In all phases associated with the reproductive system and its events and processes, reproductive health is a form of total physical, psychological, and social well-being, not just the lack of infirmity or disease [1]. As a consequence, reproductive health suggests that people can have a healthier and safer sex life, as well as the capability to reproduce and the choice to select if, when, and how regularly to do so. The following freedoms are implicated in this independence:

1. Men and women's rights to be educated about and have access to safe, efficacious, cost-effective, and appropriate family planning techniques of their preference, as well as other procedures of fertility control that are not illegal.
2. The freedom to acceptable healthcare services that will allow women to effectively navigate pregnancy and delivery while also giving partners the best likelihood of obtaining a healthy child.

The admittance to high-quality, affordable reproductive and sexual health services and knowledge, including a wide variety of forms of contraception, is critical to achieving females' rights and well-being [2]. The Sustainable Development Goals and the Global Strategy for Women's, Children's, and Adolescents' Health both demand ubiquitous admission to contraceptive services as a human right and a necessity for a healthier lifestyle for women and girls [3]. However, nations and the international health community face a huge barrier in lowering the unfulfilled necessity of modern contraceptives. In many places, facilities are either of inferior quality or inaccessible, and service delivery and social restrictions continue. Accessibility to elective reproductive and family planning health care for everybody, including couples, men, women, and adolescents, enhances individual vigor and well-being and can enhance communities and families economically, environmentally, and socially [4].

The International Planned Parenthood Federation (IPPF) recognizes and acknowledges that the freedom to select whether or not to have kids is inferred by the privilege of all people to choose the quantity and spacing of their kids voluntarily and accountably and to have access to education, information, and signifies to act reasonably, and that female should be granted special prevention throughout a reasonable period before and after conception [5]. Whereas the worldwide incidence of modern contraception among married women of childbearing age (MWRA) increased by 2.10 percent points between 2000 and 2019, from 55.0 percent (95 percent UI 53.7 percent –56.3 percent) to 57.10 percent (95 percent UI 54.6 percent –59.5 percent). The limited option of techniques; inadequate access to health services, particularly among poorer, young, and unmarried people; poor quality of available health services; the distress of side-effects; cultural and religious opposition;  providers'  and users' preconception in contrast to some methods; and gender-based obstructions to retrieving services are some of the causes for this slow increase [6].

Family planning is critical for women's health and independence, as well as that of their communities and families. The quality of family planning services is critical to ensuring that everyone achieves excellent health standards. The choice among a wide range of forms of contraception; fact information on the efficacy, consequences, and benefits of various approaches; technically adept, qualified health care workers; supplier partnerships based on mutual respect for an informed decision, confidentiality, and privacy, according to the WHO publication Making sure human rights in the providing the form of contraception services and information with guidelines and suggestions [7]. By providing evidence-based recommendations on the appropriate provision of contraceptive methods for both women and men, aims to improve the performance of healthcare in family planning.

In rural India, men play an important role in family decision-making. Many studies have been carried out on contraception that emphasizes mainly on women. The involvement of men concerning the use of contraception is necessary among couples for consistent and effective results. Men are neglected potential consumers of contraceptives. This female-oriented approach excludes men’s opinion regarding family planning, and therefore this study endeavors to consider first expectant fathers, who should be the first point of contact to effectively use proper contraception.

By 2050, India's population is projected to reach 1.53 billion people. Every fifth child born in the globe is an Indian, and half of the population of India is of reproductive age. The depletion of already limited natural resources will only be exacerbated by such population growth. As a result, contraception becomes a necessity [8]. Global estimates based on the Demographic and Health Survey (DHS) data from 34 low and middle-income countries (LMICs) reveal that withdrawal of forms of contraception while still expressing a preference to prevent pregnancy accounts for 38 percent of unmet contraception needs [9]. Family Planning is defined by the WHO as a set of beliefs and practices that is embraced voluntarily by families and individuals based on the knowledge, perceptions, and implicated choices to encourage the health and wellbeing of the family and consequently contribute effectively to a country's communal development [8]. The number of women who are now using, or whose sexual partner is currently using, at least one method of contraception, regardless of the technique employed, is stated as contraceptive prevalence.

It is most commonly recorded in married or in-union women between the ages of 15 and 49, which is the reproductive age range for females. The contraceptive reported prevalence would therefore be determined by the number of women in the reproductive age group who utilize contraception techniques (typically modern methods). The proportion of women of reproductive age, married or in a partnership, who desire to stop or delay becoming conceived for the next two years but are not utilizing any form of contraception, modern or traditional, is characterized as the unfulfilled need for FP. Furthermore, women between the ages of 15 and 49 are the target demographic, which includes adolescents, those who have recently given birth or may have lost a pregnancy, and those who may have already achieved their intended family size [10]. Furthermore, access to contraceptive information and services, informed decision-making, acceptable information and services, quality of service, nondiscrimination, confidentiality, participation, privacy, and responsibility are the nine human rights principles that underpin FP services [10]. Furthermore, counseling is still an important component of contraceptive treatments; yet, this expertise is frequently underutilized, particularly when dealing with human rights issues [11].

Male partners have an important part in reproductive health, but additional research is necessary to know the effect of male partners on prenatal care and contraception use in the modern Indian context [12]. Furthermore, the quality of FP/C information provided to men, as well as the presence of men in FP/C programs, are important considerations. Gender inequality, historical governmental policies, and hierarchical social practices all contribute to female marginalization in India, which has a detrimental impact on FP/C use. Male partners' highly negative belief systems about FP/C, restricted access to FP/C knowledge, misconceptions and myths, apparent side effects such as lower sexual satisfaction, poor economic standing, religious affiliations, restricted male birth control choice, and male desire for larger families are all factors that contribute to FP/C use being opposed. Negative experiences with healthcare providers (HCPs) are also a significant factor that determines male participation in FP/C use [13].

The focus of research on the factors that influence contraception dynamic behavior has so far concentrated on women's preferences. Notwithstanding the foundation for their examination, partner-related impacts have attracted scant attention. As a result, the majority of investigations on partner interactions has focused on partners as contraceptive use obstacles, based on validations such as the Theory of Gender and Power, which stipulates the impending impact of gender inequities across labor, power, and relationship domains. These disparities have a ripple effect on women's reproductive health, along with their significant exposure to and practice of contraceptive methods [9].

Nowadays, researchers and program managers have discovered that programs that focus solely on males or females may fail to achieve their goals since the majority of sexual, modern contraceptives, and birthing resolutions are made, or it may potentially (and perhaps ideally) be formed, by both spouses together. The International Conference on Population and Development (ICPD) recognizes the couple as an entity and states that "the goal of family planning programs must be to empower couples and people to select independently and ethically on the amount and placement of their offspring". Males generally predominate in many developing nations when crucial family decisions are made, such as reproduction, family size, and contraception use, according to existing research [14].

Considering the significance of gender and partner interactions in reproductive choice, this research aims to learn more about the influence of alliance impacts on women's form of contraception use interplay, such as partner support for contraceptive methods, conversations with partners about preventing pregnancy before being used, and perceived partner fertility aspirations. Moreover, emphasizing the involvement of partner support in contraceptive subtleties will be critical as a recurring pattern to emphasize male participation in family planning services. Moreover, messaging and interventions should be targeted to individual contraceptive patterns, with an emphasis on improving contraceptive usage and continuance as well as managing contraceptive cessation [9]. Furthermore, in rural areas, where there is a lot more pressure on females to use contraception, young married females who are under the influence of their in-laws choose the permanent form of family planning. Numerous studies have shown that spousal participation in family planning decisions is common. For making educated decisions on the small family idea, inter-spousal dialogue is essential [15].

Although the variety of contraceptive techniques for men comprises withdrawal vasectomy, condoms, and which men use directly, as well as the Standard Days Method (SDM), which entails their participation, family planning programs has traditionally concentrated on females [16]. The goal of FP2020 is to reach an extra 120 million women with family planning services. At the 1994 International Conference on Population and Development (ICPD) in Cairo, attention to gender culminated in a renewed push for males to participate more vigorously in reproductive health. The ICPD was framed in such a way that it emphasized men as partners in supporting women's autonomy, with little respect for men's reproductive health and privileges. Moreover, recent exertions to broaden the apparition for positive male participation in family planning and reproductive health have shifted from allowing men to be compassionate partners of women's reproductive health choices to also being enablers in their families and societies, as well as fulfilling their own reproductive health needs [17]. While involving men in reproductive health and gender outcomes is beneficial, the majority of evidence focuses on men as partners. Men as users of family planning services are less well known. Male and male collaboration methods have stayed about one-quarter of contraceptive users globally over the last few decades, with current local and national diversity in the use of the different methods. This examines current programs and indications, particularly those that discourses gender norms that influence men's contraceptive usage and makes recommendations on how to improve programs for men who use contraception. The study considers strategies that provide an enabling environment, as well as services and behavior modification intermediations to direct policies, norms and demand formation [18].

AIMS AND OBJECTIVES

The purpose of this paper is to assess the partners' or husbands' approval and realize the partners' or husbands' reinforcement of the use of modern contraceptive use based on women’s perceptions.

The prime objective of his study is to understand and analyze the knowledge, attitude and practice among first-time expectant fathers about contraception.

This study was accompanied in compliance with the protocol, Good Clinical Practices standards, and all institutional ethical research requirements.

This is a community-based cross-sectional study in the rural field practice of a tertiary care hospital in India. The study population comprised of the first expectant fathers attending the antenatal outpatient department.

Inclusion Criteria:

All men were the first expectant fathers and those who were capable of effectively interacting in their local language and willing to participate.

Exclusion Criteria:

The men who refused to take part in this study.

Collection of Data:

The primary investigator interviewing the first expectant fathers using a pre-designed proforma gathered the data. After explaining the study's purpose and getting consent, participants were given the interview, which was kept confidential. Before collecting the data, a strong connection with the participants was developed, and the informants' privacy was respected throughout the process. Their age, parity, education, socioeconomic level, societal hurdles, and knowledge of various contraceptives and their use were all gathered. The participants were informed about contraceptive techniques and acknowledged for their cooperation after the interview.

Sampling of Study:

A sample size of 300 was calculated considering the prevalence of an average of 19 primigravidae attending antenatal OPD daily. A purposive, consecutive type of sampling technique was used for data collection. Statistical analysis was done in percentages.

Total 300 first expectant fathers attending the antenatal OPD with their wives were included in the study.

Socio-Demographic Segmentation:

The analysis of sociodemographic variables is presented in the following table.

In this study, most of the first expectant fathers were between the age group of 26 – 30 years (51.67%), educated up to high school (49.67%) and their wives were mostly illiterate. 70.67% of men were unskilled workers, and their wives were homemakers, and (68.60%) of the respondents belonged to the lower class of socioeconomic status.

Knowledge and Awareness of Contraception:

In this study, respondents knew partially about various methods of contraception like 93.3% about condoms, 88.3% about abstinence, and 72.7% about withdrawal method. About 78% of men knew regarding the permanent method of contraception i.e. female and male sterilization. Out of this incomplete knowledge regarding contraception most of the preferred using condoms (89.3%) and 36.3% preferred withdrawal technique.

Figure 1: Awareness of Contraception in Respondents

In this study, it was clear that the main source of information regarding contraception were friends (66.3%), followed by the Internet (43.7%) and family (36%). Only 29% agreed that health professional was the source of information. 49.7% of men believed that there are side effects of using contraception. However, 74.3% of men believed that using contraception is beneficial.

Attitude Regarding Contraception:

In the study, 72.30% of men agreed that the pregnancy was unplanned. There were multiple responses to the reason for non-use. However, they agreed the commonest reason for not using contraception was peers and friends (66%). About 69% of men desired to know more about Male methods of contraception and upon explaining the various methods that they can use for family planning about 48% of men approved using the male method of contraception. When enquired about their opinion regarding sterilization 62% of men believed that they will opt for permanent sterilization however, 73.7% of them preferred their wives to undergo female sterilization.

Figure 2: Sources of Information for Contraception among Respondents

Figure 3: The preference of contraception of respondents

It is also realized that the majority of the respondents prefer the condom as a tool of contraception.

Practice of Contraception:

In this study, only 11% of wives practiced contraception mostly emergency contraception. It was found that men did not use the same method of contraception at all times. 90.5% of men used condoms for contraception, 31% used withdrawal technique and 32% followed the rhythm method.

Figure 4: Current Usage of Contraception of Respondents

Figure 5: Previous Usage of Contraception of Respondents

It is understood from the analysis that, majority of the respondents have used and currently using condoms for contraception.

Over 6 billion people live on the planet, with India accounting for one-sixth of that number. Uncontrolled population increase results in a scarcity of natural resources, poverty, and a slowing of the country's growth pace. India is the world's second-most populous nation, prompting the Indian government to become the first to implement a "Family Planning Program" in 1952, with two main goals: first, to have only the desired number of offspring, and second, to space these offspring properly [19][20]. Today’s men and women’s fertility decisions, as well as their ability and freedom to act on these decisions [8], will determine future population trends, conferring to the United Nations Fund for Population Activities (UNFPA). Moreover, researchers have found out that it is because of high awareness but low utilization of contraceptives that population explosion remains a major problem [21].

Generally, men play an important role in family decision-making [22]. Similarly, in rural India, the fact that the socio-demographic profile of respondents played an important role in having some knowledge regarding contraception. As most respondents were less educated and belonged to the lower middle class of SES, they had only partial knowledge of any method of contraception including condoms through government takes every effort to spread knowledge regarding contraception especially through mass media [23]. Furthermore, respondents were found to be least bothered to use any contraception as they thought it to be a less important aspect of life. As seen in other studies contraception methods being women-oriented, men who play important role in family size are not targeted at all for use of any contraception [24]. Friends and peers were found to be a key social barrier for use of any contraception as they discouraged the use of any contraception in newly married couples. Couples in rural India are reluctant to use any method of family planning as they considered that these methods had certain side effects again emphasizing that their knowledge and awareness were poor. However, this study revealed that men appeared to be interested to get more knowledge about family planning methods as they were found to be interested in spacing out future pregnancies. They were also interested to know regarding the permanent method of contraception but wanted only women to follow it.

Many studies have been carried out on contraception that emphasizes mainly on women. The Association of men concerning the use of contraception is necessary among the couples for reliable and operative results [25]. Men are neglected potential consumers of contraceptives [25]. This female-oriented approach excludes men’s opinion regarding family planning, and therefore this study endeavors to consider first expectant fathers, who should be the first point of contact to effectively use proper contraception

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