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)