Men, Family Planning and Men, Family Planning and Reproductive HealthReproductive Health

Richard Lord

Men’s Share of Responsibility Men’s Share of Responsibility for Family Planningfor Family Planning

What percentage of What percentage of worldwide contraceptive worldwide contraceptive use involves male use involves male methods? methods?

Jane Turner

Is this percentage Is this percentage increasing orincreasing ordecreasing? decreasing?

Male Methods: 26% of Global Male Methods: 26% of Global Contraceptive UseContraceptive Use

FemaleFemalesterilizationsterilization

MaleMalemethods:methods:

22%

Other femaleOther femalemethodsmethods

Oral contraceptivesOral contraceptives

Source: United Nations, 1998.

Withdrawal Withdrawal andandAbstinence: 12%Abstinence: 12%

IUDIUD

5%

33%

26%

14%

Vasectomy: 7%Vasectomy: 7%

Condoms: 7%Condoms: 7%

Use of Male Methods Declining as Use of Male Methods Declining as Proportion of Overall UseProportion of Overall Use

Source: United Nations, 1987, 1998.

0

5

10

15

20

25

30

35

40

Global use ofmale methods

Global use ofvasectomy

Global use ofcondoms

1987

1998

Gender Imbalance: Gender Imbalance: Knowledge/Use of SterilizationKnowledge/Use of Sterilization

Australia

Belgium

Canada

China

Republic of Korea

Nepal

Netherlands

New Zealand

United Kingdom

United States

Source: United Nations, 1998.

Use of Sterilization in 10 Countries with Highest Levels of Vasectomy

Female Sterilization

Vasectomy

Percent of Married Couples of Reproductive Age

0 10 20 30 40

Why Involve MenWhy Involve Menin Family Planning?in Family Planning?

Male responsibility in reproductive health Male responsibility in reproductive health issues is essential to decreasing HIV/AIDS issues is essential to decreasing HIV/AIDS and other STIsand other STIs

Men play dominant role in decision-makingMen play dominant role in decision-making Global contraceptive use has reached Global contraceptive use has reached

a plateau a plateau Funds for family planning have declinedFunds for family planning have declined

Husband Disapproval Husband Disapproval Major Factor in Unmet NeedMajor Factor in Unmet Need

Sources: Bongaarts, Stud Fam Plann 1995;26(2).

USAgency for International Development

Photo??

Contraceptive use Contraceptive use and continuationand continuationare higher when are higher when husband and wife husband and wife agree agree

3 of 7 pregnancies in the world are 3 of 7 pregnancies in the world are unintended unintended

Couple Counseling ResultsCouple Counseling Resultsin Better Continuation Ratesin Better Continuation Rates

Source: Terefe, Am J Public Health 1993;83(11).

One-year One-year contraceptive contraceptive continuation continuation twice as high twice as high when husband when husband counseled with counseled with wife wife (Ethiopia)(Ethiopia)Husband

involved incounseling

Husband NOTinvolved incounseling

Percentage of couplescontracepting after 12 months

0

5

10

15

20

25

30

35

33%33%

17%17%

Barriers to Men’s Use of Barriers to Men’s Use of ContraceptionContraception

Lack of accurate informationLack of accurate information Provider bias Provider bias

against male against male methodsmethods

Limited access Limited access to services to services

Beryl Goldberg

Barriers to Men’s UseBarriers to Men’s Useof Contraception of Contraception (cont.)(cont.)

Lack of provider training Lack of provider training Men’s misunderstanding Men’s misunderstanding

of correct useof correct use Limited range of male Limited range of male

methodsmethodsS. Khalaf/Family Health International

Why Some MenWhy Some MenChoose VasectomyChoose Vasectomy

Simpler, safer and less expensive than Simpler, safer and less expensive than female sterilization female sterilization

Love for wife and concern for her healthLove for wife and concern for her health Desire to take responsibility in family Desire to take responsibility in family

planningplanning Greater sexual enjoyment by eliminating Greater sexual enjoyment by eliminating

worries about unwanted pregnancyworries about unwanted pregnancy

Condoms: Dual Protection Condoms: Dual Protection Against Pregnancy and STIsAgainst Pregnancy and STIs

Can be highly effective Can be highly effective in protecting against in protecting against pregnancy AND pregnancy AND preventing HIV/STIspreventing HIV/STIs

Should be promoted in Should be promoted in family planning, HIV family planning, HIV prevention, and other prevention, and other programsprograms

Men’s Public ApprovalMen’s Public Approvalversus Private Useversus Private Use

Men report high knowledge and support Men report high knowledge and support of contraception even where use is low of contraception even where use is low

Public approval different than private usePublic approval different than private use Programs need to change attitudes and Programs need to change attitudes and

practicespractices desire for more childrendesire for more children belief that religion prohibits usebelief that religion prohibits use desire for control over wifedesire for control over wife

Sources: Drennan, Popul Rep 1998;J(46); Wilkinson, Man-Myths, AVSC International, 1998.

Creative Outreach Efforts Creative Outreach Efforts Reach Men in CommunityReach Men in Community

Sports eventsSports events WorkplacesWorkplaces Small businessesSmall businesses Truck stops Truck stops Military basesMilitary bases Media Media

R. Witlin/World Bank

Community Education Community Education Successfully Involves MenSuccessfully Involves Men

Agricultural agents and community Agricultural agents and community volunteers reached farmers with reproductive volunteers reached farmers with reproductive health and family planning information health and family planning information

Interactive materials for low-literacy clients Interactive materials for low-literacy clients stressed importance of birth spacing for child stressed importance of birth spacing for child health health

Family planning increased from 37 to 55% Family planning increased from 37 to 55%

Honduras:Honduras:

Clinic-basedClinic-basedStrategies for MenStrategies for Men

Stand-alone Stand-alone male clinics male clinics

Separate Separate hours/entrances hours/entrances for men for men

Integrated servicesIntegrated services Male or female Male or female

counselorscounselors Debbie Rogow

Men Respond Positively to Broad Men Respond Positively to Broad Reproductive Health ServicesReproductive Health Services

Family planningFamily planning STI/HIV prevention STI/HIV prevention

and treatmentand treatment InfertilityInfertility Sexual dysfunctions Sexual dysfunctions Reproductive cancersReproductive cancers

W. Graham/World Bank

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Involving Men in Family Planning Can Involving Men in Family Planning Can Promote Gender EquityPromote Gender Equity

Women want their partners involved:Women want their partners involved: To support their own contraceptive useTo support their own contraceptive use To share responsibility for contraception To share responsibility for contraception

and protecting healthand protecting health To increase men’s understanding of To increase men’s understanding of

reproductive health issuesreproductive health issues

Encouraging men to take control of fertility Encouraging men to take control of fertility can disempower womencan disempower women

In Zimbabwe, men who wanted sole In Zimbabwe, men who wanted sole responsibility for decision-making responsibility for decision-making rose from 27 to 37%rose from 27 to 37%

Positioning men as responsible and caring Positioning men as responsible and caring can be productivecan be productive

Source: Kim, Involving Men in Family Planning, Johns Hopkins CCP, 1996.

Assure That Women’s Reproductive Assure That Women’s Reproductive Health Needs Remain Primary FocusHealth Needs Remain Primary Focus