In Nigeria, conversations about reproductive health and rights have traditionally been framed as conversations about women. Women are often at the center of discussions on pregnancy, childbirth, family planning, maternal health, and access to reproductive healthcare, while men are frequently treated as peripheral to the conversation.

Yet the reality within many Nigerian families tells a different story.

Women bear the biological experience of pregnancy and childbirth, but decisions about their reproductive health do not always happen in isolation. Within many households, decisions about when and where to seek care, whether to spend money on treatment, whether to use certain reproductive health services, and how to respond to pregnancy-related complications are influenced by partners and wider family structures.

These dynamics are embedded in gender roles, economic realities, cultural expectations, and social norms.

This creates an important contradiction: men may have significant influence over reproductive health decisions while receiving limited information, support, or encouragement to participate meaningfully in reproductive healthcare.

Nigeria cannot sustainably improve its reproductive health outcomes without deliberately engaging men as informed, supportive, and accountable partners. A reproductive health strategy that ignores the realities of household decision-making is incomplete.

Reproductive health decisions are rarely made in isolation

In many Nigerian households, decision-making power is not evenly distributed. Men may hold significant influence over household finances and healthcare decisions, including decisions that ultimately determine whether, when, and how women access medical care.

In this context, reproductive health is rarely a “women-only” concern. It is often negotiated within relationships and household power structures.

Evidence supports this reality. Research has found that male partners can play a significant role in women’s use of reproductive health services, influencing decisions ranging from family planning to timely access to maternal healthcare (BMC Reproductive Health, 2019).

However, influence does not necessarily translate into meaningful participation.

Some men may discuss reproductive health with their partners or provide financial support, yet far fewer participate directly in the healthcare process by accompanying their partners to hospital appointments or taking an active role in pregnancy-related decision-making.

Research by Adelekan et al. (2015) found that only about 30.9% of men studied were actively involved in reproductive healthcare practices.

This presents a significant gap: men can be influential in reproductive health outcomes while remaining largely absent from the systems and spaces designed to support those outcomes.

 

The paradox of male influence and male absence

In many Nigerian communities, men continue to have considerable influence over household health spending and healthcare decisions.

Research involving community conversations with male elders in rural Edo State found that a husband’s financial position and personal views could significantly influence whether his wife used a health facility or a traditional birth attendant. The research also found that men were more comfortable providing financial support than participating directly in pregnancy-related issues (Yaya et al., 2019).

Similarly, research involving married Nigerian men found that while many discussed reproductive health with their wives, fewer accompanied their partners to health facilities, and only 30.9% were classified as actively involved in reproductive healthcare (Ani et al., 2016).

This gap, men influencing decisions without necessarily participating in the care itself, is at the center of the challenge.

It did not emerge by accident.

For decades, reproductive health programming has often been designed primarily around women. While this focus is understandable given the direct biological and health consequences women experience, it has sometimes left men at the margins of reproductive healthcare conversations.

The result is a system in which influence can outpace information.

Men may be expected to make or participate in important household decisions without necessarily having access to the information, services, or conversations needed to make those decisions responsibly.

The question, therefore, is not whether men should replace women at the center of reproductive health. Rather, it is how men can be appropriately engaged as partners while preserving women’s autonomy, rights, and decision-making power.

Why are men less engaged?

Cultural and Social Norms

Part of the challenge lies in deeply established social norms.

In many communities, reproductive health is still regarded as “women’s business.” Pregnancy, childbirth, antenatal care, breastfeeding, and even family planning may be viewed primarily as matters for women to manage.

This framing can discourage men from asking questions, attending health appointments, seeking reproductive health information, or seeing themselves as active participants in reproductive healthcare.

At the same time, traditional expectations around masculinity may position men primarily as providers and decision-makers rather than caregivers and partners.

As a result, a man may consider paying for hospital bills or providing financial resources as sufficient involvement, without recognizing that emotional support, communication, accompanying a partner to care, understanding pregnancy danger signs, and supporting timely healthcare decisions are equally important.

Health-System Barriers

The health system can also limit men’s participation.

Many reproductive health services are designed primarily around women, and some facilities may not intentionally create spaces that encourage male participation. Clinic hours may conflict with men’s working schedules, health education materials may primarily target women, and service environments may not always make male partners feel that their participation is expected or welcomed.

These barriers can reinforce the perception that reproductive healthcare is primarily a woman’s responsibility.

Research published in BMC Public Health (2025) similarly highlights the importance of accessible, welcoming services in encouraging greater male engagement.

If health systems want men to participate, they must also create opportunities for that participation.

The cost of exclusion

The consequences of limited male engagement extend beyond individual households.

Nigeria continues to face a substantial maternal mortality burden. The United Nations Maternal Mortality Estimation Inter-Agency Group estimated Nigeria’s maternal mortality ratio at *993 maternal deaths per 100,000 live births in 2023* (WHO, UNICEF, UNFPA, World Bank Group and UNDP).

While estimates vary across data sources and methodologies, the scale of maternal mortality in Nigeria underscores the urgency of improving access to timely, quality maternal healthcare.

One of the most widely recognized frameworks for understanding maternal mortality identifies three critical delays:

1. Delay in deciding to seek care;
2. Delay in reaching an appropriate health facility; and
3. Delay in receiving adequate care once at the facility.

(Thaddeus & Maine, 1994).

Household decision-making can influence the first delay.

When a woman experiences a pregnancy-related complication, the speed with which the household recognizes the seriousness of the situation, decides to seek care, mobilizes resources, and supports transportation to a health facility can have significant consequences.

This is why male engagement matters.

Engaging men is not a substitute for strengthening health facilities, improving access, addressing financial barriers, or ensuring quality maternal healthcare. Rather, it is one part of a broader response to the factors that shape reproductive health outcomes.

What should meaningful male involvement look like?

Meaningful male involvement should not mean giving men greater control over women’s reproductive choices.

Instead, it should mean building shared responsibility while protecting women’s autonomy and rights.

Men can contribute by:

– Supporting partners in accessing reproductive healthcare services;

– Encouraging timely care-seeking when complications or danger signs arise;

– Learning about pregnancy and reproductive health;

– Participating in conversations about family planning and reproductive goals;

– Providing practical, emotional, and financial support where possible;

– Supporting skilled birth attendance;

– Understanding the importance of emergency preparedness during pregnancy;

– Challenging harmful myths and misinformation within their families and communities; and

– Encouraging respectful and informed reproductive health decision-making.

Involvement should therefore move beyond simply providing money.

A man who understands reproductive health issues, knows where his partner can access appropriate care, supports her decision to seek treatment, and is prepared to respond in an emergency is participating in reproductive health in a meaningful way.

The goal is not to transfer responsibility from women to men.

The goal is to expand responsibility.

From silence to action

Closing this gap requires intentional, community-driven engagement.

Dialogue sessions, peer education, community advocacy, and collaboration with traditional, religious, and community leaders can create spaces where men can ask questions, challenge misconceptions, and reconsider assumptions about their role in reproductive health.

This matters because changing behavior requires more than providing information. It requires creating environments where new forms of participation are socially accepted and supported.

They happen in homes.

They happen between partners.

They happen in conversations with parents, religious leaders, community leaders, friends, and peers.

If we want to change reproductive health outcomes, we must therefore engage the people who influence these conversations.

Building more inclusive health systems

Community engagement must also be matched by changes within health systems.

If men are expected to participate, health services must create opportunities for them to do so.

This could include:

– Developing reproductive health information specifically designed to engage men;

– Providing opportunities for partners to participate in health education;

– Making service environments more welcoming to supportive male partners;

– Exploring clinic schedules that are more accessible to working men;

– Training healthcare workers to engage male partners appropriately;

– Integrating men into community reproductive health education; and

– Promoting couple-focused approaches where appropriate, while always respecting women’s confidentiality, autonomy, and individual rights.

Male engagement should never become another mechanism through which women lose control over their own healthcare decisions.

Instead, it should strengthen communication, support, and shared responsibility within relationships.

A shared responsibility

Reproductive health does not exist in isolation.

Families, relationships, communities, health systems, social norms, and the decisions people make every day shape it.

Women must remain central to conversations about their own reproductive health because they experience many of the direct physical consequences of pregnancy and reproductive healthcare. But being central does not mean women should carry the responsibility alone.

Men have a role to play.

That role should be informed, supportive, respectful, and accountable.

Nigeria’s reproductive health challenges cannot be addressed by women alone, nor can they be solved simply by asking men to become more involved. What is needed is a broader understanding of reproductive health as a shared social and family responsibility, one that protects women’s autonomy while encouraging men to become informed and supportive partners.

The conversation therefore needs to change.

From seeing reproductive health as women’s business to recognizing it as a shared responsibility.

From men being decision-makers from a distance to becoming informed and supportive partners.

From silence to dialogue.

From influence without information to informed participation.

Because when men are meaningfully included in reproductive health conversations, and when women’s rights and autonomy remain protected, we create stronger families, more responsive communities, and a more sustainable pathway toward better reproductive health outcomes.

The missing conversation is not about giving men control.

It is about ensuring that men are part of the responsibility.