FutureLife-Now! Sharing Meeting

3-5 February 2020

Programming for men and boys

Marten KiviRenata Tallarico

“Boys diaries”: insight into the challenges boys face trying to live up to their parents and societal expectations (Zimbabwe)

https://www.youtube.com/watch?v=9_Xi2eKfAHk

ICPD Programme of Action

ICPD PoA (2014): https://www.unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf

Conceptual framework for work on men’s and boys’ SRHR

• Balance between different components desirable

• “Male engagement” may be understood differently

• An emerging area of work is men as clients and primary recipients of services - this is also the focus of the regional needs assessment

UNFPA and IPPF (2017): https://www.unfpa.org/publications/global-sexual-and-reproductive-health-package-men-and-adolescent-boys

“Better meeting the diverse SRH needs of men and adolescent boys improves their own health. It also

improves the SRH of their partners, and is an effective way to promote sexual and reproductive

health and rights for all.”

Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys, UNFPA and IPPF (2017)

SRHR of men and boys

• Men and boys have substantial SRHR needs • Prevention and treatment of HIV and other STIs, contraception, sexual dysfunction, infertility,

male cancers, SGBV, etc.

• There has long been research gaps as regards SRHR of men and boys• Needs and programmatic approaches

• Growing body of knowledge in last two decades (often HIV and AIDS)

• Unmet needs due to, for example • Low utilization of services (e.g. health-seeking behavior, attitudes)

• Policy- and structural factors (e.g. inclusive language and services)

• Relevant policy frameworks, for example • Strategy for SRHR in the SADC Region 2019-2030

Current knowledge about SRHR needs of men and boys often focus on HIV/AIDS

UNAIDS RST ESA SI Hub based on UNAIDS Estimates 2018

Country New infections PLHIV AIDS deaths ART coverage

Angola M < F M < F M < F M > F

Botswana M < F M < F M > F M < F

Eritrea M < F M < F M < F M > F

Kenya M < F M < F M < F NA

Ethiopia M < F M < F M > F NA

Lesotho M < F M < F M < F NA

Madagascar M > F M > F M < F M < F

Malawi M < F M < F M < F M < F

Mozambique M < F M < F > F NA

Namibia M < F M < F M < F M < F

Rwanda M < F M < F M < F M < F

South Africa M < F M < F M < F M < F

South Sudan M < F M < F M < F M < F

Swaziland M < F M < F M < F M < F

Uganda M < F M < F M > F M < F

U.R of Tanzania M < F M < F M > F M < F

Zambia M < F M < F M < F M < F

Zimbabwe M < F M < F M < F M < F

Estimated number of adult (15+) AIDS-related deaths in Eastern and Southern Africa, 2000-2017: AIDS-related deaths declined more rapidly among girls and women

Differences in the male (M) and female (F) epidemics at country level in estimates of new infections, PLHIV, AIDS deaths and ART coverage

Global Sexual and Reproductive Health Service Package for Men and Adolescent Boys

Building blocks1. Using a gender-transformative approach

2. Delivering quality SRH clinical services

3. Meeting men’s diverse SRH needs often requires a different approach

4. Including a focus on young men and couples

5. Adapting to the context and local needs among men

6. Building a committed organization and workforce

7. Taking a primary prevention and integrated approach

Services1. Assessment questions on male client history

2. Physical exam of male client

3. Contraception

4. Sexually transmitted infections

5. HIV and AIDS

6. Disorders of the male reproductive system, including sexual dysfunction

7. Male cancers

8. Fertility and infertility

9. Supporting prenatal and postnatal care, including safe motherhood

10. Supporting safe abortion care

11. Sexual and gender-based violence support

12. Information and counselling

13. Information, education and communication materials

14. Skills building and support

15. Advocacy issues in which to engage men and adolescent boys

UNFPA and IPPF (2017): https://www.unfpa.org/publications/global-sexual-and-reproductive-health-package-men-and-adolescent-boys

Gender integration continuum

There is a risk of engaging men and boys without explicit attention to gender inequalities, as this may undermine women’s rights and autonomy.

UNFPA and IPPF (2017): https://www.unfpa.org/publications/global-sexual-and-reproductive-health-package-men-and-adolescent-boys

Review of reviews of interventions including male engagement

Ruane-McAteer et al. 2019: https://gh.bmj.com/content/4/5/e001634

Regional SRHR needs assessment forboys and young men

Purpose:

“To undertake regional needs assessment of the structural, social, behavioural and health related needs of men and boys to inform the development of programmesthat strengthen the SRHR, HIV and GBV prevention and treatment needs of adolescents and young men in selected countries.”

Regional SRHR needs assessment for boys and young men

• Who? Boys and young men between 10-35 years old in all their diversity

• Where? 23 countries in East and Southern Africa, with a specific focus on Lesotho, Malawi, Uganda, Zambia and Zimbabwe

• When? 2019-2020

• How? The methodological approach includes desk-based research and in-country field research, conducted in urban and rural settings in the five focus countries using qualitative and quantitative methods.

Regional SRHR needs assessment for boys and young men: Deliverables

• Inception report (completed) • Research plan

• Data quality assurance plan

• Ethics compliance plan

• Research tools (completed)

• Literature review (completed)

• Situational analysis based on quantitative data in the public domain (completed)

• Mapping of (programmatic) initiatives in five focus countries (draft stage)

• In-country research in five focus countries (anticipated in 2020)

Literature review

• >600 articles screened, 315 articles included

• While there is a growing number of articles that address non-HIV SRHR needs of men and boys, the overall finding of this literature review is the lack of both general and specific research that can support much needed technical improvement and evidence-based programming.

• Much of the overall limited research on men and boys non-HIV SRHR needs are derivatives of women’s SRHR and that comparatively few articles found for this review have as their starting-point men’s and boys’ own SRHR concerns.

• Few articles address male youth/adolescents’ and key populations’ non-HIV SRHR needs specifically

Literature review – key recommendations • A multi-pronged approach consisting of community outreach,

male-targeted clinic days, flexible clinic hours and extended services for evenings and weekends, community-based services, mobile services, mobile technology, point-of-care diagnostics outside of health facilities, integrated SRHR-HIV health services, peer education and sexual health couples counseling and testing.

• Gender-transformative approaches that address both men’s health needs as well as harmful notions of masculinity and gender inequitable attitudes

• Beliefs, ideas, values and attitudes have mostly solidified by ages 10-12, making it critical to engage boys to redefine problematic notions of masculinity and gender relations.

• Gaps in health provider knowledge and ability to provide non-judgmental services are consistently identified as substantial barriers to health care services.

• The access for men to correct and reliable information about non-HIV SRHR issues, e.g. contraception, vasectomy, causal factors for sexual dysfunction, STIs, male cancers, etc. is limited

Mapping of initiatives

• Focus on Lesotho, Malawi, Uganda, Zambia and Zimbabwe

• Limited number of interventions identified so far that specifically address SRHR needs of men and boys

• Some promising practices identified

Do’s and don'ts for engaging men and boys

• Do recognize and meet men’s distinct needs

• Do seek to transform harmful gender relations and norms

• Do gather evidence with men and boys (and not just women and girls)

• Do start early in the life course (10-12)

• Do engage men on their own and in groups of men, as well as together with women

• Don’t engage men at the expense of women

• Don’t discount the structural barriers men face when accessing health services

• Don’t start with the assumption that all men are bad actors

• Don’t overlook the diversity of men and boys in the population

• Don’t overlook scale and sustainability for achieving impact

USAID and IGWG (2019)

Available UNFPA guidance

https://www.engenderhealth.org/pubs/gender/gender-toolkit/toolkit.htmlhttps://www.unfpa.org/publications/adolescent-boys-and-young-menhttps://www.unfpa.org/publications/strengthening-civil-society-organizations-and-government-partnerships-scale-approacheshttps://www.unfpa.org/resources/engaging-men-and-boys-brief-summary-unfpa-experience-and-lessons-learned

https://www.unfpa.org/publications/global-sexual-and-reproductive-health-package-men-and-adolescent-boys

I thank you!