Male involvement in reproductive health (RH) refers to men actively participating as both clients and partners in RH matters.

This includes seeking and sharing RH information and services, assisting with domestic duties and childcare, and engaging in joint decision-making regarding family planning, STI prevention, and prevention of mother-to-child transmission (PMTCT) of HIV. This concept is recognized within the International Conference on Population and Development Program of Action, which identifies male responsibilities as crucial for enhancing RH outcomes, promoting gender equality, and empowering women. This approach broadens the concept of gender to include men.

Male participation is vital to reducing maternal and infant mortality in Uganda. Culturally, men often hold decision-making power in families. Many women lack the autonomy and economic means to seek healthcare without their spouse’s consent. Delays caused by waiting for male approval, particularly when a woman experiences danger signs during pregnancy or after childbirth, have significantly contributed to high maternal and infant mortality rates. Decisions regarding family health and care are deeply affected by gender power dynamics. Men control household resources, indirectly influencing the costs associated with seeking care. Other areas where male involvement is essential include:

• STD/HIV Control: Men’s often higher risk behaviors necessitate their active involvement in prevention efforts.

• Family Size Decisions: Men frequently dictate the number of children.

• Emotional Support: Both men and women require emotional support throughout the RH journey.

• Resource Control: Women often need to justify healthcare visits due to male control over resources.

• Preventive Services: Men may find it harder to prioritize preventive services than emergency care which equally important for men.

• Male-Specific Health Issues: Men also face a range of SRH issues, including HIV/AIDS, fertility problems, midlife concerns like andropause, sexual dysfunction, and genitourinary conditions.

Cultural beliefs and expectations of masculinity can encourage risky behavior in men, such as avoiding seeking medical care, even for serious issues like HIV/AIDS. Additionally, a sense of masculine dominance can lead to violence against women. These issues are deeply rooted in societal norms and have severe consequences.

While some women’s health advocates have historically been apprehensive about incorporating male-focused services, programs for men can enhance, not diminish, women’s services if properly integrated into existing healthcare systems. The 1994 International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing both called for men’s constructive roles to be incorporated into reproductive health programs.

Neglecting to provide RH information and services to men can actually hinder women’s overall health. Men who are educated about RH issues are more likely to support their partners’ decisions regarding contraception, family planning, and safe sex. When men are well-informed, they can provide better support during pregnancy and may be more likely to help their partners access emergency obstetric care. Moreover, the spread of STDs and HIV requires joint participation. Both partners should share the responsibility for disease prevention and understand contraception risks and benefits.

Importance of Male Involvement

Explanation: This section highlights why actively engaging men in RH is beneficial for various stakeholders.

Involving men in RH benefits men, women, communities, and healthcare providers. It leads to:

• Increased male support for women’s reproductive choices and respect for their rights.

• Greater access to male contraceptive methods, expanding family planning options.

• Promotion of responsible sexual behavior among young men.

• Inclusion of men in counseling and RH information sessions with their partners.

• Reduced spread of HIV/AIDS and STDs.

• Increased awareness of the negative impacts of risky male sexual behavior on women’s and children’s health.

• Greater male support for family planning and women’s contraceptive use.

• Improved health outcomes due to the influence of male decision-making.

• Meeting women’s growing demands for increased male participation in RH.

• Using RH programs as a platform for promoting gender equity and transforming gender roles.

Factors Limiting Male Participation in Reproductive Health

Explanation: This section identifies the barriers preventing men from actively engaging in RH.

Several factors impede male participation in RH:

1. Programs Not Geared for Men: Many primary health care (PHC) programs are designed for women and children, making them less accessible to men.

2. Socio-cultural Barriers: Social and cultural norms often restrict men’s involvement in family planning and RH decision-making.

3. Service Focus on Women/Children: Services are primarily designed for women and children, making men feel excluded and often lack trained staff to meet male needs. Men may feel embarrassed attending facilities primarily serving women.

4. Limited Male Contraceptive Options: The limited range of male contraception (condoms, withdrawal, vasectomy) restricts choices.

5. Misinformation and Rumors: Lack of accurate information can lead to misperceptions and fear about male contraceptive methods. For example, men may mistakenly associate vasectomy with castration or impotence or believe condoms reduce sexual pleasure or cause allergies.

6. Provider Bias: Some providers have biases against male contraceptive methods, which can result in the neglect of information for male contraception.

7. Socio-Religious Barriers: Open discussions on sexual matters can be uncomfortable in some societies. Young men face particular pressures that prevent seeking services. Some may believe contraception is against religious teachings.

8. Priority to Women’s Services: Some programs prioritize women, allocating less resources for male engagement.

9. Predominantly Female Health Providers: Many PHC service providers are female, making it difficult for men to feel comfortable discussing their needs.

10. Prioritization of Women and Children’s Healthcare: Healthcare systems tend to prioritize services for women and children.

11. Provider Attitude: Some providers are biased against male involvement.

12. Lack of Information: Lack of information and awareness about men’s SRH issues limits their involvement.

13. Limited Spousal Communication: Limited communication between spouses about family planning (FP) needs.

14. Resource Constraints: Health centers may lack male health workers, specific clinics for males, and resources.

15. Psychological Factors: Men may experience shyness or discomfort accessing these services.

16. Limited Pre-Pregnancy Contact: Difficulty reaching couples with healthcare information before pregnancy.

Reproductive Health Needs and Services for Men

Explanation: This section outlines the specific information, skills, and services men need to be healthy and informed participants in RH.

Men require information on:

• Basic sexual and reproductive health education.

• Genital health and hygiene.

• Healthy relationships.

• Pregnancy prevention.

• STIs, including HIV.

• Fatherhood.

• Accessing services for violence, abuse, and genetic counseling.

• Contraception.

• Reproductive physiology.

• Sexuality.

• Pregnancy and birth preparedness.

• Male reproductive cancers.

• Sexual and gender-based violence.

• Fertility and infertility.

They also need skills in:

• Pregnancy and STI prevention and safe sex practices.

• Fatherhood skills.

Preventive healthcare services include:

• Sexual and reproductive history assessment.

• Cancer screening.

• Substance abuse screening.

• Mental health assessments.

• Physical examinations.

• Links to other necessary services.

Clinical services include:

• Testing and treatment for STIs, including HIV.

• Diagnosis and treatment of sexual dysfunction.

• Fertility evaluations.

• Contraceptive services (vasectomy).

• Treatment for urologic conditions.

Social and Reproductive Health Responsibility of Men

Explanation: This section details men’s roles and responsibilities for promoting SRH.

Men should:

1. Discuss contraception with partners.

2. Use STI/HIV screening with their partners.

3. Accompany their partners for antenatal, delivery, and postnatal care.

4. Only marry partners who are 18 years and above.

5. Abstain from sex until marriage.

6. Use condoms to prevent STIs/HIV and unwanted pregnancies.

7. Maintain healthy relationships with their partners during pregnancy and after childbirth.

8. Provide moral and financial support during pregnancy and after birth.

9. Support their partners’ infant feeding choices.

10. Assist in child rearing.

Social Norms, Beliefs, Practices and Taboos

Explanation: This section highlights the social and cultural challenges influencing SRH in the context of male involvement.

Social barriers include:

1. Promiscuity.

2. Power imbalances where male dominance is the norm.

3. Inadequate communication between spouses.

4. Limited participation of men in childcare.

5. Gender-biased roles.

6. Culturally accepted early marriage.

7. Wife inheritance.

8. Polygamy.

9. Competition among wives.

10. Poverty.

Strategies to Increase Male Involvement in Reproductive Health

Explanation: This section outlines strategies for effectively engaging men in reproductive health services.

Strategies to increase male involvement include:

1. Working with young men to address gender biases in schools and communities.

2. Integrating male-specific services into existing healthcare programs.

3. Improving services at existing clinics.

4. Sensitizing communities to address gender biases that negatively impact RH.

5. Building the capacity of health workers to involve men in RH services.

6. Developing educational materials that address male involvement and responsibility in RH.

7. Focusing RH information and services on couples rather than individuals.

8. Debunking myths about condoms and vasectomy.

9. Sensitizing service providers to men’s RH needs.

10. Offering discrete and confidential services in clinics.

11. Establishing separate clinics for males.

12. Providing workplace-based services.

13. Offering community-based services.

14. Utilizing commercial and social marketing techniques.

15. Increasing contraceptive options for men.

16. Training providers on male FP/RH needs.

17. Utilizing culturally appropriate messaging.

18. Recruiting male health workers.

19. Engaging various institutions (e.g., Ministry of Health and NGOs).

20. Developing guidelines on male involvement in RH.