Prepared by Rebecka Lundgren, Consultant, for:
Division of Health Promotion and Protection
Family Health and Population Program
January, 2000
Research Protocols to Study Sexual and Reproductive Health of Male Adolescents and Young Adults in Latin America
TABLE OF CONTENTS
- I. INTRODUCTION
- II. STUDY METHODOLOGY
- A. Objectives
- B. Research Questions
- C. Design and Implementation
- D. Sampling
- E. Interview Guides
- F. Data Analysis
- G. Informed Consent Procedures
- H. Dissemination of Results
- III. CURRENT KNOWLEDGE OF THE REPRODUCTIVE HEALTH AND SEXUALITY OF MALE ADOLESCENTS AND YOUNG ADULTS
- A. What are the Reproductive Health Needs of Adolescents and Young Adults?
- B. How Can the Needs of Male Adolescents and Young Adults be Met?
- C. The Meaning of Masculinity
- D. Experience of Sexuality Among Male Adolescents and Young Adults
- E. Teen Fatherhood
- F. Victims or Perpetrators of Sexual Abuse?
- Appendices
I. INTRODUCTION
This protocol describes a proposed study of the reproductive and sexual health of male adolescents and young adults in selected Latin American countries. The results of this study will guide the development of policies and programs which promote the sexual and reproductive health of male adolescents through a better understanding of their knowledge, attitudes and practices, taking into account the influence of the social construction of masculinity in Latin America.
Relatively few studies have focused on male adolescents and young adults. This gap is particularly glaring in view of the voluminous literature on female adolescents. The limited body of scientific literature concerned with the reproductive health of adolescent males in Latin America consists of a few single city studies and even fewer individual country studies. These findings cannot safely be generalized, even to other cities in the region, let alone to rural populations or men in other regions and continents. The proposed study will attempt to overcome these limitations in the following way:
Focus group, life history and survey methodologies will be combined to provide information on social norms and behavior and to permit quantification and triangulation of findings.
- Information will be provided on a broad target group in both rural and peri-urban settings, rather than on specific populations such as university students or street kids.
- Finally, it is designed specifically to examine the interaction of gender roles and male sexual and reproductive health.
During recent years, there has been a renewed recognition of the role of men in the reproductive and sexual health1 of women and the importance of including them in programmatic efforts. Interest in men in family planning has waxed and waned over the last three decades, but as the millennium approaches, the debate about male responsibility has taken a new turn and the question is increasingly being raised: What is in it for men? The renewed focus on men in the family planning and reproductive health field is cogently expressed in the International Conference on Population and Development´s action plan; "...the objective is to promote gender equality in all spheres of life, including family and community life, and to encourage and enable men to take responsibility for their sexual and reproductive behavior and their social and family roles" (Paragraph 4.25).
A better understanding of men and their reproductive behavior is essential to the achievement of one of the central policy goals of the ICPD. Nevertheless, little is known about how male adolescents behave in the reproductive health and sexual domain, and much less is known about their attitudes and feelings toward related behaviors and their social-cultural meanings. Although the Young Adult Reproductive Health surveys conducted by the Centers for Disease control provide essential information on sexual behavior and contraceptive use, they were not designed to cover the full breadth of reproductive health topics pertinent to male adolescents.
There is a notable lack of research on the meaning and significance of sexual activity, contraceptive use and other reproductive health issues for male adolescents and young adults. Information on coital experience and contraceptive use is only a small part of the picture, it may be even more important to understand the circumstances of sexual behavior, particularly its emotional dimension.
Most studies from the reproductive and sexual health field have examined males from the perspective of deficit; men need to do more or participate more. This discourse does not explain men´s side of the story. Rather than understand what men believe or feel, men have often been studied from the perspective of what we could learn about them in order to convince them to participate in preconceived reproductive and sexual health or male involvement programs. A review of the literature on men and family planning finds that it focuses almost exclusively on how men influence women´s health. The literature reflects the assumption that meeting women's reproductive and other needs has been and will remain a priority of reproductive health and family planning programs. It also however, recognizes that research from diverse settings suggests that these goals will be difficult to accomplish without appropriate inclusion of men.
The justification provided for this position is that while women bear greater health hazards associated with reproduction than men, it is men who are largely responsible for contributing to these hazards - for example, in a situation where an unwanted pregnancy is followed by an unsafe induced abortion. Therefore, the field recognizes the need to increase male responsibility, particularly with regards to the consequences of their sexual actions for their partners.
Differing approaches to men and women in the reproductive health literature reflect the fact that men are conceptualized primarily as a “problem” or a means to an end. In the ICPD document, the language that refers to male responsibility and participation is familiar to those in the reproductive health field. Male involvement projects often approach the issue from the simplistic view that men in and of themselves are the obstacles to family planning or condom use. The literature tends to refer to the “Empowerment and Status of Women”, while projects or research on men are labeled as “Male Responsibilities and Participation”.
While the empowerment of women is fundamental, what is often lost is the idea that the hoped for transformation and expansion of men's roles will also benefit men. The fact that men have sexual rights that are linked to freedom from oppressive norms, such as the right to show emotions without their virility coming into question, is seldom recognized. An exception to this is the work of Gary Barker (1996) and Benno Keijizer (1995) who suggest that the transformation and expansion of traditional sexual roles will be liberating for men. The reproductive health field should recognize that what is usually phrased as a responsibility or a duty (e.g. support women in family planning) can in many cases also be proposed as a right (e.g. the right to participate in deciding the number and timing of their children). A greater emphasis on male rights would lead to strategies to create the conditions in which men would be enabled to assume more responsibility.
When referring to male participation, it is important to recognize that men already are in involved in reproductive health, albeit sometimes with negative consequences. Therefore, it is not merely a question of increasing male involvement, but rather profoundly changing the way in which men are involved. As family, community, religious, professional and political leaders, men are instrumental in promoting or hindering women´s health. Therefore it is vital to bring men into positive decision-making with their partners, while neutralizing resistance which they pose to women.
Finally, talking about men alone – like talking about women alone - is an inadequate approach. As Judith Helzner argues, “In general, if little or no attention is paid to the general picture - including both sexes before the spotlight is focused just on the men – there is the potential for family planning programs to reinforce the status quo in gender inequalities” (1996). Some programs aimed at increasing male involvement have resulted in increased male control of their partners´ decisions. Gender analysis reminds us to ask what consequences particular strategies would have for women partners´ health and autonomy, and for the communication and sexual dynamic. In many countries, although men have little correct information on contraception they are the ones making many of the decisions. Some strategies may increase patriarchal decision-making at the expense of women´s equality and right to make decisions affecting their lives.
Empowerment
In this post-Cairo age, the nature of the discourse of male participation is changing. There is still no universally accepted understanding of what it means to include men in sexual and reproductive health efforts and what is sexually healthy for adolescents. However, there is an emerging awareness that reproductive health programs and services should reach out to men not only as a means of fulfilling women's reproductive health needs, but also to fulfill their own. Recent research suggests that men's health needs, especially those of male adolescents, may be more pressing than commonly thought. In fact, Rutter (1990) suggests that masculine gender is a variable that generates greater vulnerability to risk. For example, overall in Latin America and the Caribbean, the health burden for men is 26 percent higher than it is for women (Keijizer, 1995). Much of this morbidity is associated with the social construction of masculinity: traffic accidents, homicides, injuries and cardiovascular diseases, often related to alcohol use, stress and lifestyle. These trends suggest the need to work with male adolescents because many of the behaviors that lead to these health problems in adulthood emerge from patterns learned in childhood and adolescence.
Interest in men and sexual and reproductive health suggests the importance of designing interventions for male adolescents and young adults. It is widely recognized that intervention during the adolescent years can result in improved sexual and reproductive health during the adult years. Adolescence marks the onset of sexuality and the adoption of behavior patterns that may have lifelong implications for reproductive health. Empirical research suggests that early sexual habits and patterns of interaction in intimate relationships form the basis of lifelong habits and patterns. For example, research in the United States has found that consistency of condom use reported among teens is related to age at first sexual relations and earlier condom use. Males who started sexual activity later were more likely to use condoms and those who used condoms during their first sexual relations were more likely to use condoms consistently thereafter (Sonenstein, Pleck & Ku, 1995).
A focus on adolescent intervention prompts us to take a new look at male adolescents and young adults. How accurate is the popular image of male adolescents as “roving inseminators” who cause unwanted pregnancies and spread sexually transmitted diseases exclusively for their own sexual pleasure? More importantly, how does this perception influence our efforts to formulate programs that are effective in improving the sexual and reproductive health of women and men?
We have much more to learn about how male adolescents form their gender identity, how male socialization influences contraceptive use and HIV risk, how they weigh their conflicts and alternatives related to masculinity, what rewards and costs go along with changing their sexual behavior and attitudes, and what kind of fathers and husbands they want to become. Emerging research on domestic, dating and courtship violence has not offered sufficient insight on how to work with male adolescents to prevent domestic violence and sexual coercion. Very few studies have asked men their opinions about these issues, or about their own experiences of having been violent, with the aim of preventing relationship violence. Another priority area for research is the issue of peer interaction and sources of information on sexuality and family planning among youth. Research is needed not only to provide a fuller understanding of men and male sexuality, but also in terms of efforts to promote safe and more responsible sexual activity.
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