Evaluating if men are supporting women's reproductive health decisions.

Men play a critical role in women's reproductive health. Frequently, they decide if and when a couple uses contraception, how and when to make resources available to a female partner to help get healthcare, and whether and when a female partner seeks prenatal care. Men have also been shown to play a key role in deciding whether and when a pregnant woman seeks emergency obstetric care.

Unequal power relations between men and women leads to situations in which women often do not have the power to insist on safe and responsible sex practices. Addressing the unequal power relations can only be achieved by encouraging men to fully participate in actions that lead to the goal of gender equality.

But to what extent have reproductive health service providers been successful in motivating more men to support their female partners in making reproductive health decisions that will lead to better health outcomes for women? This is an important component of a comprehensive gender-sensitive health service.

Gender-sensitivity of health services refers to the extent to which health services are designed and implemented to ensure analysis of issues and the solutions related to the unequal power relationship of men and women. Furthermore, gender-sensitive services do not reinforce gender roles and stereotyped behaviour, but actively aim to challenge gender inequality and promote women's rights and autonomy in deciding on and having their needs met.

Innovative indicators, while few, have been developed to assist service providers in evaluating the extent that men are participating to support the choices of their female partners with regards to sexual and reproductive health at the service level. Such indicators (see table) assisted in assessing men's responsibilities in the following two case studies undertaken in a five country regional action-research project coordinated by ARROW.

A case study conducted in China by the Yunnan Reproductive Health Research Association at a government health centre indicated that Yunnan women wanted their husbands to be involved in reproductive tract infection treatment but service providers had not yet reached out to these men (1). Women interviewed pointed out that without their husbands' involvement, their own treatment would not be effective. A Bangladesh Rural Advancement Committee (BRAC) study examining maternity care revealed men were not allowed into the delivery room (2). Only female relatives could provide such support as this was the cultural practice. Furthermore, women and men were not asked by researchers nor providers whether they wanted their husbands by their sides during delivery. This practice thus reinforces gender stereotyping and expectations of men and women's relations and is not sensitive to the need to change gender roles.

Health providers must use clear indicators to assess men's responsibilities. Only then can they understand what changes must be in place in order to provide gender-sensitive health services. Service providers can also play an important role in removing negative or perpetuating stereotypes that harm the well being of women. Through encouraging dialogue with women and understanding women's needs and desires, health providers will be able to challenge damaging cultural and patriarchal practices, paving a way for a more gender equal society.

* By Rathi Ramanathan, Programme Officer.

* Endnotes

(1) Fang Jing, Xiong Qiongfen, Shi Zhenli, Guo Jimei, Zhang Jianping, Xiao Xia. 2003 "Women's access to RTI services in Yunnan, China". In The Asian-Pacific Resource and Research Centre for Women (ARROW). 2003. Access to Quality Gender-Sensitive Health Services: Women-Centred Action Research. Kuala Lumpur: ARROW. p 29-42

(2) Afsana, Kaosar; Rashid, Sabina Faiz; 2003. "A women-centered analysis of birthing care in a rural health centre in Bangladesh", in The Asian-Pacific Resource and Research Centre for Women (ARROW). 2003. Access to Quality Gender-Sensitive Health Services: Women-Centred Action Research. Kuala Lumpur: ARROW. p 43-60

Community level

Extent to which providers ask women if they want their men partners' involvement in resolving their health needs and problems and extent that providers follow up by encouraging the men partners to take responsible action

Service level

Extent to which the services provided do not reinforce unequal gender roles and gender stereotyped behaviour but promote gender equality e.g extent that men are allowed and encouraged to participate in the childbirth process e.g decisions on contraceptive methods and STD screening and treatment.

Source: Asian-Pacific Resource Resource & Research Centre for Women. 2003. Access to Quality Gender-Sensitive Health Services : Women-Centred Action Research. Kuala Lumpur: ARROW.