The State of World Population 2000 Chapter 4: Men, Reproductive Rights and Gender Equality

United Nations Population Fund

Equality between men and women is a matter for society at large, but it begins in the family.

Understanding gender discrimination means understanding opportunities and constraints as they affect men as well as women. Men's attitudes and behaviours are strongly influenced by societal expectations about what it means to be a man.

Shehzad Noorani/Still Pictures
Shehzad Noorani/Still Pictures
How men behave in their families is strongly influenced by expectations about what it means to be a "real man".

In particular, the assumption that contraception, pregnancy, childbirth and prevention of sexually transmitted diseases are exclusively women's concerns reinforces men's lack of involvement in safeguarding reproductive health — both their own and that of their partners.

Definitions of masculinity are often rigidly stereotypical. In many settings, for example:

  • A "real man" acts, he is not the object of action: he is demanding or aggressive in articulating his desires and striving towards his goals. His proper sphere of action is economic or political, not domestic or familial;
  • A "real man" is the head of his family. He provides for his household, but he is entitled to use his resources as he chooses. He may choose personal pleasure above family expenses
  • A "real man" is strong. He does not recognize or admit uncertainty — a sign of weakness;
  • Emotion may also be a sign of weakness. A "real man" therefore admits little concern for his partner's wishes, pleasure or well-being. He does not readily attend to the emotional, as opposed to the instrumental, aspects of relationships.

These stereotypes and others like them do not match reality, either for men or for those who depend on them. Men who — consciously or unconsciously — measure their lives against such stereotypes set themselves up for failure, difficulty in family relationships and unreasonable stress.

In cultures where patriarchy is accepted as the only proper family structure, men and women may be trapped in a pattern of relationships and dependencies that can frustrate them both. A woman without a husband may have no social standing, and have difficulty even finding the means of survival: but a man too may find life hard without a wife to do "woman's work"-grow food, cook and bring up children.

Men who cannot live up to expectations that men should be powerful and competent may respond by retreating into passivity and escape through drugs or alcohol, by resorting to violence towards those still weaker, or by exhibiting exaggerated bravado and risk-taking.

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Men's Roles and Changing Realities

Particularly among men who are poor, undereducated, underemployed and marginalized, attempts to live up to ideals of "masculinity" are frequently compromised by harsh and changing realities.

A detailed analysis of gender relations in the Kisii District of Kenya1 shows how men's self-esteem can be undermined. Most men in Kisii can no longer aspire to be owners of large amounts of land and many cattle, husbands of multiple wives and fathers of many children.2 At the same time, they are acutely aware of the extent to which they depend on women's homestead farming and of the increasing cost of living.

They are now required to pay for their children's education and health care, formerly free or provided at a nominal charge. Their wives' demands for money and support regularly remind men of their reduced ability to satisfy expectations.3 Their paternal authority is further weakened by changing circumstances and new values: land fragmentation, increased migration to cities, fewer arranged bride-wealth marriages, stronger local women's associations, and their children's expectations as a result of education.


UNICEF/0789/Nicole Toutounji
Responsible fatherhood can advance gender equality and improve families' welfare.

Women and men both feel the stress. Even if they understand its causes, they have no means of coping with it. As a result, wives are increasingly vocal about their frustration; husbands are withdrawing from family responsibilities; many households are becoming violent battlegrounds; and the number of "broken homes" is increasing.4

Changing circumstances are producing similar strains in Latin American households, where persistent ideals of machismo — a conception of masculinity based on male control and force — pose problems for family relations, adolescent socialization and women's self-realization.5

Over the past three generations, expectations of men as rulers and protectors of the household have changed. Husbands today give greater recognition to their wives' perspectives and sexuality, and fatherhood is more important to their self-esteem. A recent public opinion poll in two Peruvian cities, Lima and Callao, concluded that the ideal of fatherhood now values affection towards and communication with children.6

A study in Peru showed that when men and women talk about relationships, women recognize great variety in how they interact with men.7 Men, however, see their sexual roles only in terms of the extent to which they are dominant or passive. This difference hinders communication and change.

The internal tensions that undermine impossible ideals of male performance and competence can allow men to seek new role models and forms of behaviour.

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Violence

Male violence against women is increasingly recognized and acknowledged. It results from a complex web of causes, including family and cultural traditions, the breakdown of protective traditions and institutions, and male frustration and disempowerment.

One analysis of North American culture sees traditional masculinity as involving:

suppression of a range of emotions, needs and possibilities, such as pleasure in caring for others, receptivity, empathy, and compassion, which are experienced as inconsistent with masculine power. The emotions and needs do not disappear but are not allowed expression. The persistence of emotions and needs not associated with masculinity is in itself a great source of fear. Such hidden pain may be expressed in aggression against others or against themselves.8

A study in the Philippines found that 13 per cent of married women had experienced physical violence by their husbands.9 Violence was found to be more likely in urban areas, when men were unemployed, in households where the wife considered earnings inadequate, and where women earned more than 50 per cent of the income.10 The probability of violence was also greater when men kept most or all of their earnings; men who turned over all of their earnings to their wives (as is customary) were only half as likely to hit their wives as men who did not.

Violence was least prevalent in households where spouses communicated and shared responsibility for decisions.11 Where no decisions were made jointly, 25 per cent of couples reported that the husband had hit the wife. Where all decisions were made jointly, the incidence of domestic violence was 6 per cent.

This study affirms that helping men and women to communicate about their family roles and responsibilities — including contraceptive decisions and reproductive health care — is important to strengthening relationships, eliminating gender inequality and reducing recourse to violence.

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Gender Inequality and Cultural Expectations

It is taken for granted that change in the public sphere — economic growth, political transformation, and new means of communication and transport — will be reflected in changes in individual attitudes and behaviours. But this expectation does not extend to the private sphere, where basic issues of identity and family are involved. Society may change, but gender roles are not expected to change with it.

This anomaly is at the root of continuing gender inequality. Many cultures maintain a traditional patriarchal system in which men are the primary decision makers in family and social relationships. Although the result is generally not to their advantage, women may acquiesce to keep their place within the community, and eventually to earn the respect due to a mother or an elder.

The view that family, home and private life are the province of women's authority and concern restricts women's opportunities and subjects them to control by men. However, it also offers rewards: it "protects" women from external violence, assigns them a recognized position, and offers them an arena in which to exercise particular skills and capacities.


Jorgen Schytte/Sill Pictures
Mexican parents. Gender equality in health care is important throughout the life cycle.

In many cultures, increased status and rewards accrue to women later in life, after they have ceased to bear children. This can result in compliance from older women, while the expectation of future benefits can mute younger women's dissatisfaction. Alternatively, fear of family or community disapproval may compel women's acquiescence, particularly when it is reinforced by threats of physical punishment or expulsion.

The traditional arrangement reinforces men's sense of power and competence. This may become more important when men face external challenges, as in periods of rapid social and economic change. For men of relatively low status in their societies, control over women offers a position of power denied in other parts of their lives.

Myths and misconceptions perpetuate the power structure and weaken women. For example, in parts of India, family members encourage women to eat little during pregnancy, believing that they will have smaller babies and easier deliveries.12 Nutritious food such as eggs or milk may be associated with supposed malign influences over the mother or foetus. There may be prejudice against exercise, employment outside the home and even education, because they will make women "too much like men". Women's sexuality is often feared and is the subject of bizarre and ferocious myth; severe female genital mutilation is only the most extreme means taken to control it, short of murder.

Ignorance of alternatives and fear of the unknown reinforce traditional behaviours and attitudes, and make change difficult for men. Better information and open discussion can help the transition, but the best route to change is through example and leadership.

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Men's Support for Sexual and Reproductive Health

Men, who are more likely than women to be literate and to have better access to information, are often in a better position than women to inform themselves about reproductive health. They lack interest, however, because reproductive health — including everything to do with contraception, pregnancy, childbirth and STDs — is considered to be a woman's concern. "Real men" do not concern themselves with such matters. (Even if they acquire an infection, a woman is blamed, and sometimes a woman is seen as the "cure". The belief that sex with a virgin can cure AIDS is responsible for an unknown number of infections among young women.)

This can be changed. With the correct timing and approach, informing men about reproductive health, maternity and child care leads to more support for safe pregnancy and delivery and breastfeeding.13 A successful project in Egypt has demonstrated that men are eager to know what they can do to help their wives after a miscarriage, and are willing to learn about reproductive health.14

Dr. Leela Visaria, long active in reproductive health policy in India, concludes that "research needs to go beyond estimations of incidence and prevalence and probe into power relations between partners", including the negotiation and decision-making process.15

Various efforts have been made to increase men's interest in their own and their partners' reproductive health. Community-based approaches have addressed a range of concerns. Programmes have worked with groups of men, creating opportunities for easier communication. Traditional authorities have been enlisted to motivate men. Better ways for men to find accurate information have been created.

Lessons from India

Several projects in India demonstrate some generally valid points about securing men's involvement in reproductive health issues.16

Men and women often perceive reproductive health issues differently. Among married adolescent couples interviewed in one study,17 the men described the positive effects of marriage on their daily lives, and indicated they believed their wives shared their opinion. Wives had a more mixed assessment of marriage, as they adjusted to the burden of their multiple responsibilities.

Men's illnesses were immediately apparent because of their impact on wages; wives' illnesses became known only when they told their husbands or when the household routine was disturbed; women were more likely to conceal their health needs because of the expense. Women felt strong pressure to conceive early in marriage. Men did not know much about family planning, and were aware of their lack of information.

Men accompanied their wives to their first check-ups to confirm a pregnancy, but wives did not expect or want further visits with their husbands. Clinic workers seeking to shield other women did not encourage them.

Husbands ignored women's health care during pregnancy except for appreciating the need for a nutritious diet. While they advised women to reduce their workload, they generally did nothing to help, except in some cases where they assisted with household chores. Childbirth was seen as women's concern, and men were generally unaware of any problems.

Discussion of reproductive health concerns offers the prospect of change.

Traditional beliefs can undermine reproductive health. One project found that traditional beliefs about semen and sexuality led to reduced protection from STDs. Traditional beliefs about such matters as erectile dysfunction impeded reproductive health care. Concerns about sexual inadequacy among a minority of young men led to family violence and discouraged them from using contraception.

Efforts to involve men in reproductive health must include education about gender relations and shared opportunities. The NGO Social Action for Rural and Tribal Inhabitants of India (SARTHI) has worked in traditional settings to improve women's status and reproductive health. The group's initial work on women's health was found to improve men's awareness and sensitivity to gender issues. Contrary to expectations, men did not feel threatened by women's meetings, and even volunteered to take on domestic chores so that their wives could participate. SARTHI then began to include men of all ages in the programme, and began training men as health workers in a new community health programme serving men and children.

After several years, SARTHI recognized that work to empower women needs to be accompanied by action to sensitize men about gender relations, to free them from patriarchal definitions of masculinity. Personal transformation is necessary before male health workers can become good community role models.

Another NGO, the Centre for Health Education, Training and Nutrition Awareness (CHETNA), started working to involve men in its reproductive health programmes in the early 1990s, when it realized the extent of husbands' domination and neglect of their wives, and the effect this had on women's health; women said they were not even free to decide how much food they ate. CHETNA now concentrates on involving men in early childhood care, including teaching them about nutrition and growth monitoring; teaching adolescent boys about sexual and reproductive health; and using trained male health workers to motivate men to take an interest in women's health.

These efforts have shown that training is crucial — poorly trained men can perpetuate harmful behaviours and beliefs — and that programmes to encourage men's participation need to involve members of their extended families. Otherwise, the men may face criticism and ridicule when they help with housework or take on some of their wives' responsibilities.

Creative adaptations of existing institutions can create new opportunities to effect change. Family Welfare Education and Services (FWES) organizes men's and mothers-in-law clubs to support reproductive health.18 The men discuss issues such as alcoholism, smoking, malnutrition, family planning and women's literacy. Mothers-in-law in India exercise great influence in the household; the project encourages them to promote proper nutrition and childcare and to motivate their sons to treat their wives better, because "only a healthy and happy mother produces a healthy child".

Two local health centres offer services for adolescents, and a letterbox has been set up for their questions about sex and reproduction. There has been a definite change in young people's awareness and perspectives in the five years since the project began. Boys now ask fewer questions about girls' virginity, and more about the involvement of men in raising children. Questions about STDs, AIDS, contraception and safe sex are also frequently asked. Boys express increasing concern about girls' problems and are now more likely to ask about menstruation. More young people now view sex as not merely about pleasure or procreation, but as a part of "expressing and sharing love". More girls want to share household chores and child-rearing with their future partners.

In FWES project villages, girls' enrolment in schools has increased and sex ratios for newborns have not changed, unlike neighbouring villages, where girls' enrolment has decreased and female births have declined sharply. However, the clubs have not caught on in other villages and involvement has reached a plateau.

Other NGO Efforts to Involve Men

In Mali, the Association de Soutien au Développement des Activités de Population worked with a Centre for Development and Population Activities/ACCESS project to expand community-based family planning services and encourage men's participation. With the backing of traditional leaders, male volunteers were trained to distribute contraceptives and provide information about reproductive health, including STD/AIDS prevention, high-risk behaviours and condom use. The project increased men's interest in the health of mothers and children, and led to greater interest in modern methods of child-spacing.19

Box 22: Men Can Change Course of AIDS Epidemic, UNAIDS Reports

In Nicaragua, the NGO CaNTERA offers workshops on masculinity and sexuality; gender, power and violence; unlearning machismo; and communication skills. During a 1997 evaluation, many men reported that CaNTERA courses had changed their lives: two thirds reported that they had a different self-image, and more than two thirds said they were less violent. Nearly half the women said their partners were significantly less violent after their training, and an additional 21 per cent said that they were a little less violent. Both men and women reported that the men were significantly more responsible sexually.20

Various programmes focus on adolescent boys' roles and responsibilities. In Brazil, the NGO Citizen Studies, Information and Action targets teenage fathers in a campaign involving radio, television and comics. Save the Children UK has supported the making of four films in Bangladesh, India, Nepal, and Pakistan; the project "Let's Talk Men" uses the films to build awareness on gender relations, so boys will adopt more responsible attitudes about women and sexual relations.

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A Common Agenda

The effort to involve men in reproductive health programmes is picking up momentum, and useful programme models have been developed. In developing these activities, programme design must take care to ensure that they do not divert scarce resources from activities directed towards women, as some women's NGOs fear. Greater involvement of men in reproductive health decisions should give more power to women, not less.

Men's and women's different needs should not be in competition for resources. The common aim is the well-being of all family members.

Men can advance gender equality and improve their family's welfare by:

  • Protecting their partners' health and supporting their choices — adopting sexually responsible behaviour; communicating about sexual and reproductive health concerns and working together to solve problems; considering adopting male methods of contraception (including vasectomy and condoms); and paying for transport to services and for service costs;
  • Confronting their own reproductive health risks — learning how to prevent or treat sexually transmitted infection, impotence, prostate cancer, infertility, sexual dysfunction and violent or abusive tendencies;
  • Refraining from gender violence themselves and opposing it in others,21 and promoting non-aggressive conceptions of male sexuality and masculinity;
  • Practising responsible fatherhood — supporting their partners in child-rearing and household tasks; protecting their children's health and investing in their future; teaching their sons respect for women's needs and perspectives; developing open and supportive relationships with their daughters; and providing their children with accurate and sensitive information;
  • Promoting gender equality, health and education — supporting the education and training of girls and women; promoting women's participation in health, education and economic activity; lobbying for increased funding for basic social services and working to improve the quality of programmes; and demanding that family life education be taught in schools.

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