Involving men in family planning

“Male Involvement” has long been a buzz-word (or “buzz-term”) in family planning circles. Often it is paired with the word “increasing,” that is, assuming that male involvement in family planning – either by encouraging their wives or partners to use contraception, paying for the methods, or even assuming responsibility themselves – is deficient if not non-existent.

The question is why so many men refuse or are unable to get involved in family planning, either in decision-making or enabling their partners to use contraception. As for using condoms or undergoing a vasectomy, or cooperating with their partners on natural family planning – well, let’s just say hope springs eternal.

Some answers, though, were forthcoming during the Second International Conference on Family Planning, held late last month in Dakar, Senegal. At a workshop on “Men Behind Family Planning,” a speaker from Nigeria explained that while men have “high awareness” of the need for and importance of family planning, they have “poor knowledge” of the various modern methods of family planning and how these work. The speaker, who assisted in a project on working with men in Nigerian villages, also found the men “unwilling to use family planning” mainly because they were apprehensive and insecure, and didn’t know how exactly they fit in the scenario.

The project intervention among village families included training in spousal communications, encouraging spouses to discuss health issues and engage in “joint decision-making” in choosing the method that best worked for them.

One male workshop participant then stood up and said one part of the problem is that “there are not enough options for men.” “We can only choose between using condoms or having a vasectomy, and I tell you, both options are not attractive to me,” he said. “But if only they would come up with a pill for men, I would take it at once.”

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Another presentor on “Gender Norms and Family Planning in Tanzania,” presented the findings of the “Champion Project,” a detailed survey on men’s attitudes toward gender equity and planning their families.

The researchers found that 72 percent of those surveyed would be “very comfortable” with being counseled on family planning with their partners; while 75 percent stated that it was “very important” for men to be part of family planning. “The more a man believed in gender equality, the more likely it was for him to believe in taking part in family planning,” the researcher said. But two out of every five respondents said they “believed that health facilities do not welcome men,” with some reporting that health workers were unaccommodating, if not hostile, to the men among their women and children clients.

This is unfortunate, given the generally positive results seen when men are actually encouraged to take active part in promoting the health of family members.

Mahboob E-Alam, of Engenderhealth, Bangladesh, spoke on a project to increase the use of vasectomy in their country. While Bangladesh has a pretty high contraceptive prevalence rate of 56 percent, only 5 percent of method users are men. This was unfortunate, E-Alam said, since studies have shown that “husbands play an important role in family planning decisions,” since a disapproving or indifferent husband can actually discourage a woman from using a family planning method.

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E-alam engaged men who had gone through a vasectomy to act as “champions” of the method among other men, saying that men often felt “scared and isolated” after undergoing the procedure. What he and his team did was to gather “satisfied clients” and glean insights into what made them satisfied. Some important factors: a skilled surgeon, prompt and effective management of side effects, and effective client follow-up.

The “champions” turned out to be excellent promoters of vasectomy, using themselves as examples, and engaging men in the neighborhood or in community centers in discussions about their family planning needs and health concerns. The group later found that the “champions” were able to refer an average of two or three clients a month to undergo a vasectomy. The program is now being applied in 16 districts of rural Bangladesh.

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The value of engaging men not just in family planning but even in female genital cutting was brought home during a visit to the village of Keur Simbara in Senegal. Asked what men thought of the movement to bring an end to FGC, a man in a bright yellow tunic stood up and introduced himself as Menadou Konate, 54, a radio announcer.

Previously, he said, he didn’t believe there was any harm done by cutting. “People said that women who have been cut could not have many children, but my two wives have been cut, and they have given me many children. They also said that women who have been cut do not enjoy any sexual pleasure. But they tell me that if I don’t visit them for two days, they will cry.”

But after undergoing training in human rights, including women’s rights, Menadou began to change his mind. He also accompanied one wife to the health center and there the midwife explained the injury done by cutting and the health risks a scarred or wounded cervix posed to a woman during delivery.

“After being educated on the right to health of women, and of the dangers posed by cutting, I could no longer support the practice,” Menadou said. He then began talking to his men friends and went around talking to various groups about the risks of cutting. “When I began, talking about cutting was taboo, people would get upset and ask me to stop. But the more we talked, the more we lifted the veil that concealed the practice of cutting, and now we are able to discuss it openly.”