Can a Gender Equity and Family Planning Intervention for Men Change Their Gender Ideology? Results from the CHARM Intervention in Rural India

We assess the effect of CHARM, a gender equity and family planning counseling intervention for husbands in rural India, on men's gender ideology. We used a two‐armed cluster randomized control trial design and collected survey data from husbands (n=1081) at baseline, 9 months, and 18 months. We used a continuous measure of support for gender equity and a dichotomous measure of equitable attitudes toward women's role in household decision‐making. To assess differences on these outcomes, we used generalized linear mixed models. After controlling for socio‐demographic factors, men who received the CHARM intervention were significantly more likely than men in the control group to have equitable attitudes toward household decision‐making at 9‐months follow‐up; there was a non‐significant difference between the groups for the measure of support for gender equity. For household decision‐making, differences were not sustained at 18‐months follow‐up. Given the role of husbands’ gender ideology in women's contraceptive use, the CHARM intervention represents a promising approach for challenging root causes of women's unmet need for contraception.     

Pregnancy Motivations and Contraceptive Use: Hers,His, or Theirs?

ContextStudies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations.MethodsWe used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations.ResultsWe observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use.ConclusionProviders and those developing interventions must recognize that some women who are “not trying to get pregnant” have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies.     

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.     

Money,men and markets: Economic and sexual empowerment of market women in southwestern Uganda

Market trading requires access to cash, independent decision‐making, mobility and social interaction. This study sought to explore whether market work empowers women with respect to spending decisions and negotiation over sex and condom‐use. A semi‐structured questionnaire was administered to 212 market women; and 12 focus group discussions and 52 in‐depths interviews were conducted among market women in southwestern Uganda. Market women reported high levels of independence, mobility, assertiveness and social interaction. Access to cash was not synonymous with control over it, however. Spending decisions were limited by men's ability to selectively withdraw finances for expenditures central to women's concerns including household and children's needs. Trading in markets earns women masculine labels such as kiwagi, characterized variously as independent, rebellious and insubordinate. Earning money does not change expectations of correct behaviour for wives, making it difficult for women to initiate, deny sex or ask for condoms. Independence and income from market work may make it easier for women to enter and exit new sexual relationships. However, unable to protect themselves within partnerships, HIV risk may increase as a result.     

People's community kitchens in Peru: Women's activism pro urban food security

The women's community kitchen movement in low‐income areas of Lima and Callao has, over the last twenty‐five years, played an important role in contributing to household food security and improved nutrition. It represents a case of grass‐roots activism with food and nutrition aims, which at the same time appears to have important human development outcomes for women, as well as beneficial effects on community development.     

His and Her Job: What Matters Most for Fertility Plans and Actual Childbearing?

This study examines workplace culture and fertility plans and transitions in Sweden. This study goes beyond previous research in examining the effect of particular job characteristics as well as the influence of a partner's job characteristics on women's and men's birth plans and transitions. We use data from the 1999 and 2003 Swedish Young Adult Panel Study. Results indicate that men are more likely to intend to have a child if their partner's job makes it easy to take parental leave or work part‐time. Women are more likely to intend to have a child if their partner's job pays well. In addition, men whose job pays well are more likely to have a child. This research suggests that family‐friendly policies may enhance fertility indirectly through men's fertility decision making.     

Experience of intimate partner violence among women and men attending general practices in Dublin,Ireland: A cross-sectional survey

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence.

Conclusion: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.     

Are partner's features important to understand health at older ages? The Spanish case

ObjectiveTo analyse health differences among partnered individuals in Spain aged 65-81 considering their combined (education of both partners and age gap) and household (economic capacity of the household) characteristics.MethodA cross-sectional study of the 2015 Spanish sample of the European Union Statistics on Income and Living Conditions survey (EU-SILC) on partnered individuals aged 65-81 years (N = 1787). Using logistic regression models separately for women and men we obtained odds and predicted probabilities of having less than good health (95% confidence intervals) according to combined information from both partners on education and age, the household's economic capacity and partner's health status.ResultsProbabilities of not having good health are significantly less among lower educated women whose partners are more highly educated (compared to both partners being lower educated) and among women whose partner is younger or has good health status. The latter also applies to men. Living in a household without economic difficulties also favours health (both sexes).ConclusionsFor both sexes a partner's health status is the variable that shows the largest effect on elderly partnered Spanish people's health but women's health appears to be more sensitive to their partner's educational attainment and the household's economic situation.     

Finding Information About Men's Health on the Internet

Summary

It's a well-known fact that men are less likely than women to seek health care. Men tend to wait as long as possible to see a doctor about a health problem, making early diagnosis of a disease difficult if not impossible. When one looks at the statistics related to men's health, the apparent aversion to seeking health care is disconcerting. Given the fact that men seem to be more private about their illnesses, the Internet provides an excellent place for them to seek health care information. A search of “men's health” finds an overwhelming number of sites on the Internet. This article provides a highly selected list of Web sites intended as a starting place for finding information about men's health on the Internet.     

Fit to father? Online accounts of lifestyle changes and help‐seeking on a male infertility board

The reproductive realm is routinely viewed as a feminised space requiring women's commitment and labour. By contrast, men's procreative contributions and ‘reproductive masculinity’ is represented as unproblematic, with men assumed to be fertile across the lifespan. Recent scientific research has, however, cast doubt over these longstanding assumptions, suggesting that a link does exist between ‘lifestyle’ factors and male fertility. The notion that fertility can be improved with effort (for both women and men) can be located within wider cultural and political shifts which construct individuals as increasingly responsible for acting on health messages and engaging in self‐disciplining body projects. Through an exploration of ‘lifestyle changes’ within a men's online infertility discussion forum board, this paper examines how discourses of individualisation healthism and masculinity are reproduced and interlinked. Our thematic analysis indicates that ‘lifestyle work’ is construed as crucial for achieving conception ‐ and as a means to demonstrate men's commitment to the dyadic goal of parenthood, which in turn may challenge and extend previous notions of ‘reproductive masculinity’.     

Recruiting low-income healthy women to research: an exploratory study

Objective. The study goals were (1) to assess the feasibility of using an existing telephone health information and referral service for low-income, ethnically diverse women to recruit women for research participation; (2) to assess the feasibility of recruiting low-income, African American and Latino men into health research through the women callers to the telephone service; and (3) to describe the challenges women face and the strategies they use when talking to men about the men's health and research participation.

Design. We recruited women for individual semi-structured qualitative interviews via the Every Woman Counts (EWC) telephone information and referral service, a California Department of Health Services Cancer Detection Program. This paper describes our eligibility and recruitment assessment, and our qualitative data from 23 interviews with low-income African American and Latino women who called EWC.

Results. We found that it was feasible to recruit women, but not to recruit men through women who call this telephone service. Almost 50% (113) of women demographically eligible for recruitment, completed our screening questionnaire, despite calling EWC for a different purpose. Some 48% (54) of those women were eligible for an interview. Of interview-eligible women, 58% (10) of African Americans and 35% (13) of Latinos completed an interview. Only 17% (4) of women referred a man for participation in an interview for our study. Several themes emerged from our analysis of interview data: (1) women's role in men's health can be significant but is often uneasy; (2) challenges when talking to men about their health include health access, gender dynamics, and men's fear of health care; (3) women's understanding of research may be limited; (4) women use a range of strategies to address and overcome men's resistance to taking care of their health and participating in research.

Conclusions. The challenges women face when talking with men about their health affect their ability to effectively speak to men about research participation. However, EWC and similar telephone health services may be an effective means for recruiting low-income women to chemoprevention and other studies requiring healthy participants.     

Men's experiences of giving and taking social support after their wife's spinal cord injury

The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping.     

Determinants of support for female genital cutting among ever-married women in Egypt

Abstract

This study examines the effect of exposure to communication messages on support for female genital cutting (FGC) in Egypt. Data from the 2005 Egypt Demographic and Health Survey are analysed using logistic regression (n=19,106; ever-married women aged 15–49). The analysis reveals that high levels of exposure to FGC-related media messages are essential in reducing support for FGC. Women exposed to two or more FGC media messages are 1.6 times more likely than unexposed women to support discontinuing FGC. Moreover, women's belief that men want the practice discontinued, and their belief that FGC can cause fatal complications, are both positively associated with women's support for discontinuing FGC. By contrast, women's belief that FGC is an important part of religion, and their belief that FGC prevents adultery, are negatively associated with women's support for discontinuing FGC. Almost identical factors affect women's intention to circumcise their daughters. High exposure to FGC-related messages, and women's belief that men want the practice discontinued, are negatively associated with the outcome. Women's belief that FGC is an important part of religion, and their belief that FGC prevents adultery, are positively associated with it. Women's belief that a husband prefers a circumcised wife is not associated with women's intention to circumcise their daughters after controlling for all other variables in the model. Given that high level of exposure to FGC-related messages is key in reducing support for FGC, communication campaigns should be continued and intensified. Campaigns should also aim to change men's perception and support for the practice.     

Blurring, moving and broken boundaries: men's encounters with the pregnant body

Abstract This paper draws on the findings of a longitudinal ethnographic study of men's transition to fatherhood, conducted in the United Kingdom (UK). It is concerned with their encounters with the pregnant and labouring body. Until relatively recently there has been surprisingly little work, either theoretical or empirical, on the experience of pregnant embodiment. Work in the last decade has indicated that women's experience of ‘being‐with‐child’, their experience of living in and being a pregnant body, can be an ambivalent affair, as some find disconcerting the experience of simultaneously being self and yet Other. If women, who possess the embodied and therefore privileged knowledge of pregnancy, can feel ambivalence, perhaps the case for expectant men is more so. This paper draws on interviews with men making the transition to fatherhood and analyses their experiences of and relation to the pregnant and labouring body. The theoretical analysis of their empirical accounts explores in particular the blurring, moving and broken boundaries of the pregnant and labouring body and how these changing body boundaries can challenge the taken‐ for‐granted assumption that bodies should always be contained, strong and firm. The implications of men's encounters with this ‘differently bounded’ body are examined.     

Who decides? Women's status and negotiation of sex in Uganda

Women's ability to negotiate the timing and conditions of sex with their partners is central to their ability to control a variety of reproductive health outcomes. Focus group discussions and survey data from 1356 women and their regular male partners in two districts in Uganda were analysed to explore the nature of sexual negotiation and to test hypotheses about the influence of women's work and marriage institutions on norms and behaviour regarding sexual decision making. Sexual negotiation is characterized by four stages starting with normative precedent for decision making about sex and progressing to communication, disagreement, and conflict resolution. Men are generally reported to have more influence over sex in these settings, but women can and do refuse sex under a variety of circumstances. Education and urban residence consistently enhance women's ability to negotiate sex. The effect of marriage and women's work characteristics depends strongly on district context. We speculate that certain types of bridewealth agreement inhibit a woman's ability to influence timing and conditions of sex independently of other 'bargaining' resources she may control.     

Delivering the unexpected—Information needs for PSA screening from Men's perspective: A qualitative study

BackgroundMaking decisions about PSA screening tests is challenging, as it requires both knowledge of the possible benefits and harms of screening and an individual assessment of the patient''s values. Our research explores how much and what information men perceive to be necessary with regard to screening for prostate cancer.ObjectiveTo explore men''s information and associated needs for decision making in PSA testing.DesignQualitative interview study.Setting and participantsWe interviewed 32 men (aged 55‐69) about their decision making on PSA screening following counselling with a Decision Aid at their GP’s or urologist''s practice in Germany.Main Outcome MeasuresMen''s expressed needs for decision making in PSA testing.MethodsAll interviews were transcribed verbatim and analysed by framework analysis.ResultsComprehensive pre‐screening counselling is needed. For the men in our study, information about test (in)accuracy, the benefit‐harm balance and consequences of the test were relevant and surprising. Additional needs were for interpretation support, a take‐home summary and time for deliberation. For several men, their physician''s attitude was of interest. After being well‐informed, most men felt empowered to make a preference‐based decision on their own.DiscussionMen were surprised by what they learned, especially regarding the accuracy and possible harms of screening. There is large variation in the breadth and depth of information needed, and some controversy regarding the consequences of testing.Conclusion and patient contributionA core set of information should be offered before men make their first PSA screening decision. Information about biopsy and associated side‐effects could follow in a short form, with details only on request. Knowledge about a high rate of false‐positive test results beforehand might help men handle a suspicious test result.     

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.     

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.