The male half of reproductive health

Alvin Concha, MD
Gender Theories
Master of Arts in Applied Social Research
Ateneo de Davao University

Considering that reproduction of humans is not possible in the absence of men, it is quite
ironic to witness how efforts at addressing men’s reproductive health issues lag behind
those that address women’s issues in this area. Many national health policies encourage
men’s participation in family planning, but are unclear whether this means that males
should use male contraceptives or support their sexual partners’ use of birth control
methods (Hardon, 1997), or even how men should appropriate roles for themselves
during childbearing and childrearing1.

A declaration drafted during the First National Safe Motherhood Congress, otherwise
known as the Davao Declaration, “greater male involvement” is recognized as vital in
ensuring safe motherhood (“Davao Declaration,” 1999). The Beijing Platform also calls
for governments, international bodies and non-governmental organizations to promote
programs that make men responsible for their own sexual and reproductive behavior
(“Beijing Declaration,” 1995).

At the empirical level, however, “a huge gap remains between the rhetoric of promoting
male involvement and the realities of female-oriented reproductive health programs”
(Alexis, n.d., as cited in Ndong and Finger, 1998).

In this paper I will (1) attempt to explain why men’s participation in reproductive health
needs to be problematized, (2) locate the men’s reproductive health problematic in the
ramifications of the men’s movements, and (3) propose how men’s reproductive health
concerns can be advanced to achieve gender justice. This early, I would like to lay bare
my conscious effort to resist the lure to “portray men as victims” (Pease, 1996) in my
attempt to deconstruct the present reproductive health system. Later in this paper, I will
expound on the possibility of approaching men’s reproductive health through a
masculinity that is fully cognizant of the larger issue of systematized subjugation of
women throughout history (Flood, 1995b; Peczon-Fernandez, 1996). I am a male Family
Physician by profession, and I am aware that my sex and my medical training could well
influence the ideas that I articulate through this paper.

1
If reproduction refers to the roles of men and women in perpetuating the race, then childrearing, a role that
can be potentially shared by men and women, is part of reproduction.
Why problematize men’s involvement?

One’s immediate visualization of reproductive health is, almost always, that of pregnant
women needing prenatal care or seeking abortion, or non-pregnant women needing
contraception or consulting for reproductive tract problems. Hence, reproductive health
concerns would be, to many of us, that constellation of physical conditions that include
iron-deficiency anemia of pregnancy, hypertension in pregnancy, puerperal sepsis, septic
abortion, adverse effects of contraceptive pills and purulent vaginal discharge, to name a
few. And consequently, programs that are geared towards improving the reproductive
health situation of a community would be, logically, those that ensure access to
supplemental iron by pregnant women, regular prenatal checks, clean and safe delivery,
safe abortion clinics (at least in countries where abortion is legal), and free or affordable
contraceptive methods and therapy for STD/HIV/AIDS. In other words, one’s immediate
visualization of reproductive health service is, almost always, that health service which is
woman-centered.

There is nothing wrong about it. It is just worth noting that we have the proclivity to think
that concerns in reproductive health mostly refer to women. There is, of course, an
epidemiological basis for that – if we equate “reproductive health concerns” with
“physical conditions in reproductive health”.

When we start to expand the concept of “reproductive health concerns” to include

psychological, social, economic and political concerns (“Davao Declaration”, 1999), our
traditional concept of reproductive health would fall short in providing a far-reaching
view of the issue. Our traditional analysis may not account for the husband who does not
want to wear condoms during sexual intercourse or who is as physically and emotionally
ill as his wife during pregnancy, the boyfriend who infects his girlfriend with STD or beat
her when she does not want to have sex with him, the man with erectile dysfunction, the
adolescent boy who does not want his girlfriend to have an abortion, the family that does
not have the financial resources to pay for a cesarean section, or even the father who is
left home to rear his children while the mother works for a living overseas.

It cannot be overemphasized that men’s contribution to reproduction – hence, to

reproductive health – is not merely that “single copulatory act that was successful”
(Mead, 1968). Interweaved in the physical conditions within reproductive health are
equally significant psychosocial, economic and political dynamisms that have something
to do with men. Reproductive health is as much a turf of men as it is of women.

Reproductive health programs today

Back when periodic sexual abstinence, withdrawal or condoms were the only choices for
contraception, man’s participation in family planning was very much crucial to this
aspect of reproductive health program (Ndong and Finger, 1998). The advent of oral
contraceptive pills, intrauterine device and injectable hormones gave women the potential
to fully control contraception. While much has yet to be done in the contemporary
women’s practice of exercising this control (Clet, 2004), it can be noticed that, at least
symbolically, men can be spared from the decision to control conception.

Health education sessions in local health centers, especially those that orient learners to
birth spacing and control methods and home recognition and management of common
illnesses of children – the necessary competencies of reproductive and child-rearing
adults – are always packaged as “mothers’ classes”. The program that responds to the
unique concerns of parents and children especially around and within the time of
pregnancy is called the “Maternal and Child Health” program. Subsumed in this program
are prenatal checks and tetanus toxoid immunization for pregnant women,, breastfeeding
and child nutrition education and child immunizations. It can be argued that the services
were so named because usually, only women attend them, but at least in the empirical
level, such packaging is known to render these unattractive to men (Elevazo-Maningo,
2004).

It can be pointed out that psychosocial counseling and education of men before, during or
after their partners’ pregnancy, interventions to promote gender-sensitivity among men,
education and services on the more common male reproductive concerns like erectile
dysfunction, infertility and benign prostatic hyperplasia are not easily accessible from the
local health center.

In that regard, we see that the very structure of reproductive health services is designed to
cater only to women. Men’s reproductive health concerns are not readily tackled in the
local health center. Men’s participation is not explicitly petitioned for or encouraged by
the way the programs are conceptualized, named and run (Robey and Drennan, 1998).

Benefits of men’s participation

Ensuring men’s participation in reproductive health programs is viewed to be

instrumental in the success of programs to prevent physical morbidities of women (Robey
and Drennan, 1998). Men also play an important part in the effective use and even
satisfaction of a chosen contraceptive method (Herndon, 1998). The main method for
prevention of STD/HIV/AIDS is condom use; men are critical partners in prevention
because condom use requires male participation (Best 1998). There is a promising
collaborative scenario akin to the ideals of the feminist project in men’s participation in
reproductive health concerns:

It is easy to say that men always want more children, are not interested in using
contraception, do not care about spreading sexually transmitted diseases, never
share in the responsibility of raising children, and perpetuate violence against
women. Some programs have been designed on these assumptions and therefore
exclude men routinely, preventing men from getting help to understand their
needs and to change harmful behaviors. Yet surveys show that as men learn about
contraception, they want to use it, and as pressures or raising large families
increase, they want fewer children. In nearly any country or culture, there are men
 who share in parenting responsibilities and who stand against violence against
women (Ndong and Finger 1998).

Men can be, and are interested in becoming, more supportive and involved in all
reproductive health domains, specially where it concerns the welfare of children
and families (Raju and Leonard, 2000)

Not including men from reproductive health concerns would potentially undermine men’s
inherent responsibility in reproduction. It would replicate and legitimize the “traditional
forms of masculinity, which valorise self-centered, unemotional, competitive, aggressive
and sexually promiscuous behaviour” (Kulkarni, 2001).

The more important point, however, in the present level of men’s participation – or non-
participation – in reproductive health services is the fact that it is counter to the directions
of the feminist project of gender equality. It sustains society’s privileging of the
hegemonic masculine (Leach, 1994) in a patriarchal culture, wherein men are
“emotionally shut-down, dominating others [and] work-obsessed”
(Flood, 2001) and “women are considered to be essentially passive/emotional, suited to
child-bearing and home-making…. [h]ence they are confined to the private or domestic
sphere” (Kulkarni, 2001). It maintains the biological deterministic view that the presence
of the uterus determines the appropriation of the responsibilities of childbearing and
childrearing.

Medical construction of reproduction

I will now attempt at a plausible explanation of this state of the present reproductive
health system by looking at medical construction of reproduction and the theoretical
orientation of healthcare in general.

Mainstream Western (hegemonic) medicine has a penchant for regarding illness to be

solely – or almost always – physical. Those who are ill have either malfunctioning organs
or deranged bodily biochemical processes. Even mental illnesses that often manifest as
pathologic thought processes, affect and behavior, are mainly managed with drugs that
are supposed to normalize the release of neurotransmitters. For medicine, there is only
one truth out there, and its existence can be proven by hard evidence (Hodgkin, 1996).
Effects are predictable, given a set of causes; personal choices and motives are not
factored in because they hardly matter (Alderson, 1998). Psychosocial concerns must be
distanced from biologic conditions, in order for the latter to be controllable. Whatever it
is that does not fit in the equation is not a concern of medicine. In the eyes of hegemonic
medicine, therefore, only the conditions that are manifest in the physical body can be
approached with preventive, diagnostic, curative or rehabilitative measures. Only the
physical conditions can be planned for and evaluated.

It is not surprising therefore, that medical training is designed for the medical students to
learn to perform medical practice in this setting. The shorter trainings of local health
center nurse or midwife or volunteer health worker on reproductive healthcare teaches
them history-taking and physical examination skills, develops their diagnostic acumen for
physical conditions and trains them to approach management of pathologic conditions.
Reproductive health is taught in terms of “morbidity”: those who come for consults are
“patients”, and the healthcare practitioner (doctor, nurse, midwife, volunteer health
worker, etc.) can offer prevention, diagnosis, cure or rehabilitation.

During a prenatal check, when a pregnant “patient” comes for consult the doctor takes
down her history of present illness, past medical illnesses, obstetric history, gynecological
history and history of heredo-familial diseases. The doctor then performs a thorough
physical examination, including blood pressure determination, fundic height
measurement, auscultation for fetal heartbeat and vaginal internal examination. Next, the
doctor requests a battery of diagnostic tests, including urinalysis, complete blood count,
blood chemistry and ultrasonography, and then proceeds by prescribing vitamins to
prevent maternal anemia and fetal neural tube defects. Depending on the laboratory
results, the pregnant woman may be prescribed with additional drugs like antibiotics,
hormones or uterine relaxants. The exit advice is, invariably, a run through of what to
watch out for at home that may suggest pathology: vaginal bleeding, abdominal pain,
edema, persistent vomiting, etc.

The whole consult centers on the physical. The woman’s feelings over the pregnancy are
seldom discussed, or are responded to by giving “medical advice” that consists of
instructions on what to do when physical symptoms occur. Place an anxious man beside
the woman in the consultation scenario, and one can hardly think where he fits in the
picture. His anxiety is never discussed. He goes out of the consultation room with the
woman, not knowing how to deal with her emotions, how to express his own “feelings of
being left out”, how to prepare himself to be a nurturing father or even how to cope with
his own symptoms of couvade syndrome2. One can just imagine the burden of
reproductive adults when faced with the psychosocial pangs of the equally (if not more)
emotionally-laden issues of delivery, abortion, family planning, erectile dysfunction,
STD/HIV/AIDS and violence against women.

Reproductive health, as a program – and like many other programs – appropriates

services based on budget. Budget depends on what is reflected by “measurable
outcomes”. And “measurable outcomes”, for the health policymaker, are physical
morbidities that can be counted as cases: “203 cases of pregnancy for the month of
August, 34 cases of which had cesarean sections, 2 cases of which died”, “55 cases of
gonococcal infection”, “27 cases of septic abortion”, “16 cases of tubal ligation and 34
cases of IUD insertions”, and so on. The concept of reproduction as a biopsychosocial
phenomenon fraught with very dynamic events around it and a diversity of emotions, to
boot, is seen by healthcare as quantitative data of physical morbidity and mortality.

2
More than half of partners of pregnant women are also reported to feel the physical symptoms of
pregnancy (nausea, dizziness, headache, abdominal pain, weight gain, leg cramps, constipation, etc.)
alongside moodiness, vague fears and food cravings. This condition is known as couvade syndrome
(Eisenberg, Murkoff and Hathaway, 1991).
Reproductive health programs, to the extent that they are being utilized by the people,
play a very big role in people’s knowledge construction of reproduction. A reproductive
health program that emphasizes on the biomedical perspectives of reproduction at the
expense of the psychosocial perspectives legitimizes a biological deterministic view of
reproduction, and of sexuality for that matter. Furthermore, it nourishes our penchant to
indiscriminately pathologize reproduction.

Masculinities

At the base of the men’s reproductive health problematic is the incongruence of the
reproduction constructs of the health policymakers and practitioners, and the women and
men clients of the services.

How does the masculinist project advance in the arena of reproductive health? As the
emancipated woman reclaims her roles in the public sphere, and as we are moving
towards more egalitarian gender relations, shouldn’t we be working towards reclamation
of men’s responsible and gendered nurturing roles in the private sphere? My next task
here is to briefly review men’s movements in relation to the feminist project towards
emancipatory ends.

The impetus for men’s movements over the last few decades has been the feminist
movement itself (Kulkarni, 2001). Responses to feminisms have been varied, and often at
odds with each other. “Hegemonic….forms of masculinity continue to
subordinate other masculinities, men's violence against women
reaches epidemic proportions and most men continue to resist the
changes brought about by feminism” (Pease, 1996). Masculinities have evoked
honest recognition of the long-standing patriarchy within gender relations on one end of
the spectrum, and utter aggressiveness against feminisms on the other end.

Men’s rights

Of the three major camps in the men’s movements, the men’s rights movement is the
most anti-feminist. It argues that men have no power in the society and that “men are
more oppressed than women” (Pease, 1996). Its focus on legal and social realities that
threat men (military recruitment and the judicial tendency to grant child custody to
mothers, for instance) are sometimes inflated by angry men’s rights activists to warn
society against “feminist excesses” and the “social overvaluation of the female”
(Kulkarni, 2001).

Mythopoetic movement
A second strand of the men’s movement originated from the counter-cultural tendencies
in the fifties (Kulkarni, 2001). It was promoted as “men’s liberation” in the seventies and
eighties (Pease, 1996). Starting in the nineties, it found expression in the mythopoetic
movement led by Robert Bly, a poet and student of psychology of the Jungian stock. The
hub of the movement is Bly’s analysis that men are experiencing deep confusion and
alienation ever since the Industrial Revolution, when fathers started to work in factories
and become separated physically and emotionally from their families (Bryannan,
1990).The movement therefore focuses on the healing of men’s “psychic wounds”, on
regaining the “male mode of feeling” (Simmons, 1992), and on “[overcoming]
alienation through a spiritual and psychological transformation of men”
(Kulkarni, 2001).

Therapy consists of support groups and weekend workshops utilizing myths, poetry,
music and dancing. Men in the mythopoetic movement are classified into three:

The first group has experienced severe pain or grief in their lives, often through
physical or sexual abuse, and [seeks] to gain some understanding of these
emotions in order to heal them. The second group of men cannot get in touch with
their life force and spontaneity; they find it hard to express anger and feel closed
off from "the fire within." The third group of men [is] what one might call
"terminal adolescents," who need to learn to let go of their fears of manhood and
responsibility. (Bryannan, 1990)

The mythopoetic movement tends to disregard social realities uncovered to us by

feminisms and is “dismissive of political, especially feminist, thought” (Simmons, 1992).
As such, it cannot be expected to engender a movement against patriarchy. A good
attribute of the mythopoetic movement, though, is its general orientation to look inward,
within the selves of men, as a matter of exercise of reflection and self-critique. While this
in itself is not enough to dismantle patriarchal societal structures, it tells us that emotions
and experiences at the level of the self are legitimate concerns in any struggle for
emancipation.

Profeminist3 movement

The best strand that masculinity has to offer and the movement I want to identify with is
the profeminist movement. It has an “explicit and ongoing commitment to support
feminism” (Flood, 1995b) and it carries forward the belief that women’s historicity and
present status are inextricable from the question of masculinity (Simmons, 1992).

The profeminist movement was sparked off by second-wave feminism, and has
ever since espoused socio-economic and political parity between men
and women (Kulkarni, 2001). Michael Flood (1995b), the founder of

3
Sometimes, “profeminism” or “profeminist” is spelled with a dash (“pro-feminism” or “pro-feminist”).
Both forms are acceptable.
Men Against Sexual Assault, an Australian profeminist movement,
stressed that:

[T]o be pro-feminist is to be committed to challenging women’s oppression,

sexism and gender injustice. It is to be aware of women’s experiences, and to be
informed by feminist analyses of society. For men in particular, being pro-
feminist means trying to develop non-oppressive forms of masculinity and non-
sexist relations with women.

A potential area of debate among profeminists could spring from the fact that the
feminisms are, in reality, a set of diverse analyses of gender relations. Flood (1995b) did
not problematize this and merely said:

Which feminism are we “pro”? The fact of a variety of theoretical perspectives

within feminist thought presents a….complication for men’s practice of pro-
feminism. But I don’t think this is such a problem, just as long as men are
adopting some sort of feminism.

The practice of profeminism is clear, though. Profeminism advocates a movement where

“men [work] as allies with women in a struggle to transform hegemonic
masculinity and patriarchal relations of dominance” (Pease, 1996; Flood,
2001) to create “friendships and communities that embody an alternative men’s culture,
and that are not at the expense of women” (Flood, 1995a). Included in these efforts is the
struggle to eliminate expressions of sexism like rape, pornography and homophobia
(Kulkarni, 2001).

Challenges within the movements

The men’s movement is not monolithic. In the thick of the masculinist project, there are a
few important challenges that men are currently facing. The anti-feminist slant of the
men’s rights movement is a glaring problem. More subtly though, and in a more self-
reflexive sense, because of the fact that men occupy positions of dominance in society,
one can also potentially question the motives of even the more “feminist” actors within
the movements. “[A]ntisexist politics by men is no less legitimate than ‘white’
antiracism” (Mang, n.d.), and the “mobilization of members of a privileged
group in order to undermine that same privilege” (Flood, 2001) could
potentially trigger off excesses to the disadvantage of women or immobilize a movement
altogether. The other side of the discourse, and the concept that I want to explore later in
this paper, is really that the power which privileges men can potentially be the same
power that men can use to liberate women. But first of all, “it’s necessary and
legitimate for privileged people to politically address precisely those
structures of domination that privilege them…. it’s important that men
begin to see their masculinity….as a political problem” (Mang, n.d.).
Another caveat that can be pointed out is the strong tendency for men
to engage in “men-only” movements. Men in the men’s rights
movement, on the account that they brace themselves against
“feminist excesses”, alienate themselves from women. Similarly, but in
a probably less conscious sense, as the men in the mythopoetic
movement grapple with their “inner pains”, they tend to be unmindful
of women and their issues. Daniel Mang (n.d.) expressed:

I find heterosexual men telling other men things about their

sexuality that they’re not telling the women they’re involved
with, for fear of conflict or shame or whatever, quite problematic.
That may be acceptable, in particular circumstances, as an
interim solution, but as a permanent practice what is this but
masculine “solidarity” of the worst sort?

Having recognized these traps should not, however, freeze men from pursuing gender
justice. “We have grown up in a patriarchal culture and we have been taught a patriarchal
worldview, and undoing this is no simple task” (Flood, 1995b). For now, what is clear is
that:

[M]en are part of the problem, but they are also part of the
solution. For whatever aspect of gender inequality we consider —
violence against women, inequalities in political power, the
division of paid and unpaid work, oppressive and degrading
cultural imagery — men’s behaviours, attitudes, identities and
relations are part of the problem, part of what sustains and
makes up these inequalities. Men are therefore necessarily also
part of the solution. If men do not change, then gender justice is
simply impossible. (Flood, 2001)

In the face of masculinist theorizing, how then, do we take up the

men’s reproductive health problematic?

It is of utmost importance to acknowledge the fact that feminisms are

really the major impetus of masculinisms. “[F]eminism is about the
liberation of women…[a]nd in the liberation of women, feminism offers
men a shot at being human beings” (Jensen, 2002).
When feminists decided to make the personal political, society started
to problematize and act upon gender relations. “The feminist
movement has acted as a catalyst stimulating a wide-ranging
interrogation of masculinity over the last few decades” (Kulkarni,
2001). Feminisms also prompted men to develop our own agenda
towards the destruction of structures in the society, which preserve
stereotypical gender roles that oppress women. “Indeed, under the
impact of feminism, straight men have increasingly embraced the New
Man ethos, rejecting traditional machismo in favour of a caring, sharing
notion of masculinity” (Tatchell, 1999).

Important elements of men’s agenda along emancipatory lines would

include the “salvaging and strengthening of fatherhood….
[achievement] of true physical and psychological/spiritual well-being”
(Kulkarni, 2001), living out a healthy, responsible and fulfilling
sexuality, and establishing non-oppressive relationships with women
and other men. All these agenda could be achieved in a reproductive healthcare that
accommodates men. Such a set of agenda would also require “a process of
accountability in addressing men's issues which would acknowledge
the power imbalances of various groups and put in place mechanisms
to deal with these power differences” (Wadham, 1997).

The negotiated masculinity

I propose that, in the climate of a masculinity that is negotiated, men’s

agenda can be upheld to achieve egalitarian gender relations. I believe
that the characteristics of a negotiated masculinity can be learned
from the guiding principles of profeminism. In profeminist parlance, we
should be male-positive, pro-feminist, and gay-affirmative (Flood,
1995b). These principles highlight the value of pro-active negotiation in
gender politics.

A negotiated masculinity is open for collaboration, transparent and

sincere about feelings and reasons within gender transactions, willing
to incorporate, borrow or derive meaning from legitimate agenda of
women, lesbians and gays and cognizant of men’s position of privilege
in the present society and the potential excesses that that privilege
can engender. A negotiated masculinity is also self-reflexive. It is an
identity that is evolving but lived, continually renewed, defended, resisted,
challenged and modified, but applied in practice to always seek for the optimal titration
of relational powers to achieve gender justice.

Most importantly, a negotiated masculinity is committed to effectively

use men’s privilege for emancipatory ends. Masculinity is not innate. It is a
“gender identity constructed socially, historically and politically” (Leach, 1994).
Masculinity can therefore be reconstructed socially, historically and politically, in the
very same sites where it musters patriarchy. The “male participation rhetoric” can
potentially find embodiment in a negotiated masculinity.

New models for the reproductive health program

In the arena of reproductive health programs, how can a negotiated
masculinity be advanced?

Pregnancy can be approached with the general premise that women

and men are equally responsible parties in the politics and practice of
reproduction. The attributes of the negotiated masculinity can be
advanced. Measures within the health education sessions in the health
centers can be designed in such a way that the sessions encourage
and ensure the attendance of men. Responses to concerns on the
psychosocial aspects of reproduction should parallel those of the
biomedical aspect. If emotions and experiences of men and women in
the level of the self are legitimate concerns in the struggle for
emancipation, the psychosocial arm of reproductive health education
should be responsive to these concerns.

Delivery rooms should be opened to men, and some tasks in the

delivery room can be assigned to men. Husbands and boyfriends could
well be active participants in labor watching, coaching, catching of
babies, umbilical cord cutting and bathing of babies.

Men and women clients in reproductive health should also be taught to

be gender-sensitive, and to recognize and oppose gender biases in
their day-to-day interactions. At any rate, when lapses do occur in
gender relations, such as when violence is committed against women,
reproductive health should provide a venue for incidents to be
processed at both the psychosocial and legal levels.

Woman-man communication skills should also be part of the

competencies that reproductive health should be concerned of. The
whole context of woman-man negotiations around reproductive health
could be very violent, unless some skills in tempering destructive and
oppressive reactions in the course of these negotiations are taught to
the clients.

Conclusion

I have just delved into the problematization of men’s participation in

reproductive health programs, and identified the locus of reproductive
health issues in men’s movements. I have also posited that men could
best advance egalitarian gender relations within the identity of a
negotiated masculinity, and proposed an approach to the
reconstruction of the reproductive health program scheme into one
that fosters gender justice.
At the end of the day, we would like to see husbands or boyfriends who
deliberately initiate discussions with their wives or girlfriends, to come
up with responsible and negotiated decisions on the number of
children they are going to have, on birth spacing, and on contraceptive
method choices and who attend to women through childbearing. We
would like to see fathers who nurture their children as much as
mothers do, and who actively plan and execute activities in the
household with mothers. We would also like to see men who openly
talk about their own sexuality with their partners, and who are neither
hesitant nor defensive to discuss with their partners as to when, where
and how to have sex. And, most of all, we would like to witness all of
these transactions in a healthy ambiance that is non-violent, self-
actualizing and self-liberating.

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