The male role
FAMILY planning has a long history in virtually every country but reproductive health is a new direction, which got momentum after the International Conference on Population and Development (ICPD) held in Cairo in 1994. Programmatic interest in men's involvement in reproductive health issues is a recent advancement. Previously, reproductive health programs had focused almost exclusively on women.
Promotion and active involvement of men implies responsible parenthood and sexual and reproductive behaviour, including family planning; prenatal, maternal and child health; prevention of sexually transmitted diseases, including HIV; prevention of unwanted and high risk pregnancies; shared control and contribution of family income, and empowerment of women.
In Bangladesh, particularly in rural areas, gender roles are clearly demarcated. Usually, men are not involved, nor their interest particularly welcome, in the women's domain. But men could do much to ensure the success of population and reproductive health programs.
Their role is important for the promotion of gender equity, girls' education, women's empowerment and sharing of household chores and child-rearing within families, communities and work places.
In Bangladesh, the family planning program is woman-focused and, therefore, does not provide any scope for addressing the reproductive health problems of men. The ignorance of men about reproductive morbidity of women is not uncommon in many countries, including Bangladesh.
Most men need to know more about preventing pregnancy, HIV/Aids and other sexually transmitted diseases. Family planning programs can address many of the obstacles that men face by developing awareness and advocating safer sexual behaviour.
An effective way of increasing men's role in contraception is to increase women empowerment through economic participation. In Bangladesh, women usually take more responsibility of using contraceptive methods.
Men generally approve of family planning but contraceptives are mostly used by women. It has also been reported that use of contraceptives by men has declined in recent years. This discrepancy between belief and action may be due, in part, to limited contraceptive choices that men have had.
However, among currently available male methods no method has the widespread acceptability of some of the methods used by women.
Men may not favour using contraceptive methods due to a variety of cultural reasons. In various studies, these have been expressed as; fear that it will undermine their authority as head of the family or encourage their wives to be unfaithful; being opposed on religious grounds; and fear of harmful side effects of contraceptives. The views of men about family planning and fertility issues are important components of the reproductive health program.
Many obstacles prevent men and women from talking about sexual and reproductive issues. A complex web of social and cultural factors impedes such discussions. In many societies, sex is a taboo subject for men and women to discuss. Women's low status and lack of power limit communication between a couple.
Even when men and women discuss reproductive health issues, it is usually not in equal terms.
In a country like Bangladesh, where more then half of the men are illiterate, the mass media can play a significant role in achieving the demographic target. Men are more exposed to radio, television, and newspapers than women, probably because men generally have more free time, more education, more disposable income, and more freedom of movement than women.
Studies have documented increased contraceptive use and other behavioural changes following use of mass media.
National, regional and international experiences in reproductive health programs show the need for women's healthcare issue in today's world as the most important concern of all because they bear the major health hazards during pregnancy. To protect and ensure safety of women's lives, men's perception about the problems of pregnant women must be enhanced.
In conclusion, it is critically important to design a program involving men that fosters an environment where men's contributions to reproductive health including family planning decisions are valued and desired, while protecting the rights and integrity of women.
One finding that will be important to the development of such a program is that men's knowledge is strongly supportive for their wives.
It is critical to incorporate an explicit commitment to gender equality to ensure an involvement that will be mutually beneficial to both men and women. To achieve replacement fertility, involvement of male in reproductive health, including use of male methods -- particularly permanent method -- will be an important direction of the future family planning program strategy.
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