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Programming for Male Involvement in Reproductive Health WHO/FCH/RHR/02.3 Original: English PROGRAMMING FOR MALE INVOLVEMENT IN REPRODUCTIVE HEALTH Report of the meeting of WHO Regional Advisers in Reproductive Health WHO/PAHO, Washington DC, USA 5-7 September 2001 World Health Organization, Geneva, 2002 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research Family and Community Health i © World Health Organization 2002 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The view expressed in documents by named authors are solely the responsibility of those authors. ii CONTENTS Page RESOURCE PERSONS ........................................................................................... v BACKGROUND ........................................................................................................ vii 1. OVERALL RECOMMENDATIONS .............................................................. 1 2. PRESENTATIONS ............................................................................................ 7 2.1 Programmes for men on prevention and care of sexually transmitted infections (STIs)/HIV ..................................................................... 7 2.1.1 Interventions to prevent STI/HIV infection in heterosexual men— a systematic review (Dr Sarah Hawkes) ................................................... 7 2.1.2 Male involvement in prevention of pregnancy and HIV infection (Dr Edith Pantelides) ................................................................................. 15 2.2 Programming for men in family planning ........................................................ 29 2.2.1 Counselling and communicating with men to promote family planning in Kenya and Zimbabwe (Dr Young Mi Kim) .............................. 29 2.2.2 Communicating with men to promote family planning: lessons learned and suggestions for programming (Ms Manisha Mehta) ............... 42 2.3 Programming for men in promoting safe motherhood .................................... 54 2.3.1 Involving men in safe motherhood: the issues (Dr Alexis Ntabona) ........ 54 2.3.2 Male involvement in a reproductive health programme: where we stand today (Dr M.E. Khan) ................................................................. 58 2.3.3 Field experiences in involving men in safe motherhood (Dr Imtiaz Kamal) ...................................................................................... 63 2.4 Targeting men for improving the reproductive health of both partners 85 2.4.1 Opportunities and challenges for men's involvement: the regional reproductive health strategy (Dr Andrew Kosia) ....................................... 85 2.4.2 The sexual health of men in India and Bangladesh: what are men’s concerns? (Dr Sarah Hawkes) ................................................................... 88 iii Page 2.4.3 Male participation in reproductive health—a Caribbean imperative (Dr Hugh Wynter) ................................................................................. 104 2.4.4 Capacity building in reproductive health programmes focusing on male involvement: a South-to-South framework (Dr Badrud Duza) ....... 115 2.5 Present lessons and future programmatic directions ..................................... 132 2.5.1 Men's roles with multiple partners: challenges and opportunities (Dr Amy Ratcliffe) ..................................................................................... 132 2.5.2 Research on men and its implications for policy and programme development in reproductive health (Dr Charles Nzioka) ....................... 143 2.5.3 Addressing gender imbalances to improve reproductive health (Ms Judith Helzner) .................................................................................. 153 2.5.4 Lessons and future programmatic directions for involving men in reproductive health (Dr Margaret Greene) ................................. 159 3. ANNEXES ......................................................................................................... 166 3.1 Meeting Agenda ................................................................................................ 166 iv RESOURCE PERSONS WHO Regional Offices Dr Andrew Kosia Regional Office for Africa (AFRO) Dr Maria Teresa Cerqueira Regional Office for the Americas (AMRO) Dr Ernest Pate Regional Office for the Americas (AMRO) Dr Virginia Camacho Regional Office for the Americas (AMRO) Dr Matilde Maddaleno Regional Office for the Americas (AMRO) Ms Marijke Velzeboer-Salcedo Regional Office for the Americas (AMRO) Ms Kathleen Taylor Regional Office for the Americas (AMRO) Dr Jose L. Diaz Rosello Regional Office for the Americas (AMRO) Dr Ricardo Fescina Regional Office for the Americas (AMRO) Dr Ramez Mahaini Regional Office for the Eastern Mediterranean (EMRO) Dr Assia Brandrup-Lukanow Regional Office for Europe (EURO) Dr Rusdi Aliudin Regional Office for South-East Asia (SEARO) Dr Pang Ruyan Regional Office for the Western Pacific (WPRO) WHO/HQ/RHR/Secretariat Dr Michael T. Mbizvo (chair) Senior Scientist, Office of the Director Dr Heli Bathija Area Manager, Africa and Eastern Mediterranean region Dr Enrique Ezcurra Area Manager, Americas region Dr Peter S. Fajans Scientist, Technical Cooperation with Countries Dr Alexis Ntabona TAP/RH Specialist and Coordinator, Technical Cooperation with Countries Dr Wang Yi-fei Area Manager, Asia and the Pacific region WHO Temporary Advisers Dr Imtiaz Kamal National Committee on Maternal Health, Karachi, Pakistan Dr Charles Nzioka Department of Sociology, University of Nairobi, Kenya Dr Edith Pantelides Centro de Estudios de Población (CENEP), Buenos Aires, Argentina Dr Amy A. Ratcliffe (rapporteur) Medical Research Council Laboratories, Banjul, Gambia Dr Hugh Wynter Advanced Training & Research in Fertility Management, Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston, Jamaica v Collaborating Agencies Ms Manisha Mehta EngenderHealth, New York, United States of America Dr Roberto Rivera Family Health International, North Carolina, United States of America Dr William Conn Family Health International, North Carolina, United States of America Ms Victoria Jennings Georgetown University, Washington DC, United States of America Ms Judith Frye Helzner IPPF/Western Hemisphere Region, New York, United States of America Ms Vera M. Zlidar (rapporteur) Johns Hopkins School of Public Health, Baltimore, United States of America Dr Young-Mi Kim Johns Hopkins University, Baltimore MD, United States of America Dr Badrud Duza Partners in Population and Development (PPD), Dhaka, Bangladesh Dr Margaret E. Greene Population Action International, Washington DC, United States of America Dr Sam Clark Program for Appropriate Technology in Health (PATH), Washington DC, United States of America Dr Elaine Murphy Program for Appropriate Technology in Health (PATH), Washington DC, United States of America Dr Karin Ringheim Program for Appropriate Technology in Health (PATH), Washington DC, United States of America Dr Suellen Miller The Population Council, New York, United States of America Dr M.E. Khan The Population Council/Bangladesh, Dhaka, Bangladesh Dr Sarah Hawkes The Population Council/India, New Delhi, India Ms Sylvie Cohen UNFPA, New York, United States of America Ms Marguerite Farrell USAID, Latin America and the Caribbean Bureau, Washington DC, United States of America Mr Jeffrey Spieler USAID, Washington DC, United States of America vi BACKGROUND Traditionally, health care providers and researchers in the field of reproductive health have focused almost exclusively on women when planning programmes and services, especially with regard to family planning, prevention of unwanted pregnancy and of unsafe abortion, and promotion of safe motherhood. In recent years, efforts have been made in many countries to broaden men’s responsibility for their own reproductive health as well as that of their partners. Measures are also being taken to improve gender relations by promoting men’s understanding of their familial and social roles in family planning and sexual and reproductive health issues. The Cairo International Conference on Population and Development (ICPD) Programme of Action (1994), urged that: "… special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour including family planning; prenatal, maternal 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; recognition and promotion of the equal value of children of both sexes. Male responsibilities in family life must be included in the education of children from the earliest ages. Special emphasis should be placed on the prevention of violence against women and children". (paragraph 4.27) The above challenge calls for more intense efforts to foster partnerships between men and women which help men identify with the magnitude and range of reproductive illnesses which affect women. The philosophy embodied in the Programme of Action combines a primary health care approach with a human rights dimension.
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