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RHO archives : Topics : Men and Reproductive Health

IGWG Men and Reproductive Health Subcommittee

Meeting Minutes: May 25, 2000

Attendance

Elaine Murphy/PATH, Karin Ringheim/USAID, Josselyn Neukom/PSI, Alfred Yassa/JHU, Carol Sienche/JHU, Amy Weissman/Save the Children, Patrick Lemmon/MRPP, Meg Greene/CHANGE, Jeff Spieler/USAID, Mihira Karra/USAID, Martine de Schutter/PAHO, Jill Gay, Mary Nell Wegner/AVSC, Erin Anastasi/IRH, Ellen Weiss/ICRW, Chinwe Machibuike/CEDPA, Diana Santillan/URC, Caroline Quijada/URC, Justine Sass/PRB, Bill Finger/FHI, Tim Williams/JSI, Jim McMahan/PRIMEII, Bessie Lee/USAID, Audrey Seger/USAID, Sam Clark/PATH, Michele Burger, Nick Danforth, Judith Helzner/IPPF, Jodi Jacobson/CHANGE

The Men and Reproductive Health Subcommittee has a new co-chair, Sam Clark from PATH, replacing Bill Finger from FHI who rotated off after two years as co-chair. Thank you for all your hard work, Bill! The Interagency Gender Working Group, IGWG has a new coordinator, Audrey Seger from the Policy & Evaluation Division. Michal Avni is on maternity leave until September.

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Project updates

Dr. Alfred Yassa, Johns Hopkins University Center for Communication, Jordan Project: "Together for a Happy Family"
In 1996, JHU started researching assumptions and opinions about family planning. Results indicated that the husband played the principal role in decision-making, that unmet need was estimated at 25 percent, 20 percent of non-user's cited husband's opposed family planning, and that religious teachings were the primary determinant of opposition because 80 percent of men were uncertain of the morality of family planning or Islamic sanctions against family planning. To address these assumptions, JHU developed innovative approaches. First, they met with and involved religious leaders, social workers and physicians in family planning project planning. JHU also used the Royal Family's endorsement in their communication projects and finally developed recreational activities to promote family planning. These communication approaches have been successful in part because they involved men in addressing traditional assumptions against family planning.  For more information contact Alfred Yassa ([email protected] )

Erin Anastasi, IRH, Georgetown University, Water & Sanitation Program
Erin Anastasi made a presentation on IRH coordination with PSI and the El Salvador Water and Sanitation Program, IRH has been working on family planning education and referral system using the "Standard Days Method." This is a new method of counting days of a women's menstrual cycle to determine the most fertile days for which to practice abstinence. IRH has developed a new model of instruction that includes male participation in counting days and participating in monitoring fertility. The project is designed to evaluate two approaches, one with in-depth participation of husbands and one without. For more information contact Erin Anastasi ([email protected] )

Martine de Schutter, PAHO, New Men's Involvement Program
Martine de Schutter, of PAHO, made a brief announcement about the launch of a four-year Men's Involvement project in seven Central American nations (Belize, Costa Rica, El Salvador, Honduras, Guatemala, Nicaragua and Panama). Two demonstration projects will be established within each country. They plan to start with a baseline research gap assessment over a period of 1.5 years to help in developing two models to use in involving men in reproductive health programs and developing a document about changing norms. PAHO will work with governments to encourage them to with work with existing groups and programs when planning their educational strategies. For more information contact Martine de Schutter ([email protected]) .

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Presentations

Freya Sonenstein,Director, Population Studies Center, The Urban Institute
"Recommendations and Strategies from the Working Group on Enhancing Young Men's Reproductive Health"
Freya presented the recommendations from a two-year effort (supported by the U.S. Federal Title X Office of Family Planning) by a working group of 20 experts drawn from adolescent medicine, reproductive health and family planning, public health, community organization and youth development. The working group has drafted a report for DHHS to promote consensus on the goals and content of young men's reproductive health promotion in the United States, identify strategies, and make recommendations for program initiatives.

The policy arena is now open to men's involvement in reproductive health for several reasons: new welfare legislation requiring paternal support, a movement to promote fatherhood, new pressures on existing services, such as HIV/AIDS/STI prevention, and better, nationally representative data on young men's reproductive health. The recent trends about young men's reproductive health are positive, but there is continued risk-taking and a continued lack of access to information and services, particularly for young men. Reported condom use by young men at last intercourse doubled between 1979 and 1988 and increased significantly between 1988 and 1995 from 57 to 66 percent. During the period from 1988 to 1995 there was a significant drop in the proportion of young men reporting ever had sexual intercourse (from 76% to 68%) and an increase in formal reproductive health education prior to first intercourse. While a high percentage of young men report a physical exam in the last year, most of these visits failed to address reproductive health issues. Findings vary greatly based on race and ethnicity, risk-taking remains high and there is an inverse relationship between condom use and age. A major issue in young men's reproductive health is that even though services or information may be available, generally young men don't take advantage of services because they perceive family planning program to be for women's empowerment and not friendly to men.

Given the emerging consensus to involve men two key questions remain: How to attain this objective (What would programs look like) and How to pay for it? The working group developed five goals: 1) developing a holistic approach to promoting sexual health and development, 2) promoting healthy intimate relationships, both sexual and non-sexual, 3) preventing STIs/HIV, unintended pregnancy and 4) promoting responsible fatherhood. Each of these goals is to be addressed with a strategy that 1) conveys needed information, 2) fosters skills development, 3) promotes positive self-concept, 4) promotes positive values and motivation, and 5) provides access to clinical care as needed. The working group recommends improving young men's access to services through an interagency community approach. In their forthcoming report, they will present a comprehensive reproductive health strategy, including an evaluation mechanism, guiding principles, and recommendations, potential sources of funding and a list of indicators for achieving their five goals. In the discussion, Freya emphasized that the issue is not men versus women. We need to empower men to behave in new ways in order to achieve gender equity. A colleague at the Urban Institute has conducted research that indicates that the more men buy into traditional ideology, the more risks they take. We (as societies, cultures) need to redefine how men think of themselves and of manhood.

Patrick Lemmon, Co-Director, D.C.'s Men's Rape Prevention Project
The Men's Rape Prevention Project (MRPP) is a DC-based nonprofit organization that empowers male youth and the institutions that serve them to work as allies with women in preventing rape and other forms of men's violence. More than 50 percent of unwanted pregnancies in the District result from unwanted sex. Through awareness-to-action education and community organizing, the project works with high schools, colleges and other groups to promote gender equity and build men's capacity to be strong without being violent.

The presentation began with a brief discussion of how men in the United States and internationally respond to the idea that they can and must play a role in stopping sexual violence, and the challenges that educators face in attempting to speak to men about these issues. Patrick described the "act" of manhood as always looking over one's shoulder to foresee the next challenge. Men feel a constant pressure to prove manhood. While surveys show that 80 percent of men have felt uncomfortable with things their colleagues have said about women, a tiny percentage have ever said anything to contradict it, because to do so would potentially compromise their masculine persona. The men who disparage women are likely to interpret this as an endorsement.

To warm up the audience, and as one example of how to potentially break through men's initial defensiveness, the group engaged in a brief but vigorous round of sexual calisthenics. Then, the group developed a continuum of harm to efforts to advance reproductive health, examining how attitudes, assumptions, and behaviors (of both the educators and the audiences) may hinder efforts to encourage men to become engaged in healthy choices.

The group considered the following: "trying to get a girl or woman pregnant to prove one's manhood," "believing that sex is a husband's prerogative," "believing that a woman's place is in the home with the children," "directing reproductive health programs solely toward women," "comparing notes on how good a woman or girl is in bed," "believing that girls (but not boys) must wait for marriage to have sex," "using alcohol or other drugs to 'loosen a girl up,'" "refusing to wear a condom," "believing boys and men always want sex," and "staying silent when a man puts a woman or girl down."

The overall message of these different attitudes and behaviors is that somehow sexual responsibility and sexual health are "women's work," beneath the dignity and importance of men's attention. ("I don't commit rape so this doesn't apply to me.") However, by challenging these attitudes and behaviors in ourselves and one another, we can begin to redefine the culture that we have created around sexuality. To end the presentation, Patrick quoted James Baldwin, the African American author, who said, "The most radical step you can take is your next one."

From this exercise, the group moved into a discussion centered on a few questions: "If the social context described in the exercise is the one in which we are operating, what are the program implications? Do any of our current programs reinforce some of the assumptions that we have identified as problematic? Do any of our current program activities challenge the assumptions that we have identified as problematic? What should AID or CAs be doing now, given this discussion? Reinforcing what was discussed after Freya's presentation, we need to change the understanding of what it means to be a man. Men need to be empowered to speak out against violence, beginning with disparaging remarks that devalue women. Jodi Jacobsen of the CHANGE project said that we have a moral and ethical obligation to figure out what reproductive health programs can begin to do, for example about the link between sexual coercion and STDs. Are programs enforcing or reinforcing gender stereotypes? How can programs recognize and challenge the assumptions that clients bring with them, i.e., the husband's prerogative to have sex? These are issues that the working teams must grapple with as they plan work on the theme of violence in the coming year.

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Priority setting

1. Background

The Men and Reproductive Health Subcommittee has been working to identify a limited number of priority areas to focus its work for the past few meetings. A brainstorming session was held in November in which each member identified three personal priorities, and in February, these thematic areas were categorized according to our three core values and further pared down. Although there was broad consensus about the need to focus on adolescents, the remaining two areas were less clear-cut. Due to changing attendance from meeting to meeting, it was thought that an opportunity to weigh in on the three proposed themes and potential other areas could be done by an email survey. A matrix identifying proposed themes and including details for the IEC working team activities and R&E working team activities under each theme was sent out to the Men and Reproductive Health subcommittee in a survey format to firmly identify our priorities. Over e-mail, prior to the meeting, Members of the subcommittee responded to in an e-mail survey from Sam. Members were asked to express their agreement, disagreement or concerns regarding priority themes. These included 1. Young Men, 2. Dual protection (from a gender perspective) 3. Violence, and 4. Other themes. The goal was to attempt to articulate the subcommittee's priority themes.

2. Survey Response

The responses to the survey indicated a solid endorsement for the three themes:

  1. Young Men - This topic clearly headed the list of brainstorming about Subcommittee members' interests, during the exercise carried out at the November 1999 meeting held at PAHO. Gary Barker's presentation at the February 2000 meeting confirmed our choice.
  2. Condom Use/Dual Protection/Gender Analysis of Barriers to Condom Use/The Feminization of the HIV/AIDS Epidemic. This is one of the major health issues of our time. We have broadened the dual protection issue to reflect the core values of the subcommittee. Jeff Spieler argued persuasively at the February meeting that dual protection is an area that desperately needs advocacy on the part of groups like the Men and Reproductive Health committee. His strong interest in the topic, and his upcoming role as USAID steering committee member (eventually replacing Karin Ringheim) has led to the recommendation from USAID that this topic be included among our priorities for the next stage of our work.
  3. Violence - It is proposed as a priority theme because the PHN Office of USAID now collects survey data that demonstrate that violence is a pervasive problem (See Pop Report by L. Heise et al. Dec. '99). USAID would like guidance on how to address this issue in a reproductive health Concept and feedback/guidance on whether/how to delve more deeply into the area.

There is a need to further define the priority themes and define specific activities, objectives and a plan for achieving those objectives in each of the priority themes. This work will be carried out by the two working teams, in meetings following the main Subcommittee meeting. The teams will begin to develop the objectives and plans for presentation at the next meeting.

3.  Working Team Reports

A. R&E (Research & Evaluation) Working Team
Meg Greene, the coordinator of the R&E working team presented R&E's proposed upcoming activities. R&E is planning to support three case studies on innovative programs to involve men in reproductive health, in a gender equity-enhancing manner. These would include the process, what worked and what didn't and the outcomes, so that others might learn from, if not replicate, the programs. The first two case studies - Salud y Genero's work with men on such issues as domestic violence, and the Society Integrated Development of Himalayas work with adolescents, reproductive health and human rights, have been identified. The R and E team also plans to support some assistance to Salud y Genero to improve their evaluative capacity. R&E is also working on the next steps for the Men's Indicators Paper. Tim Williams, in consultation with the paper's authors, Elaine Murphy and Nancy Yinger, will develop some additional indicators addressing our three themes, as well as some more specific illustrative indicators which may be useful for those developing proposals. Bessie Lee suggested working with Nancy Yinger, Krista Stewart and Measure Evaluation on further developing the Indicators Paper. Salud y Genero has been suggested as a location for possibly field testing the indicators. R&E will also draft position statements for the Men and Reproductive Health subcommittee on the three theme areas. It is proposed to post these on the website.

B. IEC (Information, Education & Communication) Working Team
Michele Burger, a consultant hired by the IEC working committee, presented a report and her recommendations for an IEC two-year work-plan. The work-plan has two goals. First, to convince donors, including USAID and its CA's that gender sensitive male involvement is a worthwhile investment that will improve the sexual and reproductive health of women and men and the health of their children. Second, to convince sexual and reproductive health professionals that integrating gender sensitive male involvement into sexual and reproductive health agenda is a strategy that helps meet program goals and promotes gender equity. Michele's recommendations for achieving these goals included:

  • Organizing a speaker's series on topics under the rubric of male involvement
  • Disseminating the Orientation Guide with training on its use
  • Presenting and disseminating the gender equity framework of male involvement
  • Carrying out activities to raise visibility and interest in male involvement
  • Reaching out to professionals working on violence, adolescents, etc.

3. Funding Allocation Process

The resource allocation strategy for new/upcoming projects and activities will be that that the working teams define objectives and make recommendations for activities in the priority theme areas. The working should submit a brief proposal for the activity, including who will do the activity, how much money is needed and a time frame for completion of the activity to present the co-chairs. The Men and Reproductive Health subcommittee co-chairs will make the funding decision and sign-off on planned activities.

4. Identifying Champions/Experts

The Men and Reproductive Health subcommittee needs to identify experts and champions in the three theme areas to invite to our meetings to help us with our work in these new areas. Bessie Lee suggested that the Men and Reproductive Health subcommittee design a strategy for inviting people or organizations to attend the meetings, such as inviting individuals or organizations to help on a specific project or activity. Jeff Spieler suggested reviewing the list of CA's in the USAID User's Guide and targeting those CA's that are not involved in our meetings. A list of specific names and target organizations was made and those will be contacted. Please send any additional names and ideas for involvement to Sam who will send an email before our next meting asking for name, contact information, technical area and willingness to contact that person to invite to our next meeting. Bessie will work on targeting USAID PHN divisions, such as the Services Division and the HIV/AIDS Division to appoint a representative to join the IGWG. 

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IGWG dissemination update

Nancy Yinger, in her new position as Director of Measure Communication at PRB, will be heading up the Dissemination Group for the Interagency Gender Working Group, IGWG. The Dissemination Group (Nancy Yinger, Jeff Jordan, Bessie Lee, Karin Ringheim and Audrey Seger) will develop a strategy for using the funds put into Measure Communication for IGWG, including disseminating the IGWG's tools and managing the website, to present to the steering committee. In the draft of the strategy document, the co-chairs from each subcommittee will be asked to provide information on their products to Audrey.

With regards to dissemination, the next task is the IGWG brochure. Nancy has a writer for the brochure and will have a first draft ready for our next steering committee meeting. A postcard was printed for Beijing+5 workshop and extras are available to hand out at other events. Also, the IGWG LOGO is ready and available electronically from PRB.

Cille Purser, who manages the IGWG Listserv, is leaving FHI. The management of the Listserv will be handled by PRB as part of our dissemination strategy. beginning the first of August. We also discussed the future of the Listserv. Should it be more interactive? Should it serve a larger purpose? Some people were concerned with expanding the role of the Listserv. It currently it serves only for IGWG announcements and basic IGWG information. Nancy will look into the different in consultation with the Dissemination Group.

The IGWG website will be part of the Measure Communication website. (www.measurecommunication.org) Right now, the website only includes the postcard and the flyer but as other products, are ready, please send them to Nancy for posting on the website.  Links to other sites, such as RHO and other gender work created by our partners, as well as a paragraph on each subcommittee will be added. The Dissemination Group will discuss this and present a plan for the web-site at the next meeting.

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Plus-Delta exercise

Plus
Time Management  
Content Presentations  
Lunch   
Three Theme Selected  
Transparency
Accountability
Domestic Presenters
Jeff Spieler's Support
Sam's New Leadership
Thanks to Tim at JSI
Nice to have Audrey Seger

Delta
Name Tags
Introductions for Everyone
Fewer CA Updates—Longer
New persons focus areas

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Next meeting

The next USAID Men and Reproductive Health Subcommittee meeting is scheduled for August 9, 2000 at Johns Hopkins SAIS Rome building, Room 535 1619 Mass Ave. NW. Wash. D.C.(just 2 blocks from Dupont Circle Metro) from 9:00 am to 5:00 pm.

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For more information

For more information, please review the minutes of other past Subcommittee meetings.

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