His M.O.

By, Diepiriye S. Kuku-Siemons

The people in the front row mumbled amongst themselves, and peered around to take a good look at him, but said nothing. The couple next to him shifted in their seats each time it happened, but also could not be bothered to confront him. The gentlemen on the other side of him continually cleared their throats in an abrupt attempt to silence him. His mobile phone rang endlessly; after the third time the other moviegoers were tiring of being disturbed.

It was the same each and everywhere he went. His mobile phone had to ring. He had chosen a piercingly loud ring tone whose volume increased with every ring. In the car, he would take calls while cruising along the city streets. He had several mere brushes with bikes, motorcycles and auto rickshaws. While yelling at a telemarketer who tried to swoon him to another mobile service provider, he had once tipped a cow, making a narrow escape before the ensuing mob. Every since that near miss with a tractor after coming home from a disco one late evening, his girlfriend had hissed at him not to speak on his mobile while driving. He was bold, and determined to do as he wanted whenever he wanted, no matter how many people he inconvenienced.

He behaved as if he were the boss of anyone in anyone that he entered. His general modus operandi was to enter a room while speaking loudly on his mobile about the most mundane of things, trying to sound nonchalant as he divvying out instructions to each and every person is sight. Once he had walked into a lunch meeting at a posh new restaurant and barked out his drink order to his new boss’s husband, taunting him when he protested! He had gall.

His mobile phone was his expensive prop that he used to announce his power and demand respect. He loved when his phone rang in public places, and enjoyed the attention he received when folks glared at him whenever his loud mobile chimed in public places. Yet, for all of his nerve, his sex life suffered. For all his audacity to disturb the peace, he really did lack courage. In fact, it was all a cover. For, when it came to getting down to the act, he was a total flop. There was no mobile company, no loud ringtone to ring that would compensate for the fact that he could not bring himself to walk into a chemist and ask for a condom. This was his real M.O.

The Broomstick Method.

“And she still became pregnant. Now, what should I do?” The man was simple, yet earnest in his inquiry to the NGO staffer. The staffer had shown the simple man how to use a condom, succinctly and thoroughly. The demonstration even concluded with all of the participants showing what they had learned: How to correctly store, open, use and dispose of a condom. The staffer even gave a few specific pointers about conquering embarrassment around getting a condom from the local pharmacy. In fact, the simple man was so excited that he and his wife finally had a virtually foolproof method of avoiding pregnancy.

The simple man had told the group of peers gathered by the NGO to learn about men’s responsibility in birth control that he and his wife regularly have open and frank discussions about the matter. Regardless of the couple’s decision to wait several years after their marriage before having their first child, and several more still before possibly having a second child, the methods they had used in the past were unsuccessful. Moreover, the second child was born just two years after the first one, and his wife felt that she had not even fully recovered from nursing and looking after the first.

A health worker had taught the simple man, his mother and his wife the importance of breast feeding exclusively for the first six month and as long as possible even after introducing food. The couple understood that breast-feeding not only gave strength to the child to fight off disease, but it also served to help her space pregnancies. The simple man’s wife complained that she felt weak for months after the first and second births and though she was able to rest, eat well and quickly recuperate, she was not anxious to repeat the ordeal. When she became pregnant again, she resided to give her all given the situation, but worried about her health and that of the coming child. The health worker had also made clear to the couple the possible dangers of closely spaced births.

Only the husband’s mother cheered at the news of both the second and third pregnancies. The mother-in-law chided that the family desperately needed a son, and that having two girls was simply a waste. After all, the mother-in-law had given birth to four girls, all closely spaced, before she finally took things into her own hands and had a son. The simple man’s mother resented his wife and constantly insulted her for not having a son soon enough and that his wife even had the audacity to space her births- making it less likely, the mother-in-law incessantly criticized, of gifting a son to her in-laws. She blamed the wife for corrupting her son with foreign ideas of birth spacing and doting on having a girl-children. The simple man’s wife really suffered from the constant tongue-lashings; she convinced herself that the only way to save her sanity was to immediately have a son.

The couple had tried this new method, condoms. The simple man diligently fetched a new broom from the market. He had meticulously chosen a fancy, ‘foreign’ style broom with a smooth handle, just like the one the health worker had used in what turned out to be the first time that many of the participants had ever seen a condom. The simple man had paid close attention to the demonstration and took mental notes of each step. “Squeeze the air out of the tip,” he reminded himself over and over, and “Don’t use hair or cooking oils as this could break the condom.” He explained to his wife each step of using a condom, almost as if he were training her as a trainer. He was even patient enough to entertain the myriad of questions his wife posed about the condom, like “Why is it so slick,” and “What kind of magic is this western know-how?”

The simple man and his wife carefully sat the broom next to the bed after having carefully placed the condom on top and rolled it down. “This will protect us, and we can easily enjoy,” they said. It was only a short time before the simple man’s mother noticed differences in his wife. She suspected that another grandchild would be coming soon, and started praying for a boy. It was she who broke the news to the simple man that his wife may finally be able to prove herself to the family by giving them a son. Overhearing this, the wife was in tears. The couple had invested a great deal of trust in condoms, and the “broomstick method,” as she and her husband had grown to call it over the months, had failed.

Men as family planning stakeholders

Despite the fact that men are often the decision-makers in family planning matters, many studies suggest that men lack sufficient knowledge about family planning, spacing, and the variety of available contraceptives to make life-affirming, informed choices. Advancement and adoption of contraceptive technology demands male support. Women should expect support from partners and kin in her environment to understanding and coping with the responsibility and changes in menstrual cycle accompanying a variety of methods of contraception.

There are a variety of broader implications surrounding male responsibility and involvement in family planning. A study published in the Journal of the American Medical Association of 6,695 husbands aged 15-65 in the state of Uttar Pradesh revealed that men with less than five years of formal education, had more than one child, or were classified as extremely poor were factors that were all independently associated with elevated odds of (self-reported) incidence and frequency of abuse.

Both pre- and extra-marital sex, symptoms of STIs and unplanned pregnancies account for elevated odds of physical and sexual spousal abuse, even when controlling for social and demographic factors. In fact, “Abuse was more common among men who did not practice contraception than among those who did (49% vs. 42%), and was reported more frequently by men who had experienced an unplanned pregnancy than by those who had not (52% vs. 44%).” The study indicated that each variable was most strongly associated with nonconsensual sex without physical force.

Respond.
There are a plethora of policy, advocacy and intervention responses that readily emerge from these findings. First, rejecting violence as a means of conflict resolution and expressing power, particularly in family dynamics, is a worthy, long-term aim that must underscore any effort thereafter. Next, expanding access to contraceptive knowledge and technology synergistically increases life-choices for both men and women; this is a step towards raising standards of education and reducing poverty- both of which positively correlate with reduced spousal abuse and increased contraception acceptance and use. Then, alleviating the mal-effects of poverty lessens the unnecessary burden carried by women and allows men to assume greater responsibility for their lives.

Unwanted pregnancy and sexually transmitted infections decrease the overall quality of life of both partners. Behavior Change Communication efforts to thwart these factors must target both men and women accordingly. The eventual outcome enhances the lives of women and families overall. Expanding the basket, knowledge, availability and usage of contraceptives must consider both women and men, and the synergy in focusing on the empowerment of all genders. Behavior Change Communication can address both the immediate symptoms and eventual outcomes towards reproductive justice, exploiting the links between male responsibility, various forms of abuse and contraceptive acceptance.

Choosing to Involve Men in Family Planning.

The abundance of interventions and Behavior Change Communication campaigns that all primarily target women for family planning seemingly relieves men of the responsibility. Advances in contraceptive technology, such as the introduction of female condoms, injectable contraceptives and progestin only pills, imply a void in research and development of contraceptives that focus on male anatomy and physiology. This apparent irrelevance of men in turn creates even less space for the involvement of men in family planning.

Men often dominate the decision-making process whereby couples seek information about, or adopt any traditional or modern method of contraception. Further studies from India indicate that men overwhelmingly initiate discussions with their partners about contraceptives, and may “respond adversely” should the female partner do so. Research repeatedly exposes the links between male support and continuation of a variety of female-oriented contraceptives. (IPPF, 1984; Wambui, 1994)
Synovate India, a research firm, conducted a campaign tracking study in 2005-2006 in north Indian cities involving 1645 males aged 20-29. Theirs and other studies show that men who act responsibly in one way are likely to carry this attitude over to other areas of their lives. For example, men who accept the contraceptive usage are less likely to abuse their wives; increasing the pool of men in either regard positively influences the other. (IFPP, 2000) Men are stakeholders in family planning.

Many women in urban India find condoms unprocurable due to harassment at distribution points, or even greater embarrassment directly associated with female sexuality. In addition to Synovate’s study mentioned here, an array of quantitative studies suggest that male embarrassment hinders the procurement by men of condoms, the only contraceptive that offers dual protection against both unwanted pregnancy and the transmission of sexually transmitted infections and HIV/AIDS. Taken together, both women and men face social hurdles to procuring condoms, creating a barrier for reproductive justice.

These and similar studies in urban and per-urban India reveal widespread misconceptions about contraceptives among males who are often primarily in charge of decisions concerning family planning. (Khan, 1997) Such environments are non-conducive to dialogue between spouses or partners regarding the reproductive health of either partner; consensus building with spouses or partners regarding their reproductive goals does not exist.

Initial family planning efforts focused on risk reduction associated with pregnancy. These risks have included maternal mortality, excessive child-bearing, unwanted pregnancy, socially enforced pregnancy, emotional sexual abuse, lack of birth spacing, mother-to-child transmission of HIV/AIDS, female feticide and infanticide. Moreover, each risk carries its own set of psychosocial traumas, which largely remain unacknowledged and treated.

Family planning must target men alongside women to take greater responsibility for care towards their partners to conquer mutually undesirable gender-skewed reproductive outcomes such as abuse, sexually transmitted infection, unwanted pregnancies as well as maternal and child mortality.

Men as family planning stakeholders
Despite the fact that men are often the decision-makers in family planning matters, many studies suggest that men lack sufficient knowledge about family planning, spacing, and the variety of available contraceptives to make life-affirming, informed choices. Advancement and adoption of contraceptive technology demands male support. Women should expect support from partners and kin in her environment to understanding and coping with the responsibility and changes in menstrual cycle accompanying a variety of methods of contraception.

There are a variety of broader implications surrounding male responsibility and involvement in family planning. A study published in the Journal of the American Medical Association of 6,695 husbands aged 15-65 in the state of Uttar Pradesh revealed that men with less than five years of formal education, had more than one child, or were classified as extremely poor were factors that were all independently associated with elevated odds of (self-reported) incidence and frequency of abuse.

Both pre- and extra-marital sex, symptoms of STIs and unplanned pregnancies account for elevated odds of physical and sexual spousal abuse, even when controlling for social and demographic factors. In fact, “Abuse was more common among men who did not practice contraception than among those who did (49% vs. 42%), and was reported more frequently by men who had experienced an unplanned pregnancy than by those who had not (52% vs. 44%).” The study indicated that each variable was most strongly associated with nonconsensual sex without physical force.

Respond.
There are a plethora of policy, advocacy and intervention responses that readily emerge from these findings. First, rejecting violence as a means of conflict resolution and expressing power, particularly in family dynamics, is a worthy, long-term aim that must underscore any effort thereafter. Next, expanding access to contraceptive knowledge and technology synergistically increases life-choices for both men and women; this is a step towards raising standards of education and reducing poverty- both of which positively correlate with reduced spousal abuse and increased contraception acceptance and use. Then, alleviating the mal-effects of poverty lessens the unnecessary burden carried by women and allows men to assume greater responsibility for their lives.

Unwanted pregnancy and sexually transmitted infections decrease the overall quality of life of both partners. Behavior Change Communication efforts to thwart these factors must target both men and women accordingly. The eventual outcome enhances the lives of women and families overall. Expanding the basket, knowledge, availability and usage of contraceptives must consider both women and men, and the synergy in focusing on the empowerment of all genders. Behavior Change Communication can address both the immediate symptoms and eventual outcomes towards reproductive justice, exploiting the links between male responsibility, various forms of abuse and contraceptive acceptance.

References

Digest.
• India Men with Higher Socioeconomic Status are more likely to be knowledgeable about Reproductive Health. Volume 26, No.3, September 2000.

International Family Planning Perspectives.
• In India, Poverty and Lack of Education Are Associated with Men’s Physical and Sexual Abuse of their Wives. Volume 26, No.1, March 2000.

International Planned Parenthood Federation.
• Male Involvement in Family Planning. 73–76, 79–80. 1984.

Khan, M.E. and Patel, Bella C.
• Male Involvement in Family Planning: A KABP study of Agra District. Final report. The Population Council, India. June 1997.

Martin S.L et al.
• Sexual behaviors and reproductive health outcomes: Associations with wife abuse in India, Journal of the American Medical Association, 1999, 282(20): 1967-1972.

Population Council.
• Maternal and Child health. Mixed Success Involving Men in Maternal Care Worldwide. Population Briefs- reports on Population Council research. Volume 11, No.1, January 2005.

Touré, Lalla MD, MPH.
• Male Involvement in Family Planning: A Review of the Literature and Selected Program Initiatives in Africa

Wambui, Catherine.
• Male Only Centers: A New Concept in Family Planning. Published in Conveying Concerns: Women Write on Male Participation in the Family, Population Reference Bureau, Inc.: 18–19. 1994.

Zavier, Francis and Padmadas, Sabu S.
• Use of a Spacing Method before Sterilization Among Couples in Kerala, India. Volumbe 26, No.1, March 2000.