1. Men, Family Planning and Reproductive Health Richard Lord

2. Mens Share of Responsibility for Family Planning l What percentage of worldwide contraceptive use involves male methods? Jane Turner l Is this percentage increasing or decreasing?

3. Male Methods: 26% of Global Contraceptive Use Female sterilization Malemethods: 22% Other female methods Oral contraceptives Source: United Nations, 1998. Withdrawal and Abstinence: 12% IUD 5% 33% 26% 14% Vasectomy: 7% Condoms: 7%

4. Use of Male Methods Declining as Proportion of Overall Use Source: United Nations, 1987, 1998. Global use of male methods Global use of vasectomy Global use of condoms 1987 1998

5. Gender Imbalance: Knowledge/Use of Sterilization Australia Belgium Canada China Republic of Korea Nepal Netherlands New Zealand United Kingdom United States Source: United Nations, 1998. Use of Sterilization in 10 Countries with Highest Levels of Vasectomy Female Sterilization Vasectomy Percent of Married Couples of Reproductive Age

6. Why Involve Men in Family Planning? l Male responsibility in reproductive health issues is essential to decreasing HIV/AIDS and other STIs l Men play dominant role in decision-making l Global contraceptive use has reached a plateau l Funds for family planning have declined

7. Husband Disapproval Major Factor in Unmet Need Sources: Bongaarts, Stud Fam Plann 1995;26(2). USAgency for International Development Photo?? l Contraceptive use and continuation are higher when husband and wife agree l 3 of 7 pregnancies in the world are unintended

8. Couple Counseling Results in Better Continuation Rates Source: Terefe, Am J Public Health 1993;83(11). One-year contraceptive continuation twice as high when husband counseled with wife (Ethiopia) Husband involved in counseling Husband NOT involved in counseling Percentage of couples contracepting after 12 months 33% 17%

9. Barriers to Mens Use of Contraception l Lack of accurate information l Provider bias against male methods l Limited access to services Beryl Goldberg

10. Barriers to Mens Use of Contraception (cont.) l Lack of provider training l Mens misunderstanding of correct use l Limited range of male methods S. Khalaf/Family Health International

11. Why Some Men Choose Vasectomy l Simpler, safer and less expensive than female sterilization l Love for wife and concern for her health l Desire to take responsibility in family planning l Greater sexual enjoyment by eliminating worries about unwanted pregnancy

12. Condoms: Dual Protection Against Pregnancy and STIs l Can be highly effective in protecting against pregnancy AND preventing HIV/STIs l Should be promoted in family planning, HIV prevention, and other programs

13. Mens Public Approval versus Private Use l Men report high knowledge and support of contraception even where use is low l Public approval different than private use l Programs need to change attitudes and practices desire for more children desire for more children belief that religion prohibits use belief that religion prohibits use desire for control over wife desire for control over wife Sources: Drennan, Popul Rep 1998;J(46); Wilkinson, Man-Myths, AVSC International, 1998.

14. Creative Outreach Efforts Reach Men in Community l Sports events l Workplaces l Small businesses l Truck stops l Military bases l Media R. Witlin/World Bank

15. Community Education Successfully Involves Men l Agricultural agents and community volunteers reached farmers with reproductive health and family planning information l Interactive materials for low-literacy clients stressed importance of birth spacing for child health l Family planning increased from 37 to 55% Honduras:

16. Clinic-based Strategies for Men l Stand-alone male clinics l Separate hours/entrances for men l Integrated services l Male or female counselors Debbie Rogow

17. Men Respond Positively to Broad Reproductive Health Services l Family planning l STI/HIV prevention and treatment l Infertility l Sexual dysfunctions l Reproductive cancers W. Graham/World Bank Photo??

18. Involving Men in Family Planning Can Promote Gender Equity Women want their partners involved: l To support their own contraceptive use l To share responsibility for contraception and protecting health l To increase mens understanding of reproductive health issues

19. l Encouraging men to take control of fertility can disempower women l In Zimbabwe, men who wanted sole responsibility for decision-making rose from 27 to 37% l Positioning men as responsible and caring can be productive Source: Kim, Involving Men in Family Planning, Johns Hopkins CCP, 1996. Assure That Womens Reproductive Health Needs Remain Primary Focus