How can we influence more people to use modern contraception? The answer is simpleâ€”include male partners in making family planning decisions. This ploy works in many different cultures.
Why have men been left out of family planning? In the past, planners have focused on women since only they get pregnant. The family planning movement started with Margaret Sanger over 75 years ago. For many years clinics catered to women’s needs, and only recently have they started to provide reproductive health care for men. There is another reason, too. Men make millions of sperm, but women only make one egg a month. It is easier to stop the production of a single egg than of all those sperm.
Furthermore, demographic studies of fertility usually focus on women. This is because it is easier to trace the parentage of a child to the mother. For example, the total fertility rate is defined as the number of children per woman. Only recently have demographers studied the fathering of children.
Now we acknowledge the importance of men in family planning. Especially in “macho” societies where men tend to be the decision-makers, women donâ€™t have much control over the use of contraception unless their husbands concur.
Worldwide there are successes when men are included in family planning decisions. One comes from Ethiopia. Community family planning workers visited two different groups of married couples at home. In one group only the wife was present. The husbands also were present with the other half of the couples. Few of these couples were already using modern contraception.
Did these visits make a difference? Yes! One or two visits increased the use of pills, IUDâ€™s or condoms. Did the presence of the husband improve the acceptance of contraception? You bet it did! At the end of a year, a third of couples were still using a method if their husbands had participated in the contraceptive decision. Only half that many used family planning where the husband was excluded.
Here in the United States the story is similar. Education, along with the AIDS scare, has doubled teens’ use of condoms in the past decade. In the past men assumed that women would take full responsibility for contraception. Now guys are more likely to share this responsibility and to use condoms. The availability of clinics where men feel comfortable has helped catalyze this change. Whether they attend alone or with their partners, it is important to involve men.
When asked, most males believe that preventing pregnancy is partly a male responsibility. Sad to say, only 2% of federal family planning dollars are allocated to reproductive services for men. Fortunately, some programs succeed in reaching young men.
Male service providers have found several steps to build successful programs. They use mass media to reach young men and to encourage them to communicate with their partners. Then they provide information about condoms and vasectomy where men tend to gatherâ€”a favorite place is in barbershops.
Teens on Track (TNT) is a program sponsored by Planned Parenthood of Southern New Jersey. Their first step was to hire male clinic workers. Then they built a program that incorporates recreation, education and medical care. The local YMCA hosts “Teen Night”. An hour of education on male health and sexuality is followed by sportsâ€”swimming or basketball. Attendance has been excellent.
In Houston the Baylor Teen Health Clinic hired a sports medicine physician to help draw teens to their “Males Only” program. Outreach workers recruit young men from housing projects and juvenile probation centers. The programs have helped the guys stay in school, improve academic performance and prevent unplanned pregnancies.
In one of the poorest countries of Africa “…men are deliberately constructing their family sizes and structure.” Researchers conclude: “Our perception is that in the communities studied in the rural Gambia, men’s contribution to the costs of bearing and raising their children is smaller than that of their wives…. It may be that the key shift precipitating fertility transition in high fertility societies in West Africa will be the growing financial burden of fatherhood.” The Gambia has one of the highest growth rates in the world. We can only hope that the men sense this burden quickly and plan for smaller families.
It is possible to change attitudes. Including men in family planning decisions increases their use of male methods, and improves their cooperation with their partners’ use of contraception. The result is fewer unplanned pregnancies, and better communication between men and women.
Â© Richard Grossman MD, 2005