Transcript moduleII men family planning

Men, Family Planning and
Reproductive Health
Richard Lord
Men’s Share of Responsibility
for Family Planning


What percentage of
worldwide contraceptive
use involves male
methods?
Is this percentage
increasing or
decreasing?
Jane Turner
Male Methods: 26% of
Global Contraceptive Use
Female
sterilization
Male
methods:
33%
Other female
methods
5%
Withdrawal
and
Abstinence: 12%
26%
Vasectomy: 7%
22%
14%
IUD
Oral contraceptives
Source: United Nations, 1998.
Condoms: 7%
Use of Male Methods Declining
as Proportion of Overall Use
40
35
1987
30
1998
25
20
15
10
5
0
Global use of
male methods
Source: United Nations, 1987, 1998.
Global use of
vasectomy
Global use of
condoms
Gender Imbalance:
Knowledge/Use of Sterilization
Use of Sterilization in 10 Countries with Highest Levels of Vasectomy
Australia
Belgium
Canada
China
Republic of Korea
Nepal
Female Sterilization
Netherlands
Vasectomy
New Zealand
United Kingdom
United States
0
10
20
30
Percent of Married Couples of Reproductive Age
Source: United Nations, 1998.
40
Why Involve Men
in Family Planning?
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Male responsibility in reproductive health
issues is essential to decreasing HIV/AIDS
and other STIs
Men play dominant role in decision-making
Global contraceptive use has reached
a plateau
Funds for family planning have declined
Husband Disapproval
Major Factor in Unmet Need

3 of 7 pregnancies in the world are
unintended

Photo??
USAgency for International Development
Sources: Bongaarts, Stud Fam Plann 1995;26(2).
Contraceptive use
and continuation
are higher when
husband and wife
agree
Couple Counseling Results
in Better Continuation Rates
Percentage of couples
contracepting after 12 months
35
30
25
20
33%
15
10
17%
5
0
Husband
involved in
counseling
Husband NOT
involved in
counseling
Source: Terefe, Am J Public Health 1993;83(11).
One-year
contraceptive
continuation
twice as high
when husband
counseled with
wife (Ethiopia)
Barriers to Men’s Use
of Contraception

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
Lack of accurate information
Provider bias
against male
methods
Limited access
to services
Beryl Goldberg
Barriers to Men’s Use
of Contraception (cont.)
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
S. Khalaf/Family Health International
Lack of provider training
Men’s misunderstanding
of correct use
Limited range of male
methods
Why Some Men
Choose Vasectomy
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Simpler, safer and less expensive than
female sterilization
Love for wife and concern for her health
Desire to take responsibility in family
planning
Greater sexual enjoyment by eliminating
worries about unwanted pregnancy
Condoms: Dual Protection
Against Pregnancy and STIs


Can be highly effective
in protecting against
pregnancy AND
preventing HIV/STIs
Should be promoted in
family planning, HIV
prevention, and other
programs
Men’s Public Approval
versus Private Use



Men report high knowledge and support
of contraception even where use is low
Public approval different than private use
Programs need to change attitudes and
practices
 desire for more children
 belief that religion prohibits use
 desire for control over wife
Sources: Drennan, Popul Rep 1998;J(46); Wilkinson, Man-Myths, AVSC International, 1998.
Creative Outreach Efforts
Reach Men in Community
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

R. Witlin/World Bank
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
Sports events
Workplaces
Small businesses
Truck stops
Military bases
Media
Community Education
Successfully Involves Men
Honduras:
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Agricultural agents and community
volunteers reached farmers with reproductive
health and family planning information
Interactive materials for low-literacy clients
stressed importance of birth spacing for child
health
Family planning increased from 37 to 55%
Clinic-based
Strategies for Men
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Stand-alone
male clinics
Separate
hours/entrances
for men
Integrated services
Male or female
counselors
Debbie Rogow
Men Respond Positively to Broad
Reproductive Health Services
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Family planning
STI/HIV prevention
and treatment
Infertility
Sexual dysfunctions
Reproductive cancers
Photo??
W. Graham/World Bank
Involving Men in Family Planning Ca
Promote Gender Equit
Women want their partners involved:


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To support their own contraceptive use
To share responsibility for contraception
and protecting health
To increase men’s understanding of
reproductive health issues
Assure That Women’s
Reproductive Health Needs
Remain Primary Focus
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Encouraging men to take control of fertility
can disempower women
In Zimbabwe, men who wanted sole
responsibility for decision-making
rose from 27 to 37%
Positioning men as responsible and caring
can be productive
Source: Kim, Involving Men in Family Planning, Johns Hopkins CCP, 1996.