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RHO archives : Topics : Men and Reproductive Health

IGWG Men and Reproductive Health Subcommittee

Meeting Minutes: August 9, 2000

Attendance and logistics

The meeting took place at SAIS, courtesy of JHU/CCP. Attending and introducing themselves were: Errol Alexis (Sanger), Cindy Aragon (PSI),Lucy Atkin (Sanger), Caroline Blair (AED), Michele Burger (consultant), Pax Castillo-Ruiz (IDB), Seema Chavhan (USAID), Lisa Childs (USAID)Sam Clark (PATH), Sylvie Cohen (UNFPA), Ross Danielson (consultant), Martine de Schutter (PAHO), Paul Feldblum (FHI), Bill Finger (FHI), Jill Gay (consultant), Meg Greene (CHANGE), Judith Helzner (IPPF-WHR), Ruth Hope (NGO Networks), Jodi Jacobson (CHANGE), Mihira Karra (USAID), Kurusa Kiragu (JHU/PCS), Ann Leonard (Pop Council), Andrew Levack (AVSC), Ya-Shin Lin (URC), Purnima Mane (Pop Council), Peg Marshall (CEDPA), Josselyn Neukom (PSI), Emma Ottelenghi (Frontiers), Julie Pulerwitz (Horizons), Karin Ringheim (USAID), Myrna Seidman (Georgetown/IRH), Audrey Seger (USAID), Carole Sienche (JUU/CCP), Freya Sonenstein (Urban Institute), Jeff Spieler (USAID), Lindsay Stewart (FOCUS), Mary Nell Wegner (AVSC), Ellen Weiss (ICRW/Horizons), Amy Weissman (Save the Children), Alfred Yassa (JHU/CCP).

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Introductions/selected updates on CA activities

Sam Clark, subcommittee co-chair, noted there were a large number of newcomers and welcomed them all. He then called on people to make several brief announcements:

  • Karin Ringheim, who was the guiding force behind creating the subcommittee, announced she was leaving USAID after seven years and going to PATH. She expressed her heartfelt gratitude and appreciation to all those who have made the Subcommittee a success.
  • Martin de Schutter announced she was leaving PAHO and moving back to her home in The Netherlands. She also circulated a document on domestic violence.
  • Bill Finger, a co-chair for the first two years, is leaving the Subcommittee, to be replaced by Paul Feldblum of FHI, a world expert on condoms.
  • Ross Danielson described briefly his new role in working with the Population Council on couples communication research.
  • Jill Gay described the excellent reception that USAID gave the RFA/RFP guide on involving gender, which she recently presented. She and others have developed the guide through the Interagency Gender Working Group.
  • Judith Helzner circulated two book reviews on adolescent boys and gender and discussed how to send the new WHO literature review on adolescent boys to everyone.
  • Sam Clark distributed a summary of four sections of papers on men/reproductive health related issues to be presented at the APHA meeting in Boston this fall. He closed the announcements by distributing the "blue sheet," which provides background on the Subcommittee for newcomers.

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Presentation by Ann Leonard, Population Council

Ann described a new project at the Population Council being coordinated by her and Ann Blanc (formerly with DHS) on "Power in Sexual Relationships." The project involves preparation for an international conference, probably to be held in Washington in 2001. Ann presented the idea that the Men/Reproductive Health Subcommittee might have an interest in this project, specifically in recommending people to participate and present and in developing the program. This first meeting might lead to regional meetings eventually. Also, Ann announced the completion of two Population Council publications on men from Nepal and Kenya and will mail them to everyone on the subcommittee list.

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Presentation and discussion by Mary Nell Wegner and Andrew Levack, AVSC

"Introduction of the Men and Reproductive Health Curriculum"
NGO partner organizations requested that AVSC develop a broad curriculum to train providers concerning men's reproductive health with a gender perspective. AVSC developed six different modules for trainer manual and a participant's book. AVSC convened experts in CBD, clinical providers, and training methodology, with reviewers from Asia, Africa and Latin America. One module introduced participants to attitudinal and organizational issues affecting delivery of men's reproductive health services and provided basic information on male reproductive health to all staff in a facility, with the objectives of exploring the benefits of providing reproductive health services to men; the importance of considering gender issues; identifying common reproductive health problems in men; examining the role of sexuality in reproductive health and provider attitudes, and identifying barriers for providing men's reproductive health services, among others. Much information on women's reproductive health was included also. In Section One, the first module reviewed the importance of involving men in reproductive health; the range of men's reproductive health services and addressing staff concerns about working with male clients. For example, what can staff do with an angry male client? Some of the activities in the second module include addressing common client concerns, such as "will I run out of sperm?" Activities in Module 3 include discussions of gender roles and identity; sexual arousal; sexual behaviors, etc. Module 4 covers how men can support women's contraceptive choices, male contraceptive methods, etc. Module 5 covers STIs, including the physical and gender differences between men and women concerning STIs, such as power imbalances. Module 6 covers management and cost issues. Andrew Levack then led the group in a sample training activity concerning cost considerations, asking people to group various activities under no cost, medium cost and high cost.

The curriculum has been field tested in Ghana in 1999 and in the United States in June 2000; future field tests will be conducted during 2000 in the United States, Uganda, Tanzania, Nepal, and Colombia. In the United States, good results were achieved with the training knowledge was increased, and gender-sensitive attitudes increased. Participants generally gave high marks to the curriculum. Future evaluation plans will measure changes in provider attitudes toward gender equity and numbers of men served in a facility, among others. Participants from IGWG also praised the curriculum developed by AVSC.

Andrew Levack will be moving to Thailand, where he will continue to work for AVSC.

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Josselyn Neukom, PSI, "Addressing Gender Differentials through Condom Social Marketing Programs Targeting Adolescents."

PRB's evaluation of SMASH suggested that more attention is needed for gender considerations. Good marketing needs to take into account gender issues. Funded by the Gates foundation, PSI developed a methodology to incorporate gender differentials into marketing strategies for condom promotion in Rwanda, Cameroon, and Madagascar. Goals for Rwanda included postponing the age at first sexual intercourse. PSI developed a behavior change framework for HIV/AIDS prevention, which incorporated the following concerns, such as: Do they know about AIDS? Do they believe they can die from AIDS? Do they worry about the loss of sexual pleasure? Can they negotiate condom use? Research was conducted among females and males 15-19 and males 20-24 in urban areas through focus groups, evaluations, qualitative studies, DHS analysis, etc. Research identified barriers to changes, such as concerns with pregnancy rather than HIV, sexual pleasure, etc. In step 2, PSI prioritized issues, such as girls lack of confidence in negotiating condoms use, concern with loss of sexual pleasure, lack of support from peers, etc. In Step 3, PSI designed a strategy based on the priorities. Different messages were developed for men and women. One message was of a girl saying: "Ask me to use a condom you'd be surprised at my reaction." Or a girl saying: "It's my problem too." Another ad has: "I have a past you have a past we want a future."

Comments by participants included the need to develop a different model not confined by BCC, but to consider the socioeconomic framework, as well as the impact and importance of gender-based violence. Jodi Jacobson noted that another barrier is the social norms and gender stereotypes voiced by providers and adults. Jeff Speiler noted that social marketing has had some success with social marketing by celebrities on condom use. In Zimbabwe, condom use has increased, but has had no impact on the incidence of HIV. Girls should be asked about whether they can have sexual pleasure with a condom, not just men. Mary Nell Wegner asked how to market changes in gender attitudes to donors, as this is not quickly achieved.

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Discussion of the Subcommittee's role in condoms/dual protection/gender

Following Josselyn Neukom's presentation on how gender-based research was influencing the development of social marketing programs, the Subcommittee was scheduled to move into a discussion of one of the Subcommittee's priority areas: condoms/dual protection/gender issues. Because of time pressures and the type of presentation and questions that followed, however, the discussion that followed focused more on the PSI project itself rather than on next steps for the Subcommittee. Several persons including Jodi Jacobson of CHANGE and Sylvie Cohen of UNFPA commented that while PSI was making a great effort to incorporate gender-based research into its projects, gender and behavior change could be seen from a broader view than the factors in the model presented. Neukom replied that the model presented could be adapted to other issues besides simply condom use, such as STI treatment or other goals. Nevertheless, it seemed challenging to incorporate long-term goals of changes in gender norms into more short-term goals of increased condom use or STI treatment.

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Reports from working teams

  1. IEC. Mary Nell Wegner, who chairs this working team, gave a brief report. She encouraged some of the new people to join this group; introduced Michelle Burger, who is working with this working team as a consultant; and summarized briefly the workplan as now envisioned by the working team, which is to be fleshed out at the meeting later in the day. The first project of the working team is to plan dissemination of the orientation guide, funded in the first round of products, and to continue to help disseminating the other original products. For example, the HIM CD-ROM is out of print and needs to be reprinted. This working team will work with dissemination through the overall Gender Working Group dissemination process, coordinated by PRB. It is now in the process of developing a plan for specific projects around the three Subcommittee priority themes.
  2. Research and Evaluation. Meg Greene, who chairs this working team, reported that three case studies are underway. They will focus on Salud y Genero in Mexico, Society for the Integration of the Himalayas in India, and Stepping Stones in Uganda. The working plan is to produce these separately as well as together with a synthesis, bibliography and list of resources. The team is also developing position statements for the website on our three areas of interest. Jeff Spieler is drafting one on dual protection from a gender perspective; Meg Greene and Diane Rubino are working on a violence statement; and Amy Weissman and Jill Gay are working on adolescent socialization. Tim Williams and Meg Greene are working on developing more specific measures in the areas of special interest to our subcommittee, building on the indicators product.
  3. Budget update. Karin Ringheim of USAID summarized the current budget. The Subcommittee currently has $357,000 with $86,000 of that committed to programs, leaving about $270,000 to be programmed. Jeff Spieler pointed out that we needed to leverage these funds where larger amounts are available and also noted that we need to get these committed to worthwhile projects if we want to secure funds in the next fiscal year.

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Strategic planning on our thematic areas

The idea is for all Gender Working Groups to be more rigorous and systematic about their work, and to coordinate their efforts to influence the work of USAID and other colleagues in the reproductive health field. The IGWG Steering Committee is trying to take a more active role in this coordination, and had requested that each sub-committee put together a matrix of its activities, timing, resources, etc. (Bill Finger noted that just choosing the priorities and getting to this matrix represented a huge amount of work and congratulated us all on this iteration!) Audrey Seger has now drawn all of these together to give an overview of the IGWG's work, and she noted that the IGWG as a whole is willing to offer help in moving our work forward. Judith Helzner noted that although the Steering Committee is trying to coordinate the work of various sub-committees, the heart of our work is being done by the working teams.

Toward the end of this discussion, the co-chairs asked us to discuss the matrix of activities in our working team groups. For each of the three thematic areas of our work, there are similar categories of objectives. Input on missing items such as the timing, implementing agency, target audience, or funding should be given directly to the working teams, e.g., adding objectives to some of the activities. Jeff Spieler suggested we consider the "no cost" idea of getting organizations to see how our agenda fits into theirs and encouraging them to take our ideas over. He also suggested reinventing the boundaries of the working teams, asking us to think about what would work best for us.

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Emerging issues from the June IGWG Steering Committee Meeting

  • Dissemination plan: A small group is developing a strategic plan for disseminating the products of the IGWG. The money for the Men and Reproductive Health group is parked in several locations, including at Measure Communication (PRB). We will soon want PRB to help us put together a work plan for disseminating the products of the Men & Reproductive Health group as well as for the IGWG as a whole.
  • ACVFA: The American Committee on Voluntary Foreign Aid produced an assessment of the Gender Plan of Action (Brian Atwood, 1996).  The IGWG has been invited to review that document and to present the assessment to ACVFA later next week, after the steering committee. Bessie Lee of USAID noted that the PHN came out relatively favorably in the report, thanks in part to the IGWG's work. PHN is now working with Democracy and Governance and with the WID office to develop a stronger consensus document in responding to the report.
  • Audrey Seger gave us an introduction to the new logo and coherent mission statement of the IGWG. Concern that the overall group's products were not consistent nor recognized as products of the same entity led to the development of a new logo and attempts to coordinate the efforts of the sub-committees. The dissemination group is now working on turning a one-page description into a brochure.
  • The transition of the listserv from FHI to PRB has not been completely smooth, but those who had been subscribed and haven't succeeded in doing it again will be hearing from PRB.

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Orientation guide

Judith Helzner introduced the guide, noting how exciting it was to see the guide approaching completion after a long process of development. Bill Finger, who presented the orientation guide, recalled that the field test had been presented to the group a year and a half ago, and that the team had been challenged by the range of ideas and the varied audiences to which they wanted to present the ideas. They concluded that interactive exercises would not work for this presentation for CAs, and developed a generic text that can be adapted depending on the audience. The IEC working team is going to think about how the orientation guide can best be used. The advantage is that as a slide show with text modules, the orientation guide can be repackaged in many ways.

There are approximately 100 slides, that could be zipped through in a brief training or presented in smaller chunks. The guide addresses critical reproductive health issues in five segments: family planing, STIs/HIV/AIDS, adolescents, safe motherhood/family wellbeing, and violence. Bill Finger presented the STI segment, and spoke about masculinity as a risk factor. Of particular interest was the condom discussion, covering negative gender stereotypes and how these should be avoided with the single goal of just pushing condoms for family planning purposes. The text states that there is a need to support men's positive actions and to support gender equity. Starting in September, the Orientation Guide will be available for presentation at USAID and CAs, and more broadly available a couple of months after that. Interested people should speak to Mary Nell Wegner.

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Working team meetings

There was a useful discussion of how our sub-committee's meetings are organized and whether the working teams should be re-divided along different dimensions. The decline in interest and attendance after lunch led some to suggest having our working team meetings first, then have cross-cutting discussions. The general sentiment was also that we need to have more discussion after the presentations and about the activities of the working teams. Emma Ottolenghi suggested trying out a re-ordering and then voting after one round of organizing the meeting that way.

There is considerable overlap between the working teams and a couple of people said they would benefit from clarification as to what the responsibilities of each are. Ann Leonard explained that the agendas of the current working teams were haphazard as the result of the collapse of the four original teams. Even so, it is often hard to drum up sufficient participation in the working teams, although the R&E group has been fortunate that way. One of the assignments for the working teams was therefore to describe what they see as their areas of focus/endeavor.

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Next meeting/Plus-Delta exercise

Our next meeting will take place at CEDPA on Tuesday of Thanksgiving week, the 21st of November.

Plus (do again next meeting) 
Well-prepared presentations 
Good attendance
Good cake  
Nice room  

Delta (to change)
Dual protection next steps
Change caterer
More time for workplans
Put working group meetings in AM; try different meeting formats.

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For more information

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

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