Men and Boys
Research has long shown gaps in understanding of men's sexual and reproductive health and the most effective ways to reach out to them to improve their health and to engage them in supporting their wives' and partners' health.
The ICPD Programme of Action noted, “Men play a key role in bringing about gender equality since, in most societies, men exercise preponderant power in nearly every sphere of life, ranging from personal decisions regarding the size of families to the policy and programme decisions taken at all levels of government. It is essential to improve communication between men and women on issues of sexuality and reproductive health, and the understanding of their joint responsibilities, so that men and women are equal partners in public and private life.”
Men are considered supportive if they: (1) agree that a wife or partner is justified in asking her husband or partner to use a condom if he has an STI, (2) disagree that intimate partner violence is justified for any reason, (3) disagree that contraceptive use is women’s business and men do not need to be involved in contraceptive decision-making, and (4) disagree that women who use contraception might become promiscuous. The proportion of men who strongly support their partners’ sexual and reproductive health and empowerment—ie, they responded accordingly to all four statements—ranges from 12% in Lesotho to 77% in Rwanda.
Women continue to shoulder the responsibility of contraceptive use and use of male contraceptive methods has not changed much since the mid-1990s. One barrier is the few male options available, which could be addressed through greater investment in new methods for men.
Acknowledgment and expansion of men’s role in maternal and child health are also key. Given that men are often gatekeepers for women’s access to services, involving men during pregnancy, childbirth, and onward (when women want) can potentially increase gender equality and male support for women’s SRHR.
Programmes that engage men and boys
Promising programmes have been piloted in diverse country settings to promote men’s sexual and reproductive health and increase their support for their partners’ health. A WHO assessment of interventions with men related to sexual and reproductive health, maternal and child health, gender-based violence, fatherhood, and HIV and AIDS found that such interventions elicited important changes in men’s attitudes and behaviours, despite being of short duration.
Some of the more successful programmes work with individuals, groups, and communities to change norms about what it means to be men, to cultivate and reinforce the notion that masculinity can be associated with caregiving, to raise awareness about reproductive health, and to encourage men to seek medical care when needed.
The growing attention to men’s roles as fathers is promising, as evidence suggests that men who are more involved in their children’s lives are more likely to pay attention to reproductive health issues. Brazil’s Prenatal Programme for Fathers and Men’s Health Initiative, developed as part of Brazil’s national health-care policy for men, offers examples of how simple interventions, such as training health professionals (including online training), offering men and fathers opportunities to attend to their own health needs (including HIV testing), and giving women the option to have their partners present at birth, can result in large numbers of men accessing services, and women’s increased sense of safety and support during the antenatal and birth process.
Some might view investing in men’s sexual and reproductive health needs as tantamount to taking from the few funds allocated to meet women’s needs. Some programmes have avoided this binary view and instead adopt a gender-synchronised or gender relational approach that engages men, women, girls, and boys of all sexual orientations and gender identities to challenge the rigid constructions of masculinity and femininity that are harmful to health and wellbeing.
Under this approach, programmes targeting men are held accountable for their effect on women, women-centred programmes seek ways to constructively engage men, and some programmes engage both (ie, take a couples approach) from their inception. Programmes that engage both work toward mutual understanding and shared goals; they seek to equalise the balance of power between women and men through recognition of how men and women reinforce notions of masculinity and femininity and therefore need to be engaged in reconstructing these roles.
Accelerate progress – sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission, published May 9 2018