This episode, we will discuss engaging men and boys in family planning and reproductive health programs. We will talk to guests from diverse settings about: what this means; strategies for putting this into practice; and recommendations for how we can work with men to support women’s reproductive autonomy.
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From Knowledge SUCCESS, Breakthrough ACTION, and the Interagency Gender Working Group, this is Season 3 of Inside the FP Story—a podcast with the family planning workforce, for the family planning workforce.
The international family planning field has generated a lot of data, a lot of reports, and a lot of lessons learned. But we don’t often have the opportunity to get behind that information, to hear directly from the people who implemented a program, or who did the analysis, and so we reinvent the wheel or miss the mark because we don’t know what could be really critical in a particular context. Inside the FP Story is that opportunity.
Each season, we hear directly from program implementers and decision makers from around the world on issues that matter to family planning programs. Through these honest conversations, we’ll learn how we can improve our family planning programs as we work together to build a better future for all.
Narrator This season on Inside the FP Story, we are exploring the complex topic of gender and family planning. Last episode, we discussed the intersection between gender-based violence and family planning, and heard from our guests about a range of interventions and considerations to challenge the social norms that contribute to gender-based violence. This episode, we will discuss engaging men and boys in family planning and reproductive health programs. We will talk to guests from diverse settings about: what this means; strategies for putting this into practice; and recommendations for how we can work with men to support women’s reproductive autonomy.
Narrator As we have done in our previous episodes this season, we will start with some definitions.
Male engagement in family planning is defined as the involvement of men and boys in family planning programs across life stages, while addressing gender norms and gender equality. Now, let’s put this definition into historical context. Here is Mabel Sengendo, Regional Unit Manager of Sonke Gender Justice, an NGO based in South Africa.
Mabel Sengendo If you look at the history of family planning, the target has always been women, women as the beneficiaries, women as the people who the family planning is designed for, right? For example, when you had family planning in the beginning, it was always women taking pills or getting the injection. And men were never part of that conversation. What that then created was suspicion around family planning—you know, why are these women doing this behind our backs? Because of course the men initially were not part of the decisions.
Narrator Historically, family planning and reproductive health was typically seen as something only affecting women. Even when men were involved, it was often in a way that reinforced traditional gender norms—intentionally or unintentionally—upholding men’s control and their role as decision makers. Here is Jeff Edmeades, Senior Research Analyst from the Demographic and Health Surveys—or DHS—Program.
Jeff Edmeades If we're thinking about family planning in particular, the way that the field has approached men has been very limited. It’s been very much a focus on women. And I think that is actually a reflection of inequitable gender norms in the field as a whole, particularly at the time, you know, in the fifties and sixties, when these really were being formed and still continued to be kind of the platform that we build off—where reproduction and reproductive matters were defined as a woman's issue with the men being kind of peripheral to the process. Or when they were considered were largely just seen in terms of their gatekeeper role.
And I think we've come a long way as a field in that regard, but in practice on the ground, I think very often the engagement of men in family planning programs is limited very much to like, “How can we leverage the men to achieve an outcome for the woman?” And really engaging men and boys in family planning means stepping away from that kind of framework and towards one where men are really seen as active participants in the process of family planning—people who have responsibilities of their own and view it as their responsibility to engage with family planning and who are supportive of family planning and SRH for their female partners and families and communities in really positive ways. We want these men and boys to be fully informed, to be concerned, to see family planning as something that matters for them, not for just women, but it's a matter for men as well, to have the knowledge, to be able to act on that. But then also to be the supportive partner that doesn’t force their opinions on their partner in a way that disempowers them.
And the goal of all of this should be to really enhance people's reproductive empowerment—their ability to have control over their reproductive lives. And that is not just for the men and boys when you're trying to engage them, but for their partners as well.
Narrator Jeff made a convincing case for why men are crucial to advancing reproductive empowerment—and the importance of shifting roles so that couples jointly make decisions in a way that is based on open communication, respect, and cooperation.
When defining male engagement in family planning, several of our guests emphasized three key roles for men—clients, supportive partners, and agents of change within their communities. Keep these three roles in mind throughout this episode.
Narrator Engaging men and boys in family planning presents a number of challenges, and opportunities as well. As we discussed in Episode 1, “social norms” are unwritten rules about how to behave. And as we have explored so far this season, gender and social norms often dictate an individual’s ability to access and use family planning—and whether an individual is even aware of family planning.
Although men may have fertility desires or preferences, the details of contraceptive use are often left to women. This cycle is hard to break: Excluding men sends the message that they do not need to take responsibility for reproductive health. And as a result, they often then lack incentive or motivation to learn about these topics. Here is Jeff:
Jeff Edmeades I think that the key issues here are those gender norms that are driving the perceptions of what is appropriate for men and boys and women and girls, and how that then influences their engagement in family planning. We have family planning programs—I think, on a kind of more objective level, you can see that family planning matters for boys and men as well. But men and boys aren't engaged to the level that women and girls are.
Narrator While there is an obvious biological reason why women participate more in family planning programs, gender and social norms do play a critical role.
With regard to power and social norms, Ravi Verma, Director of the Asia Regional Office of the International Center for Research on Women, talked about the imbalance in decision-making. It can be challenging to carve out roles for men and boys in family planning without taking decision-making power away from women and girls.
Ravi Verma It has been one of the most difficult conversations to bring about. A conversation around gender equality and decision-making process where both men and women engage in true partnership—decide as to what they want, why they want, and when they want to accept contraceptives. And this becomes far more serious in the context where patriarchy or the male dominance is prominent, where most decisions within the family units are taken by the men on a patriarchal hierarchical system of decision-making.
Narrator While trying to address masculinity and gender norms can be overwhelming, Jeff recommended that program implementers break this down into smaller steps.
Jeff Edmeades What I would encourage for a programmer is to look carefully and think, “I understand that norms of masculinity and femininity matter for men's engagement in family planning. How can I tackle the pieces of that that are more specifically related to reproduction, that are related perhaps to family formation processes, that are related to how couples communicate or don't communicate, unfortunately, a lot of the time about these things and tackle those?”
So tackle the idea of what they talk about and work to change that, rather than thinking you have to change every aspect of gender norms in the community.
Narrator Men are not conditioned or expected to ever discuss topics like family planning, family size, parenting, or caregiving. So how are they supposed to show up in a relationship ready to have these conversations? Communication is central to all of this, in order to counteract the effects of social norms—and evidence shows that better couple communication is key to improving family planning outcomes.
Further, gender norms do not just impact relationships between people, but they can also influence the way the entire health system engages with men and boys as clients. Here is Ravi again.
Ravi Verma The entire focus of the health system—and even the education system—has been to promote maternal health for women. So health outreach is more focused towards ensuring safe delivery and getting women into the health system. Outreach workers are largely women who reach out to women and girls. There are very few male outreach workers within the program. They used to be there, but then gradually, family planning became very women focused, for some good reasons as well. Because I think family planning program has promoted choices to women in order to decide for themselves as to what method they want to use—give them more choices and they can use all those methods discreetly. But it has worked against them in some ways. It becomes their own responsibility then.
And the entire system then gets geared to addressing that trajectory of providing services and making sure that women access those services. But as a result, they have alienated men and others, and they have not bothered to look at the larger decision-making dynamics that really puts women at the receiving end. And as a result, the structures have not been created to engage with men in ways that they're engaged with women.
Narrator So we know what male engagement is, and what some of the major challenges are. But what does this look like in practice? Our guests offered recommendations based on their own experiences.
Several guests mentioned the importance of tackling gender and social norms by beginning to engage with boys at a younger age—and addressing changing needs and priorities throughout their lives.
A resource developed by Breakthrough ACTION—called “Know, Care, Do Theory of Change” presents key drivers for men and boys’ engagement in family planning, and discusses critical intervention points. This—as well as a framework developed by the Passages Project called “Understanding the Male Life Course”—are important reference documents for family planning practitioners aiming to improve male engagement. Applying a life course approach allows us to understand and address the unique needs, priorities, and experiences of men and boys. Not only can this translate into more relevant and effective family planning programs, it can also help shift and fortify social norms. Here is Jeff with more on this topic.
Jeff Edmeades If you are able to shift norms around male engagement in family planning amongst 15 year olds, those same 15 year olds, when they're 35 are more likely, hopefully, to be more engaged and to have led lives that were more in keeping with what they wanted to do.
Narrator Erin DeGraw, a Senior Associate for Family Planning and Reproductive Health at Plan International, who works on the Health Policy Plus (HP+) project, also discussed this life-stage approach.
Erin DeGraw When you think about engaging men and boys, you have to use the life stage approach because it is different for different individuals. And so when you're thinking about working with younger individuals, some of those rigid gender norms may not be quite as ingrained at that point. So you have the possibility to really start working with them at a young age and building those perspectives kind of at an early stage. And so that by the time, you know, they get to being older men and they do have their own partners and are engaging in family planning activities, some of that wider gender perspectives in that respect is already there. It's built from a young age. And in comparison, you know, when you're working with older men, some of these ideas are already pretty set in stone. So changing those gender norms and those gender perspectives can be really difficult at that stage.
Narrator Margaret Greene, Founder and Executive Director of GreeneWorks, a consultancy firm, also emphasized the importance of reaching boys early.
Margaret Greene Well, I think with boys, with younger boys, I think making sure that they have all the information that girls do. And that boys and girls have more information than they generally are offered. And that, and this is really important. It's the framing of it. It's not, “you should be concerned about this because somebody else could get pregnant or somebody else could, you know, bear consequences,” but more “this is your life and here are the negotiation skills, the knowledge of services and everything that you need to, to address this really central part of life.” And, you know, to have adults around who are not embarrassed, who speak freely about the issues and so on. I think there are a lot of similarities actually between what boys need and what men need, especially men who have grown up in this kind of, I don't know, like the desert of sexual and reproductive health information that like the majority of the people in the world face.
When you have opportunities at younger ages and everybody's kind of a blank slate, then it's easier for everybody to be learning together and potentially sharing and so on—and then that my use of the word sharing that I guess is a really important common element that I would say that needs to be there for boys and for men, that, that there's a sense of, “yes, I need to do these things to manage my own sexual and reproductive health and life, but that I can learn and I can like get clarity on my own thoughts and feelings and decisions by being able to share with others” and that peer exchange being really important. And again, for affirming that, yes, this is our issue. It's not just the issue of our partners and wives and daughters and you know, other people, those women. But that it's our issue.
Narrator Margaret explained that using this life course approach can ultimately help break the cycle—which historically has placed the majority of responsibility on women and girls. When programs actively seek to frame messaging to boys as well as girls throughout their adolescence, this can help create a sense of ownership among boys.
As men and boys become more involved in reproductive health, another potential outcome is positive couple communication. Here is Prabu Deepan, the Asia Regional Head of Tearfund:
Prabu Deepan The question is not whether we should engage men and boys. The question is more about how do we engage them in a way that the outcomes that we seek doesn’t come at a cost of somebody else, not only their partners. It's not in a way that somehow reinforces the superiority, the entitlement, the control they have over women’s bodies.
So in family planning, we need to understand what are the behaviors that we don't want to reinforce. So what it means is engaging in a way that is deeply personal, transformational, so that looks at, explores, interrogates toxic masculine traits, and not only in the individual level, but interpersonal, but also in terms of the systemic nature. But also creating a space where men themselves feel vulnerable enough to acknowledge the challenges that they see. But without, always simplifying or trivializing the lived realities of women as well.
And then, on communication, couple communication, decision-making practices, consenting, and then if, especially with, in married or first-time parents, we talk about positive parenting practices, caring and in engagement in, during pregnancies and before pregnancy and after.
Narrator What Prabu talked about here is engaging men in a purposeful way—a way that allows them to identify and challenge gender-inequitable norms and behaviors. The couple communication Prabu described is something that can and should continue throughout a relationship, through different life stages and events, such as the birth of a child. This process can also lead to systemic changes on a broader scale.
Another important consideration for male engagement programs is how and where to reach men and boys. For example, the local health center may not be considered a welcoming space for them because its messaging, information, and services may all be geared towards women and girls. In this next clip, Mabel talks about meeting men and boys where they are—tapping into their interests and going to places they frequent. The “Brothers for Life” campaign she mentions in the following clip targeted men over 30 with HIV prevention messages.
Mabel Sengendo I think also one of the things that we are very aware of is that, you know, men are very diverse and also the message that you give them is going to be diverse. So when it comes to the younger population, even with our Brothers for Life campaign, we were using musicians, we were using football—because Africa you know, they love football, they love sports.
So, you know, ex-footballers who are like heroes to these young men would be the ones, in fact, two of them were employed at Sonke. So we would go with them to these spaces, the what, now, speaking to them in a really very cool language that they relate to. And they feel like, okay, this, this is one of us, you know. So with the younger population, we used, you know, celebrities to reach out to them, but also things like music, things like drama, which, you know, they would relate to easier. And with the older population, again, you work with older men. We have a program in Sonke, where we call them community action teams. We take on community members to act as volunteers who take the message down to the communities.
But even in the community action teams, we have people from all ages. So it's not just young people. We have older men. We have leaders in their communities. So again the person who is passing on the message has to be someone who is respectable to the target audience. That's a very key thing in terms of reaching out to men, older men and younger men. But also in terms of the case studies that you're giving. you give them case studies based on their age group. You know, you bring an example from a role model who is older to speak to older men, a young guy who is to speak to younger men.
Narrator Just as we need to consider age when designing programs, we also cannot assume that the same approach will work across different settings. It is necessary to tailor the approach and strategies to the people and the context, and to include both informal and formal networks to reach men and boys. Here is Ravi with more on this topic.
Ravi Verma There are both formal and informal kinds of platforms for engaging men. For example, youth clubs or the sports clubs. We have worked a lot with these sports groups of men as one structure or one social system. Sports groups of men and boys is an amazing platform where you could bring the ideas of doing things out of the box and engage them in conversations that are breaking the boundaries or pushing the boundaries, and that sets new norms around how men should be behaving and thinking. So there are both formal and informal structures. One needs to examine, one needs to really see how stable they are and how do you create ways to influence them?
Very often, men much more than women, men's behaviors are influenced by peer pressures. And who are their peers or who are their reference groups is something that constantly changes from one context to another and any program that needs to engage with them, one needs to find what is the social system that exists within the immediate ecosystem of those men's groups where there are greater influencers of them in many different ways and they need to be engaged. Men are largely mobile. It's very difficult to engage with men in any focused programmatic manner because you can't find them on a consistent basis in groups in any place for a long time. They either move out. They are migrating. They're constantly looking for jobs. They're going out for education. So men are kind of all over and they're constantly shifting their places. And so finding structures and systems to address men has to have multiple dimensions and multilevel kind of perspective.
Narrator Ravi emphasized how important it is to first understand the lives that men lead, and then tailor our outreach. In many settings, men and boys may be moving around for work or education—and this mobile lifestyle has programmatic implications. Mabel also shared some helpful program examples to illustrate this concept. Rather than expecting men to visit health clinics and navigate uncertain waiting periods that take them away from their jobs, she described how programs can go into the communities and reach men where they already congregate. Here’s an example from the Brothers for Life campaign in South Africa, which illustrates this approach and can be applied to family planning programs.
Mabel Sengendo One of the things we do is reach men outside their traditional spaces. So for example, in South Africa, places like the, we call them a taxi park, where you are going to be either waiting for a taxi or the ones who are sitting around calling, you engage them in those spaces. Because one, that's a place where they're comfortable. They can ask you as many questions as possible without feeling threatened. So we engage them in spaces, which are not in the usual traditional spaces where you would say in the hospital, in a sitting sort of arrangement, but you go to them. We've even had such discussions in shebeens—you would call them bars in the US—shebeens, where again they are comfortable. They are receptive and they’re listening. And those are places where we've been able to engage them.
Narrator Mabel also mentioned the importance of strategic communication. This involves developing tailored messages and selecting communication channels for different audiences.
Mabel Sengendo If you saw the tool that we're using for the younger men, you know, they were very visual. They were very colorful. Whereas with the older people, you had diagrams, it had to be simplified. But even the languages. With the younger folk, English was always fine. But with the older people, you have to translate to the local languages to be able to engage with them. But even when you look at the radio programs, you have different times with that, that suits different age groups. So the older men, of course, in the evenings, they are by the radio. And you find that they're more receptive to that, to those messages around that time. But younger men, they're always on the move. So on the radio, in the cars, they’re driving through the day, they still get the message. So we also look at different ways in which we target them, even with the media communication that we did.
Narrator To understand how best to communicate with different groups of men and boys, there are a number of tools and processes—one of which is audience segmentation. This is a process of dividing a large population into smaller groups based on similar needs, values, or characteristics. Segmentation taps into behaviors, attitudes, and lifestyle characteristics of populations and creates subgroups. We can then tailor messages and prioritize communication channels. Once men have been engaged in this way, they can become allies and advocates.
Mabel Sengendo You know, we target the power holders or the religious, traditional leaders. So once you also help them understand, what is this that we’re trying to achieve, they can be very good allies in passing those messages to their communities because they hold a lot of power in the communities where they come from. So if you give them the correct information, they are very, very powerful allies in passing on that information, you know, within a church or in the communities. But also in terms of the community you look at men who you would call role models, you know, who have shown that they're very transformative in how they live their lives and how they engage with their partners and you use them to speak to other men. You know, you use them as examples to speak to other men. But I think most importantly, it's using community radios. Because almost every household has a radio, you know, so how do we utilize that space to give this communication and not just family planning or family planning, this and that, but even talking about issues of power, issues of women's rights, the right to choose what's right for their body, you know, but also giving a very good picture of what it means for a woman to be able to space, you know, her children because that's, when you get you give men the information that they need to make those decisions.
Narrator Let’s turn back to norms-shifting. We know that norms-shifting is a critical part of engaging men and boys in family planning and helping them to view themselves as clients, supportive partners, and positive agents of change. However, more is needed to ensure that any shifts in social norms translate into gender-equitable behaviors that are sustained over time. Ravi shared a helpful program example. Oftentimes, participants may demonstrate gender equitable attitudes immediately after a training, but these attitudes do not necessarily translate into behaviors.
Ravi Verma And that is the double-edged sword. We have always, we have been working on issues of men and masculinities for so many years. And I always felt I had a self doubt that the programs where we’re engaging men and boys to prevent violence, advocating self-proclaimed protectors, who are now benevolent.
And that's a real issue that remains the issue and that gap between what one thinks and what one does, always there’s a gap. We have seen in many of our programs where we had boys and men who have undergone the gender equality programs, at the end of the program demonstrated very high gender equitable attitudes in their perceptions. But when you see the bystander interventions and whether they have intervened when they see somebody from their peer groups harassing a girl, then you will find that very few of them intervene. Very few of them really go against their peer groups.
Narrator The gap that Ravi and colleagues observed—between what men and boys think and what they do—is an important one for us to note as family planning practitioners. We need to consider how programs can foster and sustain an enabling environment for gender-equitable norms and behaviors. We also need to consider the relational piece of how men and boys act alone, versus in a group.
This relates to the “Know, Care, Do Theory of Change” that we mentioned earlier. As men and boys begin to understand the impact of their behaviors on women and girls, they are more likely to change their behavior. Mabel gives a real-life example of this.
Mabel Sengendo And we've had some really good success stories in terms of engagement of men and boys. And I'll give you a real example of a partner we worked with, UNFPA. She began to take her husband with her for antenatal sessions, before the baby was even born. And he began to understand the pressure of a woman—hours spent in the hospital sitting, waiting to get a service. And so when, when he went into the doctor, he began to ask, so, you know, what does this mean? Can my wife take a break? This is too much, you know. And they began to speak to him about family planning and you know, him hearing from the doctor himself, you know, and even questioning some of his own misconceptions about family planning. When they had the baby, he was quick to say, “I'd like my wife to, choose whatever family planning method she wants, and I will support her.” And the wife said, “Look, I don't want to take anything hormonal, because I feel for now, it's going to affect the baby. But on your end, you can, you can choose a family planning method that works for you.” And that's where it got interesting because when he began to ask, “What family planning methods can men take?” And he was told, “Well, there are long-term methods, which is vasectomy. So he was given either vasectomy or condom use. And of course vasectomy seemed like a very permanent, decisive, you know, method.
Of course, between the two of them, they were still planning to extend their family. So he himself actually chose to use the condoms in the relationship until the wife was ready to go onto the hormonal family planning method. But I think for us, that story was very powerful because the man was now being involved in giving the burden to the wife to decide, how does she prevent the pregnancy? He became part of the solution as opposed to part of the problem.
And you see that when you involve the man in the decisions, he actually can make decisions that are good for him and his partner. So I think the key lesson there is that men need to one, get information, but also be involved. Because we always assume that they will not support it. But in this case, this man was given a chance to, you know, to ask questions, understand what it is. And he supported it. In fact, he came up with a solution that worked for both of them. So basically if you engage men and boys in family planning, they can make better health decisions for themselves and their partners.
Narrator This example shows us the importance of recognizing men as family planning clients as well as partners. However, in reality, men often face issues accessing family planning and reproductive health services—and health systems often face challenges providing these services. Policies that support male engagement in family planning can help ensure that men and boys can access the care they need. Specifically, policies can ensure that clinics are male-friendly—for example, by ensuring that healthcare workers are trained in counseling male clients, that male family planning methods are discussed and available, and that family planning messages reach men in places where they congregate.
The HP+ project has developed some helpful resources to help with these policies. We’ll hear more about the policy framework for male engagement they developed in a few minutes.
Narrator Supportive policies can help make family planning services more accessible to men, which can help solidify their role as family planning users and partners. But how does this affect the women already using these services? Is it possible to engage men and boys in the family planning space—which has traditionally been thought of as a space primarily for women and girls—without decreasing women and girls' agency?
The short answer is yes. Here is Margaret with more on this topic.
Margaret Greene Well, I don't see those things as necessarily being in conflict at all. I mean, when people talk about, you know, if I were just speaking about men's and boy's rights and not speaking about gender, then I guess it does raise a greater concern about the potential conflict, like a conflict of interest. But boys and men who are raised both with knowledge and with an appreciation of relationship dynamics and mutual respect and bodily integrity, and all of those things, what is in their interest is largely reconcilable with the interests of women and girls. Only largely because people don't always agree about, you know, do we want to be pregnant now or do we want to have a child now? And people have to work that out, but I think as long as the, not the exclusion of boys and men from the narrative—that has not really helped women and girls either, in the sense that it has put on their shoulders all responsibility for pregnancy and knowledge, like so many things, including in many circumstances where they can not make those decisions by themselves.
Narrator Bringing in men and boys for only specific, small family planning or reproductive health programs is a missed opportunity. Excluding them does nothing for shifting harmful gender norms that place the burden of family planning on women.
But as Prabu discussed earlier in this episode, engaging men and boys needs to be done thoughtfully, without reinforcing or exploiting gender norms and stereotypes. And when we acknowledge the contribution of men in supporting gender equality, we shouldn’t rely on tokenism or superficial measures. For example, a man simply holding a child is not necessarily an indicator of overall gender equality. While Prabu emphasized that we are making progress, he urged us to still go deeper.
Prabu Deepan So I think we are evolving and I think it needs to be converging, right? So I think you don't engage men and boys at the cost of women, co-opting the struggles of women, but this conversation needs to converge for the benefit of men and women. So it's not just, let's be on this parallel process of improving the lives of men. Of course not. We want to see the improvement of men's lives and boys’ lives as well, but not at the cost of somebody else. It also needs to converge with the realities of women. So that needs to decrease violence, increasing equal practices and attitudes and relationships and decision-making around family planning and all of those things. So I think we need to see that in that whole system, rather than just engaging them as just individuals, but seeing through the ecosystem.
Narrator Male engagement in family planning programs should be viewed as a net positive for everyone involved. As the “Know, Care, Do Theory of Change” says, if implemented with intentionality and thoughtfulness, male engagement interventions support men and boys to participate fully and meaningfully in family planning—both individually and with their intimate partners, families, and communities—in supportive, affirming, and gender-equitable ways. The “full and meaningful” piece means that men and boys are taught to care about, and take ownership in, reproductive decisions while supporting the decisions of others.
Mabel shared another tool that helps guide her work in male engagement and couple communication.
Mabel Sengendo There's a manual—it’s called the One Man Can manual—that Sonke uses. So in this manual, we actually really go to great lengths to show the power imbalances in the community and how those power imbalances affect women and girls, whether it comes to GBV, whether it comes to making their own decisions. So that tool has been very critical in helping us, you know, even as we engage with the men in the spaces where we engage with them. To begin with the position of showing them that society has given them too much power, which sometimes harms women. And then when you bring in the discussion around family planning, you give them examples where women have to hide. And therefore, as we go into this work, we expect the men that we're talking to, or we are giving information to, are listening from the point of being supportive to their partners or to their wives in terms of accessing as opposed to making the decisions. So for us, the issue of communication is very critical in the way we talk about family planning, that the couples have to communicate and agree. Because it's someone's body, whether it's the man or the woman, it’s going to affect someone's body, either vasectomy for the man, but as we know, most of the family planning options are, you know, on the woman's body.
So that's been very clear to the men in that your partner is going to go through all these things, but it needs to be her or, I mean, you and her, to agree on what works best for her body. So for us, the issue of women's agency is very clear as we, as we do the, you know, the communication with the communities that we work with.
Narrator We have heard some excellent program recommendations from our guests, with examples of ways to engage men and boys in family planning programs. But how do we measure this work so we know whether it is having an impact?
Let’s get back to the HP+ policy work for male engagement. Erin worked with her team to conduct a policy scan of 26 USAID family planning priority countries—primarily in Africa and Asia—to better understand the policy environment for male engagement in family planning. They learned that the monitoring system across the board was generally weak.
Erin DeGraw We didn't really get too deep into like what indicators are in each of the different countries' policies. But overall, you know, when you're looking at policy provisions and indicators for metrics, they really focus on men as clients. And that's really only if the country is disaggregating by age and sex when it comes to family planning uptake and usage. So many of the countries just really don't have any kind of metrics around how men can be engaged as supportive partners or as agents of change. And it's a really big weakness within the policy landscape.
Narrator According to Erin, current metrics are designed to capture men as family planning clients—and not only that, but measurement is usually limited to those reached through traditional health centers. It is also important to develop metrics to look for other ways that men are reached—for example, in areas where they congregate. And it’s also important to look at other areas of male engagement—for example, joint decision-making and comprehensive sexuality education, abbreviated as CSE.
Erin DeGraw There's a number of different indicators out there that have been already identified for male engagement. But incorporating areas such as joint decision-making, but not just like how many people are actually doing joint decision-making, but how many programs are actually working with clinicians to support joint counseling or I think a lot of them around CSE could be strengthened around separating out, you know, CSE programs for boys and girls and making sure you're in your indicators are measuring whether CSE is actually meeting boys needs and building gender equality, you know, perspectives from that level and gender transformative CSE programs. A lot of that type of measurement indicators are really missing from policies.
Narrator A stronger monitoring system for male engagement requires work from the district and local levels, and requires national-level investments as well.
So why all this focus on data and measurement in a podcast about male engagement in family planning? Well, you may have heard the phrase, “What is measured gets done.” And it is a pattern that we need to break—the lack of strong indicators around male engagement in family planning strategies may be preventing us from doing this work, which is preventing us from measuring it, and so on. More robust data would reveal gaps and allow us to make changes.
But what kinds of things should we be measuring? Well, one suggested indicator is “the percentage of men who have used a male family planning method or a method that requires male cooperation (for example, a male condom).” This can tell us more about men’s individual use of family planning. MEASURE Evaluation’s 2017 publication, “Male Engagement in Family Planning: Gaps in Monitoring and Evaluation,” has a number of additional suggestions, and also includes ways to measure community and structural engagement of men in family planning. For example, is vasectomy included in policy? And how many family planning providers are trained in counseling men?
As Erin noted earlier, very few policies include indicators related to men as supportive partners or as agents of change. According to the MEASURE Evaluation guide, one suggested indicator for measuring men as partners is the percentage of men who share in the decision making of reproductive health issues with their spouse or sexual partner. And to measure men as agents of change, we could look at attitudes towards gender norms or national advocacy campaigns that address gender equity.
As we’ve noted, it is imperative that we engage men in our family planning programs. But without improved indicators, we just don’t have the information we need to better design and implement male engagement programs and services appropriate for a given context. It is also difficult to monitor how policies and programs affect men and boys, and to track our progress.
So it is critical that national policies and strategies acknowledge men’s participation in family planning programs and that they include strategies and specific measurement indicators for engaging them. Including these indicators in policies will help encourage, guide, and track male engagement among those who implement family planning programs.
In addition, we should also talk to men to get formative data. As Margaret suggests in this next clip, the more data we collect among men, the more examples and illustrations we will have about how access to family planning information and services impacts not just women, but men as well.
Margaret Greene I think in terms of some of the most powerful data for making the case that this is important is long-term economic data, basically, that show the impact of unintended pregnancy on men's lives—not just on women's lives. We have much more data on women in that respect. But the few studies that we have on the impact of unintended pregnancy on men of high school or college age indicate that men, especially those men who are more engaged, take a hit—it affects their life prospects. So I think that if people wrap their minds more around that kind of evidence also they would appreciate how central these issues are in men's lives as well.
Narrator These stories can help show men and boys the importance of family planning in their lives. We can also demonstrate to policymakers and donors the importance of advocating for investments in men’s health and well-being—and the impact of gender-integrated work with men and boys.
While we need more long-term data on male engagement to make our family planning programs more effective, it is clear that engaging men and boys is imperative in order to counter harmful gender and social norms, improve couple communication, and support women’s autonomy and agency around family planning. Moreover, this work supports the health and well-being of men and boys as well.
In this final episode of the season, we explored what it truly means to engage men and boys in family planning programs. We spoke with experienced implementers and researchers from different contexts on what works and what does not work. We talked about the harmful and restrictive gender norms that exclude both men and boys and women and girls in different ways from different aspects of family planning, and how to begin shifting these norms in a productive and thoughtful way. Our guests shared insights on how to simultaneously measure male engagement and monitor women’s reproductive empowerment.
This concludes our gender-focused season of the Inside the FP Story podcast. We hope these real-world examples and experiences—including what works, what doesn’t work, and recommended actions—will help you address gender inequality in your own policies and programs.
Season 3 of Inside the FP Story is produced by Knowledge SUCCESS, Breakthrough ACTION, and the USAID Interagency Gender Working Group. This episode was written by Natalie Apcar and Sarah Harlan and edited and mixed by Elizabeth Tully. It was supported by an additional team, including Danette Wilkins, Brittany Goetsch, Joy Cunningham, and Reana Thomas.
Special thanks to our guests: Mabel Sengendo, Jeff Edmeades, Margaret Greene, Ravi Verma, Erin DeGraw, and Prabu Deepan.
To download episodes, please subscribe to Inside the FP Story on Apple Podcasts, Spotify, or Stitcher; and visit knowledgesuccess.org for additional links and materials.
The opinions in this podcast do not necessarily reflect the views of USAID or the United States Government.
If you have any questions or suggestions for future episodes, feel free to reach out to us at info@knowledgesuccess.org.
Thank you for listening.
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