Theories & Approaches
Male Involvement and Adolescent Pregnancy Prevention
Traditionally, family planning and reproductive health services have been female focused. In the past, this focus made sense since most family planning methods are female dependent, and women are disproportionately affected by the negative consequences of unintended pregnancy and sexually transmitted infections (STIs). However, since the onset of the AIDS epidemic, reproductive health professionals have increasingly recognized the important role that supportive male partners can play in improving the use of contraception and in reducing the risk of unintended pregnancy and the spread of STIs. Today, a major focus of male reproductive health is on men's utilization of condoms, the one method of family planning that if used consistently and correctly, can greatly reduce the risk of unintended pregnancy and STIs, including HIV.1 Other foci include STI testing and treatment, partner communication, gender equity, abstinence, and delay of sexual intercourse.
While there are many "women's" health centers, there are few equivalent health facilities for men.2 Those facilities that are reaching out to men often find their male services underutilized. The most recent data suggest that men make up only 2% of the clients in the federally funded Title X family planning programs.3 Many times, services for men are housed in settings where staff lack training in male sexuality and sexual health, where providers' attitudes about men's involvement in reproductive health may compromise the quality of service delivery, and where the environment itself, from the décor to the informational and educational materials, may not reflect men's interests or needs.4
Even facilities that have made efforts to make their services male-friendly struggle with underutilization, as men in general are less likely to access health care and often lack accurate information about reproductive health.5 Adolescent men are especially at risk for unintended pregnancy and STIs because they are more likely to be misinformed about sexuality and sexual health. Young men are socialized to "know it all" when it comes to sex, to not ask questions, and to always be ready and willing to engage in sexual activity.6 Young men initiate sex earlier than young women and tend to accumulate more partners over their lifetime.7 These factors, combined with adolescents' overall sense of invulnerability, lead many young men to engage in sexual activity that puts their own and their partners' reproductive health in jeopardy.
The emerging awareness of the important role young men can play in improving their own and their partner's health has led to an increase in the number of programs focusing on male involvement. While male involvement has taken on many forms over the years, the term has come to encompass any clinical, community outreach, and/or educational initiative that improves young men's ability to make informed decisions about their reproductive and sexual health.8 The goals of many of these programs include:
- Increasing men's support and awareness of their partner's reproductive health needs and choices,
- Increasing men's use of contraceptive methods, especially condoms to reduce the spread of STIs,
- Increasing men's access to and utilization of comprehensive reproductive health services.9
While most male involvement programs strongly emphasize pregnancy prevention, some programs also work to increase men's role in gender equity10, shared responsibility for childrearing, and men's important role in fatherhood.11
Public support for male involvement has increased as attention has been drawn to the costs of unintended pregnancy and child support. Recent studies suggest that 70% of births to adolescent women occur out of wedlock and that 4 out of 5 young mothers begin receiving welfare soon after the birth of their first child.12 Some policymakers believe that by requiring financial responsibility, men will be motivated to support unintended pregnancies and births, yet less than one-third of nonmarital births have paternity established, half of custodial parents have child support orders, and only half of those orders are fully paid.13 These statistics draw attention for the need to focus on helping men avoid unintended pregnancies.
There is some encouraging evidence that male involvement programs are working. Data from the 1995 National Survey of Adolescent Males (NSAM) describes some of the possible positive effects of male involvement programs.
- 90% of teenage males having sex used condoms in the last year (although less than half used condoms 100% of the time).
- About two-thirds of teenage men express little discomfort about discussing condoms with a new partner.
- Among sexually experienced teenage males, more than half have one partner or less in one year.
- More than 90% of teenage males agree that male responsibilities include: talking about contraception before sexual intercourse, using contraception to protect against unwanted pregnancy, and taking responsibility for a child they have fathered.
- Few teenage males express the belief that causing a pregnancy would make them feel like a "real man."
- By age 19, 15% of males are still virgins.
Despite these positive trends, the report warns that many teenage males still engage in unprotected sex and do not use contraceptives as consistently as they could. Many of these men are involved in key social institutions such as sports, youth groups, the criminal justice system, school, or the workforce – settings where men can be reached with important reproductive health information.