ការពន្យារកំណើត គឺជាការសម្រេចចិត្តគ្រួសារ៖ ការចូលរួមរបស់បុរសនៅក្នុងកម្មវិធីពន្យារកំណើត

“ខ្ញុំគិតថា កម្មវិធីនេះល្អ ពីព្រោះការយល់ដឹងអំពីការពន្យាកំណើត ជួយលុបបំបាត់ការយល់ច្រលំ (អំពីការពន្យារកំណើត) រវាងបុរសនិងស្ត្រី ហើយវាលើកទឹកចិត្តឱ្យយើងពិភាក្សាគ្នាអំពីមធ្យោបាយបែប​ធម្មជាតិ និងទំនើប។” – ឆន ស្រៀង (ខេត្តបាត់ដំបង)

តើ “ការពន្យារកំណើត” គឺជាអ្វី? ការពន្យារកំណើត គឺជាការប្រើប្រាស់មធ្យោបាយដើម្បីកំណត់ចំនួនចំនួនកូន (ឬធ្វើឱ្យមានចន្លោះកំណើតរវាងកូនមួយទៅកូនមួយទៀត)។ វាមានប្រយោជន៍ព្រោះវាជួយកាត់បន្ថយការមានផ្ទៃពោះដែលមិនបានគ្រោងទុក ហើយក៏អាចកាត់បន្ថយអាត្រាមរណភាពរបស់ទារក កុមារ និងមាតាផងដែរ (Anbensu, ២០២២)។ ការសិក្សាក៏បានបង្ហាញផងដែរថា ការពន្យារកំណើតនាំទៅដល់ការពង្រីកការអប់រំ និងឱកាសការងារសម្រាប់ស្ត្រី ការបង្កើនសិទ្ធិអំណាច ដែលជាការនាំឱ្យមានការអភិវឌ្ឍន៍សេដ្ឋកិច្ចប្រកបដោយនិរន្តរភាពសម្រាប់ប្រទេស។

គម្រោងលើកកម្ពស់ឥរិយាបថប្រកបដោយសុខុមាលភាព (PHB) គឺជាគម្រោងផ្លាស់ប្តូរឥរិយាបថ ដែលផ្តល់ថវិកាដោយទីភ្នាក់ងារ USAID និងចាប់ផ្តើមក្នុងឆ្នាំ២០១៨ ដល់ឆ្នាំ២០២៥។ គោលបំណងរបស់កម្មវិធីពន្យារកំណើតរបស់គម្រោងនេះ គឺ ១) លើកទឹកចិត្តដល់ការប្រើប្រាស់មធ្យោបាយពន្យារកំណើតទំនើប (ទាំងមធ្យោបាយរយៈពេលវែងនិងខ្លី ដូចជាស្រោមអនាម័យ ថ្នាំលេបពន្យារកំណើត កងដាក់ក្នុងស្បូន កងដាក់ក្រោមស្បែក និងថ្នាំបង្ការកំណើតបន្ទាន់ ២) បង្កើនការយល់ដឹងអំពីការពន្យារកំណើត ក្រោយសម្រាលកូន ៣) ប្តូរពីការប្រើប្រាស់មធ្យោបាយពន្យារកំណើតធម្មជាតិ (ដូចជាការដកចេញ) មកប្រើប្រាស់មធ្យោបាយពន្យារកំណើតទំនើបវិញ។

បុរសមួយចំនួនគិតថាការពន្យារកំណើតគឺជា “ការទទួលខុសត្រូវរបស់ស្ត្រី”។ មានហេតុផលជាច្រើនដែលនាំឱ្យគាត់គិតដូចច្នេះ ប៉ុន្តែមានហេតុផល ២ សំខាន់ៗនោះគឺ មធ្យោបាយពន្យារកំណើតភាគច្រើនផ្តោតលើស្ត្រី ហើយកន្លងមកអន្តរាគមន៍ផ្នែកសុខភាពបន្តពូជ និងពន្យារកំណើតភាគច្រើន បានកំណត់ស្ត្រីជាក្រុមគោលដៅ។ ទោះជាយ៉ាងណាក៏ដោយ ការសិក្សាស្រាវជ្រាវបានបង្ហាញថា ការចូលរួមយ៉ាងសកម្មរបស់បុរសនៅក្នុងកម្មវិធីសុខភាពបន្តពូជ បង្កើនប្រសិទ្ធភាពនៃអន្តរាគមន៍នោះ (Drennan, ១៩៩៨) ។ ការចូលរួមទាំងបុរសនិងស្ត្រី ក្នុងការសន្ទនាអំពីការពន្យារកំណើត បង្កើនការសម្រេចចិត្តរួមគ្នា ហើយបង្កើនការយល់ដឹង និងចំណេះដឹង សម្រាប់គូស្វាមីភរិយានីមួយៗ។ គូស្វាមីភរិយាដែលបានពិភាក្សាអំពីការពន្យារកំណើតគឺភាគច្រើន ប្រើមធ្យោបាយពន្យារកំណើត និងមានកូនតិចជាងគូស្វាមីដែលមិនបានពិភាក្សាគ្នា។ ការពិភាក្សាគ្នារវាងគូស្វាមីភរិយា គឺជាចុងក្រោយជួយផ្តល់សិទ្ធិអំណាចដល់បុរសនិងស្ត្រី ដើម្បីគ្រប់គ្រងអនាគតនៃសុខភាពបន្តពូជ និងសេដ្ឋកិច្ចរបស់ពួកគេ។

In 2019, PHB completed the “High responsibility for healthy lives: PHB gender analysis & action plan”. Through their analysis they found that gender roles can exist as a “source of pressure for many men and limit women’s agency, time, and leadership” (PSI, 6). They also found that women’s decision-making power has increased, with respect to the family, but still encouraged programming in this area. Data also showed that “unmarried women, particularly in the provinces, face restraints on their freedom of movement and contraceptive knowledge due to norms that say they should be protected “(PSI, 6). There were also mixed findings on the decisions related to family planning, with half of the focus groups saying that “women and men discuss childbearing and decide together, but others report these decisions are more directed by men” (PSI, 6).

Given this gender and family planning landscape, it was important to the PHB team to design interventions that were inclusive and encouraged dialogue that increased women’s agency. Thus, the “Heart Protector” and “Loving Relationship” interventions were designed to integrate both men and women into family planning activities. The goal of integration was to facilitate discussions about women’s negotiating power and to normalize couples’ communication about family planning. The goal is really to bring awareness and to start a conversation, about modern methods, but also about reproductive intentions, and family size and plans in general.

Loving Relationship is a more conventional Family Planning intervention – focused on couples connecting to one another, communicating openly, and starting a dialogue about modern methods of contraception. The program team designed a series of tools to use in the intervention – including educational pamphlets, real product samples, and take-home materials to continue the conversation in private.

Heart Protector is an innovative intervention designed to engage men in topics related to family planning. Run by an interpersonal communicator (IPC,) it involves getting together a group of men to talk about modern methods of contraception and ultimately, making a commitment to having a conversation with their partner about family planning. The title “Heart Protector” plays into the role of men as “protectors” of their partners and their families. The intervention urges men to not only think about physical protection from harm, but also the steps necessary to protect themselves, and their partners, from unwanted pregnancy and STIs.

I received some information about MM from a doctor at the health center after we had our first child 13 years ago and decided to use condoms until the appropriate time to have our second child three years ago. It is important to think about family planning to plan for a better family life with sufficient income to care for both children. I learnt about details of each MM option after joining the men’s session and together with my wife, we decided to switch to daily contraception pills.” – Chhum Pohn (Chak Village, Kampong Chhnang)

As of project fiscal year 2023, total people reached through FP IPC community events = 105,560;

Number of males = 66, 849 males;

During 2023 alone, PHB’s interventions reached 20,970 males through IPC community events related to FP.

An assessment of recall of program messages found that:

  • After being exposed to the PHB intervention 60% of respondents (N=1197) had a conversation with their partner about family planning. Of those who had conversations (n=717), 67% of them were men.
  • Of those who had an initial conversation with their partner (n=559), 64% of them were male respondents.
  • 83% of conversations were related to modern methods of contraception.

PHB’s work is also meant to inform future interventions related to health. Some major lessons learned from the FP intervention relate to the barriers and motivators for transitioning to MM:

  • For both men and women, barriers to adoption of MM have included:
    • Myths about the severity of side effects
    • Lack of information about the benefits or options of contraception
    • The belief that MMs will interfere with the enjoyment of intercourse – studies have also shown that the power dynamics here reveal that men’s sexual pleasure takes precedence over women’s concerns about pregnancy or STIs.
    • Concerns about cost of modern contraceptive methods
  • On the flipside, consistent motivators for adoption of MMs include:
    • Positive prior experience with MMs
    • Knowing where to find MMs in one’s community
    • Being recommended MMs by trusted people
    • Hearing or reading testimonials about MMs
    • Economic status
    • Pleasure

Recommendations

With these lessons in mind it is important to design interventions that address key barriers to MM adoption and incorporate the key motivators. It is also important to continue to involve men in Family Planning activities – both on their own in groups of peers and also with their partners.

*The USAID/Cambodia Promoting Healthy Behaviors Activity (Cambodia PHB) project is a five-year, USAID-funded, social and behavior change project (2018-2023) being directly implemented by Population Services International (PSI). The goal of Cambodia PHB Activity is to improve health behaviors among Cambodians and ensure they seek and receive quality healthcare with decreased financial hardship. PHB targets 6 key health areas: maternal & child health; nutrition; water, sanitation and hygiene (WASH); tuberculosis; family planning; and malaria. Cambodia PHB Activity is working with partners in Phnom Penh, Kampong Chhnang, Kampong Cham, Tbong Khmum, Battambang, and Pailin.