Involvement of males in promoting reproductive health

Curationis 30(1): 71-76 At the international conference on Population and Development held in Cairo 1994, specific aspects of reproductive health addressed endorsed among others, were that unwanted pregnancies must always be given the highest priority and that every attempt should be made to eliminate the need for abortion. This paper focused on the involvement of males in promoting reproductive health through prevention of unplanned and unwanted pregnancies. A total of 71 males (48 adults and 23 adolescents) were selected conveniently from two health care centres, North of Tshwane, Gauteng province. Structured questionnaires having open and closed questions were used for data collection. Results indicated that most males (young and old) had general information about contraceptives and common side effects associated with contraceptive use. Despite this knowledge, only (29,2%) adults and almost half the number (50,0%) adolescents reportedly used condoms every time when having sex, whilst (35,0%) adults and only (13,6%) adolescents had never used condoms when having sex. Generally, males felt positive and wished to be involved in issues affecting their relationships, such as open communication about contraceptives used by their partners, discussing contraceptive problems together, planning families jointly with partner only, being informed about contraceptive failures and also playing a role in resolving such problems. Recommendations were made to encourage more visible involvement of males in promoting sexuality issues and reproductive health. Correspondence address: Dr Tod Maja Tshwane University of Technology PO Box 58858 Karenpark 0118 Tel: (012) 382-9306 Fax:(012)382-9378 E-mail: majatmmfotut.ac.za Introduction The World Health Organization (WHO), other intergovernmental, international and bilateral organizations made a com m itm ent to the princip les o f promoting reproductive health at the international conference on Population and Development in Cairo in 1994. Specific aspects of reproductive health endorsed at the conference indicate that prevention of unwanted pregnancies must always be given the highest priority and that every attempt should be made to eliminate the need for abortion. Good reproductive health should include freedom from risk of sexual diseases, the right to regulate one’s own fertility with full knowledge of contraceptive choices and the ability to control sexuality without being discriminated against because of age, marital status, income or similar consideration (United Nations,


Introduction
The World Health Organization (WHO), other intergovernmental, international and bilateral organizations made a com m itm ent to the p rin cip les o f promoting reproductive health at the international conference on Population and Development in Cairo in 1994.Specific aspects of reproductive health endorsed at the conference indicate that prevention o f unwanted pregnancies must always be given the highest priority and that every attempt should be made to eliminate the need for abortion.Good reproductive health should include freedom from risk of sexual diseases, the right to regulate one's own fertility with full knowledge o f contraceptive choices and the ability to control sexuality without being discrim inated against because o f age, marital status, income or similar consideration (United Nations,

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Curationis M arch 2007 1994).Unplanned and unwanted pregnancies pose major reproductive health problems to both women and men throughout the world, including the Republic of South Africa (RSA).The majority o f these pregnancies are terminated either legally or mainly using illegalized procedures.In the United States of America (USA) and some Eastern European countries for which data are available, about half to three th ird s o f p reg n an cies are unplanned.In m any dev eloping countries, the proportion of births that are unintended exceeds 40%; even in regions where families still want large fam ilies, 10 to 20% o f b irth s are u nplanned (The Alan G u ttm acher Institute (1997;Rosoff 1999:2).Estimates are that o f the five million unsafe TOPs perform ed annually in Africa, these constitute 3% o f all maternal deaths (WHO 1998:8).Prevention of unplanned and unwanted pregnancies could save countries money and other resources than caring for clandestine abortions or unwanted children.According to Varkey and Fohn (2000:8), in the RSA the government spends over R18,7 million an n u ally to treat in fectio n s and complications associated with illegal TOPs.
Men are the main decision makers in most African countries and should therefore be involved in prevention of unplanned and unwanted pregnancies.Historically, limited attention and resources have been devoted to initiatives that emphasize m en 's co n stru ctiv e involvem ent in contraceptive practices and fertility issues (Bankole & Singh, 1998:15;Levack, 2000:7).One o f the biggest problems is that men are left out of the picture when decisions about reproductive health issues are discussed.They are often marginalized by health services which do not have provision for males.The WHO (1998:9) emphasize that males should be empowered through the provision o f information and services targeting boys, youth and adults w ithin the home, communities and work settings.Young and old males must be educated about responsible sexual behaviour, treat women as equals and support efforts to respect women.The importance o f male participation has become much greater with the emergence of the HIV/AIDS pandemic and the increasing prevalence of sexually transmitted diseases.

Problem statement
The failure o f families and schools to educate youth including males about sex is a primary cause o f unplanned and unw anted preg n an cies.Even with sufficient knowledge o f the means to avoid the pregnancy, w om en may continue to be victims o f unwanted pregnancies if their male partners are not playing a positive role to prevent such pregnancies.Research pertaining to contraceptive practices focus on women and ignore males who could play a major role in promoting reproductive health.A study to determine the involvement of men in p rev en tin g unplanned and unw anted preg n an cies becam e necessary.

Purpose of the study
The purpose o f this research-was to determine the involvement o f males in prevention of unplanned and unwanted pregnancies.

Objectives
The purpose o f the research was addressed through the follow ing objectives:

Key Concepts
Contraceptives are defined as agents used to tem p o rarily prevent the occurrence of contraception, including oral pills, condoms, intra-uterine devices, diaphragm and injections (Ketting & Visser, 1994:161).
Pregnancy implies the condition o f a female after conception until the birth of the baby.

Reproductive Health
The WHO defines health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.Reproductive health implies that apart from the absence of disease or infirmity, people have the ability to reproduce, to regulate their fertility, to practice and enjoy sexual relationships.It further implies that reproduction is carried to a successful outcom e through infant and child su rv iv al, grow th and healthy development.Finally, the concept of reproductive health is not limited to w om en, but also includes men (Fathalla, 1997:24).
Termination of pregnancy is defined as the abortion o f a live foetus of a woman with the intent to kill such a foetus (Choice on Termination o f Pregnancy Act 92 of 19%).

Unplanned pregnancy
Refers to a pregnancy that may occur accidentally without any intention.Most unplanned pregnancies often become unwanted and result in unintended births or are resolved by termination.

Unwanted pregnancy
Unwanted pregnancy is that pregnancy which may not have been planned, and that may be unintentio n al and unwelcomed by the pregnant woman.

Research methodology
The purpose o f the research was addressed w ithin a q u an titativ e, exploratory and descriptive design to determine the involvement of males in preventing unplanned and unwanted pregnancies.

Population and sample
The target population for this research comprised all males who visited the health care ccntres to collect condoms as well as those accompanying their partners who came for contraceptive consultations.
As it was not possible to pre determine which clients would be visiting the health care centres during the period o f data collection, a convenience sample was deemed the most ideal method to use.A convenience sample consists of selecting the most readily available or convenient persons or units for the sample (Polit & Hungler 1999:281).
A total of 71 males, comprising of 48 adults and 23 adolescents participated in the study.Criteria for inclusion were: • Males aged 16 to 55 years.
• Males who visited the selected health care centres to collect condoms and those who accompanied their partners for contraceptive consultations.

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Participants had to be residents of Tshwane North, Gauteng province.

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Participation was voluntary.

Research instrument
Following a thorough literature review, a structured questionnaire was developed for data col lection from males who visited the selected health care centres.

Ethical considerations
Written permission to conduct research was sought and granted from the authorities of the two health care centres selected for the study.Ethical approval was also obtained from the Ethics com m ittee o f UNISA p rior to com m encem ent o f the research.
Participation of respondents remained a v o luntary p ro cess and they w ere informed of their right to withdraw from participating if they so wished without fear of being victimized.Confidentiality and anonymity were ensured throughout the research.

Data collection
The researcher and research assistants visited the selected health care centres on days o f data co llectio n and questionnaires were adm inistered to respondents who m et the selection crite ria.R esearch a ssistan ts were inform ed to read questions to the respondents and fill in answers as stated to those who had problem s in un d erstan d in g co n tracep tiv e term inology even though the q u estio n n aire was tran slate d in Setswana, the predominant language spoken in the area.

Data analysis
Data was analysed using the Statistical Package for Social Sciences (SPSS) computer programme with the assistance of a statistical analylist from the MRC.

Number of children respondents had and wished to have
A total o f 27 (38,0%) males had no children, 24 (33,8%) males had two children each, and only one adult male had five children.Two (4.2% ) ad o lescen ts adm itted having two children, whilst 3 (8.7% ) had three children each.A lthough m ost respondents had only one or two chi ldren each, no conclusion could be drawn about the ultimate number of children they would have as a further majority were not married and could still wish to have children after marriage.O f particular concern was the number of adolescents who already had two and three children in spite o f the freely av ailab le contraceptives.In response to how many children respondents wished to have,

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C urationis M arch 2007 slightly more than half the numbers 25 (52,1% ) adults and 12 (52,2% ) adolescents preferred having fewer children mainly to have better lives and afford the high cost of living.

Knowledge and Sources of information about contraception
Most adults 44 (87,3%) and 16 (76,2%) adolescents had general knowledge about some methods of contraceptives such as the pill, injection and mainly condom s, as w ell as side effects commonly experienced by their partners.Common side effects mentioned were w eight gain o f partners, excessive bleeding or no menstruation at all when using the pill leading to infertility.
Regarding sources o f information, the media seemed to have been the main source o f information as stated by 26 (54,2%) respondents followed by 11 (22,8%) who rated teachers as the second important source of information.Only 2 (4,2%) adolescents indicated that their sisters and nurses w ere th eir least im portant sources o f contraceptive information.Nurses are well placed in specific w o m en s' health, g eneral, occupational and school health settings to be informed providers of information regarding contraception and should therefore play a major role in this aspect.None of the adolescents had received contraceptive information from their brothers and fathers.Involvement of males in sharing such information to their sons could help reduce the levels of unplanned and unwanted pregnancies, STDs and H IV /A ID S. Fathers and brothers could explain better about the correct use of condoms ( Sharma, Dave, Sharma & Chauhan 1997:712).

Positive
Ambivalent Negative th eir study w ere inform ed about contraception, the majority of 65% would not discuss family planning issues with their wives, some even to the extent of displacing aggression tow ards their wives and children.

Contraceptive practices, availability and frequency of condom use
Effective and regular condom use when having sex could reduce high levels of unplanned and unwanted pregnancies with concomitant complications.Out of 71 males, 36 (70,5%) adults and 15 (68,2%) adolescents used condoms; 3 (16,1%) adults and 2 (9,1%) adolescents were using the withdrawal method; only 3 (4,3%) adults had been sterilized and had visited the clinics to get condoms for protection against STDs and HIV/AIDS.
Regarding the availability of condoms, the majority of 53 (77,9%) respondents always received condoms when needed from health care services.These findings seem to be consistent with the results o f a British survey conducted to establish mens' views on male hormonal contraception at a fitness centre in Bristol.A total o f 81% of men stated that birth control is a shared responsibility o f both partners.The authors added that men are already involved in family planning despite the few contraceptive options available (Brooks, 1998:7).In the RSA, Myburgh, Gmeiner and Van Wyk (2001:38) found that biological fathers of their partners' unw anted preg n an cies expressed pow erlessness related to having a decision of termination o f pregnancy and experienced a turmoil related to the impact of the decision on interpersonal and intrapersonal relationships.

Conclusion and recommendations
The study results permits the conclusion that males, young and old need to be adequately informed about reproductive health issues.Such information could im prove th eir p ercep tio n s about contraceptives positively and thus play a better role in preventing unplanned and unwanted pregnancies.
Males should be empowered through the provision of information and services targeting youth and males within the home, communities and work settings.
Although a significant number of males had knowledge about contraceptives including condoms, few had ever used them consistently to prevent unplanned and unwanted pregnancies.Reasons provided by respondents for non-use of condoms imply that much still needs to be done to get more involvement of males in re p ro d u ctiv e health.Recommendations include involving males (health care providers) in family planning services, open communication about reproductive health issues starting from homes, and schools to dispel myths associated with prevention of unplanned pregnancies.Further research is needed to clarify and explore from m ales contributions they could make to improve reproductive health.

Figure
Figure 1: Perceptions about contraception