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Developing a pregnancy prevention program for Black and Latino young men

Few pregnancy prevention programs are designed for males and even fewer programs focus on young men of color in an uplifting way. This matters because birth rates for Black and Latino teens are 50 percent higher than the national average, and 75 percent of teen pregnancies are unintended. Additionally, 80 percent of young, unmarried Black men and 78 percent of young, unmarried Latino men believe it is important to prevent pregnancy at this young age. However, Black and Latino men often face barriers to accessing reproductive health care services and have historically been excluded from reproductive health efforts. Developing and evaluating programs and conceptual models that support young Black and Latino men in making informed decisions about having sex and using contraception can play a key role in reducing unintended teen pregnancy in the United States.

Promundo and the University of Pittsburgh developed Manhood 2.0, which encourages young men—through reflective discussions—to question and challenge inequitable gender norms, reduce intimate partner violence, improve contraceptive use, and prevent unintended teen pregnancy. This program was informed by input from young Black and Latino men in Washington, DC. [1] In 2017 and 2018, Child Trends conducted a rigorous evaluation of Manhood 2.0 in Washington, DC with a sample of Black and Latino young men. At the end of the evaluation, Child Trends conducted focus groups with 27 of the 56 young men (48%) who completed Manhood 2.0 to understand what they had learned from the program and how they felt about the program content and delivery. This brief describes the experiences of the 14 young men (25%) who participated in the 2020 long-term follow-up.

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Findings from Long-Term Follow-Up with Former Manhood 2.0 Participants

In 2020, Child Trends conducted interviews with nine young men and two focus groups with an additional five young men (N=14) who had participated in at least 50 percent of Manhood 2.0 sessions in 2017 and 2018. Participants described the lessons and knowledge they gained from Manhood 2.0, aspects of the program they had incorporated into their lives, and additional services and supports that future programs could incorporate to help support young men—particularly Black and Latino young men. Most participants (71%) were Black, 18 years old, and had completed the Manhood 2.0 program 1.5 to 2 years prior. These participants had significantly higher attendance in the Manhood 2.0 program than those who did not participate in focus groups or interviews. Half of participants reported visiting a health care provider for sexual or reproductive health services in the past year, half were in a current relationship, 50 percent had ever had sexual intercourse, and 43 percent were sexually active in the last three months. Almost all sexually experienced young men reported ever having a pregnancy scare. See the appendix for detailed information on the study methods and participant characteristics. This brief presents the most salient themes emerging from the long-term follow-up study.

In the 2018 immediate follow-up focus groups, Manhood 2.0 participants discussed how they had gained a broader understanding of the various forms of birth control methods as a result of the program, and how this knowledge had increased their confidence in talking with potential partners about using birth control. In the 2020 long-term follow-up interviews and focus groups, we asked the young men to discuss any opportunities they had had to use this knowledge with previous or existing partners. One participant said, “[Manhood 2.0] helped me a lot with just being able to openly have conversations about prevention.” Most young men had not been directly involved in birth control decision making with a partner, largely because they had not been sexually active or in a serious relationship since completing the program. However, overall, the young men—regardless of relationship status or sexual activity—noted that they would still feel confident discussing birth control use with potential partners, if they needed or wanted to. For example, one young man said, “If [my girlfriend] was bringing up the idea that she wanted to be on birth control, I would be able to have a conversation with her and have knowledge about it.” Another participant stated:

“[Manhood 2.0] helps you understand … it’s more than a condom for birth control methods. And so, I guess that can make me feel confident. I know this type of information, and I can use it to help me and the relationship too.”

Participants also reported that Manhood 2.0 had provided a collective space to ask questions and discuss various birth control methods. One young man described how participating in open discussions in the program with facilitators and other young men helped him see birth control as a “discussable topic” between partners, rather than solely a female’s responsibility. Another participant said, “Before the program, I didn’t know much about female birth control … but once I got into Manhood … I was able to see that there’s a lot of other different methods that we can use as well. And they helped me understand and be able to have that conversation.” Overall, these findings indicate that participants have sustained comfort and confidence discussing birth control use with partners up to two years after participation.

In the long-term follow-up interviews and focus groups, we explored what young men saw as their role in pregnancy prevention and in decisions about birth control use. Several young men reported that they should be equally responsible for preventing pregnancy and mentioned ways they could support their partners in making decisions about contraceptive use—for example, by contributing knowledge about the pros and cons of birth control. One participant said, “I feel like [young men] should take the time to think about, learn the positives and negatives of birth control, and then they just speak with their partner about it … I think they should really discuss it together.”

For men who had been directly involved in decision making with a partner, the side effects of birth control played a large role in conversations and thinking around birth control use. One participant said, “[Previous partners] who used birth control … they really told me that it’s good for some physical aspects, but for things like emotional and mental stability, it sort of varies by person.” He reiterated the importance of discussing birth control, given that women may have had negative experiences with it in the past.

A couple of young men mentioned encouraging their partners to stop taking birth control, citing concern for their partner’s well-being. One young man explained how his partner had experienced negative side effects from the pill, so she switched to the shot. However, “so far, that has not been the brightest option either. So right now, I just told her that we’re just going to stop using birth control, period.” When speaking hypothetically, another participant said, “I mean, me personally, I wouldn’t really want her to [use birth control] because, like I said, it does come with side effects too, that you know might affect you sometimes a little bit in the long run.” Even though some men expressed concerns about side effects, some described how the program helped shift their negative perceptions of birth control in a positive direction. For example, a participant said, “I thought birth control was a way to— … I thought that harmed women or something, but the program taught us how it benefits and how it helps.”

Given the complexities of these decisions, young men emphasized the importance of being understanding and respectful of women’s birth control decisions, saying that “[young men] should support females’ decision even if they don’t use birth control. They should support it even if they do use birth control. Either way, support it all the way—no matter what circumstance.” This aligns with the immediate follow-up focus groups, where young men largely agreed that birth control decisions are ultimately up to women.

Young men also emphasized that decisions about having children should be made equally. One participant remarked, “Both the male and the female should be in the right position in life to be able to make a decision on whether to have a baby or not. That’s when they should both equally consult one another.” While young men agreed that both partners should be involved in the decision-making process and have a mutual understanding about the implications of having children, they ultimately felt that it was a woman’s decision. One participant explained how women of color have particularly difficult interactions with the health care system during pregnancy and childbirth—“where doctors don’t understand pain, they don’t believe that when women say that things are not right, it’s not right. And so, with that kind of stress and pressure, I rely on the woman to make her decision …”

Young men who participated in Manhood 2.0 gained a more nuanced and deeper understanding of sexual consent, which stuck with them up to two years after the program ended. Young men reported that the program had taught them to be aware of any discomfort before engaging in sex and that sexual consent needs to be obtained while sober. For example, one young man explained that if someone is “saying they want to do it, but they look uncomfortable, that’s their sign that you shouldn’t pressure them into doing something they don’t want to do.” Young men also discussed how, before participating in the program, they had not been aware that consent could be revoked midway through sex, and that Manhood 2.0 had taught them that “you need to constantly be affirming the consent is still there at all times.” The program had also helped them understand that men pressuring women into providing consent does not qualify as consent. For example, a participant said, “If they said, ‘no,’ and you continuously, continue to ask them, and they say ‘yes.’ I didn’t really see that as a big deal until when I really got into Manhood 2.0 because one thing they told me like, ‘Trust me. If they want to do it, they’ll say it and you don’t have to keep pressing them.” He continued: “Sometimes a female don’t want to do things but guys are very good at like seducing their minds so they just do it.”

Since half the participants had never had sex, many of the young men discussed how consent plays out primarily for other young men. Participants discussed how sexual consent may be “ignored” or “rushed,” and that young people do not usually think about consent before sex happens; instead, they just “go with the flow.” Similarly, young men discussed how, even though they define consent as a verbal “yes” or “no,” sexual consent can be nonverbal and confusing. One participant explained his views: “I feel like sometimes consent can be physically shown because if a guy and a female just keep looking at each other and they just kiss … I mean nobody verbally said it, but you know they physically said it, and that’s why I feel like consent can be physically and verbally dependent.” The participant continued to say that, even if he were to kiss before verbal consent, he would ask his partner, “Are you sure this is what you want to do?” noting that other men typically don’t do this.

Young men who participated in the 2018 immediate follow-up focus groups reported that Manhood 2.0 had shifted their views on gender norms, specifically around allowing themselves to express emotions. Similarly, in 2020, many participants reported that Manhood 2.0 had helped them see that “it’s okay to not be okay”—and that expressing emotion doesn’t make you less of a man. At least one third of participants mentioned that young men struggle to communicate their feelings. As one young man said, “if there is one issue that I would like to solve about men, it’s how we communicate how we feel.” Having a safe space to talk to other young men, like Manhood 2.0, was important for participants who felt that they did not have anyone they could turn to: “There was nobody I could talk to. I just had to keep it in, and that messed with my head …” Even participants who felt they had someone to turn to mentioned that “[men] are not raised to be able to have those kind of conversations” and benefited from learning, through Manhood 2.0, how to communicate feelings and express their emotions.

Young men also delved more deeply into what they feel society expects of them, including the pressure to provide financial stability and sacrifice for their families. The young men discussed how they are expected to “step up more than the female” and have the added pressure to “pay all the bills.” These pressures and responsibilities around what “men are supposed to do” resulted in several participants wanting more equitable relationships, in which “both people go to work, providing for one another.” As a result of Manhood 2.0, young men also learned that they do not have to be “the dominant figure of the house” and that “the man has to help somehow in the family … in the house”—and that not just the woman should serve in this role. Overall, Manhood 2.0 guided the young men in understanding how gender plays a role in society and in relationships; years later, this continues to be reinforced through their everyday lives.

Similar to the immediate follow-up focus groups, interview and focus group participants in 2020 identified racism, discrimination, and stereotyping as the biggest issues they face as young men of color. One participant explained that “young Black males like myself are being accused of stealing or committing a crime that they didn’t do, and they’re getting killed over it for no apparent reason.” The young men reported that, because of pervasive racism and stereotyping, they have to “watch the way” they carry themselves because “it’s so easy for a Black man to get locked up or be imprisoned.”

New issues, such as the challenge of being a young father and the lack of positive role models, also emerged in the long-term follow-up interviews and focus groups. Although only one young man had a child, several participants discussed the challenges of being a young father—notably the financial strain and educational sacrifices. Participants felt that young fathers often “don’t have enough money to provide for the kid.” The young men also discussed how some of the issues around being a young father are compounded by being a young Black man. One young man discussed how, as a young Black father, “you are already down a couple points because you’re Black and have a kid. [Society] don’t think that you’re going to be there [for the kid].”

Several participants also mentioned the lack of positive role models for young men of color as one of the biggest issues they face. One participant explained: “[young men of color] don’t have that father figure that’s been there to really mentor them.” Young men also wanted to learn more about how to “deal with society.” For example, one participant explained how “in school they’ll teach you how to read, how to write, but when you go to the real world, they’re not showing you how to do taxes or other stuff that a grown man is supposed to do.” Another participant expanded on this, saying that young men of color lack representation in successful careers. Overall, the young men felt that more successful role models who looked like them would be critical for helping them “find what they want to be when they get older, what path they want to take, what life they want to live.” One participant highlighted how young men of color “have the mindset to go far,” but that they “need people that can push us forward, that we can listen to, that will really be a strength that can help a lot of Black men in the community.”

When asked what had resonated most from Manhood 2.0, the young men reiterated the importance of facilitators who fostered a feeling of togetherness, provided a judgement-free space, and taught the young men that they “have other people there to talk to.” The young men frequently mentioned how Manhood 2.0 was unique because participants felt they could “say anything and not have to worry about anybody judging” and could be themselves around the facilitators and “laugh” and “joke around with them.” This sense of comfort—along with a reflective, discussion-based format—encouraged strong bonds between participants and made the young men feel that Manhood 2.0 was a safe space where “you can share anything.”

Young men noted, however, that it can be difficult to have conversations about masculinity, relationships, and sex outside of a program setting, and that Manhood 2.0 “holds a lot of value” because “not everyone has a place where you can go into like, ‘man, I need to talk.’” Most participants reported that, since Manhood 2.0 had ended, they had not yet found another safe space in which they could express their emotions and discuss what it means to be a man. Other participants felt they had friends, partners, or family members they could talk to, but mentioned that it can be difficult to carve out a time or space for those conversations. One participant explained: “When you’re hanging with your friends, you’re not going to talk about consent in the middle of a game.” He continued, “It’s better to have that sort of opportunity to talk, not only with other males, but males who lived through the times that you have and get their opinions on things.”

Even though participants had not found other formal spaces like Manhood 2.0, several young men discussed how the program had made them more comfortable reaching out to friends or family for support. One young man said that, while he didn’t talk “specifically [about] being a man,” he was able to seek support from his girlfriend and mother and express how he was feeling. Another participant mentioned that Manhood 2.0 had taught him how “constructive conversations are supposed to go”; because of that lesson, he is “more able to have those kinds of conversations with my friends back at school.” Overall, the young men felt more comfortable talking about their emotions and sensitive topics since participating in Manhood 2.0.

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Discussion

Both the content and the delivery of Manhood 2.0 continued to influence this sample of program participants years after the program ended. For example, program participants recalled detailed knowledge about sexual consent and indicated that they still felt comfortable communicating with potential partners about birth control, even years later. The discussion-based format with nonjudgmental, relatable facilitators prepared young men not only for future conversations on family planning and sexual consent with their partners, but also for conversations with other young men, friends, and family members on sensitive topics. Some data suggest that the skill-building and discussion-based components of the curriculum, in combination with knowledge building, might help enforce equitable romantic relationships.

The young men who participated in Manhood 2.0 take seriously their role in supporting partners in their contraceptive decisions. This is especially important as more of these young people enter into romantic and sexual relationships. In the two-year follow-up, the young men continued to note their increased awareness of birth control methods, which made it easier for them to discuss contraceptive options with partners. However, despite this additional knowledge and awareness of birth control, young men continued to respect women’s autonomy over their bodies and noted that decision making around birth control and pregnancy was ultimately the female’s decision because it involved her body.

Young men also highlighted ongoing concerns, which have implications for future programming. Young men underscored the persistent racism and discrimination they live through as men of color and described how these factors impact their ability and confidence in achieving their career goals. Now that most of the men were out of high school, they acutely felt the pressure to provide financially for themselves and others, and they desired increased mentorship and male role models who have achieved career goals despite a racist and discriminatory environment. Research indicates that positive youth development programs that address contextual factors, provide holistic programming, and build opportunities for youth are more likely to help youth succeed. In addition, health equity cannot be achieved unless programs address contextual factors such as racism. Future family planning programming for young men might benefit from combining sexual health programming with goal setting and could include components that address inequities faced by Black or Latino men—for example, by providing opportunities for mentorship with other Black or Latino males.

Several young men also reported concerns about the side effects of birth control, which may influence their conversations with female partners and can present barriers to contraceptive use. In a couple of cases, young men noted that they had encouraged, or would encourage, a partner to stop using birth control altogether because of concerns about side effects. These findings align with previous literature, which finds that inaccurate beliefs around birth control are associated with more negative attitudes toward birth control pills among Black respondents. Communities of color also report greater concerns about hormonal and LARC methods, which may stem from mistrust of the medical system due to historical medical exploitation and lower standards of care. These higher levels of mistrust can discourage hormonal or LARC methods, which require more interaction and dependency on medical providers for insertion and removal. These findings illustrate the need for additional programming that discusses both the side effects and effectiveness of contraceptive methods, while also acknowledging current and historical community experiences with the health care system. To address this issue holistically, sexual education should be accompanied by reforms within the reproductive health care system. Notably, almost all sexually experienced men in the long-term follow-up study reported ever having a pregnancy scare, and many reported recent unprotected sex—highlighting the ongoing need for sexual health education among young men.

Lastly, while young men felt more comfortable discussing sensitive topics because of the program, finding a safe space to talk was difficult outside of the program and its facilitated setting. These young men expressed a desire for a continued space, which highlights a need for sustaining programs like Manhood 2.0 and integrating safe spaces within high school and post-high school/college support systems.

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Strengths and Limitations

A major strength of this study was its ability to reach and collect long-term data on program participants years after they had left the school and community system from which they were originally recruited. Another strength was the study’s collection of long-term qualitative data to understand young men’s experiences in the program and its comparison of these data to qualitative data, with largely the same sample, collected in 2018. Comparing data at two timepoints illustrates the staying power of Manhood 2.0 content among the young men. Our qualitative data collection also allowed findings to emerge that might have not otherwise emerged in a survey. For example, participants highlighted their comfort with having discussions about birth control; however, when probed about the nature of these discussions, their views and concerns about side effects emerged, which may have otherwise gone unnoticed in a survey.

Half of the participants had ever had sex, and only half were in a relationship (i.e., either in a serious relationship, dating relationship, or only having sex) at the time of interviewing, almost two years after receiving the program; therefore, not all participants were able to speak to the application of the skills they had learned (e.g., discussing birth control or consent with partners). While every effort was made to reach each Manhood 2.0 participant who attended at least 50 percent of sessions—including having LAYC staff serve as recruiters and using multiple forms of contact for each participant—the sample size (n=14) represents only one quarter of the Manhood 2.0 participants. This sample had significantly higher attendance in the program than those who did not participate, suggesting that their recollections of and views about the Manhood 2.0 program might be more positive than the full program sample. Low overall program participation can be a particular issue for after-school and community-based programs. However, if Manhood 2.0 was able to improve attendance and engagement, these men’s experiences could be representative of the actual effects of the program.

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Conclusion

Our findings indicate that both the content and delivery of Manhood 2.0 had long-term relevance for young men, suggesting that this program may be a promising approach for increasing and improving young men’s communication with future partners, encouraging more equitable relationships, and addressing underlying causes of teen pregnancy. The young men still faced several ongoing challenges; however, if addressed in a program like Manhood 2.0 or integrated within school support systems, solutions to these challenges might prove even more beneficial. Future programs should spend more time addressing contraceptive side effects and method effectiveness and incorporate program elements that address inequities that Black and Latino men face, such as a lack of mentorship and opportunities for career development.

Footnote

[1] Manhood 2.0 has maintained a focus on serving structurally disadvantaged young men. Promundo, in partnership with LAYC, conducted initial focus groups with young Black and Latino men to inform the Manhood 2.0 curriculum and adaption. They also developed a youth advisory board to test and advise the team on the relevance of curriculum activities for the target populations.