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INSIGHTS LEARNED ABOUT INVOLVING MEN IN FAMILY PLANNING
By Rebecka Lundgren, PhD, Director of Research | Institute for Reproductive
Health at Georgetown University – April 15, 2015
Engaging men in family planning is a personal issue. Some of us are passionately on board, and others find it
uncomfortable, risky or inequitable. In 1994, I reported to work in Honduras
for my first real job in family planning the same week as the landmark
International Conference on Population and Development (ICPD). The call to
action from ICPD recommended programs and policies to enable men to play a more
active role in reproductive decisions, including contraceptive method choice
and use. This reverberated globally, reaching even tiny Honduras, the
only country that did not sign the agreement.
Not long afterwards, I found myself in a dim rural school
room, crowded with farmers dressed in boots and cowboy hats, discussing how to
address sexual and reproductive issues in their agroforestry program. When I
mentioned to my supervisor how uncomfortable I felt in a room full of men
discussing family planning, he responded, “I kind of like it.” That day marked
the beginning of a journey that taught me two things: (1) sometimes the
professional is personal, and vice versa, and (2) ongoing reflection on the
role of gender in our lives and our work, accompanied by rigorous research to
inform our programs, is important.
Since then, I’ve been privileged to participate in the
development and introduction of the fertility awareness-based Standard Days Method ® (SDM). Because
SDM requires the cooperation of men, its introduction in 2001 created an
opportunity: test strategies for engaging men in family planning service
delivery, while promoting male participation in contraceptive use. Over the course
of this research, I’ve developed a list of things I know for sure about
engaging men in family planning:
1. Check your assumptions. Start by examining your own assumptions about men and
family planning, but don’t stop there. What do you want to get out of it? Do
you view men as a means to an end or individuals with their own needs? Are men
obstacles or partners in your worldview? Are they careless or caring? Once you
understand what you bring to the table, find out what the women and men you
serve want. Don’t let your own assumptions and feelings get in the way of
programs that meet their needs. While sharing SDM as an opportunity to reach
out to men, I found many disagreed, instead viewing the need for male
participation as a major disadvantage. In fact, decision makers often cited
this as the reason they could not support including SDM in their norms,
policies or budgets. They advised me with authority that their men were
not interested in family planning, could not behave responsibly and really had
no relevant role to play in the family planning domain. But subsequent research
disproved assumptions. Indeed, many women would like their partners to be more
involved, and many men support family planning.
2. Understand power dynamics. Tackling male involvement in family planning requires
applying a contextualized understanding of power and gender role dynamics.
Family planning programs usually give little attention to the way that societal
and cultural expectations of what it means to be a man or how gender-related
power dynamics impact modern method use. But gender norms affect couple’s ability to discuss
and make informed decisions about family planning and influence
access to information and services. Consider how your program contributes to
efforts to transform gender roles and promote more gender-equitable
relationships between men and women.
3. Own the reality: for better or for worse, men are
involved. When it comes to
family planning (and sex), men are involved in one way or another –
whether positively or negatively. Gender synchronized approaches recognize this
reality by reaching out to men as well as women the way they live their lives,
sometimes apart, sometimes together, but always in relation to each other.
4. Men are underserved, yet many want to be engaged fathers
and supportive partners. The
global evidence is clear –family planning programs rarely reach men, and many
men desire greater involvement in reproductive health. They need information
and the opportunity to form positive attitudes and communication skills.
However, there is limited space for men in most family planning programs. Some
providers are uncomfortable with male clients and fail to welcome them or
provide information.
5. Men are family planning clients and users in their own
right. Men have their own needs and
preferences and particular ways of accessing information and services. There
are many effective strategies for reaching men. One approach that does NOT
work: expecting them to have the same needs and preferences as their wives and
girlfriends.
6. Don’t count men out from health services. Offer male and couple methods (like condoms, vasectomy,
SDM). Although men don’t often go to clinics for family planning
services, they DO show up if something is offered that they want. It is also
common for men to accompany their partners to the health center. On a number of
occasions when family planning providers have told me that it is impossible for
them to reach men, a quick look in the waiting room or on the veranda revealed
many men waiting for their wives. SDM introduction research in four different
program settings found that 30% to 90% of the husbands
of women using SDM had been counseled by a provider.
7. Providers need to think about social norms, too. Provider reflection on the influence of social norms and
power dynamics on fertility and family planning use is essential. SDM
introduction studies found that training providers to offer SDM
is one way to challenge assumptions about the role of men in family planning,
increasing their comfort and skills addressing issues such as partner
communication, sexual autonomy, gender-based violence, alcohol use, and
STI-HIV/AIDS, many of which are rarely addressed during family planning
counseling. Providers told me that before they began offering SDM, they had
never given much thought to involving men; others considered it a fruitless or
impossible task. Research from India and Guatemala
showed that once providers began offering condoms as part of SDM integration,
they felt more comfortable offering them to all of their clients.
8. Address men even when they are not present. There are a variety of ways to involve men without
requiring direct contact with the provider, which can be challenging in many
settings. Initiatives to incorporate SDM into family planning and community
development programs attempted to explore partner dynamics and address relationship
issues related to family planning through strategies that did not require
direct interaction with services. These included discussing couple-related
issues and coaching women to negotiate with their partners during family
planning counseling sessions. Some programs also provided women with take-home
materials for their partners. Other strategies included targeted male
involvement messages in posters, flyers, radio programs and wall paintings.
9. Reach men where they are, through their networks. It may not be easy to reach men in the clinic, but they
can be found in the work place, community and at home, especially during
weekends and evenings. This requires organizational commitment to monitor and
reward efforts to reach men and offer flexible work hours. Research from many
settings around the world suggests that men receive much of their information
and influence through peer networks. SDM programs capitalized on this
understanding by sharing information and sparking
discussion in agricultural cooperatives, microfinance groups and
community development committees.
10. Men can and do participate positively in family
planning. Men learn about contraception and
talk about it with their partners. They can also provide resources to obtain a
method and mediate family/community disapproval. In the case of SDM, men help
keep track of the fertile days, purchase CycleBeads or condoms and use condoms
or abstain during fertile days. As a woman in El Salvador told me, “I
think the best thing about the SDM is that the husband and wife can both
participate. With the other methods, it’s the woman who does everything.”
11. When done right, involving men in family planning yields
huge benefits for women and families. Research on SDM suggests
that interventions that involve men can lead to more gender equitable
attitudes, better couple communication and improved contraceptive use and
continuation. Many men and women reported that SDM use had a positive influence
on their relationship noting that they now discuss intimate topics, find
greater affection, understanding and sexual pleasure.