Hesperian Health Guides

Starting conversations about family planning

People are often shy or embarrassed to talk about family planning because a conversation about family planning is also a conversation about sex. Focusing instead on how family planning can benefit the health of mothers and children, and on the benefits to the entire family, can be an easier way to get started.

ActivityUse drawings to discuss benefits of family planning

small carrots planted close together next to some large carrots planted farther apart.
Spacing plants so they are not too close together is better for the soil and helps them grow better. The same is true for mothers and children. Spacing children is healthier for the entire family.
a man and woman with their arms around each other.
4 young adults in a classroom.
A woman and her partner can enjoy sex without fear of pregnancy. Waiting to have children gives young people time for schooling.
a family of 5 shown in a balance with an equal weight of food.
a family of 4 reading and playing together.
Fewer children means more food for everyone. Parents have more time to relax and help educate their children.
  1. Show the group these images without the captions (you can adapt them to local situations). Ask the group to discuss what health or other benefits of family planning the image represents.
  2. Build on the group’s ideas with questions such as:
    • What difference does birth control make for a young woman who goes to school? For a woman who has a job and takes care of her house and family?
    • What difference does family planning make for a family that struggles to have enough food? or lives in a small space and cannot afford to move?
    • What difference does family planning make for providing decent housing, clean water, sanitation, and schools for everyone in the community?
  3. Ask participants to make their own drawings of other benefits of family planning. Encourage them to think about how family planning can make a difference in a woman’s life, her family, and the whole community.

Involving men

a man speaking to 2 men holding clipboards.
Thank you for the information about the new family planning clinic. I’ll talk with my wife about it.

Most men want to have healthy partners and children, but some men may not want to talk about family planning because they do not know much about it, or they may have heard too many negative things about birth control. Having a chance to talk and learn about family planning helps men respect women’s decisions about having children and encourages them to share responsibility with their partners for using birth control. It can also help men to say how they and their partners may enjoy sex more if they are not worried about getting pregnant.

This next activity has a group play a game to show the story of 2 different families and how they grow. This is a fun activity that is good for involving men in a discussion.

ActivityStory game: A tale of 2 families

  1. Draw 2 equal-sized shapes on the ground, big enough for 4 people to stand inside. Ask the group to pretend that these shapes are the homes of 2 brothers.
  2. Ask volunteers to pretend that they are the 2 married couples, and give them names. In our story, one couple is Juan and Rosa, and the other is Pedro and Alma. Ask each couple to stand in one of the "homes." Explain that the brothers got married on the same day. Play music and ask the couples to dance in their homes to celebrate!
    2 couples dancing inside inside shapes on the ground.
    Juan and Rosa
    Pedro and Alma
  3. Now, tell the story of each growing family with volunteers play-acting each child. For example:
    Each couple had a baby after their first year of marriage, and both babies were girls. (Ask 2 volunteers to play the roles of the babies and to stand inside the homes. You can give them each a doll or a child’s toy as a prop.)

    Juan and Rosa talked about having more children and decided that they wanted to wait. They went to their neighborhood clinic to ask about birth control. A health worker explained the different family planning methods provided at the clinic, and answered Juan and Rosa’s questions about other methods such as fertility awareness. Juan and Rosa decided that Rosa would get an injection every 3 months to keep from getting pregnant. Rosa went to work part time while her mother helped take care of the baby.

    Alma and Pedro decided not to use any birth control method after their baby was born. They believe that having children is God’s will, and Pedro hopes to have a son soon. They both want Alma to take care of the baby all the time, so she does not have a paid job. One year later, Pedro and Alma have another baby, a girl. (Ask 1 volunteer to step into Alma and Pedro’s home as baby number 2.)

    Pedro and Alma have another baby the next year, and this time it is a boy. (Ask another volunteer to step into Alma and Pedro’s home as baby number 3.)

    With 3 children under 3 years old, Alma does not want more, but she is afraid to discuss this with Pedro. In their 5th year of marriage, she and Pedro have another child. (Ask another volunteer to step into Alma and Pedro’s home as baby number 4.)

    Juan and Rosa decide to have another baby when their first child is 3 years old. (Ask another volunteer to step into Juan and Rosa’s home as their second baby.)

    In their 6th year of marriage, Pedro and Alma have another baby. (Ask 1 more volunteer to step into Pedro and Alma’s home as baby number 5.)

    At their sixth anniversary they plan a party together and prepare a meal. (You can give each family a loaf of bread and ask them to share it.)
    the 2 families, 1 with 2 children and the other with 5.
  4. Once the story game has finished, you can lead a group discussion about people’s ideas about birth control, or about family size and what influences people’s decisions. Here are some questions you could ask:
    • Why do some people prefer large families and other people prefer to have only 1 or 2 children?
    • Who decides when and how many children to have? How does this decision affect the woman? How does it affect the man?
    • How do people feel about having boys or girls? How do peoples’ attitudes about gender affect their decisions about having children?
    • How does family size affect the family’s ability to have enough food and make sure all the children grow up healthy?
  5. To conclude you can ask the group for their ideas on how family planning makes it possible for women and couples to decide when and how many children to have.

Couples need to talk about it

Talking with a partner about using birth control is usually easier if women practice, using role plays. Having women practice playing the men’s roles makes this activity a lot of fun.

ActivityPractice talking about birth control

  1. First, ask the group to think of different reasons men may not want to discuss birth control, or what they might say about not using family planning.
  2. Then ask a few pairs of women to prepare role plays in which the woman talks about her desire to use birth control and tries to convince the man to cooperate.
    2 women in a role play where 1 of them plays the part of a man.
    The more children a man has, the more respect he gets!
    Yes, but fewer children means there is more food for each child.
  3. After each role play, ask the women who watched it which arguments they thought were most useful. What other arguments can they think of to help persuade the man? Here are some examples:
    • Sex is so much better if I am not worried about becoming pregnant.
    • If we wait to have another child, I will be able to contribute more to the family.
    • If I get pregnant now, you will have to quit school and work full time.
    • You do not need many children to be proud ― think of how proud you will be when your children fare well in the world, because we were able to send them to school.
    • Having children every year will make me old before my time. Isn’t it better for me to stay strong and healthy?

Women’s group changes men’s opinions in Nepal

Women in Nepal formed Community Action Groups where they met to talk about their health and find solutions to community problems. They helped each other improve their reading and writing skills, and they set up savings programs so women could get loans when their families needed money for medical expenses and other emergencies. Men became supportive of these groups because they saw that helping women benefited the whole family.

The women also began to learn about family planning, and soon some of the men were also talking about the benefits of child spacing with other men at gathering places such as tea stalls, local festivals, and bus stops. As word spread about condoms and child spacing, it became more common and acceptable for women to plan their families with their husbands.

2 women speaking.
Before we had to ask a family member for permission to do even the smallest things, such as selling a hen.
But now we can make decisions about things that affect us and our families, such as how many children to have and whether they should go to school.

Adolescents’ needs for birth control

Adolescents face many challenges when wanting to prevent unintended pregnancy. Young women are often pressured to have sex or to have a baby before they are ready. Some young women feel ready to have sex but not ready to become mothers. Adolescents often cannot get contraceptives when they need them. And it can be especially difficult for young women to insist that their partners use condoms.

Parents are often uncomfortable talking with their daughters about sex, pregnancy, and birth control. Religious or cultural beliefs that disapprove of unmarried women having sex also make it difficult for young women to learn how to prevent pregnancy. But talking openly with adolescents about family planning does not encourage them to have sex before they are ready. Instead, such conversations can help promote mutual trust, respect, and understanding. Knowing about family planning gives young women more confidence in their relationships and control over their own lives. For more ideas, see Chapter 4: Sexuality and Sexual Health.

Activities that encourage dialogue between young people and adults can eventually lead to community solutions to help prevent early and unintended pregnancies.

ActivityA fishbowl to help youth and adults talk about birth control

A fishbowl activity can be a good way for youth and adults to listen to each other’s concerns and points of view.

a group of young people sitting on a rug while adults sit in chairs around them.
You can adapt the activity, A fishbowl about birth experiences. For example, begin by having a group of young women, or a mixed group of young men and women, sit together in a circle with a group of adults sitting in a circle around them.
  1. Ask the youth inside the circle to talk about why access to birth control is important for young women’s health now and in the future. Encourage them to discuss their experiences (or the experiences of other young people) and any difficulties in trying to obtain and use family planning.
  2. Next ask the adults to talk about what they heard. Give them a chance to ask the youth questions and have the youth respond.
  3. After a few minutes, have the groups change places, and ask the adults to talk about their experiences and any difficulties in trying to use family planning.
  4. Ask the youth to talk about what they heard and give them a chance to ask the adults questions.
  5. To conclude, ask each group questions that will help them reflect on each others’ experiences. What did they learn that they did not know before? What are some things that both groups have in common? What are some of the differences around access to and use of family planning?

Promote youth-friendly services

By working to make health services friendly to youth, you can increase the likelihood that young women and men will have access to information about birth control, sexual health, and preventing STIs.

young people near a sign that reads, "Youth Clinic, 5 to 9 p.m.," and a poster announcing a health fair.
Youth are more likely to use services that reflect their interests and needs, located at places they feel comfortable, and during hours convenient to them.

For example, you can:

  • make services available at places where youth already go, such as schools, markets, and community centers.
  • reserve "youth only" hours in a clinic in the late afternoon, evening, or weekends.
  • reassure young people that health workers will treat them with respect and will not share their information
  • train young people as peer counselors.
  • ask youth to decorate the space, provide music during "youth only" hours, and make the space their own.
  • make services and birth control free or as low-cost as possible.

Encourage youth to participate and lead activities and events. For example, a youth group could organize a dance or a neighborhood clean-up to bring people together in a fun activity where health services could also be available. Young people have great ideas and a lot of energy. They may come up with ideas jarring to adults, but they will almost certainly reach more young people. There are more ideas for youth-friendly services in Chapter 4: Sexuality and Sexual Health and Chapter 5: Preventing Sexually Transmitted Infections.

The following activity can help promote discussion between young people and adults about the needs of adolescents and obstacles to care, and then imagine changes for health services to meet the needs of all youth.

ActivityCrossing the river to health

  1. Create an imaginary river in the middle of the space where you are gathered using stones, rope, or a long piece of cloth. Ask young people to sit on one side of the river and adults to sit on the other side. Ask everyone to think about why adolescents need complete sexual and reproductive health services, including access to pregnancy prevention and abortion services, and also orientation about sexuality and life choices, and why the river separates the adults and young people.
    illustration of the above: 2 young people and 2 adults speaking on either side of the imaginary river.
    We already have women’s bodies, but we do not want to get pregnant. We need to know how to take care of ourselves as women.
    We need to be able to talk with adults who will not judge us. We need information and straight answers to our questions.
    No one has told us how to talk with young people about these matters. I don’t even know if it is legal.
    There are so many risks these days, I don’t know what to tell my kids.
  2. Point out that access to health services can save young women’s lives, but sometimes getting health care can be as difficult as crossing a raging river. Sometimes adults need to toss a lifeline to help youths get across.
    Ask the group to think about the obstacles or reasons why adolescents cannot or will not visit health centers to get sexual health services such as birth control, condoms, or STI tests. For each obstacle, ask "But why?" to encourage the group to think of more obstacles.
    cards with obstacles written on them.
    No services
    school hours
    Parents' permission required
    No privacy
    No free tests for STIs
    Youth don't know they have reproductive rights
  3. When all of the obstacles have been written on cards, form 2 groups and give half of the cards to each group. This time the groups should be mixed between adults and youth, gathered on either side of the imaginary river.
  4. illustration of the below: people joined by a web of yarn across the imaginary river.
  5. Ask a group to read out loud one of its obstacle cards to the group on the other side of the river. The other group has to come up with a solution or “lifeline.” When they have a good solution they call it out, and if the other group agrees that it will solve the problem, then they can throw a ball of yarn across the river to the other group. The groups on either side of the river take turns calling out obstacles and coming up with solutions. Everyone who has spoken holds onto their part of the yarn. By the time the game is completed, the yarn will cross back and forth across the river, like a web or bridge!

    As the groups name solutions, you can write them on a large piece of paper that everyone can see.
  6. When solutions for all of the obstacle cards have been identified, ask for any new ideas for solutions and then come to a close. Ask everyone to reflect on the meaning of the bridge that is being formed.
  7. Then ask the whole group to talk about what is needed so all young people can use all the services at the health center. Review the different solutions and give the group time to talk about which solutions would work best or be most needed. Encourage both adults and youth to think about how they could take action to work for change.