MenSSR HarkinsMarch1606

Slide1: 

. “Promoting Men’s Participation in Sexual and Reproductive Health Programs in Central America” Woman and Maternal Health Unit (WM), Family and Community Health Area (FCH) in coordination with the Gender, Heath and Ethnicity Unit (AD) 2006

Focusing on Women and Sexual and Reproductive Health (SRH)¿WHY?: 

Focusing on Women and Sexual and Reproductive Health (SRH) ¿WHY? Three Reasons: Women are the one’s who become pregnant The majority of contraceptive methods are designed for women SRH Services can be conveniently offered as part of the maternal and child health package *** Many programs have avoided men because they believe that women need privacy and autonomy in questions of reproductive health*** Informe Técnico #28 1995 UNFPA

Male Involvement in SRH:An Innovative Program Intervention: 

Male Involvement in SRH: An Innovative Program Intervention The role of men in SRH has not been addressed until relatively recently - ¿Why Now? The HIV crisis International movement against domestic violence The growing emphasis in the role of men as the next logical step in reducing maternal mortality

The Consensus to Include Men in SRH Programs Worldwide: 

The Consensus to Include Men in SRH Programs Worldwide International Conference on Population and Development (ICPD) 1994 Cairo The Fourth Conference on Women in Beijing 1995 Follow-up Statements: - la CIPD+5 - la Beijing+5

The Responsibilities and Rights of SRH: 

The Responsibilities and Rights of SRH Key actions recommended by the IPCD +5 follow-up. All formulated under a gender equity approach: Satisfy the SRH needs of men without prejudicing the SRH needs of women Promote zero tolerance of harmful attitudes and practices Promote positive masculine models and images

Direction of the Programs:Some Essential Elements: 

Direction of the Programs: Some Essential Elements Encourage men to support the reproductive health options of women Foster better communication between men and women Greater use of male methods – men taking more responsibility Better behavior of men regarding the prevention of ITS Tackling the SRH needs of men Encouraging men to be responsible fathers

Alan Guttmacher Institute (AGI) Report:“In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide”: 

Alan Guttmacher Institute (AGI) Report: “In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide”

AGI Report: (continued)Life Cycle: 

AGI Report: (continued) Life Cycle Average age at which Nicaraguan men take part in fundamental events in their sexual and reproductive health lives First Sex: 16.9 years First Union: 24.5 years First Child: 26.9 years No more children desired 31.8 years Vulnerable Period: having relations outside of the union 30% of Nicaraguan Men 25-54 years old have unmet need for contraception

Contraceptive Method Mix Among Young Men by Country: 

Contraceptive Method Mix Among Young Men by Country

Alan Guttmacher Institute (AGI) Report:“In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide”% of men that have had children:4% de 15-19 years, 46% de 20-24 years : 

Alan Guttmacher Institute (AGI) Report: “In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide” % of men that have had children: 4% de 15-19 years, 46% de 20-24 years

Current method mix among Nicaraguan men 15-24 years: 

Current method mix among Nicaraguan men 15-24 years Source: AGI Report 2003

Investigation Results:“Promoting Men’s Participation in Sexual and Reproductive Health Programs in Central America”OPS/OMS GTZ: 

Investigation Results: “Promoting Men’s Participation in Sexual and Reproductive Health Programs in Central America” OPS/OMS GTZ Belice, Costa Rica, El Salvador, Honduras, Nicaragua, Panamá

Project InvestigationQuantitative and Qualitative Analysis: 

Project Investigation Quantitative and Qualitative Analysis Approximately 2500 interviews were conducted with men (more than 400 in each country) in the region (the majority in low income urban areas) with a questionnaire of 212 items In depth interviews with providers were completed in each country Focus groups were carried out with men, women, and providers Topics included: knowledge, attitudes, and behaviors of men in relation to FP, ITS, domestic violence, sexuality, gender issues and paternity.

Some Results from the RegionEach Participating Country Presented the Research Results in a Public Forum: 

Some Results from the Region Each Participating Country Presented the Research Results in a Public Forum Approximately: 80% of the interviewees are in agreement with or don’t know about the statement the “the pill causes infertility” 65% of the interviewees are in agreement with or don’t know about the statement that “a vasectomy leaves a man with less sexual desire” 65% state that a woman as much as a man can take the initiative to use a contraceptive method 75% believe that men should receive more information about SRH topics

Investigation Results (cont.): 

Investigation Results (cont.) more than 50% believe that condoms are not effective in preventing the transmission of HIV (they have small pores the virus can pass through) at least 50% believe that it is normal for a pregnant woman to experience vaginal bleeding more than 80% of the interviewees believe that a woman has the right to work outside the home more than 50% believe that the most important work for a woman is to take care of the house and cook for the family

Some Results: 

Some Results the great majority of men are in agreement with the ideals of responsible fatherhood (recognition, economic support, etc.) a very large majority reject justifications for domestic violence there is a near universal rejection of vasectomy – although it is very poorly understood and many men did not recognize the name of the procedure

The Project:Promoting Men’s Participation in SRH Programs in Central America Pan American Health Organization (PAHO/WHO)Deutsche Gessellschaft Fur Technische Zusammenarbeit (GTZ)A Sub-Regional Project in 5 Countries: 

The Project: Promoting Men’s Participation in SRH Programs in Central America Pan American Health Organization (PAHO/WHO) Deutsche Gessellschaft Fur Technische Zusammenarbeit (GTZ) A Sub-Regional Project in 5 Countries El Salvador Honduras Nicaragua Costa Rica Panamá

Objectives and Stages of the Project:The Expected Results: 

Objectives and Stages of the Project: The Expected Results R1 Evaluate with quantitative and qualitative methods of analysis the knowledge, attitudes and practices of men between 15 and 44 years of age in topics related to sexual and reproductive health R2 Develop two models/strategies that promote the participation of men in SRH activities: one in a workplace or recreational site and the other in an affiliated health unit R3 The development of methodologies and materials to increase the participation of men in SRH activities in the region.

Project Timeline:: 

Project Timeline: The Investigations: May – December 2003 Workshop with Preliminary Results in Nicaragua October 2003 Designing the Models: April 2004 Workshop in San Salvador with the National Teams Project Activities Begin: May 2004 Workshop to share program experiences in Panama May 2005

Country Activities:Clinical and Community Approaches : 

Country Activities: Clinical and Community Approaches Clinical: the training of local providers with didactic materials from EngenderHealth (NGO from New York and leader in the field of men and SRH). A Curriculum with Three Components: *1. Introduction to SRH Services for Men (for all clinical personnel) *2. Counseling for Male Clients in SRH (for those providers who communicate directly with men) 3. Clinical Management of SRH Problems (for those providers who give medical attention to male clients) Community: activities are designed in coordination with the focal points (PAHO and MOH). The efforts vary depending on the local context and the partners available. * First two components now available in Spanish.

Country Activities:A Brief Review of the Efforts: 

Country Activities: A Brief Review of the Efforts

Panamá: 

Panamá Partners: Ministry of Health Panamá (Health Promotion Department, Women, Health and Gender Section and the Mental Health Section) UNFPA, Masculinity Clinic (CAMM) Clinical Intervention - Site: Health Unit Nuevo Veranillo (San Miguelito Region, Panama City) - focus on providing clinical services with prostate cancer screenings (PSA). - several workshops with providers and community members including religious leaders. - approach will be scaled up to the province of Veraguas (UNFPA) Community Intervention - an agreement was signed with a bus drivers union. Several health fairs conducted at the bus terminal. Digital rectal exams conducted. - door-to-door brigades with promotional materials in the clinic area

Community Members Participating in Workshop with Providers: 

Community Members Participating in Workshop with Providers

Bus Drivers in Nuevo Veranillo“Sexual and reproductive health is fundamental for men and women…but working 18 hours a day makes it hard…we only go to the clinic when we can’t work” Bus Driver: 

Bus Drivers in Nuevo Veranillo “Sexual and reproductive health is fundamental for men and women…but working 18 hours a day makes it hard…we only go to the clinic when we can’t work” Bus Driver

Nurse and Social Worker in the Bus Driver’s Office“The providers perception has changed…if a men comes with a child we don’t immediately ask for the mother” - Nurse: 

Nurse and Social Worker in the Bus Driver’s Office “The providers perception has changed…if a men comes with a child we don’t immediately ask for the mother” - Nurse

Honduras: 

Honduras Partners: Integrated Program for Male Health (PAIH, MOH Honduras), EngenderHealth Honduras, World Bank Clinical Intervention - Site: Health Center El Manchen, Tegucigalpa - Sessions of “autocuidado” for providers - EngenderHealth components 1 and 2 implemented - Recently opened men’s health consult – institutionalized through PAIH and a clinical care flowchart - clients referred to EngenderHeatlh/USAID project in vasectomy Community Intervention - work with la Policia Preventiva (COBRAS) - local leaders capacitated – Patronatos Locales - coordination with religious groups (Evangelical and Catholic)

Honduran Man Brings a Baby to the Clinic“We learned about brotherhood and understand this is about protecting life” Community Member El Manchen: 

Honduran Man Brings a Baby to the Clinic “We learned about brotherhood and understand this is about protecting life” Community Member El Manchen

Clinic Team in El Manchen“Our advances in SRH will always be partial if we don’t provide care to the couple” Honduran Doctor: 

Clinic Team in El Manchen “Our advances in SRH will always be partial if we don’t provide care to the couple” Honduran Doctor

El Salvador: 

El Salvador Partners: Integrated Program for Male Health (MSPAS El Salvador), SIBASI Centro, Municipality of Ciudad Delgado, Emergency Committee Ciudad Delgado, GTZ Clinical Intervention - Site: Health Center Ciudad Delgado, San Salvador - sessions of “autocuidado” for providers (model developed here) - training for providers (EH #1 and #2) - publication of Male SRH Model (MOH) for national distribution. - approach scaled up to second health unit in Milingo Community Intervention - trainings for Emergency Committee (Fire, Police, etc.) - trainings with Sanitation workers

Providers in Ciudad Delgado“Thanks to the self-help sessions we have been able to break with myths and deal with taboos…and doing so are more tolerant and sensitive to the men who visit” Salvadoran Nurse: 

Providers in Ciudad Delgado “Thanks to the self-help sessions we have been able to break with myths and deal with taboos…and doing so are more tolerant and sensitive to the men who visit” Salvadoran Nurse

Providers in Ciudad Delgado“It has changed the way I treat men…before I was scared now I have confidence...the training took away my fear” Salvadoran Nurse: 

Providers in Ciudad Delgado “It has changed the way I treat men…before I was scared now I have confidence...the training took away my fear” Salvadoran Nurse

Sanitation Workers Reviewing STI Symptoms“We have never talked before about the things we talked about in these meetings” Salvadoran Worker: 

Sanitation Workers Reviewing STI Symptoms “We have never talked before about the things we talked about in these meetings” Salvadoran Worker

Nicaragua: 

Nicaragua Partners: Integrated Program for Women and Adolescents (MINSA), UNFPA, GTZ PROSIM, Association of Men Against Violence, Health Commission Nagarote (Mayor’s Office, National Police, Civil Society Organizations) Clinical Intervention - Site: Health Unit Nagarote, Department of León - trainings for providers (EH #1 and #2) - coordination with the MINSA León to include the approach in the national “Integrated Model of Care” - Community Intervention - Adolescent Club – Nagarote - Two work sites: HOLCIM (cement factory) and GEOSA (power plant)

Nicaraguan Providers Performing Role-play: 

Nicaraguan Providers Performing Role-play

Role-Playing the Counseling Component: 

Role-Playing the Counseling Component

Young Men in Youth Center at Nagarote: 

Young Men in Youth Center at Nagarote

Male Workers at the GEOSA Power Plant: 

Male Workers at the GEOSA Power Plant

Costa Rica: 

Costa Rica Partners: Integrated Program for Adolescent Health (PAIA), Caja Costarricense, Gender and Health (MOH Costa Rica), Ministry of Education Clinical Intervention - Site: Health Area Alajuelita, San Jose - development of training methodology - trainings in 7 health units implemented (EBAIS) - intensive involvement with reproductive and sexual rights community groups. Community Intervention - focus on working with adolescents in the Alajuelita High School - students trained as facilitators with retreats with providers - video production documenting the process

Costa Rican Students Role-Playing Negotiating SRH issues in relationships: 

Costa Rican Students Role-Playing Negotiating SRH issues in relationships

Costa Rican Peer Counselors and AV Interns at World AIDS Day: 

Costa Rican Peer Counselors and AV Interns at World AIDS Day

Providers and Students Role-Play a Clinic Visit: 

Providers and Students Role-Play a Clinic Visit

Top Ten Lessons Learned: 

Top Ten Lessons Learned Start with the providers and their own beliefs and knowledge about SRH and gender issues 2. Sessions of “autocuidado” are excellent for gaining provider “buy-in”. Very well received. 3. We can’t let the perfect be the enemy of the good. Go to where men are. Go to where the men are. And then ….Go where the men are some more! Links with the community provide stimulus to health unit and MOH action. Resistance to the project from all sides: women’s groups, male clinic personnel, public health professionals, religious groups. Involve every level of MOH from start to finish. Services should be integrated not separate and approach “sold” as another skill to make provides jobs easier not harder. Avoid implementing pilot projects in health units “flooded” with such projects. So many issues so little time – this should be a cross cutting approach.