Role of Males’ in Reproductive and
Sexual Health Decisions

The International Conference on Population and Development (ICPD, 1994) and the Fourth World Conference on Women (1995) emphasized the importance of reproductive rights and reproductive health both for men and women and the greater involvement of men in reproductive health. In post-ICPD era the world has seen a paradigm-shift away from focused family planning programs towards more general reproductive and sexual health. Specifically, the focus is on key concepts and programmatic implications for locating men’s involvement within a reproductive health framework. During the ICPD, the programme of action endorsed emphasized the need for equity in gender relations with a special focus on men’s shared responsibility and active involvement to promote reproductive and sexual health. There have also been substantive evidences, which demonstrate that disregarding sex education and sexual health needs of men could lead to wider social health consequences. Failure to address sexual health needs, particularly among males, contribute to the poor preparation of men for adulthood, contraceptive usage, and safe sex. A rational strategy for looking into males’ role in decision making, participation and shared responsibility for sexual and reproductive health are important in the context of social, economic, and political factors reflecting the disadvantaged position of women.

The present paper is an attempt to understand the role of males in reproductive and sexual health decisions in relation to sexual and reproductive health rights and reproductive health programs including women’s empowerment, and male involvement. We have seen that improved reproductive and sexual health programs have helped to reduce morbidity and mortality rates in recent years, but much remains to be done. The traditional focus on women in family planning programs reinforces the idea that women are responsible for contraception, obscuring male co-responsibility. Excluding male from family planning programs deprives them of opportunities for obtaining information and decreases women’s options. The gender focus implies that males must assume greater responsibility for their sexual and reproductive behaviour, a view endorsed in recent international conferences.

Studies have shown that males are less likely to use reproductive health services compared to women and simultaneously play an important role in sexual preferences and decisions. Men should be included in reproductive health in addition to, rather than instead of, women. Women as well as men may seek services for men, and services for men can be organized within the existing structure or separately, depending on specific requirements. There is little existing guidance for operationalizing the concept of male involvement. The workshop emphasized the male involvement in reproductive and sexual health in the broader framework of gender equity.

Studies have suggested programs to increase male participation in reproductive and sexual health, describing the context in which, it is possible to attract diverse group of males of varying backgrounds to participate at clinics, work places, or in the community, individually or in groups, to discuss gender roles, reproductive health and sexuality, fatherhood, and other topics. It is evident that there is no need to see reproduction and family health as a conflict between males and females, instead there is need to recognize that male participation should promote greater equity between the sexes and attention to the reproductive, sexual, and general health needs of male.

Role of socio-cultural factors affecting males’ decision in reproductive and sexual health is important considering that males have been left out in efforts geared toward the improvement of reproductive & sexual health.

In India, population and development programmes, and medical institutions often neglect the male’s influence on decisions related to reproductive health (RH) issues, as well as male behaviour and sexual health needs. Today, policy makers are trying to get more and more men involved in RH programs. There are certain barriers, however, such as social and cultural obstacles, weak commitment by policy makers or inadequate policy, insufficient and inappropriate information. Interventions to involve males in RH programs are intended, for instance, to ensure more responsible sexual behaviour, to increase contraceptive methods used, and to strengthen information sharing between husbands and wives. From lessons learned in many countries in the world, it was recommended that to increase male participation in RH programs: supporting IEC interventions using mass media and interpersonal communication; ensuring that RH services and information are available for males through the existent network; and training medical and non-medical personnel on these issues are important and necessary. The lessons learned also involved integrating and cooperating, research and evaluation, and policymaking and adjustments on these issues.

Only very recently in developing nations like India researchers have paid increased attention to the male's involvement in reproductive health issues. Patel & Khan, (1996) MRHS Uttar-Pradesh (1997) has studied male's attitude, knowledge and behaviour in relation to their wife's sexual and reproductive health. Males are partners in sexuality and reproduction and they should equally share satisfying sexual lives, the burdens of preventing disease and health complications. Men play a key role in bringing about gender equity since in most societies men exercise predominant power. Man is the primary decision maker in the family regarding reproduction, family size, contraception use and so on and hence man's active involvement not only helps in accepting contraception but also its effective use and continuation.

The two above mentioned international conferences and a dozen survey studies clearly emphasized the central role of men in sharing reproductive responsibility, promoting responsible parent-hood and safe sexual behaviour in the advent of the AIDS epidemic. Studies have shown that a supportive male spouse facilitates women's contraceptive use, reduces risks of spiralling rates of sexually transmitted diseases (STDS) and reduces sexual violence directed towards female partners (UNFPA, 1995; Verma and Ray, 1997). In a patriarchal society where men have an all encompassing involvement in decisions pertaining to family and society, it is most important to involve men in reproductive health decisions in order to achieve small family norm, observance of safe sex, contraception use, provide support for women during antenatal and postnatal period, healthy abortion management, prevention of STD/AIDS, gynaecological and other health complications and establishing stronger bonds between men and their offsprings. Survey data have shown that failure to involve men in family planning programmes can have serious implications. Even when contraceptive technologies are available for women, even when they are educated and motivated to practice contraception, they may not practice at all, have little say and control over fertility decisions because negative attitudes of their husbands inhibit their wives from taking action. Studies show that the reproductive preferences and ultimate decisions of women are still largely determined by their husband’s idiosyncratic reproductive motivations shaped by socio-cultural traditions, norms and value system and not vice versa (Larse and Becker 1997, caster line et al, 1997). In addition to deciding the number of children and the practice of family planning the other reproductive health decisions made by men may include; when and with whom to have sexual relations, when and how long to abstain, when and where to seek help for wife's gynaecological and obstetrical problems and the issue of domestic violence and sexual coercion within marriage (UNFPA, 1995). Survey data showed that many men tend to refuse family planning practices for themselves and their wives because they fear that it will undermine their authority, may loose power in the relationship, and may encourage extramarital sexual relationship of their wives and several such other myths and stereotypes. More over, many men encourage larger family size and view that many children in the family are related to the value and benefits of different order such as children provide source of joy, pride and fulfilment, a source of future economic support when they will grow old, a means to carry the family name, tradition and to carry out a fitting burial. Reproductive health issues are vital in order to promote the goal that a healthy atmosphere of partnership based on mutual respect, cooperation, sharing and trust be evolved. Male’s involvement focuses on responsible parenthood, facilitates expansion of couple's range of contraceptive options, improvement in use of contraception, sharing reproductive decision making and prevention of STD/AIDS transmission.

A few recent Indian studies have also shown lack of husband-wife communication in reproductive health matters (Khan and Patel, 1997), knowledge about female reproductive system and pregnancy (MRHS, 1997), initiatives in accepting contraceptive methods for themselves (Balaiah et al, 1998), for their spouse (Apte, 1998), involvement in contraception over generations (Karra et al, 1997) and sexual health (Verma et al, 1998).

Issues of women’s reproductive ill-health are rooted in a broader socio- cultural milieu where males play a significant role. Gender roles, relationships and power differentials between husband and wife significantly affect women’s health, morbidity and therefore access to service (Pachauri, 1988). Men play decision-making roles within the family households including decisions related to the health care of women. Women depend more on male partners for health management in terms of seeking access to available health care services (Mitra, 1998). A project on pati sampark programme of Deepak Charitable Trust in Nandesari industrial area of Baroda indicated measurable differences between its men’s group compared to non-intervention group of males (Dev. 1998). According to Bhatt (1997) traditional values play a significant role in excluding men from participating in pregnancy, antenatal, natal and postnatal care related matters.

Another NGO working to improve reproductive health in terms of health status of mothers, child spacing, and family planning, prevention and treatment of HIV/ AIDS in Sangam Vihar, a slum in Delhi observed that in improving women’s health, male participation is equally important. The husbands invariably were a stumbling block in women’s access to health care (Pal, 1998). Sewa Rural Research Team in Gujarat (1998) observed that husbands accompany their wives for seeking MTP services rather than going to quacks when male involvement was introduced as an intervention strategy. In case of infertile couples, although women are still held responsible for being childless, more and more husbands are willing to accompany their wives and ready to undergo repeated medical examinations and necessary treatments.

In conclusion we can say that the reproductive and sexual health constitutes an area that is not well researched and there is a need to understand and examine government programs and policies considering our population challenges. Besides the efforts and independent initiatives taken by different Government and NGOs, till recently these issues have not received any attention. Role of men in reproductive and sexual health decisions need to be targeted by schemes and development programmes.