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Programming for Male Involvement in Reproductive Health: A Practical Guide for Managers
At AVSC International's inter-regional workshop on men's involvement in reproductive health held in Mombasa, Kenya, from May 18-22, 1997, over 140 participants discussed practical ways to provide services to men and to support their constructive involvement in the health of their female partners.
During the workshop, representatives from health programs that have successfully served men shared what they have learned with colleagues who want to initiate or improve their facility's men's services. Participants took part in a series of intensive "learning labs" on topics critical to the design and provision of male reproductive health services. These learning labs focused on the following topics, described in detail below:
Program design issues
Community outreach and workplace programs
Counseling services for men and couples
Integration of STI services
Special needs of adolescents
Publicizing new and expanded services
Gender is a fundamental context for work with both men and women, as it shapes all aspects of clients' lives. Sex is biologically determined, but gender is culturally determined. Gender issues, which are inevitably culturally specific, are a crucial consideration in program design.
- Make sure staff are gender sensitive. Provide training that helps staff understand and overcome their own gender biases.
- Get information from clients, potential clients, providers, opinion leaders, teachers, and others about what the pressing gender concerns are in the community. Address these concerns in program design.
- Recognize cultural constraints related to gender that affect information gathering and service delivery.
- Make sure male clients understand women's reproductive health physiology. Use a 3-D model if necessary.
- Make sure that counselors acknowledge the role of the client's partner and other important people in the client's life. Incorporate these important people into counseling and service provision as is appropriate and desired by the client.
- Use culturally and socially appropriate terms to discuss sensitive subjects like sexuality.
- Ensure that the program has strong internal leaders and an external policy that supports linkages with key allies.
- Form linkages with other existing services in the community to ensure that the program is able to address issues like gender-based violence.
Access to Services
Access to services is of particular concern in providing men's services. For example, in many countries, there may be cultural biases against allowing men into areas designed for the provision of reproductive health services for women. In areas where men's and women's services can be integrated, it is essential that the inclusion of men's services does not compromise resources for women.
- If appropriate, integrate male services into existing female-oriented settings.
- Consider the feasibility of providing stand-alone services for men.
- Address the issue of hospital regulations restricting men's access to women's service areas such as obstetrics and gynecology so that the modesty of women in the wards is not violated.
- Set clinic hours that accommodate both women's and men's work schedules.
- Help service providers address facility and staff biases that may be obstacles to providing services to men.
- Help providers recognize the missed opportunities to reach men who are already in the clinic for other purposes--for example, by addressing information and education to men in waiting rooms.
- Design male-focused IEC activities to help improve men's knowledge about family planning and other aspects of reproductive health.
- Make sure existing services are well linked, especially where resources are scarce. (For example, some mosques have health-education facilities and a school, both of which can be important venues for men's education.)
One very important consideration in program design is determining what reproductive health services should be offered. Of course, for each institution, the services that can be offered will depend upon available resources and other practical considerations. However, when planning reproductive health services for men, program designers should consider including the following elements:
- A complete sexual and reproductive history
- Age-appropriate physical exam
- Screening for substance abuse, anger management, and mental health needs. Make on-site testing available where appropriate, or refer clients to other facilities
- Comprehensive reproductive health education, including basic sex and fertility education for both men and women
- Contraceptive education and counseling for both men and women
- Education and counseling for the prevention of STIs
- Client education on genital health and hygiene
Sustainability of services should be an important element of program design. Program designers should plan for future economic and technical sustainability, to the extent possible, from the very start of the program.
- Make sure that services are tailored to what the community wants and needs. One way to do this is to start a program by asking community members to articulate their needs and brainstorm about priorities to meet them.
- Be cost conscious. Consider the possibility of cost sharing with other organizations and cost recovery.
- Provide ongoing training for different levels of clinic staff so that if a professional leaves, a technical skill is not lost.
- Integrate services into existing programs or make use of existing facilities.
- Ensure appropriate high-level support and supervision. Garner the necessary political support.
- Ensure high-quality services are in place; this will facilitate both provider and client acceptance of the program.
- Investigate the use of existing labor pools--for example, medical, nursing, or public health students who might provide labor at a reduced cost.
Information and education should reach potential clients wherever they are, be it work, school, or in recreational settings. With the support of high-level managers, messages can be spread quite effectively in the workplace or in places where clients spend leisure time.
- Use peer educators and make sure they are trained in the use of IEC materials.
- Incorporate information and education about reproductive health into existing school-based or other training programs (such as military or police training).
- Establish links within the community to other services, programs, and institutions.
- Arrange informational meetings and distribute IEC materials during community events, such as local festivals.
- Pay particular attention to involving employers and managers in introducing and supporting the program. Provide employers and managers with additional IEC materials targeted to their particular concerns.
- Use IEC materials appropriate to the target audience in as many innovative locations as possible, such as public bathrooms, bars, and town halls, etc.
- Make sure that hours of service delivery are appropriate to the target audience's work schedule.
- Make sure that services are provided confidentially and are of high quality so that the "word on the street" is positive.
Men often have special needs when it comes to counseling for family planning and reproductive health. For example, men tend to have less information about these areas of health care, and less information about health care in general. Counseling for either men or women involves respecting each client and tailoring advice to suit his or her individual needs. All counselors should be good listeners and communicators who are both nonjudgmental and knowledgeable.
Tips for counseling individuals:
A good counselor...
- Can deal with all topics--no matter how sensitive--in a direct, honest, and self-confident manner without judgment or stereotyping.
- Is knowledgeable about clients and their sexuality and about cultural norms, as well as about the service available to the client.
- Helps clients develop good communication and interpersonal skills with their partners regarding sexual and reproductive behavior.
- Communicates with each client at a level he or she can understand.
- Is sensitive and conveys information in a non-threatening way.
- Listens carefully to find out what the client knows, what information he or she has, and what problems or issues he or she wants to discuss.
- Is prepared to answer a lot of questions (the ASSESS and GATHER techniques often used when counseling women may not be appropriate to male clients) and is aware of cultural and familial implications of divulging information.
NOTE: Health care provider training should emphasize that counseling of men is no substitute for adequate counseling of women or for addressing women's informational needs, even if the man and woman are partners.
Tips for counseling couples:
A good counselor...
- Remains neutral and does not take sides with either party, is aware of the importance of nonverbal communication, and is sensitive to how each partner reacts to the other during counseling.
- Is careful not to compromise the privacy of either partner during joint counseling sessions.
- Promotes the idea of the man as "sharing" responsibility for contraception and reproductive health.
NOTE: It may be easier for a counselor to discuss sexuality in general terms or to discuss how individuals in other cultures relate than for the couple to discuss their own sexuality.
Reproductive health services include much more than contraception and safe motherhood--they should include topics like child survival, adolescent services, and HIV/STI treatment, diagnosis, and education. The topic of STIs may present special challenges. For example, in some cultures there is great stigma attached to STIs, so clients and providers may not be prepared to talk openly about them.
- Prevention is of the utmost importance. Programs should include the provision of condoms, as well as information and demonstrations on condom use.
- Programs should provide training for providers to address concerns and biases related to STIs, including HIV/AIDS.
- Integration of STI diagnosis and services into existing programs may help to alleviate the stigma attached to going to a facility or department that deals only with STIs.
- Support groups are a good way to involve everybody in the fight against HIV/AIDS.
- It is important for clients to know their HIV sero-status in order to minimize risk of transmission.
- Education, counseling, and participation are important to help change behavior.
- Clients can be excellent community educators, thereby helping to reduce the stigma attached to STIs in their own communities.
The definition of adolescence varies among cultures, but the lack of services tailored to the special needs of adolescents is a global problem.
- Whenever possible, set up youth centers in collaboration with departments of health and education. These centers can be in areas where young people congregate for leisure, work, or school activities.
- Where services are already provided, make them user-friendly and reflect a casual, "young" atmosphere.
- Provide a separate entrance at existing facilities to allow for increased privacy.
- Use skits, plays, or other forms of drama (for example, puppet shows, songs, dance, etc.) in schools and market places to raise issues and direct young populations to services.
- Train providers at all levels to talk to and deal with young populations and ensure that they are sensitive to the special concerns of youth (physiological development, sexuality, peer pressure, etc.).
- Peer educators/counselors are very important within this population.
- Make sure that the location and hours of the services meet the needs of youth.
When trying to attract male clients to new or expanded services, male-specific information, materials, and counseling must be provided. Mass media has the potential to reach a larger audience, including non-literate populations. By making use of such channels of communication, providers can stimulate awareness as well as change mindsets and attitudes.
- Identify key messages, issues, and services for men.
- Communicate messages as simply as possible and in a way that respects men and women as equal partners.
- Ensure that all staff are well educated regarding the male services available so that the maximum number of clients are exposed to this information.
- Pretest IEC materials within the target audience.
- Involve high-level policy makers in reviewing key messages.
- Provide training, information, and education to journalists.
- Make sure services are efficient, professional, responsible, and of high quality before creating interest in them.
- Have a well-planned mass media strategy based on market research.
- Use focus group research to segment specific audiences and produce audience-specific materials for these audiences.
- Address issues in a culturally sensitive manner.
- Consider asking well-known local groups to endorse messages and contribute to a policy of advocacy.
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