COURSE ID : 4333
COURSE NAME : Politics of Sex, Life and Death
|
A POLICY BRIEF:
Involving men in Sexuality and Reproductive Health in Indonesia
Azwar Surahman
The
Hague, the Netherlands
2012
1. Introduction
Male involvement is crucial in tackling problems related to
sexuality and reproductive health (SRH). This is not only because men are
experiencing problems of sexuality and reproductive health of their own but
also men have a special place and role within the family, in society and in
organizations that the problems can negatively affect women's health. The
failure to incorporate men in SRH promotion, prevention, and care programs has
had a serious impact on men health, the health of women, and the success of the
programs themselves. Policy makers, health planners and service providers have
overlooked and even ignored the influential role that men play in the SRH of
their families, and especially their sexual partners.
According a report from Pan American
Health Organization (2001), there are main reasons for involving men in sexual
and reproductive health to improve women’s health. Those reasons are:
Ø
Recognition of men’s influential
role in the sexuality and reproduction of couples;
Ø
Recognition that men have their own
distinct SRH needs and demands;
Ø
Awareness that inequitable gender
relations affect the SRH of both sexes;
Ø
Increasing evidence of the negative
effects of men’s risk behavioral patterns on women and children;
Ø
Concern over increasing rates of Sexual
Transmitted Infections (STIs) and HIV/AIDS;
Ø
Desire to prevent unwanted or
unplanned pregnancies through the increased or more effective use of family
planning methods;
Ø
Requests from women to incorporate
their partners into SRH promotion, education, and service delivery,
particularly pregnancy and delivery.
The shift from family planning to
the broader reproductive health agenda need to take in men's involvement. Men
constitute an important role in efforts to improve women’s health. The efforts
to involve them in ways that transform gender relations and promote gender
equity contribute to a broader development and rights agenda (Greene, M.E, Mehta, M., et al. 2004).
The basic argument of this entire policy
brief is that men’s roles in sexual and reproductive health must be recognized,
understood and addressed much more extensively than they have to date. By these
doing so will have well implications beyond reproductive health for other
aspects of development in Indonesia.
2. Conceptual Framework
The need to involve men in sexual and reproductive health
had been advised through the
1994 United Nations International Conference on Population and Development
(ICPD). It stressed that ‘efforts should be made to
emphasize men’s shared responsibility and promote their active involvement in
responsible parenthood, sexual and reproductive behavior, including family
planning; prenatal, maternal and child health; prevention of sexually
transmitted diseases, including HIV; [and] prevention of unwanted and high-risk
pregnancies’ (United Nation (UN) 1994).
The extensive research on women’s
subordinate status in most societies that informs the ICPD’s Program of Action
points to widespread patterns of male prerogative and power, visible in social
discrimination such as lower levels of investment in the health, nutrition, and
education of girls and women (ibid.).
Foreman (1999) identified that inability to negotiate sex, condom
use, or monogamy on equal terms leaves women and girls worldwide at high risk
of unwanted pregnancy, illness and death from pregnancy-related causes, and
sexually transmitted infections. While, combating sexually transmitted infections and the
heterosexual spread of HIV is impossible without involving men (Hawkes 1998).
Despite of the important of presenting the men involvement in sexual
and reproductive health, in fact the men’s roles were neglected (Pan
American Health Organization 2001). Research on population and reproductive health tended to
describe women’s disadvantaged position without mentioning men’s roles, usually
because the data used were collected only from women.
Gender roles on how masculinity norms influence men’s SRH behavior and
attitudes are one of the main reasons why men’s roles were displaced. Moreover,
boys and men are often uninformed or misinformed about female sexuality,
contraception, fertility and transmission of infections. Incomplete knowledge and powerful assumptions made it
possible for the field to avoid addressing gender inequities and expressions
such as violence in its work on reproductive health.
The framework that explaining the
wide range of male involvement efforts according to their objectives and
outcomes as organized in the framework is defined below.
Box 1. Approaches to Involving Men in Sexual and Reproductive
Health
|
APPROACH
|
PURPOSE &
ASSUMPTIONS
|
PROGRAMMATIC
IMPLICATIONS
|
MEN AS CLIENTS
|
Address men’s
reproductive health needs
|
* Extend same range of
reproductive health services to men as to women
* Employ male health
workers
|
MEN AS PARTNERS
|
Men have central role
to play in supporting women’s health
|
* Recruit men to
support women’s health, e.g., teach husbands about danger signs in labor, how
to develop transportation plans, the benefits of family planning for women’s
health
|
MEN AS AGENTS OF
POSITIVE CHANGE
|
* Promote gender
equity as a means of improving men’s and women’s health and as an end in
itself
|
* Paradigm shift in
how programs are structured and services are delivered, whatever they are
|
* Addressing inequity
requires full participation and cooperation of men
|
* Broader range of
activities, working with men as sexual partners, fathers, and community
members
|
Source: Adopted from Greene,
M.E, Mehta, M., et al. (2004) 'Involving Men in Reproductive Health’.
3. The reproductive behaviour and health of men
in Indonesia
In Indonesia, it seems very
unlikely to see the role of men in reproductive health. Most of the husband in Indonesia,
they do not even know what is referred to as reproductive health. Over the
years, men’s participation in family planning in Indonesia has remained low. Based
on the Indonesian Demography and Health Survey (IDHS) 2007, the numbers of
condom users reach only 1.3% and vasectomy participants 0.2% from total Contraceptive
Prevalence Rate (CPR) (Dewi
2009).
In sequence, various
studies have revealed about reproductive behaviour and health of men in
Indonesia. There were husbands who forbid the use of IUDs as a contraceptive
option wife, because of thought that the IUD or spiral could reduce sexual
pleasure. Other things, there was a significant percentage of wives ask their
husband to use a male contraceptive method, only half of the willing. Because
the vasectomy is often thought to reduce sexual ability, while condom
intercourse may be tasteless.
Furthermore, health workers
in Indonesia also rarely involve the husband in medical consultation,
especially in the treatment of pregnancy and child birth. Rather, they wanted
to interact only with the wife. There was a fact from physicians who reported;
condoms are only offered to housewife clients of Sexual Transmitted Disease
patients (STDs).
Another study from Dewi
(2009) has identified three predisposing factors that are strongly and
significantly related with male participation in family planning and
reproductive health. Those are: parity (the number of children ever born),
women’s highest educational attainment and men’s highest educational
attainment. From enabling factors, women’s discussion of family planning with
their family and friends, women’s knowledge of places to obtain condoms, men’s
knowledge of places to get contraceptives in general, women’s knowledge of STDs
and men’s knowledge of STDs apply the strongest influences on male
participation in family planning and reproductive health. Finally, only one
factor from reinforcing factors, namely visits by family planning field workers
is strongly and significantly related with male participation in family
planning and reproductive health. These findings are important to understanding
and addressing on how to involving men related of sexual and reproductive
health policies.
4. Policies/recommendation that encourage male
involvement
Policy
makers as well as project planners should consider how men are already involved
as sexual partners, husbands, and fathers, and use those roles to try to
involve men in sexual and reproductive health programs and services from a
gender equality and partnership perspective. ‘It is now recognized that
knowledge about masculine social practices can contribute towards expanding the
impact of programs such as those focused on child health, prevention of STDs,
control of gender violence and family planning’ (Adriao, K.G, J. Lyra et al.
2002).
Adjusting with Indonesia context, this policy brief
offers some innovations to involving men in SRH. Those which inspired from Pan American Health Organization’s report are:
- Incorporating the gender and life
cycle perspectives into SRH programs;
- Creating opportunities for
discussion about masculinities and gender equality among both men and women;
- Providing comprehensive SRH
services for men that go beyond contraception, and that include the provision
of counseling to men on family planning, contraception, STI transmission and
couple communication;
- Reaching men in the workplace or
where they socialize, instead of relying on a traditional clinical setting;
- Using social marketing campaigns
to promote male involvement in SRH;
- Involving local opinion leaders
in marketing campaigns and service design and delivery;
- Reaching out to adolescents and
young men through creative marketing and public communication.
Besides that, the stakeholders
especially for executives, in the central and local government need to support ‘capacity
building exercises to train religious leaders, male police, hospital staff and
judges on sexual and reproductive health and rights’ (Harcourt 2009).
References
Adriao,
K.G, J. Lyra et al. (2002) 'Working with Men on Health and Sexual and
Reproductive Rights Rom a Gender Perspective: Experiences from Northeast
Brazil"', in Cornwall, A., Welbourn, A. (ed.) Realizing Rights:
Transforming Approaches to Sexual and Reproductive Wellbeing, pp. 201.
London: Zedbooks.
Dewi, V.Y. (2009) 'Factors that Influence Male
Participation in Family Planning and Reproductive Health in Indonesia', Master.
Adelaide: The Flinders University of South Australia.
Foreman, M. (ed.) (1999) AIDS and Men: Taking
Risks or Taking Responsibility? London: Panos/Zed Books.
Greene, M.E, Mehta, M., et al. (2004) 'Involving
Men in Reproductive Health: Contributions to Development', pp. 4-5UN Millennium
Project.
Harcourt, W. (2009) Body Politics in
Development: Critical Debates in Gender and Development. New York: Zen
Books Ltd.
Hawkes, S. (1998) 'Why Include Men? Establishing
Sexual Health Clinics for Men in Rural Bangladesh', Health Policy and
Planning 3(2): 121-130.
Pan American Health Organization (2001)
'Involving Men in Sexual and Reproductive Health'.
United Nation (UN) (1994) 'Report of the
International Conference on Population and Development, Cairo, 5-13 September,
1994', pp. 30. New York: UN.
Namun sesungguhnya 2 tahun ini masih bruto. Karna kalau diitung2, setelah dipotong masa LDR after just married ini, netto saya jadi suami utuh dekat jiwa terutama jasmani baru 1 semester. Walau begitu namanya jalan hidup, yaa dijalani saja dengan enteng. Demikian pula kusampaikan pada istriku yang Alhamdulillah kini sedang mengandung buah cinta kami. Insya Allah kami berdua diamanahi peran baru yang luar biasa: ayah dan ibu. Meskipun sang buah hati belum terlahir ke alam dunia, namun kami merasa peran itu sudah mulai kami emban semenjak ia maujud dalam rahim istriku. Semoga kami semua senantiasa dalam lindungan Allah Subhanahu wa ta'ala. Aamiin. Kini harus lebih bersabar, meski sudah di penghujung masa studi di Eropa, waktu tetap saja terasa lama berlalu.. bertambah lambat malah.. :'P
