MEN'S INVOLVEMENT IN FAMILY PLANNING: A GENDER PERSPECTIVE | Utarini | Populasi 11784 22874 1 PB

MEN'S

INVOLVEMENT

INFAMILY

PLANNING:

A

GENDER

PERSPECTIVE

Adi Utarini*

Intisari

Akhir-akhir ini,keterlibatan priadalam kesehatanreproduksisecara

umummulaibanyak mendapatsorotan.Tulisaniniterutamamembahas apakahketerlibatantersebut berartimempersempit

kesenjangan

antarapria danwanitasecaraumum.Denganperspektifgender,keterlibatan pria dan wanita dianalisis dalam 3 tingkatan, yaitu pada tingkat kebijakan internasional,tingkat programdantingkatindividu. Hasil studipustaka inimenunjukkan bahwa proses pembuatan keputusan yang berkaitan dengan keluargaberencanabelumbanyakdibahas, berbedahalnya dengan jenis keputusandan pembuat keputusan. Untuk menyatakan bahwa keterlibatan pria berakibat positifterhadap kesetaraangender (gender equality),diperlukan pemahaman yanglebih mendalam mengenaiproses pembuatan keputusan sebagaititik kritis ke arah kesetaraanjender.

Introduction

Gender perspectivehas beena

powerfulstandpointwhichcreates various

responses

across dis¬ ciplines, professions,and regions.

As anillustration,epidemiologists andpublic healthexpertsreactby initially disaggregatingtheir data accordingto sex tolook forsexdif¬

ferences; sociologists in the past

two decades begin to dig even

deeper by differentiating between hownaturedeterminesbiological

male and female (sex) and how

society or culture attaches be¬

havioral, attitudinal,andphysical expectationsto eachsex (gender)

(Auerbach and Figert, 1995);

feminists

postulate

that disad¬

vantagesofbeingawomanisthe

result of women oppression by

men.

One of many health issues

whichhasbeengivenenormousat¬ tentionin theinternational

calen-*Adi Utarini, M.A.,teaching stafat Department of PublicHealth,Facultyof Medicine, Gadjah MadaUniversity and researcheratWomenStudiesCenter, GadjahMada University,Yogyakarta.

dar is

reproductive

health.* The question is why reproductive

health? This question provokes

many responses varied from a

strong systematic discrimination

against womenbymeans oflaws

that obstruct part of women's basic righttohaveaccess toreproductive

health services, the fact that

reproductivehealthisindeedasen¬ sitive issuebecauseitisdirectlyre¬

lated to sexuality and morality

(Cook, 1993),toashortcut-simplis¬

ticway ofthinkingthat inorderto

apply gender perspectiveinhealth,

weneedto paymoreattentionto

the obvious traditional

biological

difference between female and male,thatis, inreproduction.This simplistic view, inother words,

statesthat giving moreemphasize

onwomen'sreproductivehealthis

what

gender

perspectivein health

means.

The first reason of the choice of family planningasacentralissuein thispaperisbyno meansrestrict¬ ingreproductivehealthintofamily planning,but because discussion

onfamily

planning

hasbeenheavi¬

ly centered uponwomen. The

reasonforthisfemaleorientationis,

however,inevitable: the excessive threat of child

bearing

onwomen's

health, the link between family

planning and women empower¬

ment,fast developmentof female

contraceptive methods, and the

biological,

psychological,

and so¬

cialexpectationsonthereproduc¬

tive role of women anditssocial

reproduction(Gulhati, 1986).

Second,itiscertainlysensibleto

give moreattentionto gender is¬

suesfor the other half(that is,men)

ina women-centered area, since

gender perspective demands takingintoaccountthe interaction

betweenmen and women rather

than concentratingonwomenper

se (Helzner,1996).Therefore, dif¬

ferences as well assimilarities

betweenmenandwomenshould

be given equal emphasize to

achieve mutual relationship and

mutual benefit (Busfield, 1996;

Doyal,1996;Keller,1992).Besides, fromtheprocess pointofview,do

we notrepeat thesamehistory by

notinvolvingwomen indevelop¬

mentactivitiesand

excluding

men

infamily planningprograms?

Aim

The centred idea behind this essayisthat whiletheconceptionof lackofwomeninvolvement in all

areas of development has been

*Atleasttwoconferenceserve asdie landmark of this agenda withparticular

GenderPerspective

widely

recognized and

proven

to

create disadvantage for women,

lackofmeninvolvementinanarea whichistraditionally regardedas

typical womenconcernmay also

haveanegativeimpactonwomen.

Thispaper will first demonstrate

the difference between

women-centered andgender equality ap¬

proaches

inreproductive healthin

general, followed by attempts to

answer the following questions:

How are meninvolved infamily

planning?What doesmeninvolve¬

ment in family planning means? What does this meanfor women?

LiteratureSearch

Inadditiontobookreferences,

published

articles were retrieved

fromtwo maindatabases,namely Popline upto

June

1998and Med¬ lineuptoJuly1997.Themainkey

wordsusedwere:family planning,

man or male involvement, and

decisionmaking.In theprocessof literature search,itisworthmen¬

tioning that when the key word

family planningiscombinedwith male,this results in about10%for.

popline

and5%formedlineoutof

the total articles infamily planning.

This percentage may well be a

broad indicatortoreflect how little

attentionhasbeendevotedintore¬

search involving men in family

planning.

Women-Centered andGender Equality Approachin

ReproductiveHealth

Inthinkingabout

gender

inrela¬

tion to

reproductive

health,it is

usefultodifferentiatebetweentwo

different

approaches

found in the

literature(Standing,1997):

women-centered and gender equality.

These twoapproachesarerelated

to the concept usedbyexperts in

development, that

is.

Women in Development (WID) and Gender and Development (GAD)

framework. The WIDapproachis

basedontheunderlying rationale

that the process of

development

would be much better if women

were fully incorporated in the process.Incontrast,the GADap¬ proachbelieves that to focus on

womeninisolationistoignore the realproblem,i.e.theirsubordinate

statustomen.Itemphasizesthe im¬

portance ofgender relationswhen

designingmeasurestohelpwomen

inthedevelopmentprocess(Moser,

1992).

Awomen-centeredapproachis

mainly concern with theimplica¬

tionsor specific consequences for

women astheresult ofdifferences between thesexes, or morestraight

forward,differencesofthebiology ofreproduction.Thisapproachwill

andalso focusoncosteffectiveness

of

women-specific

intervention

(Overholtet al, 1985).

Women-centeredapproach gives

particular

importanceonthe

practical

needs

as opposed to strategic needs,

therefore, deals with relatively

short-termresult(Mo6er,1992).Ex¬

amples

ofthis approachare:

* Interventionsonobstetricemer¬

gencycarefor pregnant women

atfirstreferralhealthfacilities

*

Women'sreceptivitytofamily

planning

information at post¬

abortion service

* The effectiveness of different methods of

counseling

for

womenexperiencing domestic

violence

* Interventiononnutritionalsup¬

plementation

for pre-marriage

adolescentwomen

Tounderstandthestandpointof gender equality

approach,

onehas

tostartwithadefinition ofgender. Firstofallit iswidely acceptable thatgenderissocially constructed.

The debate is whetheritincludes

biologicaldifferenceorifit isinde¬

pendent

of sex. Moreover,italso

dependsonifonedefinesbiological difference as biological sex (i.e.

reproduction)(Gulhati, 1986) or to

include other organs inthebodyin

abroadermeaning.The latter im¬

pliesthatsociallyconstructed dif¬

ferences betweenmanandwoman

also includeand deal withbiologi¬ caldifference (for furtherexplana¬

tion, see Hubbard, 1992). The definition ofgenderused inthisar¬

ticleisthedefinitionstated

by

Carol Vlassoff (Vlassoff, 1994):

"Gender

refers

not only to

biological

orsex

difference

be¬

tween menand women but also

tothecontext

of

theirbehavior in the society, the

different

role thatthey

perform,

thevariety

of

socialand

cidtural

expectations

and constraints placed upon

thembyvirtue

of

theirsexand theways theyhopewithsocietal expectationsandconstraints". Incomparison to the

women-centered

approach,

genderequality

approach

isconcerned with theun¬

derlying factors or conditions

producing

inequalityofdifferences

betweenthesexesinrelationtoac¬

cess andoptimalutilization ofser¬ vices (Standing,1997). Usingthe icebergphenomenon to illustrate thedifferencebetween thetwoap¬ proaches,thewomen-centered ap¬ proach will be tackling the

symptoms or signs in the tip of

iceberg, whereas the gender

equality

approach will enableus to

identifythe underlying factors in thebottomofthe

iceberg.

Infamily planning,almost all

explanations

relatedtohumanfer¬

tility,eitherimplicitlyorexplicitly, havesomedecisionmakingideasat

their heart. At the very least,

decisionmakingplaysa

partial

role

(Leibenstein, 1981).Thinkingabout gender equality approach,

there¬

af-GenderPerspective

fects the process andoutcome of

decision

making.

The following questionsare

examples

ofgender equality

approach:

*

Doesinvolvinghusbands inthe choice of contraceptionuse or

methodmakeany difference?

*

Are family

planning

decisions madebyway of "no decisions"

decision to avoid a

husband-wifeconflict?

* How does informationcon¬

tributetothe processofdecision making infamily planning?

How does thepowerof infor¬

mationdifferbetweenwoman

andman orwifeandhusband? * Whatdoesitmeanforwomenif

menaremakingdecisionsbased

onincompleteinformation?

MenInvolvementinFamily Planning:What is inthePolicy?

Althoughthe notion of univer¬

sal human right was already

ratified in the United Nations

Charter of1945,it took another30

yearsforwomentobesystematical¬ lyandcarefully thought aboutby

theinternational bodies when the

United Nations launched the

Women's Decade (1975-1985).

Regarding family planning, the

concept of universalhumanright

wasfirstappliedtofamilyplanning

at the 1968 International Human

Rights Conference in Teheran

(FreedmanandIsaacs, 1993;Correa

and Reichmann, 1994), which

statedthat:

"Couples

havea basic human

right

to decide

freely

and

responsibly

on thenumber and

spacing

of

theirchildren anda righttoadequateeducationand

information

inthisrespect". Apparently, the above para¬ graph doesnot yet take into ac¬ countthe interactionbetweenmen

andwomen,

by

assigning

couple

as

the smallestunit inthepolicy.Fur¬ ther populationanddevelopment policies have extended from the recognition of couple's human rightto individual's right and to

indicate that

people

should have

accessthe meanstoexercise these rights(FreedmanandIsaacs, 1993).

Thiswasbrought upin 1974,atthe

World PopulationConference in

Bucharest,Romania,onlyoneyear

beforethe InternationalWomen's

YearConference in Mexico City in

1975. In this event, women's ac¬

tivistswereinstrumental inensur¬

ingthat the conference grounded

its assertion to the right to

reproductivechoiceonanotionof bodilyintegrity andcontrol (Cor¬

reaand Reichmann,1994).

The Women'sDecade madean

impeccable result in international legal instrument, known as the

Convention of the Elimination of

All Forms of Discrimination

againstWomen (CEDAW), ratified

in1979. In this convention, it is

clearlystatedthat anydistinction,

exclusionorrestrictionmadeonthe basis of sex is classified as dis¬

to Article 1) (Cook andMaine,

1987),which should beeliminated

onthe basisof

equality

ofmenand

women.Inthe fieldof health,ex¬

plicit

statement was made to

abolishdiscrimination in accessto

health care services, including

those related to family

planning

(Article12,1).Morespecifically,the

abolishment ofanydiscrimination

in family planning should be achievedbyhaving"the sameright

todecidefreelyandresponsiblyon

the number and spacing of their

children andtohaveaccesstothe

information, education andmeans

to enable them to exercise these

rights"(Article 16,1(e)}.

Fromthe last quotation,it is eminentthatbothmanandwoman

should be guaranteed the same

righttomake informedreproduc¬

tivechoices. Itisnotonlywomen

who shouldmaintainall the bur¬

den associated with family

reproduction,giventhatwomenal¬ readybearmoreconsequencesand

risks during pregnancy and

childbirth. Nonetheless,explicit

emphasis

on the contribution of

men inreproduction is still dis¬ proportionately addressed

(Johanssonetal, 1995).

The 1994 Cairo International

Conference on Population and

Development articulates further the significance ofwomenandtheir

status as central to sustaining global development efforts. This

conference also succeeded in elaboratingtheurgentneedtohave

men

responsibility

and participa¬

tion inreproductive health, and calls for thepromotionof"gender

equality

in allspheres of life, in¬

cludingfamily andcommunitylife,

andtoencourageandenablemen

to take

responsibility

for their

sexual andreproductivebehavior

and their socialandfamily roles"

(Cohenand Richards,1994).Fur¬

thermore, any efforts to improve

menresponsibility andparticipa¬

tionshould be undertaken in the

pursue of womenempowerment,

explicitly

stated intheBeijingPlat¬ form of Action (Johanssonet al,

1995):

"Sharedresponsibilitybetween

womenandmeninmattersre¬

latedtosexualandreproductive behavior is also essentialtoim¬ provingwomen's health".

In summary, meninvolvement

infamily

planning

has been incor¬ poratedintothepolicyofreproduc¬

tivehealthto theextent that their shared responsibilities are recog¬ nizedandmeanstoenablemen to

fullyparticipatearealsoaddressed. Inaddition,itisalso statedthatin¬

creased participation of men

should notbeseen as amode to

createagreatergender

disparity

by

giving more power to men, but

should be further developed into

programs which strengthen

GenderPerspective

Program Level:How areMen

InvolvedinFamily Planning? The first ultimatequestionatthe programlevelistoaskwhydowe

needtoinvolvemeninfamily plan¬ ning.Thisposesavariety ofrespon¬

ses, from a very pragmatic reasoninguptoahypotheticalone.

Thefollowingisthe list ofpossible

answers (Gulhati, 1986;Network, 1992; Hulton and Falkingham,

1996):

* Menarealready involvedand

wehavetounderstandtowhat

extent are they involved. Example of this would be the role ofmeninreducing fertility

in developed countries before 1960s.

* It takestwo

* It'stheright thingtodo

* Menwanttobeinvolvedifthey

areasked

* Meningeneraltendtoneglect their health,so it'sgoodtoin¬

volve them for theirownheath * Ithasnothingtodo with men's

health, but women's and

children's

* Cantheybeheldresponsiblefor

their childreniftheyarenotin¬ cluded inthe decision making?

*

Menhave limited knowledge

onthismatter

* Economic and social respon¬ sibilityfortheirfamily

* Will forge a strongerbond

between them and their

children and to promote a

greater

responsibility

*

Men have paternal respon¬ sibilities

* Improve men's personal growthon asensitiveissue

*

Men can impregnate women

everyday,butwomencanonly

getpregnantonce amonth

* Decision in fertility is in the

hands ofmen,womenhave lit¬

tlepoweroversuch decisions * Higher continuation rate

among women when men are

consulted

* New emerging diseases: AIDS

andSTD

a.MenasManagers and

Providers

Morementhan women are in

thepositionofmanagers.Infamily planning, similar situations oc¬

curred. There are relatively few

menworking at the lower levels,

therefore,haveless direct contact

with clients, and relatively few

women who are physicians,

decision makers, or top level

managers.Inaway,menhave al¬ readybeeninvolvedprofessionally

orbureaucratically,which leadsto

having more power (Helzner, 1996). This isnot to say that if

womenhaveaccess to suchposi¬

tion, itwillbe easy for themtogain thesamepowernor tohavea_posi¬

tive attitude towardswomenem¬

powerment. The following is the

illustrationof maleparticipationas

Attemptstorecruit menascon¬ traceptive distributors have under¬

taken inseveralcountries. As an

example, in Peru men were recruitedascommunity-based dis¬ tributors and their

performance

was compared to female dis¬ tributors. It was found that male

distributors were more likely to

serve male clients and sell male methods(condom),andfemale dis¬ tributors were to more likely to servefemaleclients and sell female methods (pills).Therefore,recruit¬ ingmale distributors will attract moremale clients. However,inthis study, dropoutratesof maledis¬

tributorswasnotaddressed,which

may beapotential problemin fu¬

tureimplementationsince recruit¬

ment for male distributors was moredifficultthanfemale(Foreit et

al, 1992).A similar example was

also available from Kenya, by

recruitingmale Kenyan shop¬

keepers distributing non-prescribed contraceptives,as part

ofthe schemerunbythe

Nairobi-based African Medical and Re¬

search Foundation (AMREF) and theFlyingDoctor Service(People)

(Network, 1992).

b.ProgramstoEnhance Men's

Involvement:Outreach Clinic

and InformationCampaign

Several examples from

developed and developing

countrieswill be usedtoillustrate effortstoencouragementovisit a

family

planning

clinic.Thefirst

example

drawn from Britaininthe

form of integrated clinics (but a

separate space for woman and

man),targeted foryouth;and

the

secondexamplewas aspecialclinic formen,taken fromthe experience

of ProfamiliaClinicinColombia.

Thatmenare welcomed inafamily

planningclinicistheoreticallywell accepted,eventhoughtherealityis

farfromwhatisexpected by pro¬ gram managers (Network, 1992).

Otherexamples,notonlyrestricted

tofamilyplanningbuttoincludea

broaderscopeonteenagepregnan¬

cy prevention program, can be

found in the publication of the

California Wellness Foundation

and the Urban Institute which

describes 24 promising prevention programsinUnitedStatesfocusing

onthe malerole inreproduction. These programs havedifferentap¬ proachesthat canbe used for ad¬

dressing

the male role, such as

sports,cluboryouth

group,school-based, employment, health care,

criminal justice, and community-wide(Sonensteinetal,1997)

Fromallexamples,itisobvious that when decision has been made

toprovideservicesformen,the first messagetobeseenbythepotential

users is thatthisis notjustadding

menintothe availableservice for

women, and the service must be

created based on current needs,

knowledgeandattitude ofmen.In¬ deed,focusingonthe male rolein

GenderPerspective

male

participants

is the crucial

selection criteria of the

programs

documented by Sonenstein et al (1997).This couldhavelargeconse¬ quencesfromthe

practical

point of

view (suchasselectingproviders, allocating space,choosing thecon¬ tent of service) up to program philosophy. From the program pointof view,offeringservicefor

menalsomeans morecosts tobe born by the manager. The

Profamilia Clinic in Colombia,

therefore, is also diversifying its

contentof servicesto aimfora self-financing clinics.Men and women often havedifferentreasonstoac¬ cesstheclinic.Other considerations would bewhether thisclinic willbe

unisex or bisex clinics, and also

family planningclinicorcombined withanSTDclinic.

Toacertainextent,meninvol¬

vement may be enhanced by providingoutreachclinicstargeted

for them. However, the resultof

contraceptionuseand spread ofin¬

formationwillbe

highlydependent

onthe utilizationofsuchclinicsand limitedtothose who usetheclinics. Thefollowingtype of intervention may be

capable

ofreachingalarger populationof men.

Thelargestand the firstinfor¬

mationcampaign targetedtomen

inAfrica was

performed

inZim¬

babwe, known as theZimbabwean

MaleMotivationProject.Thisthree year projectstarted in1988in col¬ laborationwiththe

Johns

Hopkins

Universitywasaimedatincreasing

knowledge infamily

planning,

promoting

favorableattitudes,in¬

creasingtheuseofmodernfamily

planning

methods, andpromoting

male involvement and joint

decisionmakingbetweenspouses

about contraception and family

size.Usingthree main strategies,

i.e.radio dramaseries,educational talks for men,and

pamphlets

on

family planning, this project was abletoshowsignificant impacton

knowledge,

attitude, andpractice

of menonfamily planning.Among

those were the increase use of

modern methodsfrom56%to59%

in 16 months (20% greater than

priortothe campaign)andcondom usefrom5%to10% (Piotrowetal, 1992).The latter hasto be inter¬

preted

cautiously,since other ac¬

tivities outside this project was

probable

withtheimprovedaware¬

ness of

AIDS/S

IUs andcondom

social marketing at the same

period.

A

comparable

positiveresult is

also

emerged

fromeducationalin¬

tervention inPakistan (Network,

1992),by creating 60 community

educator teamsconsistingof man

and woman. These teams were

askedto visit familiesthroughout the city. Afteraperiodof 4 years, the contraceptive prevalence amongmarriedcouplesincreased from 9% to 21%, with methods changingfromvery temporaryto

longer lasting

methods andafew

vasectomywhichwas

regarded

as

Bothexamplesillustratethat lackof

information and services, rather

thanlack ofinteresthaskeptmen

from taking amoreactiverole in

family planning.

c.Range ofContraceptive

Methods for Men

Themostdirect involvement of

meninfamily

planning

is theiruse

ofcontraception.Forcenturies,the development of contraceptionso

far ledto four types of male-de¬

pendent methods, i.e. condoms,

vasectomy, withdrawal, andperi¬

odic abstinence.Amongthose,con¬

domhas been the onlyreversible

contraceptive available for men.

Yet,priortocondompromotionfor

AIDS,itsusehasremainedsteadily

low in most countries and more

likelyinashort-termbasisrelation¬ ship. Among the 18 countries analyzed (Network, 1992),only

two countries (Pakistan and

Bangladesh) had an increase of

more than 1%among couples

duringthe 1980s. Besidestheirlow

level of use, discontinuation of

male-dependent

methods is typi¬

callyevenhigherthan formethods used bywomen,withtheprimary

reason of method failure

(Rin-gheim,19%). Moreover,threeout

of fourmalemethodsarecoitusde¬ pendent.Whatisleft is vasectomy,

a method which is almost irre¬

versible and received low accep¬

tance in general. These current

availablemethodsplacedmenwith

hardly anychoicesbuttwodifficult

extremes,eithercoitus

dependent

or irreversible, none of them are

easytopersuadementouse.

On the other hand,promising

ideas and research and develop¬

mentformale-dependentmethods areunderway.This includesthe

ex-pansion of a new no-scalpel method of vasectomy in China,

hormonal contraceptive (tes¬

tosteroneenanthateor testosterone buciclate),chemical interference

(suchasGossypol),andantifertility

vaccine. However,these ideasmay

notbe available until thenext21st

century (Cohen and Richards,

1994),notalonetakingintoaccount

how thesenewcontraceptionsare

perceived by women. As Catley-Carlson said, "new contraceptive

methodsare only as good as the

contextin whichtheyareoffered" (Catley-Carlson,1997).

With limited contraception

choices formencoupledwith low

acceptability and use, it _appears

that direct involvement ofmenin

family planning by taking more

male-dependentmethodsmaynot

beachievable in thenearfutureto

makea significant impact on fer¬ tilityreductionandimprovedfami¬ lywell-beingingeneral.Therefore, indirectrole ofmeninfamilyplan¬ ningseemstobemorefeasibleby way of supportingwomen's choice offamily

planning.

This,however, maynotbeaccomplishedunlessa

Gender Perspective

wellas their roleand capacityinthe

decision making process at the

household level are well under¬ stood.

IndividualLevel:What dowe

know about men'sknowledge,

attitude andpractice(KAP)_in

family planning?

First of all, it is surprising to

know how little well-founded knowledgethereisconcerningmen

andreproduction.Inareviewby

Hulton and Falkingham (1996),

only 4 out of 42 surveys inthe

World Fertility Survey during

1970sandearly 1980s interviewed

husbands.The situationwasslight¬

ly changedbetween 1986and 1995,

in which26 out of 74 completed

Demographic and Health Survey collected data from malerespon¬ dents. Even in UnitedStates,data

about men's involvementin con¬

traceptive decision is scarce, and

mostof itfocuses onadolescents

(Edwards, 1994).

Research on men's KAP on

family planninghas been ap¬

proached

indifferent ways, i.e.

usingmenonly,couples,oralterna¬ tively usingmenonly asrespon¬

dentsbutthe dataisthencompared

to a larger existing survey on women. Incase of attitude and practice,it isalso possibleto ask

women about their partner's at¬

titudes and practices. However,

findingshaverevealedthatwomen ingeneraltendtoconsistentlyun¬

derestimate men's attitudes and

practicesortheyaremorelikelyto

report their owncontraceptiveuse

if bothcouples approved. Onthe

other hand, when men is asked,

they may overestimate their own

role.

Discussion: Does Men's

Involvement LeadtoGender

Equality?

Inthis section, perhaps more

questions than answers will be raised.Themostcriticalquestionto

askiswhethermen'sinvolvement

this wouldactuallymeansharpen¬

ing current inequalities in the power relationship between

women and men or would it

facilitate women's reproductive

right in the spirit of gender

equality.

Most heard examples

suchashusbandaccompanyingthe

wifetoanantenatalclinicmaybe interpreted as enforcing gender equalityif thisdoesnotserve asa

requirement for the woman to receivea

service

norforwomento receive abetterqualityof service.

Likewise, an informedconsent

fromthehusbandtoobtainafamily

planningmethod may not em¬

powerwoman, if

lacking

thecon¬ sent isidentical to noservice for

woman. Helzner (1996) gave a

warning statement that "male in¬ volvement efforts which attemptto

reachwomenthroughmenrather

thantoincrease maleuse of con¬

Table1.

Summaryoffindings from researchon menonly

Country (N) Design MainResults

Brindisetal (1998)

Obionu

(1998)

Grady etal

(1996)

California, Clinic-based The likelihood ofuseof last intercoursewasincreasedamongmales USA (1,540) survey whoagreed with their partner about the methodand thosewhohad

never impregnatedapartner (1.4and 1.9 respectively).

Nigeria Survey

(380)

USA(2,526) Survey

Werei Karanja

(1994)

Kenya (355) Survey

Pfllai (1993) Zambia (85) Survey

Mbizvo& Adamchak

(1991)

Piotrowet al (1992)

Khalifa (1988)

Zimbabwe Survey

(711)

Zimbabwe

Sudan

(1,500)

90% of respondents agreed that couple should decide the number of children.Whilemorethan32%ofmenbelieved that the wife alone shoulduseFP methods, only10%thoughtitwasthehusband's role tousefamily planningmethods.

Genderequality indecisions about having sex, contraception, and child raising responsibilitieswas favoredby 60.8%, 78.2%,and87%

ofmenrespectively.Menwith non-egalitarianorientations perceive femaleas dominating decisions about timing ofsexandmenhaving greaterresponsibility in contraceptive decisions. Men who felt women asmost responsible incontraceptivewereolder, black,have a hispanic partner, less educatedorhaveahighly educatedpartner

comparedtomenwithegalitarianorientation.

63.9%ofmensaid lhat decision making on family size should be made by couple and 33.6% by husband alone; 78.6% infavourof couple counselling, 56.9% said that wife alone shouldactively participate inFPcomparedto 31.5%by couple and 10.1%by husbandonly

78% of mendiscussed FPwith their wives, only 29%feltthat womenaloneareresponsibleforFP.

83.5% of men approved FP;80.6%ever-used contraceptive and amongthese,58.5%saidthat they should dominate the decision in

FP,48.3%said thatmenalone should decide.60%ofmensaid that obtaining FP informationwaswomen's job andwifeobtained the supply 782% of the time.

Before-after,52%ofrespondentswere exposed to the campaign. When exposed no Control mencompared to the non-exposed,the exposed grouphadbetter group knowledge,61%and47%respectively said that men should make FP decision, 31% and 45% said that it should beajointdecision. Before-aftercomparison: joint decisiononfamily size increasedfrom 32 to 54%,husbandalone decreasedfrom54%to 30%.

N

GenderPerspective

Table2.

Summaryof findings from researchon both men andwomen

AuthorfYear) Country(N) Design MainResults

Henry J. USA(503 Telephone Kaiser Family menand 502 survey

Foundation women) (1997)

Kim& Zimbabwe Marangwanda (1997)

HHSuiveys, client interviews

Valente& Bolivia(2,354 Beforeand

Saba(1997) menand after

women) intervention

Beitrandetal Zaire(3,140

(1996) men and

3,465 women)

HuttonS Falkingham

(1996)

10countries in Asia, Africa,and Latin America (69,623)

Isiugo-AbaniheNigeria (1994) (3,073

couples)

Salway(1994) Ghana(661 couples)

Survey

Survey

Sunrey

Survey

Ezeh(1993)

Teiefe&

Larson (1993)

Mott&Mott

(1965)

Ghana(1,010 Survey couples)

Ethiopia(527 RCTtwith

women) andwithout husband participation

Nigeria(296

women,345

Survey

Mostmen(67%)andwomen(71%) believe thatmenshould haveagreater role in choosing contraceptive and ensuring itsuse.Most menreportedtheir

awarenessthatwomenwant them to bemoreinvolved incontraceptive choice (71%) anduse(77%). However, most respondentsagreed that womenleel

moreresponsiblethanmentortheir children and they have the mostinfluence onthe decision to havea child. Morethanathirdofmenandwomenbelieved thatmen leel excludedfromcontraceptivedecisionmaking, andmorethan

half ofmenreportedlackofknowledgeoncontraception

88%of menandwomen wereexposed tothe campaign, recallwasachieved

more among#temen,educated,and marriedrespondents.Knowledge and approvaloflong-term contraception increasedamongwomen morethanmen. About42-51% ofmenand 37-57%ofwomen reporteddiscussingFPwith theirspouses.

85%wereexposed tothe intervention, and positive attitude toward reproductive health increased from 86% to 91%.Intentiontouse or

continuationof FP use inthefuturerose from25% to 60%among the males.

Similarityinthe attitudes, beliefs,knowledge levelsand practices ofmenand

women regardingfertilityandfamilyplanning.When theydffiered,mentend to

bemorepronataiistthanwomen.

Overall,menhave greater knowledgeofmale methods thanwomen.Although

women'sknowledgeof femalemethodsishigherthan men's, thedifferenceis notlarge.Men'severand currentuse are alsogreater than women's,

nonethelessknowledge is nota goodindicator ofuse.

88% ofmenand 78%ofwomen saidthatmen'sviews are moreinfluential in

decisionmaking. 40%ofmen and50%ofwomen mentioned #iatfamily size

wasajoint decision, althoughwomen arelikelytohavecompromised their position.Whencoupleswere asked about their responsestowardmenas decisionmakings, the greatest dteparitywas inmen's rale to decide when to havesex,whereas the lowest agreementwas aboutusingFP methods. Only35%ofwomen and39% ofmendiscussed FPwithspouses. When couple approvedFP,wivesaremoretksly to report contraceptiveuse Attitude andpreferencesof wifeare moreimportanttodetermine whether she

uses contraceptionthanthoseofherhusband.

53.6% couplesapproved FP(husbandwasslightly higher than wife), 21% disapproved.Spousalinfluenceis only exercised by husband.

A greater proportionofcouplesin experimental groupwereusing modemFP

at2 months(25%and 15%)and 12months(33%and17%).By 12months, experimental subjectswere morelikely to have started usingmodem contraception.

72%ofwomennever discussed FPwith spouses. 10.4%of monogamous

(mon)and0%polygynous (poly) couplessaid thathusbandisthedecision

maker, 23.5%monand15.6%poly said that itwas ajointdecision,and64.3%

mon and 81.3%poly stated "no-one"made8ie decision. 43%wives and47%

Adi Utarini

decisions about

contraception

are their alonetomake andmay,there¬ fore,reinforce patriarchalviews".

Fromtheliteraturereview,men

may be involved directly or in¬

directly

once they accept family

planning. Direct participation of

men meansactual shared-respon¬ sibility bymenandwomeninusing family planningmethods, Le. for

womentochoosea

female-depen¬

dentmethodand for mentochoose

a male-dependentmethod. While thisiscertainly promisingboth in

termsoftrends ofmale-dependent

users across time as well as the developmentofawider choice for

meninthe future, itsimpactonfer¬ tilityreductionwillnotbeassig¬

nificant as the increase use of

female-dependent methods

by

women. The latter iswhere men maycontribute

indirectly

ina fami-ly planning program, i.e. by makinga more positive attitude andbetterdecisions basedoncur¬ rentknowledgeandattitude.

Hypothetically,

if men have

more access to knowledge and

positive attitudes toward family planning,althoughthis isabadin¬

dicator of contraceptionuseitself

(HultonandFalkingham,19%), it

is

expected

thattheyatleastwould

contributetocreate ahealthyen¬ vironment for womento practice family planning. At this point,

morequestionsmaybeasked:With

better knowledge and attitude,

wouldmenmake better decisions,

would it lead to a more equal

process

of decision

making,

or

wouldtheybe morelikelytobe in favor of joint decision making? Data from theliteraturereviewdo

not necessarily suggest the same

directionaswemayhave assumed. Itappearsthatknowledgeandat¬

titude on onehand and decision

makingonthe other hand operates

at a different level. Decision making, albeit influencedbyinfor¬

mation, may be more associated withgender

disparity

inthe com¬

munity in general, rather than

specific information on family planning. Therefore, programs

which attempt to merely provide

informationonfamily planningin

isolation to addressing other

gender-relatedconcernsmay failto

influence the decision making process.

A morereasonableobjectiveto

achieveby involvingmeninfamily

planningmaybetofacilitateabet¬

ter communicationbetweenmen

andwomeninordertomakeajoint

decision.Creatingamutualcom¬

munication betweenmen and

women wouldcertainly reinforce

gender equality,ignoring whether

it would lead to an appropriate

decisionornot.Thishypothesisis,

however,noteffortlesstoprove.As

anexample,anintervention study

conductedinZimbabwebymeans

of information campaign showed

that

although

theproportionwho

said that family sizeshould bea

joint decisionwas increased from

afterwards,acomparison between

the

exposed

and

non-exposed

men

revealedthatjoint decisionmaking

about family

planning

was less

commonamongthe

exposed

men

(31%infavor of joint decisionas

comparedto 45%of non-exposed

men)(Piotrowetal,1992).

In addition to the content of decision making, another issue

which was less explored inthe

literature istheprocessof decision making.The fact that decisionon

family planningisin the hands of

men is already well known and may be generalized across

countries. However,inordertoim¬ prove the role of women in the

decisionmaking process,weneed

toraisequestionsnotonlyrelated

to factors affecting the decision makingprocessbutalsotodescribe the process itself. How decisions

areactuallymadeislessclear.So far,literatures usedin this paper only illustrate what decisions are

made and who makes the decision inaquantitative fashion. Further¬

more,only inone study the pos¬

sibility of havinga "no decision"

decisionwasmentioned(Mottand

Mott,1985) and therewasanother

GenderPerspective

study

which briefly saidthat wives

may compromiseinthebargaining process,

perhaps

topreventfroma

family conflict (Isiugo-Abanihe,

1994). A qualitative type of

methodology

maybeappliedtoex¬

plorethe processinmore

depth.

Onlywhenmoreknowledgeinthis

area is gained, one may feel op¬

timistic to have awin-win situa¬

tion.Thisis,asituation where the

involvement of men would rein¬

forcegender

equality.

Conclusion

In light of applying gender perspectivetoanalyzemen's invol¬

vement infamily planning,three levelsof men'sinvolvement, i.e.at

the policy, program, and in¬

dividuallevel,havebeenpresented

withspecialreference to thecon¬ tentandprocessofdecisionmaking

onfamily planning.Overall,lack of

investigation in the process of

decisionmakingatthe household

levelisdiagnosed.Yet, itsunder¬ standingiscriticaltodetermineif

men'sinvolvement infamilyplan¬

ningwouldsynchronizeall efforts

Adi Utarini

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