Repositioning Family Planning in West Africa Repositionnement de la Planification Familiale en Afrique de l’Ouest Sponsored by: U.S. Agency for International Development (USAID), World Health Organization (WHO), Action for West Africa Region Project - Reproductive Health (AWARE-RH), Advance Africa, the POLICY Project Male Involvement: A Practical Overview Levent Cagatay, M.D. Lissette C. Bernal Verbel, M.I.A. The ACQUIRE Project New York, New York

1.Background 2.Why involve men? 3.A Global Mandate 4.MAP Program 5.A Framework for Working with Men 6.Country Highlights Presentation Overview

Why Should We Involve Men? “Although African men play an important role in childbearing decisions and are crucial to efforts to prevent sexually transmitted infections (STIs), family planning programs have for the most part ignored their needs.” Source: Rosen, James E. and Shanti R. Conly. Africa’s Population Challenge: Accelerating Progress in Reproductive Health. Population Action International. Washington, DC: 1998.

Why Should We Involve Men? (con’t.) “Failure to target men in reproductive health interventions has weakened the impact of reproductive health programs” Source: Mbizvo, M.T. and Bassett, M.T. “Reproductive health and AIDS prevention in sub-Saharan Africa: The case for increased male participation.” Health Policy and Planning 11 (1): 84-92, March 1996

Men Often Play a Critical Role in Women’s Health Men tend to be the primary decision- makers regarding many reproductive health decisions such as the use of family planning or the access to a skilled provider during delivery Men often have control over access to resources

Involving Men Helps Women Men can play a constructive role in contraception and childrearing Partners who can discuss and jointly make reproductive health decisions can make better, more informed, and healthier decisions

Women Welcome Men Into the Reproductive Health Arena Studies have shown that women want their partner to accompany them to family planning appointments and would like their partner to be present during family planning counseling sessions. Source: Danielson, R, Roy, K., and De Vargas, T. “Women’s Perceptions—Providers’ Challenges: CEMOPLAF clients on partner participation in reproductive health services,” Population Council Summary Report, New York, 1998

Need for health care as individuals Access to reproductive health is a human right Men Need Services Too

Men who are informed about reproductive health issues and/or are involved in reproductive health decision making can serve as important role models in the community and with young men Men as Partners, Men as Allies

A Global Mandate “Special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; maternal and child health; prevention of STIs, including HIV;.... shared control and contribution to family income, children's education, health and nutrition; and recognition.... of the equal value of children of both sexes. Male responsibilities in family life must be included in the education of children from the earliest ages. Special emphasis should be placed on the prevention of violence against women and children” (United Nations, 1994).” - Cairo Plan of Action

EngenderHealth’s Men As Partners Program

To use evidence-based strategies to increase access to information and services that improve men’s SRH and promote the constructive role men can play in HIV/AIDS, maternal care, and family planning in their families and communities. MAP Program Goal

Linking Clinics and Communities: The Supply/Demand Model Working with Men: Addressing Gender Issues that Lead to Negative RH Outcomes MAP Approaches

Build capacity at the two sites through training Develop a supportive environment for male clients Create awareness about importance of male involvement Encourage the use of these services MAP Strategy in Guinea: Using a Supply & Demand Framework to Meet Needs

SUPPLY SIDE ACTIVITIES: Building Capacity at the Site Level Trained 30 staff members at two sites Whole Site Approach Themes –Sexuality –Anatomy & Physiology –FP & RH –STIs & HIV –Sexual Dysfunction –Management and Cost Considerations

DEMAND SIDE ACTIVITIES: Developing a Supportive Environment for Men’s Services Designated area & staff to provide men’s RH services IEC messages geared to men Specific RH services for men Community outreach to men Better linkages between staff at the sites

Results From Guinea Increased staff comfort, interest, and commitment to meeting men’s RH needs Increase in the numbers of couples that come in together for consultations and treatment. Decrease in repeat cases of STI infection among women (as their partners also receive treatment) Increased community knowledge, better attitudes, and improved practices regarding RH Increased linkages between the community and the service delivery sites

Quotes From Guinea One provider: Helped me to communicate with clients including men… before, I was very timid. Another provider: Before I only knew about women’s reproductive health. Now, I know more about men’s RH health. I encourage female clients to bring in their husbands and young men to learn about male RH during counseling.”

One male client: In the past, family heads have been giving their daughters in marriage before age 18. This poses many dangers for the daughters’ health …as a result, there have been concrete cases where families have decided to abstain from this custom One imam: During prayer time, we advise all the men, women, and youth of the importance of going to Boulbinet Health Center. At Boulbinet, they can receive care at a much lower cost – and people are very happy about this Quotes From Guinea

MAP Strategy in South Africa: Men Taking a Stand For Gender Equity and Positive Male Involvement in RH and Against Men’s Violence Against Women

HIV/AIDS: At the end of 2001, five million South Africans were living with HIV/AIDS: 2.7 million women, 2 million men and 250,000 children. Violence Against Women South Africa has the world’s highest per capita rate of violence against women. Unemployment Nearly 40% --Country with highest disparities between rich and poor MAP in South Africa in Context

MAP Overview Developed MAP in conjunction with PPASA beginning in Currently working in South Africa with wide range of organizations: PPASA, HOPE Worldwide, Solidarity Centre, AIDS Consortium and the South African National Defense Force.

1.Violence Against Women 2.Gender Equity 3.High Risk Sexual Practices and HIV/AIDS Prevention 4.Male Support for Female Reproductive Health Decisions 5.Information on Male and Female Reproductive Health 6.Men & PMTCT 7.HIV/AIDS Care & Support/HB Care Evolution of MAP Priority Issues

Technical assistance with focus on: Workshops TOT & facilitation skills development Social Norm change Community Mobilization Organizational Buy in and change Coalition Building Strengthening Capacity within Private, Public and NGO sectors. Program Description

Typically 4-5 days using participatory methods. Create opportunities to explore, challenge and discuss alternatives to attitudes and behaviors that compromise men and women’s health. Encourage men to take action. Develop implementation strategies and action plans for individual and community action. Workshop Approach

Act upon specific commitments made during the workshop to end violent and abusive behavior & prevent HIV/AIDS Hold informal discussions with peers in the community & take a stand for gender equity and against violence. Distribute condoms, using opportunity to talk about gender related issues. Encourage men to access VCT services Use picture codes to prompt discussions in the community Mentor a young man in the community. Conduct outreach for future MAP workshops Develop theatre pieces to be performed in the community Selected Activities for MAP Participants Post Workshop