension			Attitudes Towards Methods Subdimension			Attitudes Towards Pregnancy Subdimension
Demographic	Characteristics	Mean	SD	Test. P, Scheffe	Mean	SD	Test. P, Scheffe	Mean	SD	Test. P, Scheffe	Mean	SD	Test. P, Scheffe
Age	18–29 years	75.9	34.7	F:0.34, p:0.711	32.3	16.1	F:1.09, p:0.338	25.2	12.6		18.3	8.8
	30–39 years	73.2	28.3		30.8	13.1		24.8	10.4	F:0.25, p:0.783	17.5	7.6	F:0.39, p:0.672
	40 years and older	75.4	28.8		33.5	14.1		24.1	10.8		17.9	7.7
Education Status	Primary School (1)	100.2	31.4	F:11.85 p:0.001* (1–4) (1–5) (1–6)	46.9	15.7	F:17.09 p:0.001* (1–3) (1–4) (1–5) (1–6)	25.2	13.6	F:6.27 p:0.001* (2–4) (2–5)	22.8	8.9	F:5.51 p:0.001*, (1–5)
	Middle School (2)	94.5	35.9		42.7	16.7		24.8	12.2		20.9	9.8
	High School (3)	82.6	30.0		35.6	13.3		24.1	10.9		19.7	8.2
	Associate degree (4)	69.4	26.5		29.2	12.5		30.5	10.4		17.1	7.3
	Undergraduate (5)	66.8	26.9		28.1	12.2		30.9	10.3		16.3	7.3
	Master’s Degree (6)	64.9	25.7		25.6	11.3		27.2	10.2		15.9	6.7
Occupational Group	Worker	73.9	26.7	F:0.52 p:0.670	32.8	13.4	F:0.88 p:0.453	23.5	10.2	F:1.12 p:0.346	17.7	7.1
	Private Sector	71.4	25.3		30.3	11.8		23.6	9.7		17.4	6.8	F:0.88 p:0.451
	Self-employment	76.2	32.5		33.3	15.3		25.7	11.8		17.2	9.1
	Officer	75.6	33.9		31.3	15.4		25.5	12.0		18.7	8.4

*p < 0.05; One-way Anova Test and Scheffe Test were conducted

The results of the analysis, which was conducted to compare the total scores and sub-dimension scores of the participants from the FPAS with the demographic data of their marriages and spouses, are presented in Table 3. The significant difference was identified in men’s attitudes towards the community from the sub-dimension of the FPAS according to the number of pregnancies (F = 3.340; p = 0.005, < 0.05). The Scheffe test was conducted to determine which groups exhibited the greatest discrepancy. The findings revealed that individuals whose spouses had experienced three or more pregnancies exhibited significantly higher attitudes towards society (M = 35.93) compared to those who had never been pregnant (M = 28.91).

Table 3.

Comparison of family planning attitude scale total score and subscales results and variables related to marriage and spouses

		Family Planning Attitude Scale Total Score			Attitude Towards Society Subdimension			Attitudes Towards Methods Subdimension			Attitudes Towards Pregnancy Subdimension
Variable	Characteristics	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe
Spouse Age	18–29 years old	31.8	14.9	F:0.02 p:0.985	31.8	14.9	F:0.17 p:0.851	31.8	14.9	F:0.688 p:0.504	17.7	8.2	F:0.16 p:0.855
	30–39 years	31.5	13.8		31.5	13.8		31.5	13.8		17.8	8.2
	40 years and older	32.7	13.3		32.7	13.4		32.7	13.4		18.3	7.0
Spouse Education Status	Primary School (1)	42.5	14.3	F:8.66 p:0.001* (1–5) (1–6)	42.5	14.3	F:11.05 p:0.001* (1–3) (1–4) (1–5) (1–6)	42.5	14.3	F:5.24 p:0.001* (2–5) (2–6)	21.9	7.9	F:5.55 p:0.001* (1–3) (1–5)
	Middle School (2)	37.7	16.5		37.7	16.5		37.7	16.5		21.6	9.3
	High School (3)	33.0	14.3		33.1	14.3		33.0	14.3		16.9	7.9
	Associate degree (4)	32.1	13.7		32.1	13.7		32.1	13.7		18.4	8.1
	Undergraduate (5)	27.2	11.6		27.2	11.6		27.2	11.6		16.5	7.0
	Master’s Degree (6)	26.5	11.8		26.5	11.8		26.5	11.8		15.9	7.3
Duration of Marriage	Four years and below	31.9	15.2	F:0.95 p:0.417	31.9	15.2	F:1.33 p:0.264	31.8	15.2	F:1.15 p:0.328	18.2	8.6	F:0.47 p:0.707
	4–8 years	29.9	13.4		29.9	13.4		29.9	13.4		17.0	7.5
	8–12 years	30.6	9.5		30.6	9.5		30.6	9.5		17.4	6.9
	13 years and above	34.3	14.6		34.3	14.6		34.3	14.7		18.1	7.5
Age at having a first child	18–25 years (1)	37.3	17.5	F:4.48 p:0.012* (1–3)	37.3	17.5	F:3.39 p:0.021* (1–3)	37.3	17.5	F:2.76 p:0.065	20.8	8.8	F:4.62 p:0.011* (1–3)
	26–30 years (2)	32.8	13.3		32.8	13.3		32.8	13.4		18.4	7.2
	31 years and older (3)	30.9	12.9		30.9	12.9		30.9	12.9		17.0	7.8
Number of Pregnancy	None (1)	28.9	14.2	F:1.94 p:0.123	28.9	14.2	F:4.34 p:0.005* (1–4)	28.9	14.2	F:0.44 p:0.725	16.6	8.5	F:1.29 p:0.277
	One time (2)	33.1	14.8		33.1	14.8		33.1	14.8		18.3	7.9
	Two times (3)	30.5	13.3		30.5	13.3		30.4	13.3		18.3	8.0
	Three times or more (4)	35.9	13.6		35.9	13.6		35.9	13.6		18.5	7.1
Spouse Employment Status	Yes	68.0	27.7	t:-3.32	27.9	12.4 14.8	t:-4.39 p:0.001*	23.7	10.8	t:-1.53 p:0.127	16.5	7.6	t:-2.67 p:0.008*
	No	78.3	31.4	p:0.001*	34.2			25.4	11.3		18.7	8.1
Age at Marriage	26 years and below	77.6	32.8	t:2.09 p:0.037*	33.5	15.5 12.7	t:2.45 p:0.015*	25.4	11.9	t:1.09 p:0.273	18.7	8.4	t:2.05 p:0.041*
	Over 26 years old	71.2	27.4		30.1			24.2	10.3		17.0	7.5
Having a Child	Yes	76.8	29.9	t:2.49 p:0.013*	33.2	14.4 13.4	t:3.14 p:0.002*	25.1	10.9	t:0.93 p:0.351	18.5	7.9	t:2.59 p:0.010*
	No	68.5	31.1		28.3			23.9	11.8		16.2	8.2
Wife’s Abortion	Yes	71.6	26.6	t:-0.48 p:0.632	30.3	12.8	t:-0.56 p:0.573	25.4	11.6	t:0.27 p:0.786	16.0	6.9	t:-1.19 p:0.233
	No	74.7	30.7		31.9	14.4		24.7	11.1		17.9	8.1

*p < 0.05; t: Independent Sample t-test. F: One-way Anova Test and Scheffe Test

The total score on the FPAS for the male participants in the study demonstrated a statistically significant correlation with the characteristics they considered when selecting a FP method (F = 6.751; p = 0.001) (Table 1). The Scheffe test, conducted to determine which groups exhibited the greatest discrepancy, revealed that the total scores of those who considered the religious appropriateness of the FP method to be a significant factor (M = 91.42) were markedly higher than those who placed greater emphasis on the ease of use (M = 69.51). Individuals who prioritized religious appropriateness in FP method selection exhibited higher FPAS scores compared to those who emphasized ease of use. These results highlight the role of both reproductive experience and personal beliefs in shaping FP attitudes (Tables 3 and 4). This outcome was similarly observed with regard to the sub-dimensions of the scale (see Table 4). Furthermore, it was established that the sub-dimension of the FP attitude scale, which pertains to attitudes towards society, demonstrated a notable discrepancy in response to the question of who should utilize FP (F = 4.130; p = 0.017).

Table 4.

Comparison of family planning attitude scale total score and sub-dimensions results with the variables of family planning method used

		Family Planning Attitude Scale Total Score			Attitude Towards Society Subdimension			Attitudes Towards Methods Subdimension			Attitudes Towards Pregnancy Subdimension
Variable	Characteristics	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe	Mean	SD	Test. p Scheffe
Considering family planning is necessary	Yes	71.6	28.1	t:-4.11	30.6	12.9	t:-3.96 p:0.001*	23.9	10.7	t:-3.47 p:0.001*	17.2	7.6	t:-3.68 p:0.001*
	No	87.8	36.9	p:0.001*	37.9	18.4		28.9	12.5		21.0	9.1
Getting information about family planning	Yes	67.6	26.7	t:-4.82 p:0.001*	28.7	12.1	t:-4.71 p:0.001*	22.5	10.3	t:-4.38 p:0.001*	16.4	7.4	t:-3.72 p:0.001*
	No	81.9	32.5		35.3	15.6		27.3	11.5		19.4	8.4
Using Contraception	Yes	71.1	29.5	t:-3.79	30.3	13.7	t:-3.69 p:0.001*	23.9	11.1	t:-2.58 p:0.010*	16.9	7.9	t:-4.19 p:0.001*
	No	84.0	31.1	p:0.001*	36.2	15.0		27.2	11.1		20.6	7.7
Considerations in Choosing a Family Planning Method	Ease of Use (1)	69.5	30.2	F:6.75 p:0.001* (5 − 1)	30.1	13.8	F:7.38 p:0.001* (5 − 1)	23.1	11.5	F:3.43 p:0.005* (5 − 1)	16.3	8.2	F:7.02 p:0.001* (5 − 1)
	Health Staff Recommendation (2)	66.8	25.7		27.5	12.1		23.2	9.7		16.1	7.0
	Cleanliness (3)	82.1	31.9		35.2	15.7		27.1	10.9		19.8	7.9
	Economical (4)	75.5	26.4		33.1	13.7		24.6	9.5		17.8	6.9
	Being Religiously Appropriate (5)	91.4	31.7		40.1	14.1		28.9	12.5		22.4	8.2
	Other (6)	76.3	31.9		29.0	15.2		27.5	11.7		19.8	7.7
Satisfaction with Family Planning	Yes	64.4	24.9	t:-0.79	27.9	11.7	t:-0.36 p:0.723	21.2	9.9	t:-1.09 p:0.276	15.3	7.3	t:-0.65 p:0.518
	No	74.5	32.3	p:0.430	30.0	13.1		26.8	12.5		17.8	8.9
The Person Who Should Use the FP Method	Man (1)	77.9	35.4	t:-0.79	34.0	15.7	F:4.13 p:0.017* (2–3)	25.5	13.3	F:1.24 p:0.290	18.4	9.1	F:1.36 p:0.257
	Woman (2)	82.7	32.0	p:0.430	36.4	15.5		26.9	11.5		19.4	8.9
	Both (3)	72.5	28.9		30.7	13.6		24.3	10.7		17.5	7.6
FP Method Used	Condom	70.3	31.4	F:0.79	30.5	14.8	F:0.40 p:0.67	23.2	11.4	F:1.99 p:0.138	16.6	8.3	F:0.69 p:0.499
	Withdrawal	74.8	28.4	p:0.452	30.7	12.7		26.3	11.3		17.9	7.7
	Other	68.1	19.3		28.4	9.1		23.2	7.9		16.4	5.8

* p < 0.05; t: Independent Sample t-test. F: One-way Anova Test and Scheffe Test

Finally, a correlation analysis was employed to assess the interrelationship between the distinct subgroups of the FPAS utilized in the study. Consequently, a statistically positive and high-level relationship was identified between the attitude toward society and the attitude toward methods (r = 0.695, p = 0.001 < 0.05). A statistically positive and high-level relationship was observed between attitudes toward society and attitudes toward pregnancy (r = 0.756, p = 0.001 < 0.05). A high statistically positive correlation was observed between attitudes toward methods and attitudes toward pregnancy (r = 0.775, p = 0.001 < 0.05) (Table 5).

Table 5.

The relationships between the family planning attitude scale subscales of the participants

Variables		Attitude towards Society	Attitudes towards Methods	Attitudes Towards Pregnancy
Attitude towards Society	R	1	0.695*	0.756*
	P		0.001	0,001
Attitudes towards Methods	R		1	0.775*
	P			0.001
Attitudes Towards Pregnancy	R			1
	P

**p < 0.05; Pearson Correlation Analysis was conducted

Discussion

Findings and interpretation

This study aimed to identify factors influencing men’s attitudes toward FP and found that overall attitudes were relatively negative. A significant relationship between educational level, spouses’ education, and attitudes toward FP emerged, with higher education levels associated with more positive attitudes. Key factors influencing FP choices included ease of use and religious compatibility, indicating that practicality and cultural beliefs play a central role in decision-making. Additionally, men who did not use FP methods showed more negative attitudes compared to those who did.

Results in the context of what is known

A review of the literature reveals a scarcity of studies on FP among men, particularly at the national level. The majority of studies evaluating men’s FP attitudes and interests were conducted in more developed countries [21, 22]. In studies conducted in Turkey, it has been demonstrated that men’s utilization of FP services has increased in conjunction with their educational attainment, exhibiting a notable upward trajectory over the past five years [11, 13]. The present study has demonstrated that the level of education is a significant factor influencing attitudes towards FP. However, the fact that this study was conducted exclusively with male participants also demonstrated the disparate effects of gender on attitudes. The study revealed that the educational levels of men and their wives were similar, with men who had completed primary school typically married to women who had also completed primary school. A different study shows that women’s contraceptive attitudes are more favorable as their educational attainment increases [13]. In this study, the inverse relationship between men’s FP attitudes and their educational level was found to be associated with the fact that men were married to women with low educational levels. It was hypothesized that as women’s educational attainment declined, their FP attitudes would become less strong, leading men to assume a more prominent role in FP decision-making. The observed lack of efficacy in women’s FP attitudes may prompt men to assume a more prominent role in this domain. In light of these findings, although this study primarily aims to assess men’s attitudes towards FP, presenting the demographic characteristics of the participants provides a broader context for interpreting the results. Education level, marital patterns, and gender roles are important sociocultural determinants that influence FP decisions. By emphasizing these factors, this study contributes to the understanding of how attitudes towards FP are shaped within a specific cultural and social framework.

The study revealed that 36.6% of men considered ease of use to be the primary factor when selecting FP methods, while religious compatibility was also identified as a significant consideration. In some cases, religious beliefs were given precedence over considerations of ease of use. This finding is consistent with studies in societies where religious norms strongly influence reproductive health decisions [2, 6]. Studies have shown that in patriarchal cultures, men often take a leading role in reproductive decisions and this is a factor that further reinforces traditional perspectives on FP methods [10, 14]. Turkey’s population policies have historically emphasized reproductive health and FP as a means to regulate demographic growth and promote maternal and child health [12]. However, cultural and religious influences continue to shape FP attitudes, as observed in this study. The findings suggest that while awareness of FP methods exists, utilization remains inconsistent due to sociocultural norms, paralleling trends observed in other developing countries [2, 6, 10, 14].

In another study, the primary reasons why men preferred FP methods were found to be effective protection, ease of use, and few side effects [23]. In studies conducted in countries where men are the primary financial providers for their families and have a dominant role in the family unit, it has been stated that economic conditions are a significant factor in the decision-making process regarding FP methods, with men demonstrating a preference for more cost-effective or free methods [24, 25]. The role of cultural and religious beliefs in FP attitudes is evident in societies where reproductive health is traditionally considered a female responsibility. In such contexts, women’s access to FP services and their ability to make independent reproductive decisions may be limited by cultural expectations and male dominance in decision-making. Research suggests that in rural communities, where patriarchal norms are more pronounced, male preferences tend to take precedence over women’s reproductive choices. This can lead to barriers in FP access for women and a lack of shared decision-making within couples [24–26]. The findings of this study indicate that all of the men involved in the study made the decision regarding the selection of FP methods by consulting with their wives. The involvement of men in the selection of FP methods is indicative of a positive shift in the role of women in society. The studies have determined that the FP method affects spousal harmony. The harmony scores of men who use withdrawal as a contraceptive method are lower than those who use effective methods. The FP methods used by the spouses are effective in protecting and maintaining family unity and also in maintaining marriages [7, 10, 23].

The study revealed that 52% of the male participants knew FP methods, with 52.2% of them indicating a preference for condoms as a contraceptive option. In a study, it was determined that 83% of the men lacked information about any FP method. Of those who did have information, 60.2% used condoms, 57.3% chose withdrawal, and 15.9% chose a vasectomy [3]. In a separate study, 83% of the participants indicated that they lacked knowledge about any contraceptive method. According to data from the United Nations, the prevalence of FP methods that require male participation on a global scale is 31%, with the condom being the most commonly utilized method at 21%. Additionally, it has been documented that the prevalence of FP use exhibits considerable variation across countries [5]. For example, research has demonstrated that method use and male participation are prevalent in developed countries. However, effective method use and male participation account for less than 0.1% of contraceptive use in developing countries, particularly in sub-Saharan African countries [22, 25, 26].

The findings of this study indicate that men’s attitudes towards FP are, on the whole, relatively negative, as reflected in the FPAS total mean score of 74.46 ± 30.42, which falls within the lower range of possible scores, suggesting a lack of strong support for FP practices among men. Similarly, a study conducted in Turkey revealed that men scored low on the FP attitude scale, but women had higher the Family Planning Attitude Scale scores (109.1 ± 18.7) [13]. Existing studies on men’s attitudes towards FP show that these attitudes are generally negative, and women are more active in the use of FP services [21, 22].

A qualitative study conducted in South Africa found that men are ambivalent towards FP use and hesitate to allow their female partners to use contraceptives due to some misconceptions [27]. In another qualitative study conducted in Nigeria, it was found that women bear the brunt of family planning responsibilities due to men’s negative FP attitudes. In the study, it was reported that although men were aware of FP methods, their utilization rates were low, and their wives opposed their use of modern family planning methods [28]. Another qualitative study found that strengthening men’s support can positively impact women’s use of self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC), enabling women to use it autonomously and act collaboratively with their male partner. In this study, it was emphasized that seeing men as a resource instead of seeing men as an obstacle would positively affect FP use [29]. In another study conducted with married men, it was found that while all men (100%) knew at least one type of modern contraceptive, only one third (33.7%; CI: 3.12, 3.64) were aware of the ovulatory cycle period and had low knowledge. In the study, men who discussed family planning with health professionals were also more likely to use modern contraceptive methods [30]. These findings align with the present study, which highlights that although men are generally aware of FP methods, their knowledge and attitudes do not always translate into consistent utilization. In alignment with previous studies [27–30], our findings confirm that educational attainment plays a crucial role in shaping FP attitudes. However, unlike some studies that report increasing male participation in FP, our results indicate that decision-making is still largely influenced by traditional gender norms, suggesting that cultural interventions are needed to shift perspectives toward more equitable FP practices.

Clinical implications

The study highlights the need for more targeted FP education and counseling programs aimed at men, particularly those with lower levels of education. Healthcare providers should consider incorporating culturally sensitive approaches that address religious and practical concerns regarding FP methods. Encouraging joint decision-making between spouses in FP matters may improve marital harmony and lead to more effective use of contraceptive methods. Clinical settings should emphasize male involvement in FP counseling sessions to promote shared responsibility in reproductive health management. Furthermore, tailored interventions that integrate gender-sensitive counseling techniques and utilize digital health tools can enhance male participation in FP programs, ultimately improving reproductive health outcomes at both individual and societal levels.

Research implications

Given the limited research on men’s attitudes toward FP in Turkey and similar contexts, future studies should explore the socio-cultural dynamics that influence men’s involvement in FP decisions. Longitudinal studies could provide deeper insights into how education, economic factors, and cultural norms shape men’s attitudes over time. Further research is also needed to evaluate the effectiveness of male-targeted FP educational interventions in improving attitudes and increasing the use of modern contraceptive methods.

Strengths and limitations

A key strength of this study is its focus on men’s attitudes toward FP in a cultural context where male involvement is typically limited. The use of both a demographic questionnaire and the FPAS allowed for a comprehensive assessment of FP attitudes, integrating general demographic characteristics with validated attitudinal measures. However, the study’s limitations include its restricted sample, drawn from a single neighborhood in the Esenyurt district of Istanbul, limiting the generalizability of the results. Additionally, the exclusion of participants who refused to discuss their sexual lives may have further reduced the study’s representativeness. This reluctance highlights the presence of social taboos surrounding discussions of sexuality, indicating the need for more privacy-sensitive methods in future research to enhance participation and achieve more representative findings. Broader studies encompassing diverse regions and socioeconomic groups are necessary to improve the generalizability of future research outcomes.

Conclusion

The findings of this study indicate that men’s attitudes towards FP are generally low, with a significant degree of responsibility being delegated to women. Additionally, it was determined that an individual’s level of education influenced their attitudes toward FP. Men, in particular, considered factors such as ease of use and religious appropriateness when selecting an FP method and typically made decisions in collaboration with their wives. These findings demonstrate the significant influence of gender roles, cultural and socioeconomic factors on FP attitudes.

Abbreviations

FP

Family planning

FPAS

Family Planning Attitude Scale

WHO

World Health Organization

SDG

Sustainable Development Goal

CI

Confidence Interval

Biographies

Derya Bağlan

She graduated from Munzur University Faculty of Health Sciences, Department of Nursing in 2018. In 2023, she completed her master’s degree in public health nursing at Okan University. In 2018, she started working in secondary health services and is currently going on.

Tuğba Yilmaz Esencan

She obtained a Bachelor of Science in Midwifery from Kocaeli University, Faculty of Health Sciences, in 2002. She proceeded to pursue postgraduate studies, attaining a master’s degree in Obstetrics and Gynecology Nursing from Marmara University in 2009 and subsequently completing her PhD at Istanbul University, Florence Nightingale Faculty of Nursing, in 2018. Dr. Esencan commenced her midwifery career in primary healthcare services. Throughout her 22-year clinical career, she has worked extensively as a midwife and senior midwife in delivery wards, contributing to clinical education, training units, and administrative services. Over the past five years, she has been working as an academic midwife, and for the past three years, she has also been serving as the Vice Dean of the Faculty of Health Sciences. She currently works as a lecturer in the Department of Midwifery at Üsküdar University.

Author contributions

Concept -TYE; Design-TYE, DB; Supervision-TYE; Resources-DB; Data Collection and/or Processing-DB; Analysis and/or Interpretation-TYE, DB; Literature Search-TYE, DB; Writing Manuscript-TYE, DB.

Funding

The authors declared that this study has received no financial support. This research received no specific grants from any funding agency in the public, commercial or non-profit sectors.

Data availability

The data that support the findings of this study have been deposited in the the National Thesis Center Archive with the primary accession code 789049.The data that support the findings of this study are openly available in the National Thesis Center at http://www.tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp.

Declarations

Ethics approval and consent to participate

Before the data collection process, ethics committee approval was obtained from the Ethics Committee of Istanbul Istanbul Okan University where this research was conducted (Decision No. 16; Date: 09.12.2020). Written permission for the use of the scale was obtained. Written informed consent was obtained from the study participants. The participants entered the study on a voluntary basis. Institutional permission was obtained from Esenpet Arena Astroturf Field, where the research was conducted, for the implementation of the study. Privacy and confidentiality of personal information were protected during the research. Research participants were informed that the research results could be used for scientific purposes. The Helsinki Declaration rules were followed during research.

Consent for publication

Necessary institutional permission forms were obtained for the article and publication permission was obtained. Written informed consent was obtained from all participants prior to their inclusion in the study. The informed consent form was designed to provide participants with detailed information about the study, including its purpose, objectives, and duration, as well as the data collection tools and procedures to be used. It also explained the intended use of the collected data, measures to ensure confidentiality and privacy, and the rights of participants, including the right to withdraw from the study at any time without consequence. The form included the researchers’ contact information and ensured that participation was entirely voluntary. Participants were given adequate time to review the form and ask any questions before signing to indicate their consent.

Competing interests

The authors declare no competing interests.