The understanding of male perspectives to reproductive health and sexuality is the starting step to set up services that respond to their needs and, as required by the ICPD, are culturally sensitive. This will make for services that are both more effective and cost-effective.
The challenge resides in the design of services for men, in light of the gender approach, from the male perspective, simultaneously revisiting the services for women, without sacrificing women's programmes, given that women suffer a disproportionate burden of ill-health, only partially explained by biological differences and rooted in the gender differences.2 This may mean either developing new services for men, or more likely, when resources are scarce, modifying existing women-oriented services to integrate men's concerns in sexual and reproductive health, making sure that confidentiality is maintained for both men and women. This may mean redesigning programmes and strategies to integrate men's needs through providers' education. While designing appropriate strategies for men, programmes can largely benefit from the lessons learned from women's services.
2 Over one-third of all healthy life lost in women is due to reproductive health problems, compared to 12% for men (WHO).
SOME COMMON MYTHS
1. Men are opposed to family planning and want more children than their partners. DHS evidence from some African countries has shown that men's opposition to family planning and desire for a larger number of children is not as widespread as previously supposed.
2. Men always want sex, initiate sex and orchestrate sex. Male desire is supposed to be separated from affection. They are not expected to be faithful and to show emotions, fear, insecurity without their virility being questioned. They are expected to be strong and take risks.
3. Men tend to engage in deviant behaviour. They are many tunes portrayed in negative stereotypes as violators, insensitive to women's concerns, uncaring and abusers of women's rights.
4. Men will talk only to male service providers. Male RH programmes with female staff, including for the practice of vasectomy have shown as good results as those with male staff. The essential is not the sex of the provider but the respect and confidentiality with which men are treated.
5. Serving men is expensive. There are a number of examples of good quality care with limited resources, especially when existing services are rationalized.
6. All men have the same needs and concerns. Specific strategies are needed to service the specific needs of different men, young, older, rural, urban, educated, non educated, homosexual. Not every action taken for men's health is male's involvement
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.