Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

Men's perceptions of women's reproductive health in South Sudan

This paper draws on a qualitative study (n = 52) and applies a political ecology of health framework to examine men's perceptions of women's reproductive health in South Sudan. The findings suggest that political practices of place making configure men's views of women's reproductive roles in this new nation state. In particular, masculinity intertwines with fears of losing traditional culture, and with lingering concerns about sovereignty to underpin men's deep aversion to modern family planning methods. In addition, the use of tribal militia to control territory and leverage political power places women's reproduction at the centre of South Sudan's post-secession politics. Improving health in such a fragile environment may require more than rebuilding the health infrastructure and guaranteeing financial access to health care.     

Culturally constructed relationships shape sexual and reproductive health in Bolivia

This paper reports on findings from five studies on the ways in which culturally specific identities and relationships shape women's and men's attitudes towards, and experiences of, sexual and reproductive health and health care in Bolivia. Quantitative and qualitative methods were used to examine knowledge, power and decision‐making in sexual relationships, and between health care providers and clients. Findings indicate that men and women hold different attitudes towards, and knowledge of, certain aspects of sexual and reproductive health. Moreover, health providers and users have dissimilar perceptions of health care encounters. In both arenas, poor communication was identified as a major constraint to improving sexual and reproductive health. Taken as a whole, these studies suggest that a deeper understanding of the relational dynamics and cultural contexts of sexual and reproductive health can contribute to the development of more successful health care programmes. They also suggest that much work needs to be done on developing ways to implement that understanding in policy and practice.     

The structural influence of family and parenting on young people's sexual and reproductive health in rural northern Tanzania

This paper explores the structural role of the family and parenting in young people's sexual and reproductive health. The study involved eight weeks of participant observation, 26 in-depth interviews, and 11 group discussions with young people aged 14–24 years, and 20 in-depth interviews and 6 group discussions with parents/carers of children in this age group. At an individual level, parenting and family structure were found to affect young people's sexual behaviour by influencing children's self-confidence and interactional competence, limiting discussion of sexual health and shaping economic provision for children, which in turn affected parental authority and daughters' engagement in risky sexual behaviour. Sexual norms are reproduced both through parents' explicit prohibitions and their own behaviours. Girls are socialised to accept men's superiority, which shapes their negotiation of sexual relationships. Interventions to improve young people's sexual and reproductive health should recognise the structural effects of parenting, both in terms of direct influences on children and the dynamics by which structural barriers such as gendered power relations and cultural norms around sexuality are transmitted across generations.     

The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV

In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18–24, 25–55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.     

Lessons learned from engaging men in sexual and reproductive health as clients,partners and advocates of change in the Hoima district of Uganda

This study examined the impact of a three-year intervention project conducted in the Hoima district of Uganda, which sought to engage men in sexual and reproductive health as clients, equal partners and advocates of change. Structured surveys with 164 self-reported heterosexual men aged 18–54 years were used to assess knowledge and attitudes towards sexual and reproductive health. Data from these were analysed using Stata and SPSS. Additionally, five focus groups were conducted with the female partners and male beneficiaries of the project and with project peer educators. Four interviews were conducted with project staff and male beneficiaries. Data from these and the focus groups were analysed using a thematic approach. Following the intervention, a significantly greater number of men accessed, and supported their partners in accessing sexual health services services, had gained sexual and reproductive health awareness, reported sharing domestic duties and contraceptive decision-making, and displayed a decreased tolerance for domestic violence. It was more difficult to assess men's involvement and behaviours as advocates of change, which sheds light on the complexities of a gender transformative project and the importance of evaluating such projects from both men's and their partners' perspectives and at different levels of the male involvement model in sexual and reproductive health.     

Time to Father

Abstract

This paper reports the qualitative findings from 40 couples involved in a study exploring men's post-natal mental health. Interviews were conducted with individuals soon after the birth of their first child. Findings suggest that new fathers want to be more involved in the direct care and nurturing of their children than their fathers were with them. Discourses which construct fathers and inform social structures have not kept pace with men's changed attitudes and role expectations limiting the options available to men as fathers. In particular men's employment circumstances figure in their experience of adjusting to life as a father. Those fathers having least flexibility and autonomy in their work report experiencing, since the birth of their child, more unhappi-ness, anxiety, and generally higher levels of stress. These findings suggest increasing workplace flexibility and provisions such as parental leave are important for men's post-natal mental health.     

Gender Inequities in Health: An Exploratory Qualitative Study of Saudi Women's Perceptions

This study aimed to explore Saudi Arabian women's perceptions of how gendered social structures affect their health by understanding their perceptions of these influences on their health relative to those on men's health. Qualitative methods, including focus group discussions (FGDs) and in-depth individual interviews (IDIs) were conducted with 66 married women in Riyadh, the capital city. Participants were purposively sampled for maximum variation, including consideration of socio-economic status, age, educational level, health status and the use of healthcare. The majority of women perceived their health to be worse than men's and attributed this to their childbearing, domestic and care-giving roles, restrictions on their mobility, poverty and psychological stress related to their responsibilities for children, and marital conflict. A minority of participants felt that men's health was worse than women's and related this to their gendered roles as “breadwinners,” greater mobility and masculine norms and identities. Gender equity should be a health policy priority to improve women's health.     

The cost of being a man: social and health consequences of Igbo masculinity

In the bid to explain reproductive health outcomes in most developing countries, men have often been seen as the cause of the problem. However, no systematic attempt has been made to examine men's perception of their own social and health needs, including how ideologies of masculinity impact men's social and physical health. This study examines the Igbo context and shows how men understand and interpret masculinity and the consequences of this for social and health behaviours. Data from adolescent and adult Igbo men aged 15–75 were collected using both quantitative survey interviews (n = 1372) and qualitative techniques such as focus-group discussion (n = 20), in-depth interviews (n = 10) and key informant interviews (n = 10) in selected areas of south-eastern Nigeria. We collected data on gender role ideologies and sexuality issues and practices. Our analysis shows that there are social and health costs associated with adherence to masculine ideologies and a strong association between masculine ideologies and men's health, risk-taking and health-seeking behaviours in the study population. We conclude that all sexual and reproductive health programmes should include services that address the specific needs of men and those negative aspects of masculinity that tend to expose men to adverse health outcomes.     

Social and cultural contexts of concurrency in a township in Cape Town,South Africa

Following the 1994 International Conference on Population and Development, the world has seen a shift in paradigm away from focused family planning programmes towards reproductive and sexual health more generally. This paper considers how the traditional emphasis on women's health and family planning can result in men's sexual health needs being overlooked. A biomedical rationale to target men with health services evolved from the rising interest in control programmes for HIV and sexually transmitted infections (STIs). To plan appropriate health interventions more needs to be known about how men perceive their sexual health. Unique data from Orissa (India) and rural Bangladesh illustrate men's perceptions of their sexual health problems and demonstrate that men are willing to seek care. While public sector programmers and health planners may be focusing their attention on the control of STIs, men in both studies indicated that their major concerns relate more to matters of psychosexual disorders. The failure of public sector programmes to take cognisance of male sexual health problems may lead to men continuing to seek care for all their sexual health problems (including STIs) in the unregulated and possibly ineffective private sector. If programmes addressing the sexual health needs of men are to be effective, they will need to be comprehensive in their scope and coverage, just as they are now aiming to be for women.     

Constructions and experiences of sexual health among young,heterosexual, unmarried Muslim women immigrants in Australia

Minority ethnic immigrant women are frequently vulnerable to poor sexual health outcomes, due to poor use of sexual health services, lack of knowledge and social stigma associated with the discussion of sexuality. This paper explores the sexual health accounts provided by a group of young, unmarried heterosexual Muslim women immigrants residing and studying in Sydney, an under-researched group in the Australian context. Ten semi-structured interviews were conducted, focusing on sex before marriage, spouse selection and contraceptive use. Feminist discourse analysis identified ‘purity versus corruption’ as the primary construction of women's sexuality, where women positioned their sexual behaviour as that of purity and uninvolvement or corruption through unwedded participation. The subthemes ‘maintaining ignorance and naivety’, ‘remaining virginal’, ‘sex segregation’ and ‘the fallen woman’ capture women's personal sexuality-related experiences and values within the context of their religious and cultural communities. Additional research with this community is needed to examine the effects of negative social constructions of sex on young sexually active Muslim women, as well as further research on young women's sexual health within immigrant communities.     

A Guy Thing

Abstract

The Men's Movement, celebrity disclosures about prostate cancer, and recent epidemiologic research identifying gender-related health risks for men have all resulted in, and simultaneously fostered, a burgeoning demand for information on men's health issues. The Internet may serve as a convenient, timely, and interactive service complementing traditional print resources for patients, their families, and their affectional partners looking for information on sexual and reproductive health and other health conditions as they present in men. Included in this article is a select list of Web-based men's health resources, with annotations, available from the Internet.     

Negotiating Respectability: Migrant Women Workers’ Perceptions of Relationships and Sexuality in Free Trade Zones in Sri Lanka

Migration has implications for women's sexual and reproductive health and rights. Our purpose with this study was to explore unmarried migrant women's perceptions of relationships and sexuality in the context of Sri Lankan Free Trade Zones. Sixteen semi-structured qualitative interviews were analyzed using thematic analysis. We found that the women's perceptions were influenced by gendered hegemonic notions of respectability and virginity. Complex gender relations both worked in favor of and against women's sexual and reproductive health and rights. Programs for improvement of migrant women's health should be informed by contextualized analysis of gender relations with its various dimensions and levels.     

Promoting safer sexual practices among expectant fathers in the Lao People's Democratic Republic

Men's decisions and behaviours influence the sexual, reproductive and maternal health of women and the health of their families, but men are rarely included in reproductive and maternal health care services. Men's attendance at antenatal care has the potential to prevent women from becoming infected with HIV during pregnancy and post-partum, when they are more vulnerable to infection and have a high risk of transmission to the infant. Greater involvement of men requires an understanding of social, cultural and organisational barriers in different contexts. In 2006, the Burnet Institute undertook fieldwork to inform a pilot project to encourage expectant fathers to attend antenatal care. A local Lao team conducted focus group discussions and interviews in Vientiane with expectant fathers, pregnant women, older women and health care providers. It was found that myths about the dangers of sex during pregnancy and women's decreased desire resulted in periods of sexual abstinence. Participants reported that unprotected extramarital sex was common but difficult for couples to discuss. Men lacked knowledge about sexually transmitted infections, including HIV. Men wanted information so they could better protect the health of their partners and babies during and after pregnancy, and reported being willing to attend antenatal care when invited. Our findings have useful implications for policy and implementation.     

Beyond “toxic bodies”: Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto,Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a “high-risk environmental area” in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond “toxic bodies”.     

The Childbearing Concerns and Related Information Needs and Preferences of Women of Reproductive Age with a Chronic,Noncommunicable Health Condition: A Systematic Review

BackgroundCertain chronic health conditions and their treatments may compromise women's fertility; some chronic conditions are more likely to affect women of reproductive age than others, and some are heritable. All have implications for women's future childbearing and fertility management.ObjectiveThe aim of this systematic review was to identify the concerns about childbearing and related information needs and preferences of women with a chronic, noncommunicable health condition.MethodThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Relevant social science and medical science databases (Ovid MEDLINE, ProQuest, and CINAHL plus) were searched for peer-reviewed, English-language papers published from 1995 to August 2012 of empirical research using quantitative or qualitative methods.ResultsOf the 5,350 articles identified, 29 met inclusion criteria and were reviewed. Despite variation in methods, the studies demonstrated consistently that women with a chronic health condition are concerned about childbearing and have questions about the reproductive implications of their condition. The evidence suggests that there is less consistency about women's preferences for the mode and timing of information about the effect of the condition and its treatment on childbearing. Most research to date has focused on the needs and experiences of women with cancer; there is almost none about other noncommunicable conditions.ConclusionThere are serious evidence gaps about the childbearing concerns and related information needs and preferences of women with chronic, noncommunicable health conditions. Research is required to address these gaps and to inform the development of appropriate tools to assist women in this situation with their childbearing decisions.     

The baby and the bath water: disabled women and motherhood in social context

The aim of this paper is to explore key dimensions of the reproductive experiences of disabled women who are, or who are thinking about becoming, mothers. The paper reports a qualitative study which involved semi-structured interviews with 17 disabled women who were contemplating childbearing, or were pregnant, and/or had young children. The interpretation of these women's experiences is situated with reference to current debates on the meaning and nature of disability, and draws attention to the ways in which these experiences can be understood as manifestations of disablism. More specifically, the paper considers three themes which emerged in the data analysis: the women's engagement with the medical ‘risk’ discourse; the pressure felt by disabled women to demonstrate that they are, or could be, ‘good enough mothers’; and their experiences of receiving unhelpful ‘help’ from health and social care workers.