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
|How men behave in their families is strongly influenced by expectations about what it means to be a "real man".
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.
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.
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
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
The internal tensions that undermine impossible ideals of male
performance and competence can allow men to seek new role models
and forms of behaviour.
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
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
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
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.
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
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
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
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
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.
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
- 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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