It's pretty clear that at a basic level, men are just as involved in the act of conception as women are. But when it comes to who's using contraception, things aren't even close to 50-50.
Women have upwards of 10 modern methods of contraception they can use. There are caps and rings, patches and sponges, diaphragms and female condoms and improved fertility awareness methods. Oral contraceptive pills that come in three categories, including an extended-cycle version. Injectable contraceptives that last for one, two, or three months. Hormonal implants good for up to five years. Intrauterine devices (IUDs) containing either copper or hormone, protective against unintended pregnancy for up to 12 years. There is emergency contraception if needed. And permanent methods (such as tubal ligation) are available for those who want to limit further childbearing.
Many men have come to see family planning as "the woman's job."
Yet even though most men are involved in making reproductive decisions, there are only two modern contraceptive methods for men: vasectomy and condoms. Vasectomy, though highly effective, is suitable only for men certain they want no more children, and it requires a minor surgical procedure. It is also largely unavailable in low- and middle-income income countries, where its use is negligible. (In contrast, vasectomy is the most widely used single method in Canada, with one in every three married women relying on it. Recent initiatives like World Vasectomy Day are also calling greater attention to vasectomy.)
Condoms, too, have their limitations. They must be used correctly with each and every act of intercourse to be effective--and often aren't properly used (or even available) in the heat of the moment. And their association with preventing sexually transmitted infections and HIV transmission often carries a stigma, even though male and female condoms are the only contraceptive methods that afford such protection.
Together, these two male methods account for only around 15% of overall modern contraceptive use in low- and middle-income countries. Nor are there new male methods on the horizon, at least for the next five to ten years. (Despite years of research, it turns out that feasibly modifying the male reproductive system remains quite challenging.)
No wonder, then, that organized family planning programs have been primarily oriented toward women, and that many men have come to see family planning as "the woman's job."
Access to modern contraception is now a globally recognized right and a widely desired social good.
Which is not to say remarkable progress has not been made. When organized family planning programs began to function some 50 years ago, not even 10% of women in the world were using modern contraception; now nearly 60% of women do so. In most low- and middle-income countries, access to modern contraception has increased substantially. Such access is now a globally recognized right and a widely desired social good.
And while the importance of responsible male involvement in family planning has long been acknowledged by policymakers, program leaders, and donors, the rhetoric of their commitments to gender equity and method choice has not been matched by the sustained prioritization, funding, and programming we need to make sure men are able to do their part in helping to plan their families.
So what can be done? Here are five constructive things men can do, starting now:
1) Be a supportive partner. If you have a female partner, support her autonomy and agency, not only in making a contraceptive choice, but also in using that chosen method correctly.
2) Use contraception yourself. If you are a condom user, use it with every act of intercourse. And if you and your partner want no more children, consider vasectomy--it's highly effective, easier and safer to perform than tubal ligation, and almost all men are eligible to use it. It will not make you weak or impotent--in fact, many couples find that it improves their sex lives!
3) If you are a health worker, provide contraceptive information and services to men as well as women. Female and male providers alike should feel comfortable and capable in providing these to all clients.
4) If you are a health system decision-maker or manager, make sure services are geared toward men, too. Every fully functioning health system needs its clinics, hospitals, and health workers to offer a constellation of male reproductive health services regularly, and in a welcoming, nonjudgmental environment. This means your health system's workforce must be well-trained, highly skilled, properly deployed, and adequately compensated.
5) Become a champion for family planning in general and responsible male engagement in particular. Policymakers, program leaders and managers, service providers, and religious and community leaders can become family planning champions. Individual health facilities can also become champions, building reputations for regularly providing respectful care and high-quality contraceptive services, without bias or barriers, to both men and women.
The international family planning community has indeed made great progress in making modern contraceptive widely accessible, especially for women. But until men are fully engaged and doing their part, the job is not yet done.
And we cannot forget what is at stake. In too many low-income countries maternal mortality is shockingly high. In South Sudan, there is 1 maternal death for every 50 births, the highest maternal mortality level in the world. And sadly, maternal death is only the tip of the iceberg: for each instance of maternal death, 20 women suffer incapacitating injuries like obstetric fistula. Yet if we could meet women's and men's current unmet need for contraception, 30% of all of this maternal morbidity and mortality would be eliminated.
Not only that, but infant and child mortality would go down, global gender equity would go up, and social and economic development would flourish.
So on this World Contraception Day, let's see if we all--policymakers and program leaders, health workers and religious leaders, donors and NGOs, men and women--can't do more to ensure that appropriate male engagement, in all its positive manifestations, becomes a greater part of the contraception equation.