Male Engagement in Reproductive Health Programs
Welcome to the programmatic area on male engagement in reproductive health (RH) programs within MEASURE Evaluation’s Family Planning and Reproductive Health Indicators Database. This is one of the subareas found in the men’s health section of sexual and reproductive health section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications.
- Engaging men in family planning (FP) and RH can be beneficial for their partners and children, as well as for the men themselves. Efforts to expand the vision of strategically engaging men in FP and RH have been slow, but steady (Dunn & Gage, 2010). Gender experts agree that men should be encouraged to be supportive partners of women’s RH while also meeting their own RH needs, and engaged as agents of change in families and communities (Greene, et al., 2006). Funds spent on well-designed health programs that seek to promote more gender-equitable behaviors among men and boys can be viewed as an investment in a larger process of gender transformation which will also benefit women and girls.
- The core indicators selected for this database focus primarily on men’s beliefs and behaviors.
Engaging men in family planning (FP) and reproductive health (RH) can be beneficial for their partners and children, as well as, for the men themselves. A number of international partners including IPPF, UNFPA, USAID, Promundo, EngenderHealth and other members of the MenEngage global alliance have programs underway to engage men more fully in FP and RH. These program outcomes can help achieve Millennium Development Goals: #3. promote gender equality and empower women; #4. reduce child mortality; #5. improve maternal health; and #6. combat HIV/AIDS.
Although they can be done in isolation, efforts to engage men and boys may have greater benefits for women and men and girls and boys when they are combined with or at least coordinated with efforts to empower women for a synchronized approach to address gender norms, reduce gender inequalities, and improve health. For example, the Global Health Initiative’s (GHI) first principle, Women, Girls, and Gender Equality (WGGE) specifies a number of gender-related strategies to accomplish these changes, including involving women and girls and men and boys in addressing gender norms and equity; enlisting men to support women’s use of FP/RH services and contraception; encouraging men to use sexual RH services themselves; improving training of health providers on gender issues; ensuring meaningful participation of women and girls in decision-making; and engaging civil society in partner countries to address gender equity in health care (GHI, 2010).
Background on Male Engagement Programs
Initiatives to involve men in RH began with the 1994 Cairo International Conference on Population and Development (ICPD). Mounting concerns for the high numbers of women diseased and dying in low-resource settings, often due to child-bearing related causes, and concurrent infant and child health issues led the ICPD to set a number of goals to improve RH. Traditionally, RH has been viewed as a woman’s domain and most programs and interventions were targeted for women. Given the gender power imbalances in many regions, all too often men and the dominant cultural norms interfered with practicing FP and women’s attempts to access healthcare resources and services, particularly sexual health services. A leading strategy from the ICPD was to involve men in RH through emphasizing communication and education programs for men about the importance of health care for women and infants.
While some successes were documented in the following decade, the high burden of women’s and children’s health issues persisted, and programs working with male involvement became more aware of how gender norms and inequalities shaped factors that influence demand for FP services (e.g., timing of marriage, fertility intentions), as well as men’s own RH concerns (e.g., use of male-controlled methods, sexually transmitted infections, and HIV/AIDS). The focus shifted toward engaging men more directly and broadly in their own and their partners’ healthcare. More attention was also put on in behavior change communication efforts to address gender inequalities. Men seeking care for their own health not only can benefit the men, but may translate into enhanced health knowledge, motivation, and concern for the health of their partners and families. Because men still hold most of the decision-making power in many settings, even with regard to their partners’ health and bodies, there’s an acknowledgement that improving women’s health undoubtedly requires programming targeting male involvement, support, and education. The most recent trends in programs working with men and RH are to engage both women and men to promote shared responsibility and decision-making with partners and use gender transformative approaches that work to challenge and transform rigid gender norms and relations. An ecological model working at multiple levels to transform gender norms has been developed by Promundo, UNFPA and MenEngage (2010) (for example) and these transformative and partnering approaches have been shown to improve program outcomes.
A concern with the shift toward male engagement has been that the increased attention on men’s health could reduce available resources for women. However, when synchronized with attempts to empower women, male engagement may have greater gender and health benefits. Further, this may be an area where cost and benefits do not act necessarily as a ‘zero sum game,’ rather women’s and men’s programs and their impacts can build on each other and many services can be integrated in facilities even if conducted separately. Promundo, UNFPA, and MenEngage (2010) note that funds spent on well-designed health programs that seek to promote more gender-equitable behaviors among men and boys can be viewed as an investment in a larger process of gender transformation which will also benefit women and girls.
A framework for monitoring and evaluating (M&E) programs engaging men has been developed by UNFPA and partner organizations. A total of 35 output and activity indicators are listed moving from the macro and social level to the micro and individual level. The nine core indicators selected for this database focus primarily on men’s beliefs and behaviors. Several indicators are directly from the UNFPA framework and others have been taken from additional sources, including a compendium of indicators for violence against women and girls (Bloom, 2008) and the Gender-Equitable Men or GEM scale developed by Pulerwitz and Barker (2008). For a toolkit for M&E specific to young men and HIV/AIDS prevention programs, see Promundo and UNFPA (2007).
Bloom, S., 2008, Violence against Women and Girls: A Compendium of Monitoring and Evaluation Indicators, Chapel Hill, NC: MEASURE Evaluation. https://www.data4impactproject.org/publications/violence-against-women-and-girls-a-compendium-of-monitoring-and-evaluation-indicators/
Promundo, UNFPA, MenEngage, 2010, Engaging Men and Boys in Gender Equality and Health: A Global Toolkit for Action. Rio de Janeiro, Brazil: Promundo. http://www.unfpa.org/public/site/global/pid/6815
Promundo and UNFPA, Young Men and HIV Prevention: A Toolkit for Action, Rio de Janeiro, Brazil: Promundo. http://www.xyonline.net/sites/default/files/Instituto%20Promundo,%20Young%20Men%20and%20HIV%20-%20Text.pdf
Pulerwitz, Julie and Gary Barker. 2008. “Measuring attitudes toward gender norms among young men in Brazil: Development and psychometric evaluation of the GEM Scale,” Men and Masculinities 10: 322–33
UNFPA, 2003, It Takes Two: Partnering with Men in Reproductive and Sexual Health. http://www.unfpa.org/upload/lib_pub_file/153_filename_ItTakes2.pdf
USAID, The Global Health Initiative (GHI). 2010. Implementation of the Global Health Initiative: Consultation Document, Washington, DC: USAID.
WHO, 2002, Technical Consultation on Sexual Health, Geneva: WHO, January.