I.

Introduction

I. Introduction
In the last few years more attention has been focusing on the issue of male
involvement1 in reproductive health, and as its importance is acknowledged, more
programmes are trying to incorporate it as one of their components. However, existing
programmes tend to share potentially problematic aspects: first, male components are
usually limited to male methods of family planning, only one element of reproductive
health. Second, they tend to address men only, in a similar way as the old programmes
addressed women only without taking into account their gender relations. A focus on
men only is as inadequate as a focus on women only because it fails to take into
account the way in which many decisions are made and the context that influences
them. Third, they tend to be grounded on a negative premise, men's irresponsibility,
rather than a positive one of promotion of men's rights. Fourth, by viewing men as a
route for women's well-being they instrumentalize men and fail to address men's
needs.
1
 The language of "male responsibility" and "male involvement" has been recently
criticised as judgmental, for it suggests that men are irresponsible or uninvolved.
Moreover, at the macro level, men are sometimes seen as being too involved in
reproductive health, for in many places they are in charge of making the important
decisions regarding policy and the provision of services (Verme, Wegner and
Jerzowski, 1996). A suggestion that it would be more appropriate to use the phrase
"men as partners", for it is considered more neutral and evokes more balanced roles
has been dismissed as trying to ascribe universality to a western concept.

These problematic aspects emanate from:

· A female bias in the gender literature, and the consequent lack of knowledge

of the male side of gender The gender literature tends to be by women on
women.

· The traditional inability to set up programmes on the understanding of gender

relations, disregarding the power relations and the gender roles that influence
decision-making related to reproductive health.
 · The way in which programmes were traditionally institutionalized, through
the maternal and child health (MCH) facility of the Ministry of Health, that
focused on women (and children, in the traditional dyed) and barred men from
access to services and from exercising a number of responsibilities in the area
of reproductive health of their wives and health of their children.

· Commonly held myths and erroneous assumptions about men's views of

family planning, sexuality and health.

· The lack of data to understand male perspectives and the extent of their

involvement in reproductive health issues. The surveys most relied upon for
reproductive health (RH) programmes usually ask questions only of women,
assuming that they are the ones who make the decisions regarding reproduction
and that the men are either not involved or marginally involved.

While it is commonly agreed that programmes that aim to improve both women's and
men's reproductive health should incorporate men, it is important to keep in mind a
potential danger for women: when not adequately focused, the result of the
programme may be the translation of the locus of control from women to men in
reproductive health issues, with the consequent loss of women's autonomy in an area
that is seen by many as one of the few in which women can effectively exercise
decision-making.

Given that the aim of the programmes is to improve the reproductive health of both
women and men, better programmes have to develop concrete strategies to understand
and incorporate the male perspective and male needs in the same way as attention is
given to women's perspectives and needs. In order to avoid a shift in the locus of
control, programmes should aim to incorporate adequate male involvement, not
only more involvement. Thus programmes should be based on the understanding of
gender dynamics, on how decisions are made and implemented, on the changing
needs of both genders and their interaction. Much more needs to be known about the
relations between men and women in the particular contexts where programmes will
be set up in order to make an effective change. This knowledge will aid in the
definition of what is meant by adequate involvement (it can be defined from the point
of view of the women, the men or the programme).

Two issues merit consideration regarding the resources needed to cater to men's
reproductive health needs: in the first place, the more services are set up based on an
understanding of the underlying gender relations, the more they will
benefit both women and men. When adequately set up, services for men will not only
address their own needs, but will contribute to relieve women of one of their many
burdens. Thus, services for men do not compete with the already scanty resources
available for women's services. Secondly, as discussed in this paper, services for men
are not necessarily expensive.

The focus on men in this paper does not mean that a gender approach is not used.
Conversely, the emphasis on women in much of the gender literature has left male
perspectives as the missing link to a true gender approach. Far from arguing that the
focus should be on men and women separately, we argue for the need to base our
strategies, be they oriented to men or to women, on the analysis of gender interactions
and needs. This paper is meant to help strengthen a component of a broader and more
comprehensive gender approach.

In this paper our aim is to look into the socio-cultural aspects that shape male
perspectives, based on the socially-embedded gender relations in the different stages
of the life cycle, and to use this knowledge to suggest ways to increase men's
involvement in reproductive health issues and to improve services. Within this
context, information, education and communication (IEC) and advocacy strategies are
also suggested. Finally, some recommendations are given for helping UNFPA
Country Programmes better address male involvement in reproductive health.

ICPD and male involvement

The ICPD devoted an entire section of its Programme of Action to male involvement and
responsibility (Chapter IV, section C). In brief, it calls for an understanding of men's and women's
joint responsibilities, so that they become equal partners in public and private life, and to
encourage and enable men to take responsibility for their sexual and reproductive behaviour. This
is to be achieved through the following actions:

- The promotion and encouragement, by Governments, of the equal participation of

women and men in all areas of family and household responsibilities, including family
planning, child-rearing and housework.

- The emphasis of men's shared responsibility and the promotion of their active
involvement in responsible parenthood, sexual and reproductive behaviour, including
family planning; prenatal, maternal and child health; prevention of sexually transmitted
diseases, including HIV; prevention of unwanted and high-risk pregnancies; shared
control and contribution to family income, children's education, health and nutrition; and
recognition and promotion of the equal value of children of both sexes.

- Ensuring that children receive appropriate financial support from their parents by, among
other measures, enforcing child- support laws.

- The promotion of the full involvement of men in family life arid the full integration of
women in community life.
In other sections of the PoA, mention is made of the need to develop new methods for regulation
of fertility for men and to carry out special research on factors inhibiting male participation in
family planning in order to enhance their involvement and responsibility in this aspect (12.14.).
Also, chapter 7 states the need to develop innovative programmes on RH information,
counselIing and services for men and adolescents such that they `both educate and enable men to
share more equally in family planning and in domestic and child-rearing responsibilities and to
accept the major responsibility for the prevention of sexually transmitted diseases." (7.8). Young
men should also be educated to "respect women's self-determination and to share responsibility
with women in matters of sexuality and reproduction" (7.41)

What should services for sexual and reproductive health of men include?

These may include the following activities: family planning including vasectomy;
fertility evaluation and infertility; information, education and communication (IEC)
including counselling; prevention and treatment of STDs and AIDS; sexuality and
sexual dysfunction; urologic conditions; screening for cancer; substance abuse and
mental health needs; referral to other services, both medical and social; prevention of
gender-based violence; promotion of responsible attitudes towards sexuality and
sharing the concerns for pregnancy support, parenting, including identification of
early signs of diseases for children, such as malnutrition. The priorities for programme
components are to be determined according to local needs.

The objectives for men's services may be:

To improve the sexual and reproductive health of both men and women by addressing
men's issues, to meet the sexual and reproductive needs of men including
contraceptive needs; to improve communication and encourage discussion between
partners regarding their sexual and reproductive health; and/or to determine men's
priorities.

WHY INVOLVE MEN?

1. Men have their own sexual and reproductive health concerns and needs which are not always
met. The focus on male involvement only as a means to improve women's reproductive health
may cause an oversight of men's own reproductive health needs. Due to their ascribed gender
roles, men tend to have little knowledge about their own physiology and health including sexual
and reproductive health.

2. Men's health status and behaviour affect women's health and reproductive health. Involving
them increases their awareness, acceptance and support to their partners' needs, choices and
rights. In terms of contraception, for example, it means encouraging them to give more support to
their partners who use female-dependant methods. In terms of HIV prevention, all methods
except for the female condom, are male controlled, therefore there is a need to involve men in this
domain. The ICPD PoA underlines the importance of having men "accept the major responsibility
for the prevention of sexually transmitted diseases".

3. Talking of female alone or male alone is not an adequate approach to reproductive health
issues. Many of the decisions regarding reproductive health and family planning are made within
a set of gender relations that affect them or their implementation. In addition, all methods of
family planning and most methods of STDs and HIV prevention, are traditionally labelled either
as male-only or female-only methods. More attention should be paid in identifying to what extent
each one of the methods requires co-operation and support of both sexes and its implications on
the health and sexual relationship of both partners.

4. Positive climate to address emerging issues: ICPD has provided the opportunity for moving
from family planning to reproductive health and from a woman-only approach to a gender
approach. Following Cairo and Beijing, in most developing countries, there is a positive climate
to promote and address a broader variety of issues on sexual and reproductive health including
gender issues and male involvement.

5. Involving men gives the opportunity for increasing and communication on the issue of equality
between men and women. The process of empowering men, regarding RH issues, will help them
to be more sensitive to women's needs and therefore more supportive of participating in efforts of
enhancing women's status.

6. There are a number of well documented examples from different developing countries of
successful and unsuccessful approaches to reach men and to support male involvement

initiatives from which lessons can be learned