Young Men’s Experiences in a Pregnancy Prevention Program for Males

Research BriefSexual & Reproductive HealthOct 4 2018

Authors

Pregnancy prevention programs that target young women overlook the pivotal role that young men can play in preventing unintended pregnancies. Few pregnancy prevention programs focus on the role of young men in making decisions about contraception.1 While 80 percent of births reported by young fathers (under age 25) are unintended,2 research indicates that about half of young men believe pregnancy prevention should be their partners’ responsibility.3,4 Developing and implementing effective programs that address the needs of young men—in addition to young women—can do much to reduce unintended pregnancy in the United States.

To address the gap in programs for young men in the United States, Promundo and the University of Pittsburgh developed the program Manhood 2.0, which encourages young men to discuss gender norms, masculinity, and fatherhood as a gateway to a broader discussion on violence prevention, contraceptive use, and pregnancy prevention. Manhood 2.0 staff reach out to young men during a key period in their identity development and encourage their involvement in pregnancy prevention (see Appendix A). The breadth of these discussions is important because decisions about sex do not happen in a vacuum. Environmental factors—such as racial discrimination, socioeconomic deprivation, and peer pressure—can create rigid gender norms and feelings of powerlessness that result in risky sexual behaviors.5-7 However, few U.S. health programs for youth have integrated discussions about gender and power as a means to develop more equitable behaviors and healthier relationships among youth.8,9

Manhood 2.0 is a 13-hour program that uses a participatory process of reflection on gender and power that is informed by young men’s own experiences and perspectives. Manhood 2.0 provides a space for young men to discuss gender, masculinity, and power; gain information about female birth control; learn about healthy sexual practices, such as consent; and build skills around communication between sexual partners. The Manhood 2.0 curriculum developers provide intensive training and technical assistance to facilitators on how to ask questions, keep participants engaged, manage challenging situations, build on existing knowledge, tactfully correct misinformation to dispel myths and stigma, and promote a peer learning environment. Promundo and Child Trends partnered with Latin American Youth Center (LAYC) to recruit participants and implement Manhood 2.0.

Child Trends conducted a rigorous evaluation of Manhood 2.0. Because unintended births are disproportionately higher among black and Latino young men,10 the evaluation focused on young black and Latino men, ages 15–18, in the Washington, DC, metropolitan area. This brief highlights qualitative findings from the evaluation.

Key Findings

  • For the first time, many young men had an opportunity to think about gender norms and stereotypes, and they shifted some of their views on gender.
  • Young men felt educated and empowered to communicate with their partners after receiving information on female birth control methods (particularly long-acting reversible contraceptives).
  • Young men increased their knowledge about sexual consent and condoms after participating in the program.
  • Young men indicated the need for shared, safe spaces to talk about their feelings and the topics covered in the program.
  • Nonjudgmental facilitators with similar backgrounds and life experiences as the young men were instrumental in creating a sense of brotherhood and openness in discussions.
  • Programs for young men of color must recognize that racism is a reality in these young men’s lives and may influence how programs work.

Findings from Focus Groups with Young Men

To understand young men’s experiences discussing topics of rigid gender norms, masculinity, power, and pregnancy prevention in the program, Child Trends conducted five focus groups with young men who participated in Manhood 2.0. Participants described what they learned, provided input on the delivery of the program, described their relationships with the facilitators, and provided important context for understanding how young men’s life experiences may influence their responses to a teen pregnancy prevention program. The qualitative study seeks to enhance understanding of how a pregnancy prevention curriculum focused on males worked and how young men perceived Manhood 2.0. Focus group participants were ages 15 to 18. The majority (97 percent) were black or non-white Hispanic, and roughly 26 percent reported that they had ever had sex. See Appendix B for detailed information on focus group study methods and participant characteristics. This brief presents the most salient themes across groups.

“There’s no real definition of what a man is.” Manhood 2.0 helps young men think about gender norms and stereotypes.

When asked what they had learned from the program, many of the young men mentioned that the program changed their understanding of gender norms. In particular, participants referenced what they learned about the “Manbox.” The Manbox is an interactive activity in which young men are asked to describe messages they receive about how to be a man or how to act like a man, and messages they receive about if they do not conform or behave accordingly; they also describe the difficulties and benefits of challenging rigid messages about manhood. Commenting on Manbox, one participant said, “It taught me that you shouldn’t be afraid of who you are in society and that there’s no real definition of what a man is.” Other comments reflect how Manhood 2.0—and the Manbox activity in particular—developed participants’ understanding of the fluidity of gender definitions. One young man said, “Men can be feminine and . . . women can do the same things as men.” Another said, “I think it’s better to float out of the box, rather than stay in what society tries to put you in.”

Young men also discussed ways that rigid gender roles cause difficulties for young men. One participant said, “Me personally, there’s . . . times that I wanted to bawl my eyes out, but when I think of the things I’ve been told, like ‘Be a man, you can’t cry, be strong . . . .’ Eventually that leads to emotional problems for men.” Another participant noted, “It’s difficult to have that discussion because no one wants to be the one to say something out of place or out of the box thing. So that fear pushes people to stay in the box.”

Participants also expressed the view that discussing gender would help young men confront stereotypes about homosexuality. One commented, “You can say, like, a gay person is supposed to be like this or dress like this, but he could look like any of us and act like that.”

“The more educated I am, the more I can help her.” New knowledge enhances confidence and communication on birth control and consent.

When focus group facilitators asked participants what new information they had learned from Manhood 2.0, young men in every focus group mentioned information about female birth control methods, particularly long-acting reversible contraceptives (LARCs), including IUDs and implants. Participants stated that they had little or no knowledge of these options prior to participating in the program. Commenting about implants, one participant said, “Before this program, I didn’t know that a girl could put a tool in her arm and not get pregnant . . . I thought, like, the only way was either birth control [pills] or condoms, but Manhood 2.0 opened my eyes to more.” Others mentioned learning about the importance of using a hormonal birth control method or a LARC for pregnancy prevention, yet they also understood that these methods do not protect against sexually transmitted infections (STIs). One young man said, “I feel like I knew about condoms, and I thought they were the best thing. But IUDs are a better way to avoid getting pregnant. It doesn’t protect you from STIs, but it’s effective.”

Although participants said they had some knowledge of condoms before the program, many gained a deeper understanding of appropriate condom use through Manhood 2.0. Participants in several focus groups specifically mentioned learning that they should not keep condoms in their wallets. One participant mentioned learning that condoms expire, and another said he had learned more about the efficacy of condoms for preventing pregnancy.

Young men also shared this information with their partners. One participant mentioned feeling educated enough to have a conversation with his partner about birth control: “I can bring [birth control] up to my partner if she wants to talk about it, so I’m not clueless about it. And if she wants to talk about it, then I have knowledge about it too.” While the program gave men new knowledge about birth control, facilitators also emphasized that decisions about which birth control method a woman uses are ultimately made by her. One participant acknowledged this lesson, saying, “It’s her decision, but the more educated I am, at least, the more I can help her if she’s feeling doubtful or not aware of certain things.” This young man noted that knowledge and communication about birth control are critical to healthy relationships: “It’s not going to be a healthy relationship, if you don’t know what’s going on.”

Participants also gained a more nuanced understanding of sexual consent in the Manhood 2.0 program, and some mentioned consent when asked about the most important lessons they would use in their everyday lives. They learned that consent must be an affirmative statement, and that it can be revoked at any time. One participant said, “They went in-depth about what consent really is. Consent is when the person actually says yes, but they say it’s an ongoing process so ‘yes’ can turn into a ‘no,’ like, three minutes later.” Participants also discussed what they learned about nonverbal aspects of consent. “Even though they might be saying yes, their body might be saying something different . . . her body language has to show that she’s comfortable as well,” one said. Another participant showed his understanding that consent is not possible when one or both partners have been using drugs. Describing a conversation with a peer, the young man said, “He was talking about how they was going to [smoke weed] before. And I was, like, you can’t do that, it’s not consent.”

Overall, young men noted that lessons about birth control and consent increased their knowledge, engagement, and sense of confidence and skill related to pregnancy prevention and led them to share their knowledge with others. Their responses reflect the messages about birth control and consent delivered in the program and show that respondents were receptive to these lessons.

“I just need to come and talk.” Participants highlighted the need for shared, safe spaces for young men to talk about their feelings.

Focus group participants frequently mentioned that young men have difficulty expressing their feelings; therefore, it is important to provide spaces where young men feel comfortable having open discussions with each other. One participant said, “Guys are not really taught many ways to express ourselves, other than sports or physical means. I feel like a lot of mental issues are caused by people not being able to express themselves in healthy ways.” Several participants noted that they feel pressured to suppress their feelings, so they lack opportunities to express emotions in a healthy way. As one said, “Like, we don’t know how to express ourselves, so when we do, it’s so many mixed emotions, and it’s all over the place.”

With respect to the difficulty young men face when trying to express emotions, participants noted that the open discussion format of Manhood 2.0 worked for them. One participant reflected, “It was fun to get to talk about stuff . . . just like man stuff, like stuff I don’t really have conversations about . . . like gender . . . . It was just nice to have a genuine discussion with a whole bunch of guys about regular stuff.” Creating a safe environment for young men to talk through issues that are otherwise not discussed in their daily lives, such as gender and expressing emotions, is central to open and productive discussion. One participant said, “There wasn’t any judging. There wasn’t any sort of bullying. What we did—we had a discussion, it was an open space for us to talk openly without judging.”

Participants felt that they did not have other opportunities for this kind of open discussion, and they expressed a desire for support or services that could offer them these spaces. One participant said, “I would like to see programs like this grow. Like in my community, there isn’t a program like this where people can sit and talk about their feelings.” Another young man said, “I just need to come and talk.”

“We felt right at home.” Program facilitators created a sense of openness and brotherhood among participants.

The facilitators of Manhood 2.0 played a powerful role in creating a safe space that promoted openness in discussions. Because facilitators were close in age to participants and came from similar backgrounds, they were able to develop strong connections with the young men. One participant said, “They’re young, so I feel like I can connect with them. They can relate to whatever we’re going through.” Throughout the program, facilitators incorporated their own personal stories into the lessons, which engaged participants and encouraged them to trust the facilitators. One young man said, “I can tell that they went through some of the stuff we were talking about, so we can actually believe them instead of someone who has never experienced that stuff ever in their life.”

Manhood 2.0 also fostered powerful bonds between facilitators and participants, and among the young men within each group. The facilitators’ informal approach to discussions made participants feel as though the facilitators were their friends, rather than their teachers. One participant said, “They just connected to me. He called me his ‘brother’ the first time.” At the same time, the environment that facilitators created allowed participants to form deeper and more meaningful bonds with one another. The fact that focus group participants were minorities, with similar life experiences, also contributed to a sense of brotherhood. One young man reflected, “I like Manhood because we’re all minorities and we’re like brothers. We could just all connect and share our experiences.” Another young man commented, “Since we’re minorities and we did the brotherhood talk about how everything stays in the room, I felt more safe.”

Focus group facilitators also asked young men to identify what characteristics program staff should look for when hiring new facilitators. Participants emphasized the importance of choosing people who are open-minded, nonjudgmental, and relatable. When asked how the program could be improved, the participants did not have any concrete recommendations, and instead simply noted they would like to have more sessions.

“They’re just judging me on my skin color”: Discrimination, stereotyping, and racism are the biggest issues black and Latino men face.

To understand the context of young men’s lives and how their experiences may influence how they respond to the program, focus group facilitators asked participants to identify the biggest issues faced by black and Latino young men. Issues that the participants immediately identified were discrimination, stereotyping, and violence from law enforcement. One young man said, “Police. Yeah, it’s self-explanatory. They’re trying to kill us.”

In three focus groups, participants talked about being followed and harassed in public spaces, particularly in stores. In one group, a participant said, “People get discriminated against . . . like for example, walking into a store . . . and you have someone following you the whole way around to make sure you’re not stealing something. It’s just because of your appearance.” When the focus group facilitator followed up by asking how many of the young men present had been stereotyped, almost all the participants raised their hands. In a different focus group, another participant also mentioned being followed in stores and talked about the psychological impact of this stereotyping: “It makes me feel less human since they’re just judging me on my skin color and automatically assume and jump into scenarios,” he said.

Manhood 2.0 gave participants a space to discuss experiences like these and reminded the participants that they were not alone. The conversations helped the young men realize how many others had had similar experiences with discrimination, and helped them form connections with one another.

Discussion

Reflective discussion about rigid gender norms is a promising approach to delivering pregnancy prevention information to young men, and addresses their need for a safe place and opportunity to talk to one another. The participants indicated that they benefited from both the content (full range of birth control methods, sexual consent, rigid gender norms) and the delivery (reflective discussion and nonjudgmental, flexible facilitators) of the Manhood 2.0 program.

While previous studies have highlighted the difficulty of engaging young men in pregnancy prevention and contraceptive decision-making, our findings show that young men in the focus groups were eager to receive information about female contraceptives.3,4 They also increased their knowledge of hormonal and long-acting reversible birth control methods and indicated that this knowledge could help them take a more involved role in pregnancy prevention. Participants also reported an improved understanding of sexual consent, recognizing signs that a partner has not provided consent—including when a partner is impaired by drugs or alcohol, and when a partner has not provided both verbal and nonverbal consent. Greater male understanding about consent may be important in reducing the incidence of unwanted and unprotected sex.

Previous research has found links between rigid gender norms and both partner violence11,12 and poorer reproductive health outcomes.11,13,14  These focus group comments suggest that some young men become more aware of pressures to “act like a man” after participating in the program. This greater awareness may lead to more egalitarian gender norms because of the intervention. However, interventions similar to Manhood 2.0 have highlighted the difficulty of changing gender norms among teen men and women.15 It is important to note that our sample consisted of young men ages 15 to 18. Older men may be less receptive to this type of program as their views on gender may be more solidified.16

One of the most notable findings is that young men need and want a place to come together to talk with one another. Manhood 2.0 provided men with an opportunity for regular discussions, and participants valued the discussion format of the curriculum. Young men appreciated being able to talk about sensitive topics such as gender and what it means to be a man. Additionally, providing a safe space, where pressures from society related to discrimination and masculinity either do not exist or can be expressed and discussed, is an important means of supporting youth. It is worth noting that the participants’ key recommendation for improving the program was to hold additional sessions.

One of the most notable findings is that young men need and want a place to come together to talk with one another.

 

The facilitator was noted as central to the successful implementation of Manhood 2.0. Facilitators who are from the same background, and who are empathetic and nonjudgmental, are central to fostering an open, honest, and safe discussion, as well as delivering information on gender and female contraceptives in a way that young men are open to receiving. An unanticipated benefit of this program was the sense of belonging and brotherhood that the young men felt with each other, which was also fostered by facilitators.

Finally, programs for young men of color cannot ignore the reality of racism in these men’s lives. In nearly every focus group, participants identified racism as the biggest issue they face as young men. Manhood 2.0 and facilitators incorporated discussions about racism into program content. Future pregnancy prevention programming focused on young men of color should provide a space to acknowledge and incorporate racism, particularly as it relates to masculinity, healthy relationships, and pregnancy. Research shows that racism and marginalization influence how messages about masculinity are received; therefore, these issues must be taken into consideration when facilitating a program with young men of color on gender norms.17 Research also indicates that racial discrimination, along with masculine self-reliance, can lead to depressive symptoms.18 Men in general are also less likely to share their feelings with others.

Our findings indicate that Manhood 2.0 was well-received by a diverse population of young men in the Washington, DC area. Our focus group results highlight the need for a program, like Manhood 2.0, that holds a safe space for young men to discuss their feelings about what it means to be a man in an effort to reduce risky sexual behaviors and have healthier and stronger relationships overall.

Click here to download the appendices.

Acknowledgements

This publication was made possible by Grant Number 5U01DP006129, a partnership between the Office of Adolescent Health (OAH), the U.S Department of Health and Human Services (HHS), the Teenage Pregnancy Prevention Research and Demonstration Program and the Centers for Disease Control and Prevention (CDC), Division of Reproductive Health Safe Motherhood/Infant Health Program. Its contents are solely the responsibility of the authors and do not necessarily represent the official position of the OAH, HHS, or CDC. We are grateful for the collaboration and input of Promundo staff and developers of the Manhood 2.0 curriculum: Gary Barker, Jane Kato-Wallace, Aapta Garg, and Che Nembhard. We are also grateful for the collaboration of Latin American Youth staff and implementers of the Manhood 2.0 curriculum: Tyvon Hewitt, Danny Mervil, George Garcia, Kelsey Norton, and Claudia Blanco.

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