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ꢅhesiꢆ/Dꢇꢈꢉꢊꢋatꢌon Sheet

Surname or Family name: Hasan

First nꢫme: Md Kꢫmrul

Other name/s:

Abbreviation for degree as given ꢘn the University calendar: PhD

School: Centre for Social Research in Health

Faculty: Faculty of ꢍꢎꢏ and Social

Sciences

Title: Masculinitieꢏ, generations and heꢫlth: Men'ꢧ sexual health in Bꢛngꢹadesh

Abstract 350 words maximum: (PLEASE TYPE)

Together, men, masculinꢑties and health comprise an ꢔmerging area of research, actꢑvism and policy dꢃbatꢃ. Intꢔrꢁational research on men's health demonsꢘratꢃs how mꢐꢒ's enactment of masculinity may bꢃ linkꢐd to theꢑr sexual health risk. However, little research to date has explored men's

enactment of dꢑfferent forms of masculiniꢂy and men's sꢖxual health from a social genꢃrational

perspective.

To address this gap, ꢑnsights from Mannhꢃim's work on social generations, Connel�s theory of

masculꢑnꢑty, Butler's theory of gender pꢃrformativꢑty, and Alldred and Fox's work on the sexualityassꢃmblage, were utilised to offꢃr a betꢂer undꢃrstanding of the implꢑcations of masculinitꢅꢃs for men's sexual health. A multi-site cross-sectional qualitativꢐ study was conducted in three cities in Bangladesh. Semi-structured ꢀꢁꢂꢃꢄꢅꢃꢆꢇ werꢃ used to capture narratives from 34 mꢐn represꢃnting threꢔ contrastꢑng socꢑal generations: an oldꢃr social gꢐneration (growꢑng up pre-1971), a middlꢔ sociꢍl genꢐratꢑon (growꢑng up in the 1980s and 1990s), and a younger social generation (growing up

post-2010). A thematic approach was applied to aꢒalysis to identify the key issues focused upon in

men's accounts.

Thꢐ analysꢑs revꢐaled generational diffꢃrences and similarities ꢑn the construction of masculinity, ꢑn sꢃxual practicꢃs and ꢑn help and health-seꢔking practices. Findings show that certain idꢃals of masculinity were common across all social genꢔrations. However, social, cultural, economic and political transformations in Bangladesh have producꢃd significant cross-generational differences aꢁd discontꢑnuitꢑꢐs. Study findings point to thꢐ ꢈꢉꢊꢋꢌꢍꢎꢏꢐ of understanding how the productꢈon and enactmꢃnt of specifꢑc forms of masculinity are shapꢃd by education, urbanisation, and globalisaꢘion, as wꢐll as by the cultural dynamꢑcs of religion (especially Islam), work, homosocꢑality, patriarchy and hꢃtꢃronormativity, and how these ꢑn turn affect sexual hꢔalth and health-seekꢑng practices.

This thesis contributes to a socꢑally located understandꢑng of masculꢑnꢑties, gender and men's sexual

health from a social gꢐneratꢑonal perspective. Iꢂ argues for the need to move beyond stꢃreotypical, rꢔductionist, ꢐssentialist and bꢑnary understandings of mꢐn, masculꢑnꢑty, gender and hꢃalth in the South Asian contexts, highlꢑghting opportunitꢑes for new forms of ꢑꢒꢓꢔꢕꢖꢗꢘꢙꢚꢛ and action to promote

men's sexual health.

Declaratꢌꢍn relatꢌng to disposition of project ꢀhꢁꢂꢃꢄ/ꢅꢆꢇꢈꢉꢊꢋꢌꢍꢎ

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provisions of the Copyright Act 1968. I retaꢇn all ꢝꢞꢟꢠꢔꢡꢢ rights, such as patent rights. I also retain the right to use in future

works (such as aꢣicles or books) all or part of thiꢒ thesis or disseꢤation.

I also authorise University Microfꢦlms to use the 350 word abstract of my ꢬheꢧiꢧ ꢘn ꢥꢦꢧꢨꢩꢪꢫꢬꢭꢮꢯ Abstractꢏ Internatꢭonal (this is applicable to doctorꢫl thesꢔs only).

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Abstract

Together, men, masculinities and health comprise an emerging area of research,

activism and policy debate. International research on men’s health demonstrates how men’s enactment of masculinity may be linked to their sexual health risk. However, little research to date has explored men’s enactment of different forms of masculinity and men’s sexual health from a social generational perspective.

To address this gap, insights from Mannheim’s work on social generations, Connell’s theory of masculinity, Butler’s theory of gender performativity, and Alldred and Fox’s

work on the sexuality-assemblage, were utilised to offer a better understanding of the

implications of masculinities for men’s sexual health. A multi-site cross-sectional

qualitative study was conducted in three cities in Bangladesh. Semi-structured interviews were used to capture narratives from 34 men representing three contrasting social generations: an older social generation (growing up pre-1971), a middle social generation (growing up in the 1980s and 1990s), and a younger social generation (growing up post-2010). A thematic approach was applied to analysis to identify the key

issues focused upon in men’s accounts.

The analysis revealed generational differences and similarities in the construction of masculinity, in sexual practices and in help and health-seeking practices. Findings show that certain ideals of masculinity were common across all social generations. However, social, cultural, economic and political transformations in Bangladesh have produced significant cross-generational differences and discontinuities. Study findings point to the importance of understanding how the production and enactment of specific forms of masculinity are shaped by education, urbanisation, and globalisation, as well as by the cultural dynamics of religion (especially Islam), work, homosociality, patriarchy and heteronormativity, and how these in turn affect sexual health and health-seeking practices.

This thesis contributes to a socially located understanding of masculinities, gender and

men’s sexual health from a social generational perspective. It argues for the need to

move beyond stereotypical, reductionist, essentialist and binary understandings of men,

ii

masculinity, gender and health in the South Asian contexts, highlighting opportunities

for new forms of intervention and action to promote men’s sexual health.

iii

Acknowledgements

I would like to express my sincere gratitude and thanks to my supervisor Peter Aggleton, UNSW Scientia Professor, and joint supervisor Dr Asha Persson, Senior Research Fellow, in the Centre for Social Research in Health (CSRH) at UNSW Australia. I am immensely grateful to them for their guidance, mentorship, comments and suggestions throughout the research process. But for their support, it would have been impossible to complete the thesis in time.

I would also like to thank the 34 men who participated in the study for their valuable time and contribution. Their rich accounts helped me to gain deeper insights into social

generational masculinities, men’s sexual practices and help and health-seeking practices

in the South Asian context. I also thank Dr Christy Newman, former Postgraduate Coordinator and Dr Loren Brenner, Postgraduate Coordinator at CSRH for their support during my candidature. Dr

Newman provided me with some of her papers about men’s health and social

generations, which I found useful. I also had an opportunity to attend a Communicating Your Research workshop that Dr Newman co-facilitated.

I sincerely thank Professor Emerita Raewyn Connell at the University of Sydney for her comments on my research proposal. It was my honour to meet her and receive valuable feedback from a person whose work in part provided the theoretical ground and inspiration for my research. My developing understanding of gender and masculinity

was largely shaped by Connell’s work on these subjects. She also provided me with

some very useful references. This research was made possible through an International Postgraduate Research Scholarship offered jointly by the Commonwealth of Australia and UNSW Australia. In addition, I received a top-up scholarship and funding for fieldwork from the Faculty of Arts and Social Sciences and conference funding from the Graduate Research School at UNSW Australia to present a paper in Switzerland.

iv

My special thanks are due to Ms Ann Whitelaw, Ms Janice Knapman, Ms Catherine Zell and many others for their support during my candidature at UNSW Australia.

I am also grateful to a number of Bangladeshi universities and non-government organisations for their assistance in recruiting research participants for my study. Thanks are due to Ms Meheri Tamanna, Senior Lecturer, BRAC University and Professor Syed M. Hashemi, former Chairperson of the Department of Economics and Social Sciences, BRAC University, Mr Shahidul Hoque, Assistant Professor and Professor A. K. Enamul Haque of the Department of Statistics, University of Chittagong.

Among the non-government organisations that helped with recruitment and letters of support were the Bandhu Social Welfare Society (BSWS), the Family Planning Association of Bangladesh and the Bonoful Social Welfare Centre. I would also like to thank Mr Shale Ahmed, Ms Kamrunnessa Ferdousi, Mr Saiful Hasan, Mr A.B.M Abu Sayem and Mr Alauddin Shaikh for their assistance in recruiting participants to this study.

I would also like to thank Ms. Sharika Khan who translated and transcribed about onethird of the interviews.

I had the chance to talk at length with Dr K. M. Kabirul Islam who was a fellow PhD Candidate at Social Policy Research Centre (SPRC), UNSW Australia about our research, rules and regulation of the University. I found these conversations useful.

I attended several workshops conducted by the Learning Centre at UNSW Australia on thesis writing and research methods. I thank Professor Sue Starfield who facilitated workshops that I found particularly useful.

I thank Dr Leanne Dowse and Dr Jamie Roberts from whom I took Qualitative Research Methods and Developing Your Thesis Proposal courses, respectively. I received feedback on my research from both of them while taking the courses in 2013.

I thankfully acknowledge excellent editing of my thesis by Dr Wendy Sarkissian.

v

I thank my wife Ruma and little son Mrinmoy for their inspiration, love and support throughout my candidature. Ruma assisted me in checking the references.

vi

Relevant publication

The following paper based on the research reported in this thesis has been published: Hasan, M. K., Aggleton, P., & Persson, A. (2015). Rethinking gender, men and masculinity: Representations of men in the South Asian reproductive and sexual

health literatures. International Journal of Men's Health, 14(2), 146-162.

vii

Acronyms

AIDS – Acquired Immunodeficiency Syndrome BBS – Bangladesh Bureau of Statistics BSWS – Bandhu Social Welfare Society BSKS – Bonoful Samaj Kallyan Sanghstha (Bonoful Social Welfare Organisation) BRAC – Bangladesh Rural Advancement Committee (now just BRAC) CMNI – Conformity of Masculinity Norms Inventory CF – Consent Forms CSMM – Critical Study of Men and Masculinities CSRH – Centre for Social Research in Health EPZ – Export Processing Zones GII – Gender Inequality Index HIV – Human Immunodeficiency Virus HREC – Human Research Ethics Committee ICDDR, B – International Centre for Diarrhoeal Disease Research, Bangladesh ICPD – International Conference on Population and Development IPC – Indian Penal Code MDG – Millennium Development Goals MSM – Men who have sex with men NGO – Non-governmental organisation NIPORT – National Institute of Population, Research and Training NHMRC – National Health and Medical Research Council PIS – Participant Information Statement SDG – Sustainable Development Goals STI – Sexually Transmissible Infections UNDP – United Nations Development Programme UNFPA – United Nations Population Fund

viii

UNSW – University of New South Wales WHO – World Health Organisation

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Table of contents

Originality and copyright statement……………………………………………………...i

Abstract........…………………………………………………………………………….ii

Acknowledgements........………………………………………………………………..iv Relevant publication........………………………………………………………………vii

Acronyms.......….……………………………………………………………………...viii Table of contents.......…………………………………………………………………...x

Chapter 1: Introduction....……………………………………………………………..1

Research aims....................................................................................................................1 Personal and academic underpinnings of the research......................................................2 Theoretical underpinnings.................................................................................................6 Methodological approach..................................................................................................9 Significance of the study.................................................................................................11 Organisation of the thesis................................................................................................11

Chapter 2: Men, masculinities and health: literature review.……………………...14

Introduction.....................................................................................................................14 Gender, men and masculinity..........................................................................................14 Men, masculinity and health: international perspectives ................................................17 Gender relations in South Asia .......................................................................................20 Men, masculinity and health in South Asia ....................................................................22

Men and masculinities in South Asi a.................................................................................. 23 Masculinities and health in South Asia............................................................................... 29

Masculinities and sexual health in South Asia................................................................32 Concluding remarks ........................................................................................................35

x

Chapter 3: Mapping the research journey..…………………………………………37

Introduction.....................................................................................................................37 Philosophical foundations: ontology, epistemology and research strategy ....................38

Ontological assumptions..................................................................................................... 38 Epistemological assumptions.............................................................................................. 40 Methodology: research strategy ......................................................................................... 42

Theoretical underpinnings...............................................................................................43

Connell’s theory of masculinities........................................................................................ 43 Butler’s theory of gender performativity ............................................................................ 45 Mannheim’s theory of social generation............................................................................. 47

Research design and method...........................................................................................48

Research sites and settin g................................................................................................... 48 Participant recruitment....................................................................................................... 50 Semi-structured interviews.................................................................................................. 52 The process of interviewing ................................................................................................ 54

Making sense of men’s narratives: data analysis ............................................................56 Ethical considerations .....................................................................................................59 A note on reflexivity .......................................................................................................61

Chapter 4: Making a man: generational masculinities..……………………………66

Three social generations..................................................................................................66 Masculinities in older social generation men..................................................................69 Masculinities in middle social generation men...............................................................76 Younger social generation men’s masculinities..............................................................82 Conclusion ......................................................................................................................92

Chapter 5: Generational sexualities: patterns in men’s sexual practices………….94

Introduction.....................................................................................................................94 Older social generation men’s sexual practices ..............................................................95

xi

Middle social generation men’s sexual practices............................................................99 Younger social generation men’s sexual practices .......................................................107 Implications for men’s self-understandings and for masculinity..................................112

Chapter 6: Men’s sexual health and help-seeking practices ...................................114

Introduction...................................................................................................................114 Older social generation men’s sexual health and help-seeking practices .....................115

Help-seeking practices...................................................................................................... 115 Health-seeking practices................................................................................................... 119

Middle social generation men’s health and help-seeking practices..............................123

Help-seeking practices...................................................................................................... 123 Health-seeking practices................................................................................................... 127

Younger social generation men’s help-seeking and health-seeking practices..............131

Help-seeking practices...................................................................................................... 131 Health-seeking practices................................................................................................... 135

Concluding remarks ......................................................................................................137

Chapter 7: Rethinking masculinities/gender and men’s sexual health: A social

generational perspective .……………………………………………………………139

Introduction...................................................................................................................139 Rethinking masculinities, gender and sexual health .....................................................140

Continuities and discontinuities across social generation s.............................................. 140

Gender, masculinities and power...................................................................................... 144 Gender, masculinities and performativity......................................................................... 146

The masculinity/sexuality-assemblages of different social generations ........................... 148

Implications of masculinity/sexuality-assemblages for men’s sexual health ...............154 Promoting sexual health................................................................................................157 Future research..............................................................................................................159 Some methodological reflections..................................................................................161

xii

References…………………………………………………………………………….164 Appendices…………………………………………………………………………...186

Appendix A: Interview Guide………………………………………………………..186 Appendix B: Participants' socio-demographic profile………………………………..188 Appendix C: Research ethics approval letter………………………………………...191 Appendix D: Participant Information Statement and Consent Form…………………193