Are men abnegating their responsibility 
for a share in the family's reproductive 
and sexual health care?

"Women point their fingers at men and say, 'We are willing to use family planning, but these people prevent us from doing so."
  Emmanuel Sabakati has heard this lament often while counselling couples on family planning.  Sabakati is project director of the Man to Man Programme in Malawi, designed to address the critical role of men in family planning.

But studies show that men are concerned for women's reproductive health, and are willing to participate in making decisions, according to The State of World Population 1997 report by the UNFPA.  The problem may be the communication: husband and wife may want the same thing, but they don't tell each other.  The result can be a bigger family than either really wanted.

Husband and wife communication about reproductive health, including family planning, has been improving over the past few decades, the report notes.  However, a large minority of men still consider sexual and reproductive health to be exclusively women's concern - so they don't discuss it.

Worse, men often impede women's efforts at family planning, as the women in Sabakati's clinic charge.  Dr Everald Hosein co-ordinates the University of the West Indies' Caribbean Population and Family Health Programming in Port of Spain, Trinidad and Tobago.  He says that almost every method of contraception a woman might choose can be opposed by her partner for one reason another.  For example, some men complain that condoms and intra-uterine devices interfere with their sexual pleasure.  One woman told Hosein, "My man doesn't want me to use the pill; he says it will make me fat."

The reports that men are frequently insensitive to women's reproductive and sexual health needs.  In many cultures, misunderstandings and myths about female sexuality and reproductive systems persist - though there are indications that male attitudes towards a range of taboos (including concerns about menstruation and 'cleanliness') are changing.

Boys and men should be taught about responsible sexuality and parenthood, the report recommends.  They need to understand the risks women face from pregnancy and childbirth, and from multiple partners, harmful traditional practices and initiation too early on in life.  Women's reproductive and sexual health requires the mutual concern and investment of both partners.

Man to Man was foundered in response to these needs.  Says Sabakati, "It is important to target males because they are the heads of families, and therefore they should know about family planning."  Participants are taught about various methods of contraception, particularly those men can use.  "When men are motivated to seek methods suitable for them, they choose between vasectomy or condoms," notes Sabakati.  "All choices are strictly voluntary.  If they use condoms, we supply them.  If they choose vasectomy, we assist them in arranging it."  Those who undergo a vasectomy are usually in their late 30s or early 40s.

When he was a boy in Zimbabwe, Joseph Mabuto received family and life education.  The experience "gave a new dimension to my life", he said.  Now a scout leader, Mabuto advises teenage scouts about family and reproductive matters.  "My scouts are always coming to me to ask about sexuality, maturity, peer pressure and the like," he says.

Zimbabwe's Chief Scout Commissioner, Ignatius Kajenga, points out that the whole society benefits from providing family life education to boys.  "The boys disseminate the information their family and friends.  We teach them about sexuality, sexual health, sexually transmitted diseases including Aids, and family planning."  Most courses are conducted in local languages.

"Decisions-making is an important aspect of the education,"  Kajenga says.  "Eventually it is incumbent upon the boys themselves to make up their mind on what types of families they are going to have."  He adds that boys are glad to receive information on sexuality and reproduction, as such subjects are generally taboo with parents.

Legal barriers also underscore the important role that men play in family planning, according to the report.  Fourteen countries require a woman to get her husband's consent before she can receive any contraceptive services.  This has the effect of denying services to unmarried women, including adolescents and the divorced or widowed, as well as to women who wish to delay or limit births but who cannot persuade their husbands.  An additional 60 countries require spousal authorisation for permanent methods.  Spousal consent restrictions often apply to only women, the report notes.

But the report finds signs of improvement, especially at the grassroots.  In the Philippines, a new centre for men is experimenting with innovative ways to involve men in reproductive health programmes.  In Indonesia, the government plans to expand its counselling programme to include training materials on male participation in family planning and reproductive health.  In Ghana, seminars and plays have been organised for both male and female audiences to generate discussions on partners' joint responsibility in the use of family planning, parenting and family life.

The Noor Al Hussien Foundation in Jordan has launched a two-year nation-wide motivational campaign with "Family Health is a Joint Responsibility of Both Spouses" as its slogan.  The campaign, began in April 1996, includes a wide range of activities: puppet shows, seminars, a mobile science exhibition, counselling and interactive educational theatre.  Special activities are intended to sensitise men about their responsibilities in family planning and reproductive health.

Efforts to reach men are eliciting a response.  "When I read in the paper about the vasectomy, I was very much interested because I wanted to give relief to my wife," said Aaron Kumwenda, a client at the Man the Man project in Malawi.  "Having borne four children, she was tired, I thought.  As the head of the family, I had to do it."

Anderson Mazengera, who underwent the same procedures after deciding with his wife that they had reached their desired family size, notes that male responsibility does not end with a vasectomy: "Now what we have to do is develop our family."