By: Lucy K Maroncha
A low number of Kenyan men use hospitals and clinics as many men believe that medical facilities are for women. This view plays a large part in the small number of men accessing sexual and reproductive health services.
Furthermore, there are only two direct family planning methods available to men: condoms and vasectomy, the second not ideal for males who desire to have children at some point. These limited options lead many men to assume that, because women have multiple family planning options, the sexual and reproductive health issue remains a woman’s responsibility.
While it has been fully recognised that, in the fight against HIV, the involvement of males in SRH and HIV is vital, very few men are engaged in family planning services. Some think they may be considered lesser men if they attend clinics and receive SRH services. Moreover, many evaluators and studies focus more on women and girls than men, a situation that is likely to make men feel left-out and confirm that SRH is a woman’s issue after all.
But the solution to promoting the involvement of men as actively as women in family planning may lie in health facilities integrating SRH and HIV services into one stop clinics. The Nairobi West Family Health Options Kenya (FHOK) clinic provides integrated SRH and HIV services. Women come to the clinic for various services accompanied by their sexual partners and the clinic will take the opportunity to educate the couple on the importance of embracing SRH and male condoms as a family planning method. Rose Ngahu, who works at the clinic, predicts that the clinic’s provision of both HIV and SRH services will enhance male engagement in SRH in time, although progress is very slow.
As research carried out by the University of California, Ibis Reproductive Health and the Kenya Medical Research Institute (KEMRI) recently indicated, condom use does not decrease as women get more involved in the use of more effective family planning methods. The study, which aimed to establish the impact of integrated services in sampled areas of Nyanza province, found that even though women were using other family planning methods, condom use was still high. Ngahu at FHOK agrees. She says that condom use may not be an indicator that men are practicing family planning. “They only use condoms as an HIV/STI prevention measure,” she says.
While abstinence from sex during a woman’s fertile days is another family planning method, very few men embrace it. Many women get unintended pregnancies while trying to use the safe-day method as they succumb to pressure for sex from their partners. Although the use of fertile and unfertile days as a family planning method was previously considered something less informed people chose, a more enhanced way, dubbed ’cycle beads’, has emerged where women keep a record of their menstrual cycle using beads to show them their unfertile and fertile days.
Rarely do men accompany their sexual partners to receive SRH services and only less that 10% of men will voluntarily go for the services. Ngahu confirms that in the Nairobi West FHOK clinic, around four men will come for vasectomy services in a year. This means that those men who are directly involved in family planning methods use condoms or rely solely on the methods used by their partners.
A KEMRI research coordinator, Dr. Maricianah Onono, who participated in the University of California research, says concerted efforts are needed to improve on inter-couple communication. She says there are hundreds of men who do not as much as know what family planning methods their sexual partners use! She calls for health service providers to encourage SRH dialogue between sexual partners to avoid unintended pregnancies and subsequent unsafe abortions.
Joshua Kikuvi, a research coordinator from the London School of Hygiene and Tropical Medicine who attended the Integration for Impact 2012 conference held in Nairobi’s last week (12-14 September), suggests intensified research is needed to establish the impact male-friendly integrated clinics would have on the involvement of males in SRH services. Many women opt to speak to the service providers in the absence of their partners for fear of intimidation and influence from the males.
Joelle Mac, a research fellow from the Faculty of Public Health and Policy, Department of Global Health and Development, says the stereotyped-view that medical facilities are for women is an issue that needs redress for involvement of men in SRH to increase. She reiterated the need for more male-friendly facilities to erase men’s views that SRH is more about sickness than health.
As integrated facilities continue to educate women on SRH services, women have likewise learnt to mentor their husbands on the importance of using family planning methods as a health measure. As Wesley Kjumwenda, a Malawian discordant partner says, men will never carry a pregnancy but even walking expectant partners to the clinics is support enough.
“It makes a man feel that he is part of the pregnancy and shares every joy and challenge with his partner,” he said.