Why family planning should include men
In the last week of January I presented some of my dissertation findings at this year’s re-scheduled International Conference on Family Planning (#ICFP) in Nusa Dua, Bali, Indonesia. The conference was energizing in many ways: I watched the youth delegates rap about family planning, connected with old friends and colleagues, met people whose names I’ve seen for years, and heard about new research on all sorts of components of family-planning programming. The event left all of us inspired to get back to work.
However, there was distressingly little conversation about men and boys’ involvement in family planning. The beautiful video that was shown during the opening and closing plenary sessions stated that the ICFP exists so that “thousands of people from all over the world [can] come together for one purpose: to give women and girls what they need to live the lives that they deserve.” The first time I heard that sentence I turned to the friend sitting next to me and asked, “What about boys?” Though there were sessions on men and boys, the conference’s overarching message was that family planning exclusively concerns women.
In the last few weeks two other conversations about family planning have been conspicuously devoid of male involvement. First, many countries in Latin America—specifically, El Salvador, Brazil, Colombia, Ecuador, and Jamaica—recommended that women avoid getting pregnant because of the risk of contracting the Zika virus, which can put their fetuses at risk for birth defects and poor health outcomes. None of these countries or their public health agencies has recommended that men also be involved in avoiding pregnancies, even as evidence has shown that Zika can be passed through sexual conduct.
Second, the Centers for Disease Control released new recommendations that women who are not using contraceptives abstain from any alcohol use in case they expose a fetus before they know they are pregnant. Nowhere in the recommendations did the CDC explore the role that men can play in contraceptive use or preventing pregnancy.
It is a common assumption in the family planning world that without intentional work on masculinity and equitable gender norms, boys and men usually just get in the way of girls and women using effective contraceptives. This is partly true. We see evidence that young men pressure girls to get pregnant early and often, that they practice sexual and gender-based violence and contraceptive coercion. There is a widespread female preference for “hidden” family planning methods like injectables or implants in order to avoid the above-mentioned realities. Sexual violence by men can result in women getting pregnant more often than they want to, or at times they do not want to. This puts them at risk for poor pregnancy and birth outcomes (including death), as well as higher rates of abortion. These outcomes are even more likely if the woman in question is still an adolescent. In fact, maternal mortality is the leading killer of teenage girls in the developing world.
But if we are going to address these issues fully, it is essential to work with boys and men to engage in conversations around masculinity, sexual violence, women’s health, and planning for pregnancies. Men are affected by the poor health of their partners, and it is time that we raise our expectations of men and help reach them. This work is not always easy. Men and boys need to learn to change their behaviors and their norms around power and gender roles (and it is important to note that sometimes this work results in lowered contraceptive use). However, research suggests that boys and men need access to effective family planning, and that boys and men who are involved in conversations with their female partners in planning their families and utilizing family planning methods are more likely to use condoms, practice safer sex, have fewer partners, and support their partner’s family planning. They are also less likely to use violence against their partners.
Thankfully, the UNFPA is increasingly taking a human rights based approach when discussing family planning. When the human rights of men are in competition with the human rights of women, there is a need to teach couples how to communicate and compromise in a manner that respects both rather than promoting one above the other. But if couples learn how to communicate and compromise with one another, arguments may no longer need to feel like a zero-sum game.
Women and girls need to be able to live the lives that they deserve, and protecting them physically and emotionally is essential. But the same applies to boys and men. And perhaps more often than we have been willing to admit or explore, helping boys to live the lives that they want and deserve may also help them learn to support their wives, girlfriends, sisters, daughters, friends, and others in that pursuit. Family planning is increasingly just that: a family issue. We must continue to strategize and study how to help men learn to communicate, compromise, listen, and work with the partners they love or have families with in order for them both to increasingly live the lives they deserve. The first step in doing so is beginning to include them in the conversation and have higher expectations.