Men and Contraception: A Necessary Disruption of the Status Quo
When men are well informed, they can become active participants in the health and well-being of their partners and children- by
James Ngugi is proud of his vasectomy.
The father of five lives with his wife Leah and their children in Kayole, a poor section of Nairobi, Kenya. Leah had suffered complications with each of her five pregnancies, and went on the pill after the couple’s youngest child was born. But she worried constantly about missing a dose.
Then James had a breakthrough realization.
“For too long, I assumed this problem was hers and hers alone,” he says. “But then I realized I could take on the burden myself.” James opted to get a vasectomy through Tupange, a family planning program funded by the Bill & Melinda Gates Foundation in partnership with Jhpiego and the government of Kenya. Tupange means “let’s plan” in Kiswahili, and the program is dedicated to making modern contraceptive methods available to the urban poor to improve maternal and newborn survival and empower couples and youth to plan their families and their lives.
For James and Leah, a vasectomy was the perfect choice. They were so happy with the results—and with the impact of the vasectomy on their family and their marriage—that they now work with Tupange to educate others about the benefits of voluntary male sterilization.
“I never knew how much James loved me until he had this vasectomy for me,” Leah says simply. “It is the most generous gift he has ever given me.”
James and Leah are a family planning success story. They’re also a reminder that men are a critical part of the family planning equation. Enlisting the support and involvement of men like James is essential if we want to expand the benefits of modern contraception to women and their partners all over the world.
That’s especially important to bear in mind now, as we observe the midpoint of the global Family Planning 2020 (FP2020) movement. FP2020 was launched at the 2012 London Summit on Family Planning with an ambitious goal: to deliver modern contraception to an additional 120 million women and girls in the world’s poorest countries by the year 2020 without coercion and discrimination. Four years later, we’ve made enormous strides, reaching an additional 24.4 million women and girls and securing commitments from more than half of the 69 FP2020 focus countries. While our actions are strong, they have not caught up with our ambition yet and we risk falling short of achieving the transformational changes we promised: that women and girls, regardless of where they live, should have the same access to life-saving contraceptives.
To accelerate progress urgently, we need to continually and critically examine our strategies, review the data, and break the mold of doing business as usual. We must challenge ourselves to think creatively, disrupt the status quo positively, act on innovations and identify new partners with bold ideas to urgently expand access and use of contraceptive information, products, and quality services.
One area where we’ve fallen short is male engagement: getting men and boys to actively participate in frank conversations about sex, consent, contraception, and sexual and reproductive health and rights. We know that male opposition, power dynamics, lack of communication and gender equity remain serious barriers to expanding quality, access and improving the uptake and continuation of contraceptive use. Tackling these barriers head on will help drive progress forward.
Globally, the vast majority of family planning programs are oriented towards women and girls. Programs focusing on male engagement in family planning have fewer dedicated resources, even though men are often the primary decision makers about family size, health services, and family planning methods. But if we’re going to reach our FP2020 goal—let alone our long-term goal of universal access to reproductive health—we’ll need to expand the dialogue and involve men and adolescent boys as valuable and effective partners. Programs that optimize the positive engagement of men can improve health outcomes for women, men, and their families.
Stories of progress in family planning are often stories of innovative partnerships with governments, civil society, service providers and the private sector. And one bold attempt to ratchet men’s involvement up is World Vasectomy Day, an innovative partnership designed (by men) to proactively take charge of their own health and well-being. Launched in 2013, World Vasectomy Day has quickly grown into the largest male-focused family planning event in the world. The information isn’t limited to vasectomies though; conversations also focus on preventing HIV and other STIs, male circumcision, gender equality, and the importance of men in family planning.
The innovation of World Vasectomy Day is that it isn’t just a one-day event. It’s a larger movement aimed at encouraging men to become agents of change in their communities; to take an active role in their sexual and reproductive health throughout their lives. Men tend to be negligent of their own health, and the gender dynamic in many cultures means that men are unaccustomed to thinking about how their actions affect their partners and children. Masculinity norms also make some men unsure about family planning.
That’s why it is so critical to secure men’s engagement on this issue. When men are well informed, they can become active participants in the health and well-being of their partners and children. Their involvement can also foster joint decision-making and improve communication between partners that lead to shared decision making about family size and method choice. Men can also play a powerful role in transforming rigid gender norms, promoting women’s and girls’ empowerment and well-being, and ending gender-based discrimination and violence.
This year the Government of Kenya is stepping up to host World Vasectomy Day on November 18. Kenya is a country that is on the forward edge of family planning, actively embracing new ways to broaden the dialogue around contraception. In 2014 Kenya showed a dramatic increase in its modern contraceptive prevalence rate for married women, which rose from 32% in 2003 to 53%, thereby exceeding its FP2020 goal.
Another important trend globally and in Kenya, is the number of women and men who have achieved their family size and want to stop childbearing. Half of married women age 15-49 and 42% of currently married men consider their families complete. The Government of Kenya is responding to this trend and is moving forward to innovate and forge strong, bold partnerships with NGOs and local communities to improve quality, access and choice.
While the gains are worthy, challenges remain in Kenya. Almost 20% of teens aged 15-19 are mothers or pregnant with their first child – numbers that have remained stagnant over five years. The modern contraceptive prevalence rates for all women including those who are unmarried, sits at 39.1%. In terms of male engagement, condoms represent only 2% of modern contraceptive use and less than 46% of married women had even heard of male sterilization.
Let’s be clear: to deliver on the promise of FP2020, we need to reach 120 million additional women and girls and their partners to promote family planning, expand access to information, services and supplies in order to accelerate contraceptive uptake and reduce discontinuation.
We need to design programs with men and adolescent boys to address myths and misconceptions and help get them on board to become champions, users and supportive partners. Many men are like James: they see their wives suffering with fear of pregnancy or contraceptive complications, and they long to step up and relieve them of the burden. For other men it’s about their children: they want to give them the best possible chance in life, and that means making sure they can support them fully. These are positive, heroic instincts. If we are going to hold ourselves accountable to the promise we made back in 2012, we must take a closer look at men’s needs, develop an evidence base, cultivate different partnerships and gear more information towards men and adolescent boys.
When James opted for a vasectomy, he knew he was taking a risk of being one of the first men in his community to get the procedure done. And now, with only four years left on the clock to reach the FP2020 goal, the family planning community must take some risks too. That means we’re going to have to try new approaches, bring new partners to the table, listen to fresh voices and move out of our comfort zones to get things done and ignite real, lasting change.
The kind of change that involves all of us breaking down silos and building bridges – working together with men and adolescent boys so we can go further faster.