Please note: This archive was last updated in 2005.

RHO archives : Topics : Men and Reproductive Health

Program Examples

The following programs described below illustrate some of the strategies and efforts to involve men in reproductive health in low-resource settings, and outline the lessons learned from program experience.

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Brazil

Instituto PROMUNDO is a Brazilian nongovernmental organization (NGO) that has been working to promote sexual and reproductive health among adolescent males since 1998. PROMUNDO specializes in research, training, policy advocacy, and implementing community-based interventions. PROMUNDO’s work is mainly centered on community support for children, youth, and families; gender, health, and adolescence; violence prevention, including gender-based violence; and support for children and families affected by HIV/AIDS. PROMUNDO’s approach includes integrating gender specificity (that is, identifying needs of male adolescents based on socialization) and gender equity into its programs.

The organization has several ongoing projects that work with young men. The Guy-to-Guy Project is an example of a community-based project that recruits and trains young males to be peer promoters for reaching other young men. Based on the results of baseline research, the program was designed to use peer promoters to communicate relevant issues using educational materials; a condom social marketing strategy; publication of a lifestyle magazine emphasizing gender equity; and plays about gender-based violence prevention and male involvement in sexual and reproductive health. An example of PROMUNDO’s work in training is Project H: Working with Young Men in the Promotion of Health and Gender Equity. Project H is a training manual and video set for health professionals that consists of five modules on sexual and reproductive health, mental health, violence prevention, fatherhood and caregiving, and HIV/AIDS. PROMUNDO conducts regional and national training workshops on using the manuals throughout Central America, Mexico, and Brazil, among other regions,. PROMUNDO’s advocacy work includes launching the White Ribbon Campaign in Brazil to engage policy makers and men in the fight against gender-based violence. PROMUNDO has also conducted research on young men, sexual and reproductive health, and gender-based violence. It is in the process of conducting a two-year evaluation of its gender-equity projects to determine their impact on attitudes and behavior changes among men.

Lessons Learned

  • Developing and maintaining partnerships with other NGOs and governmental organizations is essential.
  • Although the process can require a lot of time, it is an important investment for ensuring success and significant impact.
  • Engage young adolescents by focusing on multiple issues that affect their daily lives.
  • Combine research with practice. Designing programs that are evidence-based offers more credibility at the policy level. Furthermore, dissemination at the national level has contributed to other organizations adopting ideas and findings.
  • Focus on the potential of male adolescents and not their shortfalls. When addressing sexual and reproductive health and gender-based violence prevention, it is important to engage men as the solution. As a result, the potential of men to be engaged, respectful, and nonviolent partners can be achieved.

For more information, please contact:
Instituto PROMUNDO, Rua México 31 Bloco D, Sala 1502 - Centro, CEP 20031-144 - Rio de Janeiro - RJ - Brasil
Telephone/Fax: 55-21-2544-3114/3115; Email: [email protected]; Web: www.promundo.org.br/english/index.asp

Information adapted from Barker, G. "Instituto PROMUNDO: Engaging Young Men in Gender-Based Violence Prevention and Sexual and Reproductive Health." Presentation at Oxfam workshop, Gender Is Everyone’s Business: Programming with Men to Achieve Gender Equality, England, June 2002. Available at: www.oxfam.org.uk/what_we_do/issues/gender/gem/downloads/Promcase.pdf.

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India: Central Himalayas

SIDH (Society for Integrated Development of Himalayas) is a nonprofit organization that focuses on education as a means of addressing gender inequities in the villages of the Central Himalayas. SIDH has developed an innovative training strategy for village youth that views gender as part of the larger issue of social injustice and explores the relationship of gender equity to men's and women's reproductive health. SIDH's holistic approach acknowledges that gender equity and reproductive rights are deeply rooted in the cultural and traditional values of communities and therefore cannot be considered in isolation.

SIDH's work on gender issues grew out of several years of experience working with women's groups. SIDH staff realized that most of their programs with women did not fully succeed because of lack of support from the men in women's lives. SIDH felt that a genuine attempt must be made to enroll men in women's issues, both to ensure that efforts to empower women did not adversely impact the lives of women and their families as well as to help liberate men from the social pressures of sex-role stereotypes.

Through a series of workshops, focus groups, and interviews, SIDH gathered information from men, women, and youth in selected villages about their beliefs, customs, and values, related to gender relations. They also conducted a detailed exploration of reproductive health issues, as well as caste and class aspirations. Selected findings include:

  • Both men and women said that health was a major problem, though most of the other problems identified by the two groups were different (problems identified by the men were mostly to do with infrastructure, like lack of roads or transport, and women's problems were linked to those around their daily lives, such as untethered animals eating their produce).
  • Health problems of women increased after marriage. Usually women had problems of white discharge and men had problems related to urinary infection.
  • The most significant finding was the extremely high infant mortality rate.
  • Women knew very little about their health problems and men's health problems; men had much more information about their own and women's health problems.
  • Women and men adhered to a variety of prenatal and postnatal beliefs and practices (such as a pregnant woman must work hard and eat less to have less pain during childbirth and that male children are more fragile and need to be breast fed twice as much as girl children).
  • Both men and women support family planning and appropriate birth spacing; men feel that more children mean extra expenses while women feel they create extra work. There is knowledge of pills, IUDs, and condoms, but the "operation" (female sterilization) is seen as the only safe family planning method (though many women believe it ruins women's health). Women are not in favor of using condoms because it deprives them of the "shakti" (power) they get from the man's sperm.
  • Priorities and access to health care are different for each sex. Men, who are more mobile than women, go to the marketplace or nearby town and are able to visit the doctor at the first sign of ill health. Women must be accompanied by their husbands to visit a doctor. Traditionally, it is believed that women are able to bear more pain, and are taken to the doctor only in extreme conditions.
  • The local word for husband is "malik"(owner). "Our husbands own us. We must do as they say". Women feel that men are incapable of demonstrating affection. "They are made that way by God, just as women are made to love."
  • Most of women's work is invisible with no tangible result, therefore it is not valued. "The wood and fodder a woman gathers has more value than cleaning, tending children, cooking, as it can be seen and measured. When I come home with a big bundle of grass on my back it can be seen and I am treated with respect and my mother-in-law rushes to me with a glass of water or tea. That is why I prefer working outside the home, where my work is seen".

Using these and other findings from their research, SIDH staff set about the challenging task of designing a training module on gender issues, including reproductive health. The training is designed to change social attitudes rather than to impart knowledge and/or a particular skill. In the training module SIDH attempts to sensitize participants toward their blind spots and prejudices and invoke their sense of justice. SIDH believes that this in turn will pressure them from within to become more responsible toward women and their reproductive health issues. The training is designed for youth as, in SIDH's experience, they are most receptive to new ideas and most capable of making lasting changes in their attitudes and behaviors.

SIDH's workshop curriculum takes a step-wise approach to introducing the sensitive issues related to gender and reproductive health. The first day focuses on objective information, such as the difference between "gender" and "sex" and statistics and case studies that illustrate gender discrimination. The second day goes a step further to reach the participants at a deeper emotional level, using popular idioms, songs, and films. Only on day three are participants exposed to direct information about reproductive health issues. On the fourth day, participants make "Personal Work Plans" to help them follow up on their workshop experiences after they return to the village routine.

To date, SIDH has conducted 12 workshops involving about 250 rural youth from 42 villages. At the end of these 4-day workshops, there was much more interaction between women and men. Women spoke more and were more animated, challenging the men and voicing their opinions more than they had done at the beginning of the workshop.

SIDH has found that the change in participants' personal lives is most visible in married men. The case of Gulab, a participant who had been married for ten years, provides an interesting example. Despite many opportunities to work near his home, he preferred to be away from his family, as he could not cope with the number of complaints from his wife. After the training he confessed that he had never realized how cruel he had been to his wife. He decided to move to his home even though it meant taking up a less desirable job. His wife now appears to others to be happy and relaxed, and those who know her are surprised to see her smile. The change is also visible in Gulab. He too looks happy and has become far more energetic in his work place.

Lessons Learned

  • A holistic and integrated approach is essential. Change cannot be compartmentalized. Hence gender and reproductive health issues need to be seen in the larger context of social injustices.
  • Beliefs are culture-specific and need to be challenged within the cultural context. Hence identification of beliefs through research is essential.
  • Lasting change is possible only if the cluster of beliefs and attitudes impacting gender discrimination are identified and information provided that conflicts or creates dissonance with these beliefs. The assumption is that this conflict or dissonance will lead to change, or a shift in attitude.
  • Gender justice is about healthier relationships at the micro-level. Hence men's involvement is important for the sake of both justice and happiness.
  • Making the training modules non-threatening and empathetic to men is important, as the goal is to involve men, instead of making them defensive. Male facilitators are important to this objective.
  • The training needs to focus on attitude shift, rather than just imparting information. Attitudes of both participants and trainers need to be challenged.
  • Participants' enthusiasm diminished approximately one month after the initial training. Fear of alienation, isolation and ridicule are the biggest obstacles to maintaining new attitudes and behavior change in these Indian villages. Broader training programs are important so that the participants would not be in the minority and would have peers and/or family members who would support them. Other means of post-workshop support should be explored.
  • A strong commitment on the part of the organization and the trainers to gender equality and involving men in women's reproductive health is required, as well as a capacity for reflection and flexibility.

For more information please contact:
Pawan K. Gupta, Executive Director, Society for Integrated Development of Himalayas, Hazelwood, Landour Cantt, P.B.No.19, Mussoorie 248 179, India
Telephone/Fax: 91-135-631304/632904; Website: www.sidh.org

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India: Gujarat State

Sewa Rural operates in a poor, largely tribal region of Gujarat State. Their experiences in attempting to include men in women's health include a safe motherhood initiative, a program for newly married couples, and distinct family planning and adolescent health awareness programs. Between 1993 and 1995, Sewa Rural revised their approach to maternal care, seeking to involve men and other family members in preparing for safe childbirth by supporting women in registering early, obtaining adequate nutrition, planning ahead for delivery, recognizing signs of complications, and taking appropriate action in response.

To remind pregnant women and their families of the anticipated delivery date, the date is inscribed on the walls inside the family home, using appropriate reference to local calendars. Sewa Rural also uses a postcard system to inform families of the expected delivery date (reminders are sent to the expectant mother's home as well as that of her parents where many women opt to deliver, especially for first-time pregnancies). Postcards also are used to remind families of impending doctor's appointments or special care prescribed in abnormal circumstances.

The safe motherhood initiative also involves field visits that are tailored to men's schedules. The initiative's overall success is evidenced by the 40 percent increase in men seeking out health workers to register their wives for early antenatal care, a one-out-of-three rate of men accompanying their wives for visits to the hospital, and a significant increase in the number of fathers who have started bringing their young infants for immunization.

Less encouraging are observations that men, family members, and women themselves continue to believe that a man must not be present during his wife's labor. Also, all family members, including women, are reluctant to have men donate blood for their wives—even in critical situations—for fear that this will physically weaken the husband.

A program to initiate rapport between Sewa Rural health workers (male and female) and newly married couples has also been started. It consists of meetings that attempt to organize discussions with the couple alone, as well as with the couple joined by their elders. In addition to various information, education, and communication (IEC) materials, newlyweds are also provided with a Sewa-Rural gift pack containing trinkets and an appropriate gender-specific sample contraceptive (condom for men, regimen of oral pills for women).

Lessons Learned

  • Early rapport between health workers and newlyweds was deemed of great importance. Once established in the community, capable health workers who effectively manage ailments ensure active participation and utilization of services by both men and women.
  • In their adolescent health and awareness initiative, Sewa Rural has found that multiple, ongoing, and continuing sessions with the same group, over a period of time and covering a few topics per session, are most effective.
  • Male and female health workers play an important role in motivating couples and often become role models that help establish healthier reproductive habits in the community. Male health workers in particular assist in motivating male members of the community and are vital in adolescent groups.
  • Health and well-being need to be approached in a holistic manner in which the family is seen as a unit and a comprehensive package of health services is delivered. In addition, the underlying fabric of socio-cultural traditions and the economic milieu has to be kept in mind while introducing any such strategy.

For more information, please contact:
Sewa Rural (SR) Research Team, Anil and Lata Desai, Jhagadia 393 110, District Branch, Gujarat State India

Information adapted from Population Council/India, Draft Report (1999).

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India: Nandesari

The Pati Sampark ("meeting husbands") program of the Deepak Charitable Trust is an effort to involve men in antenatal care. The program is part of a larger World Bank funded national program to promote a small-family norm by supporting safe motherhood and childbirth practices in India.

The Pati Sampark program is being implemented in Nandesari, an industrial area 20 kilometers north of Baroda, India. The population is primarily Rajput, which is characterized by conservative and restricted roles for women. The program was started in 1995 in response to low attendance by high-risk women at monthly antenatal clinics. It eventually was expanded to include all pregnant women, regardless of risk status. The program is implemented by both male and female outreach workers as well as trained midwives. It aims to motivate husbands to monitor their wives' clinic attendance and consumption of the iron and calcium supplements at the prescribed times. It was hoped that by incorporating husbands into an existing antenatal service delivery program, attendance at antenatal clinics would rise and the incidence of low birthweight babies would fall.

When the program started, male outreach workers visited the husbands of pregnant women who were not attending monthly antenatal clinics. The outreach worker spoke to the husband about the importance of antenatal care, specifically (1) tetanus toxoid vaccination, (2) hemoglobin testing, (3) blood pressure checks, (4) a proper diet, (5) iron and calcium supplements, and (6) safe childbirth. Men whose wives were identified as having high-risk pregnancies also were given information on the various symptoms of a high-risk pregnancy and appropriate treatment. All men also were given information about family planning methods and the benefits of spacing children at least three years apart.

The Pati Sampark program did influence the degree of attendance at antenatal clinics. An evaluation of the program found that while many women attended the clinics two to three times during their pregnancy, women whose husbands had participated in the program were more likely to attend the clinics on a repeated basis (6 to 7 times) than were women whose husbands did not participate. The program also succeeded in raising men's awareness of their wives' use of antenatal services (including vaccinations, routine tests, and supplements). Men who participated also reported a greater awareness of various contraceptive methods and the benefits of child spacing.

For more information, please contact:
Deepak Charitable Trust, 9/10 Kunj Society, Alkapuri, Baroda, 390007 India
Telephone: 0265-339410; Fax: 0265 330994; Email: [email protected]

Information adapted from Dev, A. Involvement of Husbands in Antenatal Care: Evaluation of Deepak Charitable Trust's Outreach Program. Baroda, India (1998).

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Mexico

Salud y Gnero (Health and Gender) is an organization which aims to contribute to a better quality of life and health for women and men through activities in the areas of mental, sexual, and reproductive health. It serves various rural and urban sites throughout Mexico. Salud y Gnero grew out of efforts to address the physical and mental health issues of women displaced by the 1985 Mexico City earthquake and Guatemalan refugees in Southern Mexico. During the course of this and subsequent work, the need to include men in the discussion of health issues became apparent.

A Participatory Approach

Over the past few years, having built expertise through working with women, Salud y Gnero has been conducting participatory workshops that encourage men to explore traditional gender role expectations and the influences these expectations have on men's relationships with their partners, families, and communities. Each workshop lasts two to three days. Most are for men only, though some involve both men and women as participants. Salud y Gnero has held workshops for interested men from the community, secondary school youth, men in prisons, staff and volunteers from health and development organizations, public sector teachers, and staff and volunteers working in health promotion among indigenous groups.

Each workshop includes a variety of activities designed to encourage participants to reflect upon their experiences and perspectives related to gender issues. Examples of these activities include:

  • The Gendered Body: Participants draw the male and female body and make a list of the cultural characteristics attributed to men and women. They also list the health problems that are common in men and women and use this as the starting point for a discussion of the gender bases of health.
  • The Time Tunnel: This exercise asks participants to review their life stories, with attention to gender roles that were presented to them in their families. Using these recollections, participants develop collages and share the images of the persons, institutions, and experiences that have influenced them the most.
  • Management of Emotions: Men discuss five basic emotions (fear, affection, sadness, anger, and happiness) and the social constraints that men feel in terms of how they can or cannot express these emotions.
  • Violence in the Couple: Participants discuss expectations in male-female relationships, manifestations of violence, and ways to detect and react to feelings that could or have led to violence against one's partner. A related exercise allows men to look at the various ways that anger can be expressed and explore ways of managing it.
  • Images of Fathers: Participants talk about images of their own fathers and the feelings they have related to the presence or absence of their fathers in their lives.

Challenges and Lessons Learned

  • Viewing masculinity as a risk factor is an important and non-threatening starting point for discussion of issues related to sexuality, health, and intimate relations.
  • Discussing gender and masculinity is not possible at an institutional level until the individuals involved have first reflected about their own values and realities related to gender.
  • While involving individual men is important, expanding outreach to institutions is an important way to access larger groups of men. Salud y Gnero is in the process of developing training materials to accompany its workshops and implementing a "multiplier" strategy, which seeks to reach men affiliated with organizations or institutions who can then replicate the workshops for others.
  • Women can play an important role in encouraging men to participate in gender-related workshops.
  • A two-workshop series is generally needed to allow men time to process the ideas discussed and develop skills to facilitate future workshops.
  • Activities to address gender issues should start with a clear idea of desired outcomes and indicators to measure success in achieving these outcomes.
  • Awareness-raising activities, such as radio spots and public education about gender issues, are helpful in creating a positive environment for workshops and recruiting participants.

Adapted from IPPF/RHO and AVSC 1998.

For more information, please contact:
Emma Reyes, General Coordinator, or Benno de Keijzer, Research Area Coordinator, AP Postal 171, Xalapa, Veracruz, Mexico 91000
Telephone: 28-151175; Fax: 28-151175; Email: [email protected]

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Nicaragua

This UNFPA-supported project trained the Military Medical Corps of the National Army of Nicaragua to provide information, education and communication  (IEC) on sexual and reproductive health.  The overall purpose of the project was to improve men's and women's access to reproductive health and family planning services.

The project had two components: training and education for military personnel in reproductive health/family planning and service delivery.  The Military Medical Corps of the National Army provides health care services to army members and their dependents. This project aimed to strengthen the quality of health care within the army and addresses the shortage of public health services by providing primary health care, IEC, and reproductive health care to communities surrounding military units.

The project promoted the concept of sexual and reproductive health as a human right. Doctors, nurses, and nurses auxiliaries were trained to integrate reproductive health/family planning services into primary and secondary health care offered by military health units. One thousand soldiers and officers were trained to carry out information and sensitization activities on reproductive health and sexual rights. Educational material produced by the Nicaraguan Community Movement was adapted for use in reproductive health and IEC activities. 

The Military Medical Corps developed a working relationship with several government and non-government reproductive health projects.  For instance, the Center of Information, Services and Counseling on Health (CISAS) and the Nicaraguan Community Movement worked with the Medical Corps to train health leaders and promoters in reproductive health and family planning.

Results

  • Army commanders, officers, and soldiers became much more aware of the various issues related to sexuality that need to be addressed, particularly STI prevention, and gender-based violence.
  • Military personnel, men, and women, were sensitized about reproductive health, family planning, and gender equity.
  • During the post-Hurricane Mitch reconstruction and rehabilitation period, military health teams working in the disaster zones provided reproductive health and family planning information, and distributed oral contraceptives and condoms.

Lessons Learned

  • The Military Medical Corps and army are effective mechanisms for reaching large number of men, including male adolescents.
  • The army can become a provider of quality service delivery to rural populations who have little access to information and services.

For more information, please contact:
UNFPA Representative, United Nations Development Programme, Apartado Postal 3260, Managua, Nicaragua
Email: [email protected]

Information adapted from: "Support to reproductive health activities of Nicaraguan Army". UNFPA Project Nic/97/PO4 (1997).

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Nigeria (Conscientizing Male Adolescents)

The Conscientizing Nigerian Male Adolescents (CMA) program was established in 1995, with funding from the International Womens Health Coalition. The program aims to teach and encourage Nigerian male adolescents, ages 14 to 20, to develop a critical awareness and abandon sexist prejudices and practices. The program includes a curriculum that focuses on various topics while taking cultural norms into consideration. Among the topics included are Nigerian society, women's roles and family structures, sexuality, reproductive health and rights, and violence against women.

At its inception, the program started with 25 participants that met on a weekly basis for a 9-month period. The adolescent males convened each week to discuss, debate, question, and analyze issues related to reproductive health, violence, gender equity, and human rights, among other topics. They focused on creating a dialogue, led by adult facilitators, which enabled the adolescents to explore their attitudes, beliefs, and values with respect to the program topics. As a result, the participants became better equipped to think independently and analytically.

Based on findings of the first-year evaluation, CMA added a second year to the program. In 1999, the two-year program grew to 100 participants. The first year of the program continued to include the weekly dialogues. A second year was added to conduct monthly meetings to reinforce what had previously been learned. Since then, CMA has expanded by adding a peer-education practicum, an outreach program, and a training manual/curriculum guide.

In upcoming phases of the program, several initiatives will be implemented, thereby, maximizing and extending its benefits. One such initiative is the establishment of CMA discussion groups in several Calabar postprimary and secondary schools, as well as in a neighboring state. Additionally, there are plans for CMA's newsletter, The Male Adolescent, to be disseminated more broadly to reach a wider audience of schools. Ultimately, Dr. Madunagu, CMAs founder, hopes to replicate the program in several other locations so that it has a greater effect on changing the entire society.

:

  • Conscientization is fundamental; mobilization needs to occur from the roots.
  • Challenging the attitudes of teachers and parents will take time.
  • Do not set goals that are out of reach; aim for identifiable changes.

Information adapted from Irvin, A. Taking Steps of Courage: Teaching Adolescents about Sexuality and Gender in Nigeria and Cameroun. New York: International Women's Health Coalition (2000). Available at: www.iwhc.org/index.cfm?fuseaction=page&pageID=71.

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Nigeria (New Society Project)

Nigeria's New Society Project (NSP), a male-focused NGO established in 1997, is an initiative by men aimed at increasing male concern and participation in sexual and reproductive health in a positive and supporting way, while promoting gender equity in family and society. NSP also promotes the sexual and reproductive health and rights of boys and young men through education and increased access to health services and information.

While many programs have addressed men's and women's sexual and reproductive health and rights through responses that are largely behavioral or cultural, NSP's holistic approach recognizes that it is critical to address a range of structural factors that shape sexual and reproductive health. Therefore, NSP's innovative training programs consider not just the underlying issues of culture and how it shapes men's and women's behavior, but also the range of structural factors, including socioeconomic and power relations between women and men, that create a climate of social inequality and injustice, which in turn affects sexual and reproductive health and rights.

In Nigeria, several intervention programs address women's vulnerable position in sexual relationship with men and seek to empower women. Many of these program have lacked support from men who see women's empowerment as a threat to their power. Some men may maintain these views because they have not been exposed to programs that encourage an ideological shift.

NSP believes that in a male dominated, patriarchal society like Nigeria, the support of men for women's empowerment and for their sexual and reproductive health is critical. NSP therefore seeks to involve men in exploring the influence they have on their own health and the health of women, and to increase men's support for women's sexual and reproductive health and rights and the well-being of their children.

Social mobilization strategies that engage men as active change agents are central to generating change in societal attitudes, beliefs, and gender stereotypes, and in redefining male-female relationships and roles. Through its innovative and dynamic programs, NSP is working to promote the emergence of a new, nationwide men's network to address sexual and reproductive health and rights problems—a prevailing phenomenon in Nigeria.

Already, NSP has stimulated the creation of a men's group called Men's National Network for Reproductive Health (MNNRH), which currently has chapters in six of the 36 states of Nigeria, and the Young Men's Health Network (YMHN) for boys and young men in schools. These networks include male individuals and groups in their reproductive and childbearing years across the nation who are beginning to question masculine violence, confront patriarchy and authoritarian culture, and serve as active change agents in their respective neighborhoods, villages, and communities.

Over the past few years, NSP has been conducting seminars, workshops, and training programs that encourage members of the networks to explore how gender is related to sexual and reproductive health by addressing beliefs, cultural norms, societal expectations, roles, status, power relations between women and men, and sexuality. These workshops and meetings provide opportunities for members of the network to discuss and exchange observations on their lives as men, re-educate themselves, and bring about transformation of their personal practices and behaviors. To date, 1,200 men and adolescent males have joined these networks across the nation and participated in NSP's organized activities. NSP is also reaching out to new members men through various institutions, and is developing a center for Research on Men's Health and Social Behaviour. NSP and its participants hope that these networks will take root in all 36 states of the federation.

Lessons Learned

  • Traditional male dominance is a major obstacle to promoting the much-needed social change in sexual and reproductive health and rights. Male factors are so dominant in harmful practices like marriage of
    adolescent girls, poor birth spacing, large families, polygamy, unsafe motherhood,and other reproductive health problems.
  • Nigerian men usually go to traditional herbalists when they decide to seek out services for reproductive health issues. Without increased education, men will continue to consult non-professional providers for services, thereby placing themselves and their partners at risk of infection.
  • Men themselves must become active change agents. New men's groups should be encouraged to create fora for men to re-educate themselves and to confront patriarchal, authoritarian, and violent elements in the culture.
  • Promoting behavioral research is important in addressing men's sexual and reproductive heath.
  • Ensuring that sexual and reproductive health education includes gender analysis and emphasizes the right of men and women to sexual equity and equality is important.
  • Access to health care services is essential to ensure effective treatment.
  • Since schools help to reinforce gender stereotypes, reaching out to boys and young men in schools is important.

For more information, please contact:
Andy Ike Ogara, Executive Director, or Bola Nuga, Head of Programmes, New Society Project (NSP), 3rd Floor, 121b Isolo Road, Mushin, P.O. Box 2307, Mushin, Lagos, Nigeria
Email: [email protected]

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Philippines

Harnessing Self-Reliant Initiatives and Knowledge, Inc. (HASIK) is a nongovernmental organization (NGO) in Quezon City in the Philippines. HASIK uses a participatory approach to provide services to poor communities and sectors. HASIK’s approach empowers communities and sectors through organization of the urban poor, gender advocacy, early childhood care and development, livelihood development, research and documentation, and the development of creative training methodologies for skills-building and consciousness-raising seminars.

For over 11 years, HASIK has been carrying out a project entitled Gender Seminars for Men (GSM). The GSM project is a module developed for men to increase awareness around gender issues. The goal of the project is to make men allies in gender awareness as well as to minimize the barriers to achieving gender equity. The module uses participatory learning techniques and emphasizes establishing effective commitment coupled with cognitive awareness. The module is made up of six phases: Setting the Scene; Hearing Women’s Voices, Feeling Women’s Pain; Articulating Women’s Issues; Visioning a More Desirable Future; Committing Oneself; and Acting on Commitments.

There has not been a formal evaluation of the GSM; however, empirical results indicate that the project has been successful. HASIK receives numerous requests from institutions interested in participating in the seminar as well as personal testimonies of the participants’ positive experiences.

For more information, please contact:
HASIK, 9 Don Rafael Street, Don Enrique Heights, Commonwealth Avenue, Barangay Holy Spirit, 1127 Quezon City, Philippines
Telephone: 632-931-4335; Fax: 632-932-6026; Email: [email protected]

Information adapted from Cruz, M.S. "Deciding to Dance: HASIK’s Experience with Men in Gender Advocacy Work." Presentation at Oxfam workshop, Gender Is Everyone’s Business: Programming with Men to Achieve Gender Equality, England, June 2002. Available at: www.oxfam.org.uk/what_we_do/issues/gender/gem/downloads/HASIKcase.pdf.

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Thailand

The Ministry of Public Health in Thailand started "The 100% Condom Program" in 1989 as a way of addressing high rates of sexually transmitted infections, including HIV/AIDS. Participation in the program became mandated by the government in 1991. The program's main audience is men who are clients of sex workers. The goal of the program is to achieve 100% condom usage during all commercial sex. Since many Thai men visit brothels, a reduction of STI/HIV from this source will significantly protect their wives or girlfriends as well as protect the sex workers.

The campaign uses three main strategies:

  • A mass television and radio campaign encouraging men to use condoms during commercial sex
  • Providing a continuous supply of free condoms to sex workers and sex establishments
  • Promoting and enforcing universal condom use at commercial sex establishments

If a client refuses to use a condom, the sex worker refuses to have sex and refunds the client's money. If a client contracts an STI and presents at a government STI facility for treatment, clinic staff ask where he may have contracted the disease. The sex establishment is then contacted regarding compliance issues. Establishments that fail to comply with the 100% condom program are shut down by the police.

Impact

The program appears to have had a significant impact on changing condom use and reducing STI rates among the intended audience, though other concurrent STI/AIDS prevention activities also may have contributed. Reported condom use in sex establishments increased from about 14% in 1989 to more than 90% in 1994. During the same time period the STI rate decreased by more than 85%. A study of HIV incidence rates among military recruits in Northern Thailand found that HIV incidence declined from 2.48 per 100 person-years during 1991-1993 to 0.55 per 100 person-years during 1993-1995 (Celentano et al. 1998). This dramatic decline is attributed in large part to the 100% Condom Program.

Lessons Learned

The program has been successful because it:

  • focuses on a limited goal (use of condoms during commercial sex);
  • builds upon an existing strong STI prevention program, which includes maintenance of sex establishment rosters, good availability of STI services (including for sex workers), and contact tracing of STIs to sex establishments;
  • provides an unlimited supply of free condoms;
  • applies to all sex establishments nationwide, so that customers do not have the option of seeking "condomless" sex elsewhere (thereby not threatening the income of sex workers or sex establishments); and
  • enlisted the cooperation of the government and has a mechanism for enforcement.

For more information, please contact:
Department of Communicable Disease Control, Thai Ministry of Public Health, Bangkok, Thailand

Information adapted from Rojanapithayakorn et al. 1996.

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