Men play important roles in supporting a couple's reproductive health needs. Effective
use of a contraceptive method, and even satisfaction with the method chosen, is often
influenced by men. A man's support often contributes to better use of female methods and,
for many couples, a male method may be an excellent choice.
Also, male participation in preventing sexually transmitted diseases, including HIV, is
crucial. A man must actively participate for a couple to use latex condoms correctly and
consistently, and he must remain faithful if a couple seeks protection through a mutually
monogamous relationship.
Both the 1994 International Conference on Population and Development in Cairo and the
1995 Fourth World Conference on Women in Beijing recognized the important role of men in
improving reproductive health. Consensus statements from both conferences say better ways
to reach men with reproductive health services are needed.
In Latin America, Africa and Asia, several programs and research studies illustrate
ways that male involvement contributes toward a couple's reproductive health needs.
Bolivia's Casa project -- An educational effort in Bolivia called Casa de la
Mujer (The Women's House) has worked closely with women's most urgent reproductive health
needs. The Casa team is convinced that working with couples offers optimal success.
In one Santa Cruz neighborhood, pelvic examinations of 47 women indicated that only one
woman was not infected with an STD. "In many cases, if the man is not treated at the
same time, our efforts are in vain," says Marķa Luz Bacarreza, a Casa nurse. Yet
getting men involved in any reproductive health effort is often difficult. At a Casa
community workshop on reproductive health for couples, only one man appeared. He quickly
left, embarrassed to be the only man present.
But by a second workshop held in the same community, the project succeeded in
encouraging several men to attend after two nurses visited several couples' homes to
explain the workshops. Following this participation, even more men were willing to take
part in a third session. "It is difficult to convince men to participate," says
Bacarreza. "Nevertheless, once they get involved, men often come up with a hundred
questions and are very active in the workshops."1
Ethiopian husbands -- As in 
most sub-Saharan cultures, men in Ethiopia tend
to dominate a couple's decision about family size and whether to use contraception. A
study in Addis Ababa suggests that involving husbands in family planning education
significantly influences a couple's decision on whether to begin using contraceptives.
More than 500 married women who were not using any modern method agreed to home visits
by a two-member family planning educational team. About half of the women received this
counseling alone, while the education for others was given to both husband and wife. After
one year, contraceptive use was nearly double among couples who received husband-wife
counseling (33 percent), compared with use among couples in which women were counseled
alone, without their husbands (17 percent), according to scientists at Addis Ababa
University in Ethiopia and McGill University in Montreal, Canada.
The educational team members were all women who were generally well-known within the
neighborhoods where home visits took place. They worked in the early evenings and weekends
after normal working hours, thus making it easier to arrange visits when both husbands and
wives would be present. Investigators designed the study to eliminate factors that could
distort their findings. For example, the educational teams were not aware of the purpose
of the research, and each team generally visited an equal number of homes where both
husband and wife were present compared with homes where only the wife was available.
"The differences [in contraceptive use] can be attributed to husband involvement in
the intervention program and have not been confounded by demographic, reproductive, or
knowledge and attitude disparities between the two study groups," the scientists
concluded.2
Norplant use in Bangladesh -- An FHI study in Bangladesh suggests that involving
husbands in Norplant counseling sessions can improve continuation rates for the
contraceptive implant. Counseling included information about side effects, insertion and
removal procedures, and how men can help when their partners experience side effects.
After three years, continuation rates were substantially higher among women whose
husbands were counseled (42 percent continued using Norplant) compared with women whose
husbands did not receive counseling (32 percent continued use). The study among more than
600 urban and rural women in four clinics provided counseling for both women and their
husbands for about two-thirds of the cases and for women only for the remaining third.3
In addition to counseling, husbands received a simple brochure on the method, including
a discussion of the supportive role husbands can play. Previous research had shown that a
common reason for discontinuation in Bangladesh was "personal reasons," which
included objections from husbands.4
-- Nash Herndon
References
- Paulson S, Gisbert ME, Quiton M. Case Studies of Two
Women's Health Projects in Bolivia. Research Triangle Park, NC: Family Health
International, 1996.
- Terefe A, Larson CP. Modern contraception use in
Ethiopia: does involving husbands make a difference? Am J Public Health 1993;83(11):
1567-71.
- Amatya R, Akhter H, McMahan J, et al. The effect of
husband counseling on NORPLANT contraceptive acceptability in Bangladesh. Contraception
1994;50(3):263-73.
- Akhter H, Dunson R, Amatya R, et al. A five-year
clinical evaluation of NORPLANT contraceptive subdermal implants in Bangladeshi acceptors.
Contraception 1993;47(6):569-82.
For more information, visit Family Health International's Website at www.fhi.org
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