V. Male involvement in unfpa country programmes
Within the context of UNFPA Country Programmes and ongoing activities, there are many ways that gender can be mainstreamed into reproductive health activities and programmes A culturally sensitive approach to decision-making and service and information provision can help to improve the quality of UNFPA's support without incurring a great deal of additional resources.
1. Identify men's needs in sexual and reproductive health using a holistic approach, including a socio-cultural and gender perspective.
The starting point is a clear understanding of the problem. For this, we need to collect information that will help us to understand: how men relate to women regarding reproductive health issues, based upon what factors men make decisions in this domain, what the limiting factors are for access to services (cultural, social, economic, gender relations, as well as those related to the services themselves), and the male perspectives throughout the different stages of the life cycle.
The research results provide the basis for the determination of priority goals, groups for action, as well as culturally appropriate strategies to reach them. The ICPD places emphasis on adolescents, rural populations and ethnic groups as priority target groups, but priorities need to be locally identified according to the society's most pressing needs. These could also be fishing, forestry or nomad communities, often out of reach of any reproductive health service.
UNFPA programmes could support socio-cultural research through multi-disciplinary and participatory studies that integrate male involvement issues in on-going as well as future reproductive health programmes.
2. Identify and document successful and unsuccessful approaches to reach men and support male involvement
UNFPA could support the documentation of successful and unsuccessful approaches to reach men and support male involvement initiatives, from which lessons can be learned from different parts of developing countries. Qualitative and quantitative information should be collected.
3. Introduce Strategies and approaches that will promote decision-making about the roles of men and women that will result in healthy reproductive health behaviours.
Based upon the information collected in the research, UNFPA could support the design and integration of strategies and approaches into existing programmes and services that will help to influence how decisions are made related to the reproductive health of both men and women. Where sex-specific roles result in negative reproductive health behaviours, activities could be developed to introduce new ideas and activities that would be healthier for the reproductive health of both sexes (such as rites of passage, what constitutes masculinity and masculine behaviour, etc.).
4. Identify and apply lessons learned from currently available services for men and young adults in public, private and NGO sectors.
Many activities may have been implemented by international and local NGOs or the private sector. It is important to consult with those in charge of initiating and implementing these activities to identify lessons learned in local cultures and to link the services with those already existing. UNFPA could support mechanisms for the development and maintenance of partnerships with other international, national and local groups in countries so that activities to promote male involvement will be integrated into all their programmes and that gaps in needs can be mutually covered, overlaps can be avoided, and the male population's needs are served by ensuring that the widest breadth of services can be provided in the easiest and most accessible way. Activities could be supported that will help to develop the awareness of these partners in understanding how to co-operate and why it is important.
5. Develop a culture-sensitive strategy to address sexual and reproductive health needs not already covered.
This could be done through locally acceptable approaches, based on understanding needs, bearing in mind that there are no universal approaches. Services can be set up in a variety of ways: male-only clinics and men only services; new hours of services in already existing services; outreach programmes; community-based services.
Male clinic and men only services: offering men a variety of sexual, reproductive health and general health services. On-going programmes from different parts of the world have identified the following elements of success: a comprehensive approach to men's health; start with separate services from women and later integrate them with men's services; counselling addressed to men's needs and involving both partners if necessary; media promotion; staff trained in the meaning of gender perspectives in the context of their own work; there is no need to have a new director for the male services if there is already one for women's.
New hours of services and new location: given that most of the existing experiences are on male-only clinics, much less is known about setting up special time schedules for men within women's services. One of the lessons learned is the importance of guaranteeing confidentiality and appropriate counselling for men and the presence of health providers who understand both women's and men's perspectives and concerns.
Outreach programmes community-based distribution (CBD) and informal sector: experience from women's and youth sexual and reproductive health in this regard have proven to be successful and are well documented. However, much more needs to be known about the community's perspectives regarding the acceptability of these approaches to reach men and the best way to attain this. New information is needed about effective educational strategies to reach men, their views on reproductive health and the views of both women and men on men's involvement in reproductive health.
6. Develop a client's perspective and a provider's perspective
When setting up services for men, the same as in the case of services for women, the user's perspective is a central aspect. Furthermore, the provider's perspective should also be taken into account in the design of effective services.
7. Develop a culturally relevant quality of care framework for men's services
The elements that constitute quality of care for men may not coincide with those identified for women's services due to cultural aspects and to particular aspects of the male perspective.
8. Train health workers in the issue of services of sexual and reproductive health of men throughout the different stages of the life cycle.
Assess the providers' (females and males) biases against male methods of family planning and male involvement, train them to understand the importance of constructively involving men in reproductive health, and of addressing the meaning of gender within their activities with women and men. Train them to understand men's needs and the benefits of shared responsibilities in reproductive health. This may entail training male educators to provide training for young boys. Female educators should be also aware of special needs of young boys and men.
9. Develop information, education and communication (IEC) strategies and approaches, through a participatory process involving men and their role models.
Men should be involved from the beginning in needs assessments through to the implementation of strategies and activities in identifying needs, developing convincing arguments, and selecting approaches and avenues for effectively reaching both men and women in the population through specially targeted outreach activities. UNFPA could support the use of participatory and mass media communications approaches, using multiple channels. Focus could also be placed upon interpersonal communication to improve the discussion and decision-making process related to the sexual and reproductive health of both men and women Channels should be identified and utilized to reach men and support them through specially targeted or outreach initiatives and peer educators and leaders should be trained and supported to work with men in all different phases of the life cycle. Just as men need to understand and be sensitive to the reproductive health needs and requirements of women, so too women must become aware of how improving the reproductive health of men will benefit both of them as well. Initiatives and educational programmes that stress that males and females both have shared responsibilities in sexual behaviour, family formation and child rearing based on mutual support could be promoted. Population education programmes could be reexamined so that they incorporate the analysis and promotion of male involvement in the context of education and learning; increase men's awareness and access to reproductive health services and develop services with a "male reproductive health model", according to men's sexual and reproductive needs including counselling.
10. Advocacy strategies should be developed and applied.
UNFPA could support activities to sensitize media specialists as well as activities that help to orchestrate mass media collaboration in the promotion of reproductive health and the role of men. Activities could also be supported that sensitize and mobilize decision makers. Partnerships could be developed or strengthened with key stakeholders, national and community leaders and role models, and national and locally organized interest groups. Research findings could be packaged to promote convincing arguments in favour of male involvement in reproductive health throughout the life cycle. UNFPA could also support the selection of key spokes people from all walks of life that can promote a focus on male involvement in reproductive health in many different settings and through many different interest groups.
11. Special focus on adolescent and young boys.
Transmission of STDs and AIDS and teenage pregnancy are often caused by ignorance and poor sense of responsibility of young boys. The key issue is to involve the young boys themselves in defining messages for information, education and communication (IEC), and the type of innovative services they would require regarding their own sexual and reproductive health. Currently, most projects and programmes do not take into account the gender perspectives. Information, education and communication (IEC) will promote the positive male role models, peer education, fostering of positive attitudes regarding sexuality (not focusing only on the negative outcomes of sexuality), and awareness of girls' problems. Key gathering places for young people could be identified and UNFPA could support the training of young people to serve as role models and peer educators to work with young people where they ordinarily live and play.
12. Provide support for operational research.
UNFPA could support fact finding about issues and existing socio-cultural conditions related to issues of male involvement, as a first step in operational research. UNFPA could support the testing of different participatory approaches to education and the promotion of positive reproductive health behaviours. It could also assess the impact of having male-specific and female-specific services and discussion groups as well as mixed ones to see which are the most effective.
13. Strengthen the capacity of national institutions.
UNFPA could support the coordination of activities and promote networking and sharing of lessons learned among appropriate and associated groups in the country. Include promotion and advocacy, training, and monitoring implementation, outcome and impact.
14. Links with other services.
UNFPA could provide support so that other services promoting male involvement in reproductive health in the community could be linked with services provided in clinics, hospitals, the private and NGO sectors.
15. Cost recovery.
Given the important reduction in funding that many reproductive health and family planning programmes are undergoing world-wide, it is necessary to devise appropriate cost recovery schemes. Experience has shown (i.e. PROFAMILIA in Colombia) that when services are of good quality and respond to men's specific needs, they are willing to pay for them. UNFPA could support the development and testing of different approaches to cost sharing and cost recovery, particularly in cases of promotion of greater male involvement in reproductive health.