Biomed Analysis: Include men in sexual health policies
Reproductive and sexual health programmes in the developing world are more effective if they engage both sexes, says Priya Shetty.
At a population conference held in London last month, Babatunde Osotimehin, head of the UN Population Fund (UNFPA), called for action on family planning to curb the growing global population, which is set to hit 7 billion this year.
But Osotimehin isn't just concerned about the burgeoning population. Poor sexual and reproductive health can have serious consequences. Every day, 1,000 women in developing nations die in childbirth or botched abortions. And in 2009, 1.8 million people became infected with HIV in Sub-Saharan Africa alone.
The UN will draw attention to these concerns on 11 July, World Population Day, calling on policymakers to strengthen their commitment to sexual and reproductive health. Most reproductive-health programmes target women, but some experts say that this strategy is flawed — sidelining men could mean that such programmes are doomed before they even begin.
In many developing countries, women are less empowered than men, leading health experts to believe that targeting women directly would be more effective than trying to change entrenched social mores. This approach stems from the 1994 Cairo declaration on population and development, which put women's rights centre-stage.
As a result, women's health is higher than ever on the global health agenda. But there has also been collateral damage from this approach.
Scott Radloff, director of USAID's Office of Population and Reproductive Health, blogged this month (18 June) about the dangers of excluding men. "There is a lack of information among men on the importance of delaying first birth, of spacing births … for the health of the woman and the child," he wrote.
Men often have the role of 'gatekeeper' to women's use of contraception. There is an awareness gap, says Radloff, but "involving men in international family planning programs is an uphill battle".
Sarah Hawkes, a sexual-health expert at University College London, UK, says that improving sexual health relies on engaging both partners. After all, she says, men have sexual and reproductive rights too.
"Fewer than a third of men in many developing countries know that two ways of avoiding STIs [sexually transmitted infections] are condom use and either abstinence or having only one, uninfected partner," says a 2006 report for the UN Millennium Project on reproductive health.
And when they do have an infection, many men don't tell their sexual partners. According to the report, only half of men aged 15–24 in Benin, Mali, Niger and Uganda who had had a sexually transmitted infection in the past year told their partners.
A growing body of research lends support to the argument for including men in reproductive-health programmes. A 2007 report [1.20MB] by the World Health Organization says that programmes that engage boys and men and that promote more equitable relationships tend to be more effective.
For instance, research in Brazil shows that integrated programmes involving both sexes led to more condom use and fewer STIs than programmes that included only women. Vasectomy rates are still fairly low in most developing nations, but more awareness of the procedure could make it more common.
Research in Kenyan antenatal clinics has shown that involving male partners — asking them to come to clinic visits, for example, or including them in counselling — led to a lower risk of HIV infection in babies born to HIV-infected women. 
But there is still a dearth of data on men's attitudes to sex and reproduction, especially in the developing world. "Men's roles in decision-making regarding pregnancy and abortion, their roles during the prenatal period and their roles in raising their children, as well as whether and how these roles are changing, are also essentially undocumented," says the 2006 UN Millennium Project report.
The global health community is waking up to the importance of engaging men in reproductive-health programmes. This is one of the aims of MenEngage, a global alliance involving NGOs and UN agencies such as the WHO, the UN Development Programme and the UNFPA.
Last year, the WHO published a report outlining policy approaches to engaging men in reducing health inequities and improving health for both men and women.
Last July, the International Planned Parenthood Federation, which is member of the MenEngage alliance, produced a toolkit outlining how policymakers, organisations and public-health researchers can develop policies that include men in reproductive-health programmes.
These initiatives are encouraging. Yet some organisations seem to rely on male power over women's reproductive choices.
The UNFPA, for instance, has launched 'husband schools' in Niger, where men gather to educate themselves about reproductive health. They then encourage women to give birth in clinics and to vaccinate their babies, taking the women to the clinics themselves. This implies that if the men were not involved, the women's health would be neglected.
Empowering women so they are not reliant on men is a better long-term strategy. Nevertheless, some countries may not be ready for it just yet. As the UNFPA put it bluntly, "Niger is a country where men wield power".
Health programmes must negotiate these social mores with care. Engaging men to improve the health of both sexes is long overdue, and sexual and reproductive health is never just a women's issue. But the solution is not to entrust men with power over women's health — it is to engage both sexes as equal partners with equal rights.
Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.
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