Please note: This archive was last updated in 2005.

RHO archives : Topics : Men and Reproductive Health

Overview

Introduction

Historically, most reproductive health programs focused on family planning and in turn most family planning programs offered their services exclusively to women. Most viewed women as the "target group" and paid little attention to the roles that men might have with respect to women's reproductive health decision-making and behavior. A few programs made attempts to address men's needs for information and services, with these efforts mainly focused on encouraging men to use family planning methods (such as condoms and vasectomy) or to become more active in the couple's decision-making about contraceptive use. Some programs also provided sexually transmitted infection (STI) treatments to men.

In the 1990s, many women's health programs began to acknowledge that family planning must be viewed in the broader context of reproductive health. The epidemic lead providers to consider social, economic, and cultural factors—including gender inequity—as significant to women's overall health status. The AIDS epidemic forced women's health programs that focused primarily on family planning to broaden the scope of their services and include STI/HIV prevention. As part of this broader view, programs started to focus on the role of men as it relates to women's access to and use of reproductive health services. For instance, the 1994 International Conference on Population and Development in Cairo Program of Action includes a statement on "Male Responsibilities and Participation" (www.iisd.ca/linkages/Cairo/program/p04000.html):

"Special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behavior, including family planning; prenatal, maternal and child health; prevention of STDs, including HIV; prevention of unwanted and high-risk pregnancies; shared control and contribution to family income, children's education, health and nutrition; and recognition and promotion of the equal value of children of both sexes."

The same message was reinforced at the 1995 World Conference on Women in Beijing (www.un.org/womenwatch/daw/beijing/platform):

"Shared responsibility between men and women in matters related to reproductive and sexual behavior is essential to improving women's health."

Discussions about women, men, and reproductive health also included recognition that gender inequalities between women and men have a significant influence on sexual health. Gender inequalities exist in the labor force, the legal system, government posts, the community, the home, and the bedroom; all of these ultimately affect women's health and well-being. These issues are discussed more fully in RHO's Gender and Sexual Health section.

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Men and reproductive health: goals, concerns, and questions

Today, reproductive health professionals are working to form a consensus around the issue of men and reproductive health, and many agencies involve men in their programs. Many—such as the Interagency Gender Working Group Subcommittee on Men and Reproductive Health—believe that efforts to involve men should adhere to the following core goals:

I. Promoting women's equal status in reproductive health decision-making in the context of gender equity.

II. Increasing men's support of women's sexual and reproductive health and of children's well-being, with equal regard for female and male children.

III. Meeting the reproductive and sexual health needs of men (in addition to those of women).

For specific examples of program activities that address these goals, see Programming Approaches to Men and Reproductive Health.

Intertwined with the discussion of guiding goals for programs addressing men and reproductive health are a number of concerns and questions regarding "best practices" and potential outcomes of such programs (Berer 1996; Helzner 1996; de Schutter,1999). Foremost among these is the issue of whether involving men in family planning education and services could further erode women's control over reproductive health decisions. Many view reproductive health services as a tool women can use to claim a degree of autonomy in their lives. Providing women with access to such services has been a hard-fought battle, which most would argue is far from over. Some fear that encouraging men to participate will result in perpetuating existing gender inequalities, particularly with respect to communication and sexual decision-making. For example, a "male motivation" campaign in Zimbabwe used masculine sports figures to encourage men to play a greater role in family planning decision-making with their partners. One unexpected result of the campaign was an increase in the percentage of men who thought that they should have sole control over contraceptive decision-making. Involving men in other aspects of reproductive care, such as abortion counseling, could have similar negative consequences.

A related concern is whether programs designed to involve men as partners in reproductive health will compete for funding with programs designed to improve women's health (de Schutter,1999). Some have argued that limited resources should not be allocated to men's reproductive health when the status of women's health still lags far behind that of men. Yet, many of those who include men in their service delivery programs see this as something that is mutually beneficial and therefore a good investment in women's health.

Another key question facing programs is how best to involve men. Given that most reproductive health programs have focused on women, few models for the inclusion of men exist. In addition, those that exist are typically small pilot projects and many have not been well evaluated with respect to their impact on women or men or cost-effectiveness. Programs must also find ways to overcome specific challenges or barriers related to men, including:

  • lack of information about men's perspectives that could be used to help design appropriate programs;
  • men's discomfort; because they have been excluded from services for so long, many men feel out of place or unwelcome at reproductive health clinics;
  • men's hesitance to seek medical care;
  • limited availability of contraceptive methods for men;
  • negative attitudes of policy makers and service providers toward men; for example, viewing men as irresponsible, not interested in playing a positive role, or not an appropriate clientele for reproductive health services;
  • unfavorable policies, such as prohibitions on condom advertising;
  • logistic constraints, such as lack of trained male staff, male-friendly clinics, convenient hours, or separate waiting and service areas for men.

Despite these concerns and challenges, there are ways in which well planned programs could positively contribute to women's and men's reproductive health and to normative change around gender issues. The challenge is to ensure that the activities undertaken are supportive of women and that the program itself does not contribute to worsening inequalities between women and men.

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Men's role in women's and children's health

The ways in which men influence women's health are numerous (Foumbi and Lovich 1997). As husbands, boyfriends, fathers, brothers, and friends, men can have a positive effect on women's health by:

  • using or supporting the use of contraception such that sexual partners are able to control the number and timing of pregnancies;
  • encouraging women to have adequate nutrition during pregnancy and providing the needed physical, financial, and emotional support to do so;
  • supporting women during pregnancy, delivery, and the postpartum period;
  • supporting the physical and emotional needs of postabortion women;
  • preventing the spread of STIs to their partners;
  • preventing all forms of violence against women;
  • working to end harmful health practices, such as female genital mutilation (see RHO's Harmful Health Practices section;
  • sharing financial resources with women, including support for shared property rights;
  • supporting women's full participation in civil society, including access to social, political, and educational opportunities, many of which have a direct or indirect impact on women's health;
  • supporting daughters' rights to health care, education, and respect in equity with sons.

Men who are more involved in the health of their families also may enjoy better health and closer relationships with family members (Greene 1999).

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Men's reproductive health concerns

Like women, men have reproductive health concerns that change as they move through their life cycles. As programs begin to reach out to men as partners in ensuring good reproductive health, they will need to understand these evolving needs as well as other factors influencing men's sexual behavior, goals, and perceptions.

Boys are affected by cultural and medical practices related to reproductive health as soon as they are born. For example, in some regions infant boys are routinely circumcised (in other regions, circumcision is performed when a boy reaches adolescence or not at all); research from developing countries has shown that male circumcision reduces the risk of HIV-infection by at least 50 percent (Best 1998). (See the discussion of male circumcision and HIV in RHO's HIV/AIDS Key Issues for more information.)

As boys reach puberty, they experience significant physical changes, including changes in their voice patterns, growth of pubic and body hair, and increased development of muscle tissue. These physical changes are often accompanied by new emotions and behaviors, including the development of sexual feelings, experimentation with sexual encounters, and questions about sexual issues, such as penis size, sexual orientation, and masturbation (Centerwall 1995). A boy's experience of and response to these changes is shaped to a large degree by the gender roles and expectations prevalent in his culture. Boys also may be vulnerable to sexual abuse. For more information, see Reaching adolescent males on the Key Issues page.

As young men become more sexually active, their concerns are similar to those of many young women and include sexuality, intimate relationships, peer norms, and prevention of unintended pregnancy and sexually transmitted infections. These issues may affect men and women at different times in their reproductive lives and to different degrees, however. For example, men do not suffer the serious and sometimes deadly consequences of pregnancy, childbirth, and unsafe abortion. Nevertheless, men in unions may share many of the same concerns as women about family planning, including how to prevent pregnancy, how to make decisions related to the number and spacing of their children, whether contraception is safe, and how to select and use an effective contraceptive. Preventing and treating sexually transmitted infections, including HIV/AIDS, also is a key health concern of sexually active men (see RHO's Reproductive Tract Infections section). Many men also are concerned about infertility, especially given the high prevalence of STIs in some areas and concerns that some male infertility may be linked to environmental or occupational exposures (see RHO's Infertility section).

As men grow older, concerns about impotence and other forms of sexual dysfunction may become more common (though these concerns may be prevalent among younger men as well). In addition, cancers of the reproductive tract, especially prostate cancer, become more prevalent as men age, though rates of male reproductive cancers are low compared with those affecting women. Other issues, such as urinary tract conditions, also can contribute to discomfort or inability to function normally as men grow older.

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Designing programs that include men

Various strategies have been used to engage men as partners in improving women's reproductive health and to extend reproductive health services to men. Most of the projects conducted to date have focused on including men in reproductive health services rather than on the ultimate goal of achieving gender equality through normative change. Approaches have included

  • adding services for men to existing clinic-based services or establishing separate services:
  • reaching men through the workplace, military, or men's groups with information and services;
  • condom social marketing;
  • community-based distribution of contraception using male field workers;
  • outreach to male youth;
  • mass-media educational campaigns;
  • special initiatives, such as outreach through popular sporting events.

Most of these projects have been small in scale and little information is available about how these activities have influenced the complex relationships between women and men and their health.

Given the strong influence that gender inequality plays in reproductive health status, some have argued that designing "male involvement" or "men and reproductive health" programs is an inadequate approach (Helzner 1996). Instead, programs need to look at the needs and perspectives of both men and women, to ensure that the equality of genders is considered. In designing activities, it will be important for programs to:

  • identify the needs and perceptions of both men and women;
  • use gender analysis as a tool to examine the gender implications of proposed activities;
  • evaluate the impact of activities using gender-related indicators (Yinger and Murphy 1999).

For examples of possible approaches to address the three core goals of men and reproductive health programs—increasing gender equality through normative change, increasing men's support of women's and children's health, and addressing men's own health needs, see Programming Approaches to Men and Reproductive Health.

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