Missing men: Address sexual health care needs
Take a look at your clinic’s appointment books. If there are low numbers of male patients scheduled for exams, don’t be surprised. A new analysis of men’s health services shows that only about 14% of men ages 15-49 schedule an annual sexual or reproductive health visit, and younger men, who are at the greatest risk of unintended pregnancy and sexually transmitted diseases (STDs), are the least likely to make a sexual or reproductive health care visit.1
Despite the strides made in reproductive health care, there is no standard definition of care for men, and few health professionals are trained to meet men’s needs, according to the analysis issued by the Alan Guttmacher Institute, a New York City-based sexual and reproductive health research organization. Essential services, including information on how to prevent transmission of STDs, counseling regarding relationships and parenting, and medical sexual and reproductive health services, often are unavailable, the report asserts.
Why is this so? Relative to other health issues, sexual and reproductive health receives relatively little attention in the medical community, explains David Landry, senior research associate at the institute. While much of American medicine is geared toward treatment, many of the services men require are preventive ones, he notes.
"Groups such as the American Medical Association, EngenderHealth, and the Urban Institute have gone a long way in specifying model sexual health services for men; but a great many barriers remain to further develop these guidelines, including training, inadequate reimbursement for sexual health services, and more generally, counseling services," says Landry. "Moreover, there is a general lack of awareness of how to address men’s sexual and reproductive health not only among medical providers, but among adolescents, parents, men and women, community and religious leaders, and health educators."
Young men face significant obstacles accessing sexual and reproductive health information and medical care, agrees Bruce Armstrong, DSW, associate clinical professor in the Mailman School of Public Health at Columbia University and director of the Young Men’s Clinic, both based in New York City.
Many young men lack health insurance and connection to regular sources of care; even when they see providers, sexual and reproductive health issues rarely are addressed, Armstrong observes. In addition, many family planning clinics target women’s services; as a result, many young men are left to navigate the transition from adolescence to adulthood on their own, he says.
Look at the numbers
The new report combines published and unpublished data from national surveys conducted by universities and research institutions, as well as data from the Atlanta-based Centers for Disease Control and Prevention, the Bureau of the Census and the National Center for Health Statistics. Highlights include the following:
• Most American men begin sexual intercourse in their teens, and half have married and become fathers by their late 20s; therefore, men spend an average of nearly 10 years being sexually active and unmarried, according to the analysis.
• Half of births involving men in their late 20s, and about one-third of those involving men in their 30s and early 40s, result from unintended conceptions.
• At least one-quarter of men ages 15-29, 17% of men in their 30s, and 12% of men in their 40s had more than one sexual partner in the last year.
While the message is getting out about the importance of condom use, there still is work to be done, according to the analysis’ findings. More than two-thirds of young men who became sexually active in the mid-1990s used a condom at first intercourse, compared with about one-quarter in the early 1980s; still, four in 10 men ages 20-27 erroneously believe that condom use presents health risks.
Bring men into focus
A positive approach will need to be used to include men in the family planning picture, Landry says.
"Too often, when policy-makers have addressed issues related to sexual and reproductive health, they have included men in only punitive ways, as reflected in policies that garnish the wages of deadbeat dads’ or those that enforce statutory rape laws on predatory men,’" he observes. "While the family planning community has learned to treat women as individuals and not just as mothers, it is time to do the same for men: to recognize their reproductive health is, above all, about their own well-being and their ability to engage in healthy, fulfilling sexual relationships."
1. Alan Guttmacher Institute. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men. New York City; 2002.