Wednesday December 19, 2018

Men The Missing Link in Contraception Campaigns

Men take little responsibility for family planning and think that pregnancy will keep other men away from their women.

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Men
A nurse explains to mother-of-three Kadidja Toudjani how a contraceptive implant works, in Libore, Niger. VOA
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Ask Esther Imaniragena to name her top challenge as she doles out contraceptive advice and supplies at a Rwandan health clinic and the answer comes short and fast: men.

Too many men do not share the task of family planning, said Imaniragena, one of many birth-control champions who are deploying wily tactics to encourage burden-sharing.

Be it cornering men after their wives give birth or touting a new type of “model husband” in a society that values virility, champions of birth control are trying new ways get men involved.

If they can find them, that is.

“The biggest challenge we have is males do not come,” said Imaniragena, who runs family planning at the Rwamagana Health Center in the east of the country.

Patients strolling the center’s grounds on a recent day were overwhelmingly female, babies wrapped tightly to their backs and umbrellas in hand to protect against the fierce sun.

Getting men on board has major benefits in developing nations that struggle with booming populations, a trend that puts pressure on limited resources and fuels fresh cycles of poverty, said experts, researchers and policymakers gathered at an international family planning conference this week in Rwanda.

family planning, women, men
Health worker Sylvia Marettah Katende displays reproductive health products and information at a family planning exhibition in Kampala, Uganda. VOA

Involving men increases contraceptive use, reducing infant and maternal mortality and the number of unwanted children. All of this frees up women for school or jobs.

Insuring universal access to family planning by 2030 is among the global targets for sustainable development that were adopted in 2015 by the United Nations.

The experts said the key to success is to inform and involve men while preserving women’s autonomy. And while some of the more creative efforts have worked, most schemes are localized and remain small-scale in the face of deep-seated resistance.

One way to find men

To target men, the Rwamagana clinic has started talking about contraception to husbands when they come to collect their wives after childbirth, Imaniragena said.

It is a start.

“We cannot say that they are involved as we wish, but this is the occasion to find them,” she told visitors at the rural outpost, which was ringed by rice paddies, banana trees and fields of maize.

Men
A health worker inserts an injectable contraceptive into a woman’s arm during a reproductive health clinic run by a nongovernmental organization in Tondo city, metro Manila, Philippines. VOA

The results are impressive in terms of numbers reached. Last week, 15 out of 16 couples went home with newborns as well as family planning methods, according to the clinic, which serves more than 50,000 people. Most couples opted for hormonal implants or injectable contraception.

The effort mirrored a campaign launched two years ago in Benin whose focus was cutting child and maternal deaths, said Gisele Dunia of the University Research Co., a health care company working in the west African nation. Not only did the number of couples using family planning more than double within a year, but men would influence other men to do the same, she said.

Male support ‘generally low’

As of last year, four in 10 women of reproductive age in developing regions were using modern contraceptive methods — implants, injections and contraceptive pills — with rates ranging from two in 10 in Africa to half in South America and the Caribbean, according to research by the Guttmacher-Lancet Commission, a global group of experts, published this year in The Lancet, a medical journal.

But men’s support for partners’ sexual and reproductive health and empowerment “is generally low,” the Lancet report said.

Such support dips as low as 12 percent in Lesotho and climbs as high as 77 percent in Rwanda, it said.

Men
Contraceptives are seen at a family planning clinic in Cairo, Egypt. VOA

“Women continue to shoulder the responsibility of contraceptive use,” the Lancet report said. “Given that men are often gatekeepers for women’s access to services, involving men during pregnancy, childbirth and onward (when women want) can potentially increase gender equality and male support.”

‘Not listening’

The best way to reach men in Uganda is to empower women, said Reuben Kizito of the Zaam Community Health Development Organization, which trains women and offers small loans.

“There are so many women out there who believe that the more children you give him, the more he loves, yet they are practically destroying themselves,” he told the Thomson Reuters Foundation. “So if we are in a position to empower them economically, then they are in a position to stop that habit.”

Contraception, Men
DMAU is a major step forward in the development of a once-daily ‘male pill

Men take little responsibility for family planning and think that pregnancy will keep other men away from their women, he said.

“When we have more women economically empowered, then the men will listen,” Kizito said. “Now they are not listening.”

Mali runs a project that trains “model husbands” in local communities, organizers said, while programs in Togo are promoting “positive masculinity” for boys.

Also Read: Women And Girls in Poor Countries are Using Contraceptives More: Report

In the Philippines, a project called El Hombre — using men-to-men conversations — nearly doubled the rate of contraceptive usage where it was employed, said Jose Augustus Villano of the Commission on Population, a government agency.

Those rates have dropped significantly since the 2016 election of President Rodrigo Duterte, he said. Duterte’s policies and practices, including a war on drugs that has killed thousands of people, have drawn international condemnation. (VOA)

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Trump Can’t Deny Birth Control Coverage: U.S. Court

The case became more complicated after the Trump administration last month issued new birth control coverage rules that are set to supersede those at issue in the lawsuit before the 9th Circuit.

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birth control, contraceptive
A one-month dosage of hormonal birth control pills is displayed in Sacramento, Calif. VOA

A divided U.S. appeals court Thursday blocked rules by the Trump administration that allowed more employers to opt out of providing women with no-cost birth control.

The ruling, however, may be short lived because the administration has adopted new rules on contraceptive coverage that are set to take effect next month and will likely prompt renewed legal challenges.

Thursday’s ruling by a three-judge panel of the 9th U.S. Circuit Court of Appeals concerned changes to birth control coverage requirements under President Barack Obama’s health care law that the U.S. Department of Health and Human Services issued in October 2017.

States were likely to succeed on their claim that those changes were made without required notice and public comment, the appeals court panel said in a 2-1 decision.

USA, birth control
A man stands outside the main door of the 9th U.S. Circuit Court of Appeals building in San Francisco. VOA

The majority upheld a preliminary injunction against the rules issued by U.S. District Judge Haywood Gilliam last year. It, however, limited the scope of the injunction, applying it only to the five states in the lawsuit and not the entire country.

Another federal judge also blocked the rules, and her nationwide injunction remains in place.

An email to the Justice Department seeking comment was not immediately returned.

Obama’s health care law required most companies to cover birth control at no additional cost, though it included exemptions for religious organizations. The new policy allowed more categories of employers, including publicly traded companies, to opt out of providing free contraception to women by claiming religious objections. It also allowed any company that is not publicly traded to deny coverage on moral grounds.

The Department of Justice said in court documents that the rules were about protecting a small group of “sincere religious and moral objectors” from having to violate their beliefs. The changes were favored by social conservatives who are staunch supporters of President Donald Trump.

Reproductive Rights, abortion, women, birth control
A community health worker holds up contraceptives during a lecture on family planning at a reproductive health clinic run by an NGO in Tondo city, metro Manila. VOA

California filed a lawsuit to block the changes that was joined by Delaware, Maryland, New York and Virginia.

“Today’s decision is an important step to protect a woman’s right to access cost-free birth control and make independent decisions about her own reproductive health care,” California Attorney General Xavier Becerra said in a statement.

‘Economic harm’

The states argued that the changes could result in millions of women losing free birth control services, forcing them to seek contraceptive care through state-run programs or programs that the states had to reimburse.

The states show with “reasonable probability” that the new rules will lead women to lose employer-sponsored contraceptive coverage, “which will then result in economic harm to the states,” 9th Circuit Judge J. Clifford Wallace, a nominee of Republican President Richard Nixon, wrote for the majority.

Reproductive Rights, abortion, women, birth control
Newer Contraception Tries to Engage Men. VOA

In a dissent, 9th Circuit Judge Andrew Kleinfeld said the economic harm to the states was “self-inflicted” because they chose to provide contraceptive coverage to women. The states, therefore, did not have the authority to bring the lawsuit, said Kleinfeld, a nominee of Republican President George H.W. Bush.

Also Read: To Diversify The Industry, Apple Pledges To Train More Women

The case became more complicated after the Trump administration last month issued new birth control coverage rules that are set to supersede those at issue in the lawsuit before the 9th Circuit. Under the new rules, large companies whose stock is sold to investors won’t be able to opt out of providing contraceptive coverage.

Wallace said the new rules did not make the case before the 9th Circuit moot because they are not set to take effect until January. (VOA)