CONTENTS
HIGHLIGHTSPopulation Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA
July, 1994 |
Encouraging Male Responsibility
Women, too, want men to have information. In Chile women asked that men be allowed to come to the classes at the clinic. One woman said that her husband did not always believe her and that she would "love to have him come to some of the talks" (344). Men need information about contraceptive methods for women as well as about those for men. Well-informed men can use a method themselves or support their partners in using a method. Well-informed men also can talk with their wives and cooperate in assessing their needs and choosing a family planning method. Men especially need information about sexually transmitted diseases since men play a big role in the spread of sexually transmitted diseases including AIDS (23). Although there is much variation among cultures, except for female prostitutes men are likely to have more sexual partners than women. Men have more control over condom use. Men are more likely to control the frequency of sexual relations and the possibility of abstinence within a relationship. To reduce risk, men can: (1) reduce the number of sexual partners, (2) use condoms, and/or (3) practice sexual fidelity or abstinence (271). Encouraging communication between spouses. Men can support women's choices better when couples can talk about reproductive health and family planning (see Chapter 5, Encouraging Men's Cooperation). But surveys show that even men who approve of family planning do not always discuss it with their wives. For example, in Burundi 94% of surveyed men approved of contraceptive use, but only 48% had discussed it with their wives in the preceding year (see Table 7). Family planning communication campaigns can change men's role in contraceptive decision-making. The Zimbabwe Male Motivation Project in 1988 and 1989 sought to inform men, promote more favorable attitudes, increase contraceptive use, and promote male involvement and joint decision-making. The project appeared to increase condom use particularly. Its impact on men's attitudes about decision-making was ambiguous, however. Men who heard the campaign radio soap opera, attended a lecture, or saw a pamphlet were more likely to say that the man alone should make the decision to practice family planning. At the same time, these men also were more likely to say that the couple should decide jointly how many children to have. Researchers concluded that future campaigns should put more emphasis on joint decision-making and discussion between spouses (254). Some family planning programs welcome husbands and wives who seek family planning counseling and services together. While counseling a couple, a provider can encourage the woman to ask her own questions and express her own opinions. The provider also can encourage the man to understand and respect the woman's opinions and choices. Program managers seeking to improve women's situation need to make clear, however, that the program also welcomes women and men who come alone, does not require a husband's permission before serving a woman, and keeps the names of clients and all information about clients confidential, even from spouses. Designing convenient, appealing services. Men cannot share responsibility for reproductive health and family planning if services and information do not reach them. Few men go to facilities that offer services primarily for women. Men must be reached in other ways. There are five main approaches:
In most developing countries neither condoms nor vasectomies are widely used. Just under 5% of married couples in developing countries use each of these methods. Condoms probably are more widely used outside marriage than in marriage, however, and use may be growing because of concern about AIDS (190). Neglect by policy-makers and providers may help explain the low prevalence of vasectomy. Where the procedure is accessible and promoted, men use it. For example, in Colombia the annual number of vasectomies performed by Profamilia rose by 77%, to more than 1,000, after the organization opened its first two men-only clinics in 1985. In 1991 Profamilia's eight men-only clinics performed about 5,000 vasectomies (189). Promoting male methods and men's services. Promoting men's family planning methods and services boosts their use. For example, in Turkey a social marketing campaign to promote condoms involved a television comedy, video tapes, sponsorship of a soccer team and tournament, billboards, and gift packs to medical schools (377). The program sold 4.5 million condoms in 1991, its first year of sales (319). Men's response suggests that some men are willing to take responsibility for contraception if programs make the effort to reach out to them. Social marketing programs have been directed more to men than to women. They have emphasized the economic value of small families. They also depict men as the protectors of their families (314). While most promotion has touted condoms, some social marketing programs now address advertisements for oral contraceptives to men as members of the "contraceptive decision-making team." In Morocco radio and print advertising, display boxes, and posters depict condoms as offering men the opportunity to share responsibility for reproductive decision-making (314). Promotion also has brought men to clinics. In Colombia Profamilia has promoted its men's services in the mass media and through field workers (189). In Brazil Pro-Pater increased the number of vasectomies performed monthly in 1989 at its Sao Paulo clinic by nearly 80% with television spots, billboards proclaiming that "vasectomy is an act of love," and resulting press coverage (171). Promoting positive images. Family planning communication can depict new images of men as well as of women (see side-bar, Competent Women and Caring Men). Also mass-media depictions of couples discussing family planning and making joint decisions suggest to the public that such discussions are appropriate. They also suggest to both men and women how to discuss family planning and sex and can even provide an occasion to start discussion. Men's organizations are involved, too. In Jamaica, Fathers Incorporated assists men who want to help children. The group points out that in the past men have been seen solely as providers of goods for their children. To change that image, group members are holding workshops to promote men as care-givers as well (8). |