Male involvement in reproductive health services in Bangladesh: a review
Background: Men as important decision-makers and collaborators in the process of reproductio have neither receved an adequate attention nor have been investigated extensively. In the context of reproductive health, men are identified as an under-served demographic group in the national Health and Population Sector Programme(HPSP) and in the National Integrated Population and Health Programme (NIPHP) of Bangladesh. Objectives: Recent attention on men as important candidates for reproductive health services warranted the need for a reviewing the past experiences in relation to increase men's supportiveness to their families in reproductive health services in Bangladesh. Methodology: Published national and international literatures were reviewed. Field visits were made to projects on different male involvement initiatives undertaken by government and non-government organizations (NGOs). Besides, informal discussions were hild with programme managetrs, male front-line supervisors, and selected males. Findings: Results of the review show that the use of stricly male family planning method, such as condon, vadectomy and withdrawal as an indictor of male involvement in family planning, does not show much promise as the relative share of male methods has rether declined steadily from 22 percent of all mithod use in 1975 to only 14 parcent in 1996-1997 in Bangladesh. Limited data on other selected indicators of male involvement in reproductive health show that men's approval for family planning is very high, and their family desires are quite similar to those of their wives, but they have an important role in healthcare seeking. The awareness about acquired immuno defeciency syndrome (AIDS) is higher among men than women; it is still quite low, with only about one-third of men ever having heard of AIDS and a much lower proportion knowing how it is actually transmitted. Some sexually transmitred diseases (STDs), such as syphilis and gonorrhea, are prevalent among men. To date, most male involvement initiatives have focused three major areas, such as (i) promotion of male contraception and safer sexual practices to prevent STD and AIDS, (ii) establishment of male-only sexual health clinics or holding separate clinic hours for males and carrying out of studies on the prevalence of STDs, and (iii) treatment-seeking behaviour by men. However, many areas of reproductive health issues are yet to be investigated extensively. These include men's interest, opportunities to take the responsibility in identifying and seeking qualified medical consultation for their wives' pregnancy or delivery-related complications, and taking their children for routine immunization. The areas of investigation are limitless, for example, the extent of negotiation the women can make with their husbands to prevent unwanted pregnancy or STDs. The review also shows that men are unaware of their role as a supporting partner on reproductive health issues. Men's use of reproductive health services from the government and NGO facilities is low. They rather prefer to use private sources for their health and family planning needs. Service providers often fail to include male partners in the treatment and management of STD/reproductive tract infection (RTI) clients. Whatever efforts made so far by the government and NGOs under the name of "male involvement" have addressed only part of the problem. Moreover, very few messages address the male reproductive health issues. Documentation, monitoring, and evalution of male involvement efforts are also insufficiect. Conclusion: The findings of this review are expected to be useful in developing appropriate strategies aiming at improving men's knowledge about reproductive health services by men, increasing supportiveness among husbands for the reproductive health of their wives and preventing STDs/AIDS in Bangladesh.