7.
DOCUMENT NUMBER: PIP/117850
AUTHOR: Amin M
TITLE: The India-Nepal partnership. Building cross-border collaboration in areas of affinity.
ABSTRACT:

AIDS Control and Prevention (AIDSCAP) Project research identified the trucking routes between Calcutta and Kathmandu as an important locus of high-risk sexual behavior. Voluntary HIV testing and counseling are therefore now being provided at a sexually transmitted disease (STD) treatment center run by the Bhoruka AIDS Prevention (BAP) Project in Raxaul, a checkpost city on the Indian side of the border. The project is the result of collaboration between the AIDSCAP Project and a doctor to expand a Transport Corporation of India initiative into a cross-border intervention. Data collected at regular intervals during the first year of the intervention showed that the number of people seeking counseling and HIV testing increased from 136 to 2431 and the number of condoms distributed upon request rose from 630 to 26,290.

13.
DOCUMENT NUMBER: PIP/127955
AUTHOR: Schehl M ; Green C
TITLE: Men as Partners initiative: summary report of literature review and case studies.
ABSTRACT:

This report summarizes the findings of the research component of AVSC International's Men as Partners Initiative. The report reviews the literature on involving adolescent and adult males in reproductive health programs and examines innovative strategies for reaching men at high risk of HIV/AIDS. Three promising approaches are highlighted: 1) provision of sexually transmitted disease services at maternal-child health and family planning clinics, 2) workplace programs for the delivery of reproductive health information, and 3) the design of outreach and services geared to couples. The report then summarizes the findings of case studies conducted by AVSC of six successful male involvement programs: Profamilia (Colombia), Family Planning Association of Pakistan, Busoga Diocese's Family Life Education Program (Uganda), Young Men's Clinic (US), Community Family Council (US), and the Thomason Hospital Clinic (US). All six programs share a view of men as allies in efforts to improve the reproductive choices of women and men.

17.
DOCUMENT NUMBER: PIP/109223
AUTHOR: Bankole A
TITLE: Desired fertility and fertility behaviour among the Yoruba of Nigeria: a study of couple preferences and subsequent fertility.
ABSTRACT:

Analysis of data from 1984 and 1986 fertility surveys in 3 towns and 4 villages in Oyo state, Nigeria, supports the hypothesis that fertility desires of couples are important predictors of a couple's fertility. When couples disagree, fertility falls between the 2 desires of stopping childbearing and of continued childbearing. Husbands' desires dominate when family size is small. Wives' desires are stronger in the later stages of marriage. The impact of desires on the number of surviving children is more evident after 4 children. The dominance of the wife's desires at the later stage of marriage is an important implication for determining the timing of the onset of fertility decline. The evidence supports the proposition that estimates of unwanted pregnancies and unmet contraceptive need may be overstated when collected from 1 spouse. The sample includes 3572 women and their husbands in 1984 and reinterviews of 3379 in 1986. A comparison of reports indicates that 79.9% of women reported the same number (45.1%) or a different number by one child (34.8%) between surveys. Only monogamous couples where the wives were younger than 45 are included in the analysis (2662 couples). Logistic models are constructed with controls for age, education, occupation, residence, religion, number of living children, and duration of marriage. The survey reveals that only 8% of women and 9.8% of men desired a stop to childbearing. Age, number of living children, and marriage duration were shown to be associated with reduced actual and desired fertility for men and women. Over the study period 49% of couples had at least 1 birth or pregnancy. Only 55% of either sex who desired more children actually had more children. 16.4% of wives and 17.2% of husbands who desired a stop to childbearing failed to avoid another pregnancy. 28% of couples for whom the wife desired more children and family size was 4 or fewer children had a subsequent birth or pregnancy.

33.
DOCUMENT NUMBER: PIP/127035
AUTHOR: Biddlecom AE ; Casterline JB ; Perez AE
TITLE: Spouses' views of contraception in the Philippines.
ABSTRACT:

This study examines husbands' and wives' attitudes about contraception at the couple and aggregate level in the Philippines. Data were obtained from a 1993 survey among 780 matched couples that included currently married women 25-44 years old from urban and rural barangays in Munoz in Nueva Ecija province and in Manila. In-depth interviews were conducted among 26 people. About 75% of men and women strongly approved of contraception. Men were slightly less approving and less likely to perceive that their friends and relatives strongly approved. 50-66% of couples shared the same view. About 33% of spouses did not accurately perceive their partner's approval. The highest proportion of both men and women considered prevention of pregnancy as a very important attribute of contraception. Women tended to rank spouse's and others' approval, the effect of contraception on the marriage, and contraceptive accessibility as "more important" more often than did men. Under 66% of couples ranked a specific attribute of contraception as "very" important. Couple agreement on a "very" important attribute ranged from 31% of couples' agreement on financial cost to 65% on effectiveness. The Kappa value on couple agreement on attributes indicated that spousal agreement could be attributed to chance alone. Women tended to rate each method more negatively than men did. Men and women viewed the pill and the IUD more negatively than withdrawal and rhythm. Gender differences did not vary by type of method. Moderate to low levels of agreement on the pill, the IUD, the condom, and rhythm exceeded what would be expected by chance alone. Agreement did not relate to spousal discussion of contraception or joint decision making. When couples both approved of contraception, 81% agreed on intended use in the future, and 78% were current users. Findings suggest that views on contraception have an impact on contraceptive use.

46.
DOCUMENT NUMBER: PIP/125435
AUTHOR: Campbell C
TITLE: Migrancy, masculine identities and AIDS: the psychosocial context of HIV transmission on the South African gold mines.
ABSTRACT:

Levels of HIV infection are especially high among migrant workers in sub-Saharan Africa. A case study of underground workers in South Africa's gold mines is presented, highlighting the psychosocial context of HIV transmission in the mining setting. Findings are based upon interviews conducted in early 1995 with 42 Zulu-, Xhosa-, and Sotho-speaking underground miners at a Johannesburg gold mine. Assuming that social identities strongly influence people's sexual behavior, the author explored how miners build their social identities within the parameters of their living and working conditions. She also identifies some of the key narratives used by miners to interpret their experiences with regard to health, sickness, HIV and sexuality. Masculinity was a leading narrative in informants' accounts of their working life, health, and sexuality. The author further examined how the construction of masculine identities makes miners particularly vulnerable to HIV. The implications of these findings for HIV educational interventions are discussed.

59.
DOCUMENT NUMBER: PIP/122342 AUTHOR: Danforth N ; Roberts P
TITLE: Better together: a report on the African Regional Conference on Men's Participation in Reproductive Health.
ABSTRACT:

The 66 participants from 15 sub-Saharan African countries at the first African Regional Conference on Men's Participation in Reproductive Health announced a commitment to promote men's responsible, equitable role in reproductive and sexual health and the health of women and children. The conference, held in Harare, Zimbabwe, in December 1996, was co-sponsored by Johns Hopkins University/Population Communication Services, the Academy for Educational Development/Support for Analysis and Research in Africa Project, and the International Planned Parenthood Federation/Africa Region. As the powerful decision makers in both the family and community, men are the gatekeepers to contraceptive use in Africa. Moreover, the acquired immunodeficiency syndrome has dramatically increased men's concern about reproductive health. Participants identified five themes that must be considered in the design and implementation of men's programs: men as a diverse audience, young men and their particular concerns, integration of IEC for men into reproductive health, cultural obstacles to men's participation, and program sustainability. Men's programs should be conceptualized as part of an integrated approach to reproductive health that creates a synergy of complementary and mutually supportive men's and women's programs. Announced was the Men's Sports Initiative Challenge CUP (Caring Understanding Partners), a program of matching grants to African organizations involved in promoting reproductive health to men through sports. By building on existing IEC, using existing knowledge about gender issues, and linking communication programs to service delivery, African health professionals can reach increasingly larger numbers of men of all ages as well as their partners.

61.
DOCUMENT NUMBER: PIP/091402
AUTHOR: Dixon-Mueller R
TITLE: The sexuality connection in reproductive health.
GENERAL NOTES: RH Training Materials.
ABSTRACT:

The aim of this article was to identify some impact connections between sexuality, gender, and reproductive health for helping family planning professionals. A review was provided of sexuality and gender in conventional family planning literature. A theoretical framework was provided for sexuality and gender, which drew from a review of sexual behavior in sub-Saharan Africa on behavioral and objective, psychological and cultural, and subjective dimensions. Sexual partnerships were differentiated from sexual acts, sexual meanings, and sexual drives and enjoyment. The relevance for family planning workers was that adoption of a "sanitized version of sexuality that treats intercourse as an emotionally neutral "act" interfered with the need to learn about their clients' sexual and reproductive concerns. This information can be obtained through intake questionnaires, physical examinations, contraceptive counseling, and clinic-based group discussions. Clients could be asked about their partners attitudes toward and practices of contraception, and cooperation in practicing contraception and disease prevention. Examinations and routine questioning can reveal signs of physical and sexual abuse, reproductive tract infections, and damage from genital mutilation, vaginal medication, or other practices. Group discussions might address topics on transmission of AIDS and reproductive tract infections, infertility, contraceptive preferences and beliefs, fecundity cycles for females, misconceptions about menopause and menstruation, causes of unwanted pregnancy and abortion, and male responsibility for birth control and child rearing. Community teach-ins can work to dispel misinformation; videos can focus on specific topics such as multiple sexual partners. Research activity might include not only standard questionnaires, but also analysis of print media or daily diaries of sexual and contraceptive activity. What is important to understand is the number, duration, and social identities of a person's sexual partnerships and the person's ability to protect oneself. Population policies need to be adjusted to accommodate equal rights policies on legal, social, and economic goals, such as gender equality, sexual choice, male entitlement, or sexual enjoyment.

72.
DOCUMENT NUMBER: PIP/142818
AUTHOR: deGraft-Johnson J ; Tsui AO ; Buckner B ; Singh KK ; Bou-Saada I ; Fowler C ; Viadro C ; Beamish J ; Khan M
TITLE: Uttar Pradesh Male Reproductive Health Survey, 1995-1996.
ABSTRACT:

The Uttar Pradesh Male Reproductive Health Survey (MRHS) was carried out in 5 districts between November 1995 and April 1996 to obtain in-depth information about husband's reproductive and sexual knowledge and behavior. 6727 married men aged 15-59 who lived with their wives were successfully interviewed. Male knowledge of the female reproductive system and pregnancy was found to be limited. 90% of husbands were aware they could help prevent their wives from becoming pregnant. The findings suggest that men are frequently exposed to mass media family planning messages regarding family size norms and contraception. Slightly under one-fifth of husbands had discussed unwanted pregnancy with their wives. 98% knew a family planning source. Contraceptive prevalence reported by men was 40% compared to 25% reported by married women aged 13-49. Most of the discrepancy was in condom use. One-third not currently using contraception intended to do so in the future. 30% of husbands reported physically abusing their wives; 64% in the past year. 8% reported their wives were pregnant in the most recent episode of abuse. 28% reported having sex when the wife was unwilling. 82% of husbands spent money in the past year on health care for their wives, children, or parents, and 73% spent money on their own health care. 34-40% reported that their wives received medical care during the most recent pregnancy. 15% of husbands reported premarital and 4% reported extramarital sexual activity. 9% reported current symptoms of sexually transmitted diseases. No major differences were observed in husbands and wives' responses on questions regarding fertility preferences or contraceptive usage.

76.
DOCUMENT NUMBER: PIP/113111
AUTHOR: Ezeh AC ; Seroussi M ; Raggers H
TITLE: Men's fertility, contraceptive use, and reproductive preferences.
ABSTRACT:

This report presents findings from 17 Demographic and Health Surveys on the role of men in the family-building process. The male surveys in this report were conducted in 7 West African countries and 6 East African countries, in Egypt and Morocco, and in Bangladesh and Pakistan. Eight other male surveys were conducted but not analyzed in this report. This analysis pertains only to currently married men and indicators that were common to all countries (fertility levels, fertility preferences, knowledge and use of contraception, and intention for future use). Findings show that West African countries had high fertility, high ideal family size, and low contraceptive use. East African countries had lower fertility, smaller family size preferences, and higher contraceptive use than West African countries. Ghana and Tanzania did not follow the regional trends. Ghana had lower fertility and greater use of contraception than the region. Tanzania had higher fertility and lower use of contraception than the region. Fertility levels and preferences were lowest in Bangladesh and North Africa. Fertility was about 5.0 children in West Africa, about 4.5 children in East Africa, and under 4.0 in North Africa and Asia. Men's reported ideal family size was 9 children in West Africa, 5 children in East Africa, and about 3.5 children in North Africa and Asia. The proportion of men desiring more children ranged from 60% in Ghana to 90% in Niger in West Africa. Under 45% in North Africa and Asia desired additional children. Over 65% of men in all countries had knowledge of at least one method. Knowledge ranged from 90% to 95% in East Africa, North Africa, and Asia. Male approval of family planning ranged widely in West Africa from under 50% to about 90%. Current use patterns also ranged widely in West Africa from under 2% in Mali to 15% in Cameroon. Current use was 25%-33% in East and North Africa and Asia. The exceptions were Tanzania with 22% of men currently using and Pakistan with 15% of men currently using. Only for approval of family planning did the proportion of women exceed that of men. Men reported greater use of contraception in all surveys but two. A greater proportion of women intended to use. Differences between genders were sometimes small.

100.
DOCUMENT NUMBER: PIP/111285
AUTHOR: Green CP ; Cohen SI ; Belhadj-El Ghouayel H
TITLE: Male involvement in reproductive health, including family planning and sexual health.
ABSTRACT:

A supportive male partner encourages his female partner to use contraceptives. The AIDS pandemic and the increasing rates of sexually transmitted diseases (STDs) lend more importance to safer sexual practices and condom use. Male involvement programs address specific obstacles: men's disapproval of partners' use of contraception; increasing rates of STD/HIV infection and out-of-wedlock pregnancy; restrictions on condom advertising, promotion, and distribution; and underutilization of vasectomy services. Major obstacles to expanding male-involvement programs revolve around sociocultural considerations (e.g., men's fear of losing control), lack of political commitment, policy barriers (e.g., strict eligibility criteria for vasectomy), provider bias (e.g., programs oriented to women), and inadequate information. Well-targeted, focused male involvement programs can have a positive influence on both male and female reproductive health behaviors: more responsible sexual behavior, increased contraceptive use, and greater communication between partners. Program managers often have traditional assumptions about male involvement activities that hinder such activities. These assumptions are that men are difficult to reach, men are resistant to changes in their reproductive attitudes and behavior, and that male involvement activities increase the cost of services. Male reproductive health services can be provided at primary health care facilities, maternal and child health/family planning clinics, male-only clinics, STD clinics, mobile units, and military hospitals. Information, education, and communication need to be tailored to male audiences. Men respond to messages that promote positive role models, appeal to their economic interests, use personal testimonials, improve their self-image, and are funny. The messages can be delivered through interpersonal, community-based, and mass media approaches. A key lesson learned from male involvement programs is that male involvement activities should be integrated into overall program goals and strategies.

118.
DOCUMENT NUMBER: PIP/115980
AUTHOR: Hulton L ; Falkingham J
TITLE: Male contraceptive knowledge and practice: what do we know?
ABSTRACT:

While interest in male involvement in family planning has increased since the 1994 International Conference on Population and Development, little is known about male knowledge of, attitudes toward, and practice of contraception. This study, which focuses on male knowledge and practice, comments on current findings reported in the literature and adds to those findings through an analysis of data from the Demographic and Health Surveys (DHS). Very few studies have sought information about male knowledge and use of contraception until the mid-1980s when 26 of the 74 completed DHS collected information from men. Small-scale studies have revealed positive attitudes, high knowledge levels, and low usage levels. The present study analyzed data on currently married men and currently married women from 10 DHS (Egypt, Morocco, Pakistan, Bangladesh, Niger, Ghana, Cameroon, Malawi, Kenya, and Tanzania). Nine graphs compare male and female knowledge, ever use, and current use of any method, of modern methods, and of traditional methods. Six tables illustrate knowledge, ever use, and current use of male contraceptive methods as well as knowledge, ever use, and current use of female contraceptive methods. These data reveal that male contraceptive knowledge is higher than expected but that use remains limited except for condoms and coitus interruptus. The inconsistency between these data and reported female behavior may be due to a higher use of contraception by men in sexual encounters which occur outside of marriage. Future research should focus on why male knowledge is so high and what motivates male contraceptive use.

122.
DOCUMENT NUMBER: PIP/119965
CORPORATE NAME: Johns Hopkins School of Public Health. Center for Communication Programs.
TITLE: Reaching men worldwide: lessons learned from family planning and communication projects, 1986-1996.
ABSTRACT:

The USAID-supported Johns Hopkins University's Population Communication Services (JHU/PCS) has provided technical assistance and support to more than 24 programs addressing men's participation in family planning and reproductive health since 1986. Mass media, community mobilization, and interpersonal dialogue are communication strategies applied to reach men. These programs use mass media channels (radio, TV, and newspapers) to reach men through the programs and events men enjoy (sports, films, popular theater, and music). They improve men's willingness and ability to communicate with partners, peers, and health providers. Programs geared to the entire community have motivated men to take part in discussions about their concerns in a comfortable and informative environment. JHU/PCS has published this review of its projects in Africa, Asia, Latin America, the Near East, and the New Independent States. Over its 10 years of experience, JHU/PCS has learned the following lessons. Research must be conducted to determine what men want and need, so that targeted, focused messages can be developed to increase male participation in family planning and reproductive health. Men should not be portrayed as obstacles to family planning efforts but as caring partners. Communication programs need to encourage men to talk to their partners and make joint family planning decisions. They need to publicize and promote service sites for men so the men can have better access to information and service providers. Communication programs must center on facts and perceptions to surmount myths or rumors that sometimes bring about men's opposition to some family planning methods. Since community and national leaders contribute to the public discourse and public opinion, communication program staff must work with opinion leaders to increase men's social support and family planning use. Programs should use many communication channels to generate a synergistic effect. They should address the needs of young men.

129.
DOCUMENT NUMBER: PIP/121463
AUTHOR: Karra MV ; Stark NN ; Wolf J
TITLE: Male involvement in family planning: a case study spanning five generations of a South Indian family.
ABSTRACT:

Family planning program planners tend to assume that men are opposed to family planning and will, if involved in reproductive decision making, prevent women from regulating their fertility. Available data, however, suggest that the most successful family planning programs target men as well as women and promote communication about contraception between spouses. The authors examined fertility decision making across five generations of one middle-class, South Indian, high-caste Brahmin family from the state of Andhra Pradesh and the factors affecting its sudden observed fertility decline. Data were collected through interviews with 77 male and 101 female family members from the five generations. Men in this family were significantly involved in family planning over several generations. Indeed, fertility levels dropped during the periods of greatest male involvement and practically no female involvement in reproductive decision making. Such male involvement has resulted in fertility decline and long-term benefits for women. Traditional notions about gender roles and family, together with economic concerns, shaped fertility decision making. Individual motivation rather than choice of methods was more important for positive male participation in family planning.

141.
DOCUMENT NUMBER: PIP/121446
AUTHOR: Lasee A ; Becker S
TITLE: Husband-wife communication about family planning and contraceptive use in Kenya.
ABSTRACT:

According to couple data from the 1989 Kenya Demographic and Health Survey, both knowledge and approval of family planning are virtually universal in Kenya: among 98% of couples, one or both partners know of at least one modern method, and among 85% of couples both partners approve of family planning. Discussion with the partner about family planning was reported by 82% of couples. However, only 67% of wives and 75% of husbands correctly predicted their spouse's approval of family planning. Knowledge and approval of family planning, husband-wife communication, desire for more children, and ideal family size are all significantly associated with current use. Multiple logistic regression analyses show that husband-wife communication, particularly the wife's perception of her husband's approval of family planning, is highly associated with current contraceptive use (odds ratio, 4.2). Dialogue appears to increase the effectiveness of communication: specifically, one spouse's perception of the other spouse's approval is more likely to be correct if they have discussed family planning than if they have not, and this relationship significantly affects contraceptive use. (author's)

157.
DOCUMENT NUMBER: PIP/112406
AUTHOR: Mbizvo MT ; Bassett MT
TITLE: Reproductive health and AIDS prevention in Sub-Saharan Africa: the case for increased male participation.
ABSTRACT:

In Sub-Saharan Africa, reproductive health care research and interventions as well as AIDS prevention and STD (sexually transmitted disease) control programs all place a disproportionate emphasis on women and ignore the equally important role of men. STD risk and incidence increased in the region as labor migration of husbands became necessary and the number of sexual partners for both men and women increased. In many cases, the sex behavior of married men is the main risk factor for their wives. Research into STDs and HIV has provided what is known about male sexual behavior, and AIDS has highlighted the importance of behavior in disease transmission and contraception. While HIV risk awareness is increasing, few men report condom use or appropriate changes in their behavior to minimize their risk. The female bias in family planning (FP) programs ignores the fact that in this setting men often control the contraceptive usage of their wives and adolescent children. Inclusion of men in counseling programs has led to an increase in contraceptive usage among their wives, and some data suggest that men are susceptible to change initial biases against FP. FP programs that offer infertility services are also more likely to be accepted, and whereas the women are usually blamed by their husbands for infertility, the husbands in infertile couples should be examined first. Research into sexual relationships, sex behavior, condom acceptance, and cultural constructs surrounding STD and HIV transmission is necessary and should be accomplished using a wide range of data collection methods.

159.
DOCUMENT NUMBER: PIP/111406
AUTHOR: McCauley AP ; Salter C ; Kiragu K ; Senderowitz J
TITLE: Meeting the needs of young adults.
ABSTRACT:

The overview of this report, illustrated with tables, discusses the size and proportion of the population ages 10-19; the definition of young adult; the falling age of puberty; sexual activity among young adults (including premarital sexual activity); the rising age at marriage; fertility patterns; contraceptive usage (including factors that inhibit usage, such as a lack of information, of access, of decision-making ability, and/or of power); and unmet contraceptive needs. The report's essay on growth, change, and risk behavior associated with youth deals with the specific topics of sexually transmitted diseases, sexual violence and coercion, the health risks of early pregnancy, unintended pregnancy and the complications of unsafe abortion, the social and economic consequences of early childbearing, and ways to meet needs and, thus, prevent problems. This last subject leads into an overview of programs available for young adults, including large school programs, small health programs, and European youth programs and social norms. A table gives types of reproductive health programs for young adults that defines the audience/activities, extent of the program, special issues addressed, and research findings for 1) family life education programs, 2) clinic-based programs, 3) AIDS prevention programs, 4) condom distribution programs, 5) school clinics, 6) communication through the entertainment media, and 7) peer education. In the next major section of the report, evaluations of the various types of programs for youth are reviewed to determine whether the programs lead to a delay in initiation of sexual intercourse, an increase in sexual intercourse, and/or an increase in contraceptive usage. Consideration is then given to what makes programs work and how to win support for programs from the community and from young adults. These major essays are punctuated with short highlights on such topics as whether adults and youth have differing views about sex behavior, whether young people are different today than they were in the past, reaching boys with services, where young people learn about sex, contraceptive choices for youth, and lessons learned from youth programs.

168.
DOCUMENT NUMBER: IND/8030241 ; PIP/105851
AUTHOR: Morris L
TITLE: Sexual behavior of young adults in Latin America.
ABSTRACT:

There are currently 82 million persons aged 15-24 living in Latin America and the Caribbean. The number of people in this age group will grow to 128 million by 2020. Analysis of survey and interview data from Latin America indicates the existence of high fertility, unintended pregnancies, and sexually transmitted diseases among teens and young adults in the region. Most sexually active young adults for whom data are available report a low frequency of sexual activity, generally with one partner. Such a low frequency and sporadic nature of sexual activity may contribute to the inconsistent use of contraception. While the most commonly used method at first intercourse in many areas was rhythm, less than 31% of female respondents in those countries could identify the most fertile period during the menstrual cycle. Less than 26% of young males could identify the period of the menstrual cycle in which a woman is most likely to conceive. The combination of sexual experience at an early age and such lack of knowledge concerning reproductive health and contraception points to the need for effective sex education programs at the primary level in school and better surveillance data on youth risk behaviors.

173.
DOCUMENT NUMBER: PIP/131275
AUTHOR: Muhondwa E ; Rutenberg N
TITLE: Effects of the Vasectomy Promotion Project on knowledge, attitudes, and behaviour among men in Dar es Salaam, Tanzania.
ABSTRACT:

This study tested whether promotion of vasectomy by the mass media and service providers and availability of high-quality services draw clients and increase adoption rates in Dar es Salaam, Tanzania. A pilot project, during October 1995 and March 1996, relied on mass media, posters and leaflets, and presentations by men in the workplace, to promote vasectomy. Data were obtained from a household survey of men, a situation analysis of clinics where vasectomies were provided, mystery client (MC) visits, and in-depth interviews with men who elected to have a vasectomy during the promotion period. Findings indicate that the messages reached just over 60% of the sample population. The most effective media were radio, newspapers, and stimulating discussions. The IEC did not combat negative attitudes toward vasectomy. Vasectomy is associated with the practice of castrating bulls and goats. Promotional messages should dispel fears of loss of sex drive, sexual ability, and obesity. Respondents were not knowledgeable about where to obtain a vasectomy. Even family planning clients did not know vasectomy services were offered at their clinic. MCs learned in counseling sessions that counselors gave misinformation, communicated vasectomy prejudices, and did give privacy for discussing sensitive topics. MCs gauged that only 10 out of 24 counseling sessions were adequate. Only 50% of service providers received any training, half of which was adequate. 11 of 95 counseled men were vasectomy adopters. Three project lessons learned are identified.

178.
DOCUMENT NUMBER: PIP/127967
AUTHOR: Ngom P
TITLE: Men's unmet need for family planning: implications for African fertility transitions.
ABSTRACT:

This study examines men's unmet need for family planning in Kenya and Ghana. Data are obtained from the 1988 and 1993 Ghana Demographic and Health Surveys (DHS) and the 1989 and the 1993 Kenya DHS. An initial discussion centers on the methodological problems of measuring men's unmet need. The sample is restricted to samples of marital pairs. Unmet need in the DHS is defined as married men or women who desire no more children and are not using any modern method. Unmet need includes those who relied on traditional methods. In both Ghana and Kenya, a large proportion of men had unmet need for contraception. 24% of married men in Ghana and 24% in Kenya in 1993 did not want more children and were not using any modern method. Most couples agreed with their family planning demand status. Around 75% of couples in Ghana had unmet need, no demand, or modern method use. Around 65% of couples in Kenya agreed on their family planning status. 34% of couples in 1988 and 36% in 1993 in Ghana had disagreements between spouses on family planning. 23% in 1989 and 25% in 1993 in Kenya did not agree. The figures on unmet demand varied between husbands and wives. Large percentages of women with no demand were married to husbands with unmet need: 22-41% in Kenya and Ghana during 1988-89, and 25-27% in 1993. Unmet demand increased in Ghana during the 1980s and declined in Kenya. Contraceptive prevalence rose from 27% to 33% in Kenya and from only 5% to 10% in Kenya. It is expected that as fertility transition advances, unmet need will decline and contraceptive prevalence will increase. Findings suggest that programs that encourage couple communication may facilitate the satisfaction of both partners' unmet need.

183.
DOCUMENT NUMBER: PIP/066633 ; IND/8018530
AUTHOR: Oni GA ; McCarthy J
TITLE: Family planning knowledge, attitudes and practices of males in Ilorin, Nigeria.
ABSTRACT:

A household survey of 1022 married men from Ilorin, the capital of Kwara State, Nigeria, was performed to obtain data on knowledge, attitude, and practice of contraception and marital communication on these issues. Awareness of at least 1 contraceptive method was virtually universal (97%), and very high even among men from poor areas (90%). Most men said they learned about contraception within the last 5 years from radio, television and newspapers. Ever-use, however, ranged from 6% in uneducated, to 53% in men with postsecondary education. Condoms were the most commonly used method, by 4-43%, rising with educational status. Other methods used were withdrawal by 14%, pill, IUD, injectables, or female sterilization by the wives of 7%. While 77% of the most highly educated men had discussed family planning with their wives, only 13% of the uneducated men had done so. Very few respondents stated that husbands alone should use contraceptives: 40-59% though that wives alone should use contraception. Very few men though that wives should make decisions about contraception, but 30-61%, depending on education, though that husbands should do so. 57% of the most educated men said that decisions should be made jointly. Discrepancies in the data may be due to lack of detail regarding the 18% of polygamous men, the question of nonmarital sexual activity, and lack of communication among spouses on actual contraceptive use. The results revealed better knowledge and acceptance of family planning by Nigerian men than the stereotype would suggest, but showed that men have knowledge gaps about the details of obtaining contraceptives, and still prefer that women take responsibility, while men control most decision-making.

202.
DOCUMENT NUMBER: PIP/125528
AUTHOR: Riley NE
TITLE: Gender, power, and population change.
ABSTRACT:

This report describes fertility and mortality trends in developing countries and discusses how gender is defined and measured in some countries. The discussion relies on case studies and country statistics to reveal how gender shapes the lives of all people in all societies. Gender is defined as the different roles women and men play in society. Gender is manifested in institutional structures, power relations, and culturally determined behavior. In no society do women and men share equal roles. The effects of inequality for women are manifested differently between countries. The 1994 International Conference on Population and Development in Cairo established the goal of gender equality. Educational enrollment and illiteracy are two measures of gender inequality that affect opportunities in society for advancement, power, and status. Girls are less likely to be enrolled in school than boys and more likely to have higher absenteeism rates. In China, absenteeism of girls is actually increasing under reforms. Marriage practices may devalue the investment in girls' education. Women experience different working conditions: they work longer hours, are paid less or not at all, and hold lower-status jobs. The exceptions are found in the Philippines and Brazil, where women hold more professional jobs than men. Women carry multiple responsibilities that consume time and prevent greater involvement in public life. Dowry and brideprice can constrain family relations. Women generally have fewer inheritance rights. Few women hold high-level public office positions or parliamentary seats. The extent to which gender inequality is reflected in demographic processes depends upon the gap in power in education, employment, and income. The relationship between gender and demographic processes is a central topic currently being researched.

209.
DOCUMENT NUMBER: PIP/133524
AUTHOR: Robey B ; Thomas E ; Baro S ; Kone S ; Kpakpo G
TITLE: Men: key partners in reproductive health. A report on the First Conference of French-Speaking African Countries on Men's Participation in Reproductive Health, March 30 -April 3, 1998, Ouagadougou, Burkina Faso.
ABSTRACT:

Although women are the focus of reproductive health services in Africa, men play key roles in fertility-related issues in their roles as individuals, family members, community decision-makers, and national leaders. The first conference of French-speaking African countries on men's participation in reproductive health was held in Ouagadougou, Burkina Faso, in 1998. Its aim was to overcome barriers to men's participation and build on decision-making traditions in the region. Research indicates that IEC campaigns can portray men as responsible partners rather than obstacles in reproductive health, encourage men to communicate with their partners and make decisions together, improve the image of contraceptives, promote sexually responsible behavior on the part of young men, and provide information and counseling to help men use services. To be effective, advocacy must identify audiences carefully, design messages based on audience research, and establish networks and coalitions among supporters. Conference participants recommended that national policy makers, program managers, technical support organizations, and international donors should enhance their efforts to promote men's participation in both their own reproductive health and that of their partners. The conference report presents country action plans, key recommendations, and information on the Men's Reproductive Health and Sports Initiative.

241.
DOCUMENT NUMBER: CPFH/17550cr984
AUTHOR: Swanson JM ; Forrest KA
TITLE: Men's reproductive health.
ABSTRACT:

This book provides information and guidelines for health professionals on men's reproductive health concerns. A broad definition of men's reproductive health is adopted encompassing the anatomy and physiology of the reproductive system itself, whether or not the individual wishes to reproduce; sexuality, sex roles, and the male self-image; sexual and reproductive health-related behaviors; and fertility control. Urology, traditionally being the medical specialty dealing with men's sexual and reproductive health concerns, offers an important contribution to the work. This book is also aimed at the generalist; it brings together in 1 volume information on men's needs collected from areas of urology, nursing, occupational health, family planning, sexuality, psychology and sociology. Although this book mainly addresses men's reproductive health, it does not exclude women entirely. The information presented in many instances concerns women as well as men, since sexual and reproductive health, by its nature, involves a partner. Sexual, contraceptive, and reproductive concerns, disorders, or discontentment may well have effects on partners, relationships and families. As part of the section on the male reproductive system and its disorders, the following areas are discussed: sexual development during adolescence; sexually transmitted diseases; male infertility; sexual and reproductive effects of pharmacologic agents; and environmental and occupational reproductive hazards. A social and historical update is presented on men and family planning. Condoms, withdrawal and vasectomy are discussed as contraceptive methods. Male socialization and sexual malaise, diagnosis and management of organic male sexual dysfunction, behavior treatment and counseling on disability illness and aging are given consideration in the final section.

243.
DOCUMENT NUMBER: PIP/105664
AUTHOR: Tangchonlatip K ; Ford N
TITLE: Husbands' and wives' attitudes towards husbands' use of prostitutes in Thailand.
ABSTRACT:

In order to develop programs for the prevention of HIV infections in Thailand, information was sought on the attitudes of husbands and wives towards husbands' patronizing of prostitutes. A survey using a multi-stage sampling design was carried out to collect data on socioeconomic and demographic variables as well as on the perceptions, attitudes, and sexual behavior of the couples. Eight focus group discussions of occupational groups were carried out among married men and woman. Approximately 400 couples or 800 respondents were interviewed. The project commenced in mid-June 1993 with pilot testing among 2 groups of male and female construction workers (3 in-depth interviews and 2 focus group discussions) followed by 2 group discussions and 2 in-depth interviews. The subsequent 2 focus group discussions were undertaken among 1 group of female government employees (white collar), 32-44 years old, and 1 group of male dock laborers (blue collar), 20-32 years old. All groups expressed the view that men were not wrong to visit prostitutes and that it was impossible to remove prostitution from Thai society. However, they deemed prostitution a repulsive occupation. Most women in the discussion groups believed that although their husbands had visited prostitutes before, they had stopped doing so after marriage. Both the male and female blue collar workers said that it was impossible for them to discuss sexual matters with their partner. In contrast, female white collar workers tended to discuss meeting their husbands' sexual needs, which they considered a way of preventing them from visiting prostitutes. Most wives did not mind if their husbands visited prostitutes, but they asked them to use condoms. The blue collar workers said that they had never used condoms, whereas some of the white collar females and a white collar male said that they had used condoms until they chose a permanent method of birth control.

251.
DOCUMENT NUMBER: PIP/142679
CORPORATE NAME: UNICEF
TITLE: The progress of nations, 1997.
ABSTRACT:

The Progress of Nations 1997 is an annual scorecard of the social health of nations published annually by the UN Children's Fund. It records achievements in the form of statistics measuring the fulfillment of fundamental human needs. Discussed in the report are issues on the well-being of the people, specifically health and education, quality of life, participation in decision-making, water and sanitation, progress for women, employment, and the rights and welfare of children. Progress, regression and disparity among nations in the important indices of well being are measured in yearly statistical data. Surveys and follow-up studies on areas whose ways of living are difficult to measure are also presented. The social indicators and statistical profiles of the less populous countries are also presented. Additionally, issues such as violence against women and girls, the treatment of young offenders by justice systems, and unethical practices to market infant formula as an incursion into breastfeeding are highlighted. Each country is assessed in terms of its degree of approach to fulfillment of the goals. The Progress of Nations helps people who are in search of information by providing data on the social conditions of the people with special focus on the well-being of the children.

276.
DOCUMENT NUMBER: PIP/131860
AUTHOR: Wegner MN ; Landry E ; Wilkinson D ; Tzanis J
TITLE: Men as partners in reproductive health: from issues to action.
ABSTRACT:

A growing understanding in the international public health community of the role of gender in reproductive health has helped to make reproductive health professionals aware of the need to develop creative strategies to reach men. While pilot programs and initiatives for including men in family planning and other reproductive health services have existed for more than 20 years in a number of countries, only few are well-established and even fewer have been fully integrated into countries' health care systems. Program managers and policymakers in many countries have routinely assumed that men are not interested in or supportive of family planning and contraceptive use, even though recent research indicates that many men are. Research also indicates that many women want men to become more involved in reproductive health decision-making and activities. 145 men and women from more than a dozen mainly African and Asian countries met in Mombasa, Kenya, in May 1997 to share their experiences with, knowledge of, and concerns about fostering men's involvement in reproductive health care. Conference participants developed and presented plans to create programs for men in their countries with the goal of integrating them into existing national reproductive health systems.

292.
DOCUMENT NUMBER: IND/8013763 ; PIP/067975
AUTHOR: Worth D
TITLE: Sexual decision-making and AIDS: why condom promotion among vulnerable women is likely to fail.
ABSTRACT:

This article examines the reasons for resistance to condom use among high-risk women (primarily intravenous drug users and/or the sexual partners of intravenous drug users) in 2 New York City AIDS (acquired immunodeficiency syndrome) prevention programs. The data collected indicated that a lack of economic, social, cultural, sexual, and technological options combine to lead vulnerable women to concentrate on addressing the more immediate risks in their lives: poverty, homelessness, and the frequent disruption of socioeconomic support systems. Resistance to condom use was also found to be related to its negative associations (promiscuity, for instance). The process by which decisions are made about using condoms (and other contraceptives) is related to a complex mixture of social, economic, and cultural influences that promote the role of motherhood for a woman, even when she knows she might already be infected with human immunodeficiency virus (HIV). The implications of these findings have far-reaching effects, and the socioeconomic context of these women's lives, as well as imbalances in power in the relationships between the women their male partners, are replicated in many communities where AIDS is already present. (author's)