Men – You Can’t Live with Them, and You Can’t Live Without Them.

Engaging Men and Boys in Family Planning

Shawn Malarcher

USAID | Senior Advisor on Utilization of Best Practices
© 2013 Valerie Caldas/ Johns Hopkins University Center for Communication Programs, Courtesy of Photoshare

A Suaahara field supervisor with his family in District of Dolakha, Nepal. © 2013 Valerie Caldas/ Johns Hopkins University Center for Communication Programs, Courtesy of Photoshare

The older I get, the more I understand the deep truth behind this cliché. Despite piles of evidence and loads of rhetoric about their importance, men remain nearly absent from family planning programming worldwide. Rather than return to the tired old question about, “What works in male engagement?” I propose we ask ourselves, “Why do we continue to leave men out of family planning programming?”

I believe one significant reason for leaving men out of the picture is the type of programming we typically propose and support. Male engagement tends to be compartmentalized, such as male support groups or separate services for men—activities completely separate from female-focused activities. While such approaches may be effective on a small scale, they face serious challenges in large-scale implementation. The complexity of the activities and dependence on highly charismatic individuals make large scale implementation difficult. In addition, ownership or responsibility for implementing activities often falls between the mandates of government entities.

And when policy makers are faced with decisions of how to allocate scarce resources, male to male interpersonal communication often loses out to the need to reach women with information, clinical training, support for commodities, and other priorities.

In my view, the more promising approaches look for ways to integrate men into existing family planning activities. For example, couple counseling during antenatal visits has been shown to improve compliance with medical directives and increase postpartum contraceptive use in some cases. Also, providing pamphlets during clinic visits may encourage couple communication and joint decision-making.

Of course, the focus of these activities assumes stable relationships and fails to address sexual activity that falls outside the bounds of marriage. It’s also important to remember that some women prefer to use contraception without their partner’s knowledge. They have the right to do so, and their privacy should be protected. While these are valid arguments, they focus on the exception, not the rule. Globally, most sex occurs within marriage. Rather than programming for the exception, perhaps we should place greater emphasis on the norm. When given a chance, many men want to be involved and informed partners. In Turkey, men often report they began using withdrawal as their method of contraception because they felt it was their way of taking care of their family and living up to their responsibility as a partner.

To the naysayers: When I was born, my father sat in a waiting room and knew nothing of the delivery process or birth of his children. As my nieces and nephews were born, it was never a question that my brothers and brothers-in-law would be beside their wives and involved in deciding how and where the birth of their children would take place –a monumental change in the span of less than a generation.

Around the world, men and women enter into relationships as partners. The roles and responsibilities of these partnerships vary substantially, but they are partnerships nonetheless. Family planning programming can facilitate or inhibit increased male participation in contraceptive and reproductive choices. Which will it be?

Visit K4Health’s new page on Engaging Men and Boys in Family Planning to learn more about how male engagement can improve women’s health in addition to educational and socio-economic outcomes.