Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?

**Background:** Male involvement in family planning (FP) decision-making is recognized as a critical factor for improving reproductive health outcomes, yet remains low in many sub-Saharan African countries. In Malawi and Tanzania, patrilineal norms often position men as primary decision-makers regarding family size and contraceptive use, but their actual participation in FP decisions is understudied. Previous research has shown inconsistent findings regarding the extent and determinants of male involvement in these two countries. This study aimed to assess the prevalence of male involvement in FP decisions and identify associated socio-demographic determinants within the household context.

**Methods:** The study used data from the 2015–2016 Malawi Demographic and Health Survey (MDHS) and the 2015–2016 Tanzania Demographic and Health Survey (TDHS). A weighted sample of 10,992 men aged 15–54 years who were sexually active, knowledgeable about FP methods, and likely to have been involved in FP decisions in the five years prior to the survey was analyzed. The final sample comprised 7478 men from Malawi and 3514 men from Tanzania. The outcome variable was male involvement in FP decisions, defined as having discussed FP with health workers or health professionals in the months preceding the survey, and was categorized as 'Yes' or 'No'. Independent variables included age, place of residence, education, wealth index, marital status, occupation, exposure to media, contraceptive knowledge, and sex of household head. Descriptive statistics, chi-square tests, and binary logistic regression (unadjusted and adjusted odds ratios with 95% confidence intervals) were performed using STATA version 14. Variables with a p-value < 0.2 in bivariate analysis were included in the multivariable model, and statistical significance was set at p < 0.05.

**Key Results:** The mean age of respondents was 32 years (±8 SD) in Malawi and 36 years (±6 SD) in Tanzania. The point prevalence of male involvement in FP decisions was 53.0% in Malawi and 26.6% in Tanzania. In Malawi, factors significantly associated with higher odds of male involvement included: age 35–44 years (AOR = 1.81; 95% CI: 1.59–2.05) and 45–54 years (AOR = 1.43; 95% CI: 1.22–1.67) compared to age 15–24 years; secondary/higher education (AOR = 1.62; 95% CI: 1.31–1.99) compared to no education; rich wealth status (AOR = 1.18; 95% CI: 1.07–1.31) compared to poor; access to media information (AOR = 1.35; 95% CI: 1.21–1.51); and female-headed household (AOR = 1.79; 95% CI: 1.70–1.90). Muslim (AOR = 0.82; 95% CI: 0.70–0.95) and traditional religion (AOR = 0.70; 95% CI: 0.52–0.93) were associated with lower odds compared to Christianity. In Tanzania, significant predictors included: primary education (AOR = 1.94; 95% CI: 1.39–2.72) compared to no education; middle wealth status (AOR = 1.46; 95% CI: 1.17–1.81) compared to poor; being married (AOR = 1.62; 95% CI: 1.38–1.90); working (AOR = 2.86; 95% CI: 2.10–3.88); and rural residence was associated with lower odds (AOR = 0.66; 95% CI: 0.57–0.78) compared to urban. Female-headed household in Tanzania was associated with lower odds (AOR = 0.80; 95% CI: 0.64–1.01).

**Clinical Implications:** The substantially lower prevalence of male involvement in FP decisions in Tanzania (26.6%) compared to Malawi (53.0%) indicates an urgent need for targeted interventions. The findings suggest that FP programs should be redesigned to accommodate socio-demographic determinants such as age, education, wealth, media access, and household structure. Increasing male participation through spousal communication, media-based awareness campaigns, and educational initiatives may improve FP uptake and continuity, contributing to reduced maternal mortality and better reproductive health outcomes. The study supports the integration of male involvement strategies into national FP programs to help achieve Sustainable Development Goal 3 (universal access to reproductive healthcare) and SDG 5 (gender equality).