“IN FAMILY Planning, men are like Voldemort in ‘Harry Potter,’ mostly unmentioned. Going forward, instead of saying ‘women, children and adolescents,’ it would be more efficient to simply say ‘not men.’”
That’s the observation of Jonathan Stack, who took part in the just-concluded International Conference on Family Planning held in Bali, as an organizer of activities marking World Vasectomy Day. Stack, a filmmaker newly converted to the world of family planning and reproductive health and rights, may have been speaking tongue-in-cheek. But he had a point.
“Male involvement” has long been mentioned as a sought-after goal, a “holy grail” of family planning, where policymakers and planners bemoan the lack or minimal participation of men and boys in an issue where they are, at the very least, half-involved.
Women and girls, after all, do not get pregnant by themselves. And yet it seems that much of the burden is expected to be borne by them, and while men can (and often do) walk away from a single sexual encounter with little care for results, their female partners must face more far-reaching consequences. For one, there is a possible infection (something her partner could be afflicted with, too), pregnancy (if the sex occurs during a fertile period), nine months of bearing the “fruit of conception,” the ordeal of birthing and its many side effects, and, sad to note, much of the responsibility of rearing and nurturing the child.
And yet, says Emily Jane Sullivan (presenting a study on the “motivations and barriers” that men in low- and middle-income countries face in deciding whether or not to undergo a vasectomy), men do want to take more responsibility in planning and managing their families. But they face numerous barriers ranging from lack of information to myths and misconceptions surrounding vasectomy, religious beliefs and—believe it or not—opposition from their wives and partners.
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“FEMALE sterilization is one of the most common methods of family planning around the world,” states Sullivan, and yet “vasectomy rates for men rarely reach over one percent” of any given population.
In fact, there are only six countries that report vasectomy as the most common method of family planning, with Canada topping the list. (Another reason for crushing on “Apec hottie” Canadian Prime Minister Justin Trudeau, all of us women at the seminar agreed.)
Indeed, ever since 1980 when “non-scalpel vasectomy” (NSV) was successfully tested and developed in China, vasectomy has become an “almost painless” procedure (for which the only medical intervention necessary, say doctors who have performed NSV, is a Band-aid over the puncture site). Indeed, say health authorities, NSV is “20 times safer” for a man than ligation is for a woman. It is also cheaper, including less “down time” for the patient (who can walk away on his own after an hour or so), while providing the same number of “couple years protection” as ligation would. Although it is possible to “reverse” both vasectomy and ligation, the operation necessary for it would be far more complicated, expensive and risky; so individuals and couples are counseled to think long and carefully before undergoing these “permanent” methods.
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BUT “male involvement” in family planning is not confined to simply undergoing a vasectomy (or using a condom).
In a workshop called “It Takes Two,” on couple decision-making and family planning acceptability, speakers noted how couples, even those already affianced or in the early months (or years) of marriage, rarely talked about their family plans or preferences.
Usually, said Foglabenchi Lily Haritu, who hails from Cameroon but was presenting a study on couples from Madhya Pradesh in India, “spousal communication is rare and triggered by the crisis of an unplanned pregnancy.” Only then, her subjects told her, would husband and wife begin discussing their family planning preferences and options. The discussion, she added, is usually initiated by the man, for if a woman would open up the topic, “that is considered a perversion,” or else trigger suspicions of infidelity.
And in case of a conflict or clash of opinions, they found that the standoff would most commonly “be resolved by the wife submitting to the (decision of the) husband.”
Jagranath Behera, presenting a study on “encouraging young married women to improve intra-spousal communication” in rural India, said they found that when there was “communication between spouses, it was more likely that they would be using contraception.”
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CLEARLY, both field workers and clinicians should work harder to “rope in” the men into the discussion and practice of family planning.
And yet, in the desire to get more men involved, health authorities may end up marginalizing even more already marginalized and silenced women.
A friend reports being “scandalized” by a report from another workshop in which it was disclosed that women who come to a health center accompanied by their husbands or partners receive greater priority from the center personnel and are indeed pushed to the head of the line. “But what of the women whose husbands could not or would not accompany them?” she asked. “Should they be penalized for having uncooperative husbands or partners?” Indeed, shouldn’t they be accorded even higher priority given the barriers they had to hurdle before going to the health center?
There is also the possibility that some women may be “reading” their husbands wrong, thinking or assuming that the men are against family planning—when in truth they believe in it and would encourage their wives to practice it or, who knows, may even be willing to undergo a vasectomy if told the full, unvarnished facts.