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Meeting the health needs of men: Ensure that your facility stacks up!
Survey shows there is room for improvement in reaching young males
Review the number of services offered at your family planning agency, then check off the number that address the reproductive health needs of men. If your agency is like most of the facilities participating in a recently published survey, you may be serving some male patients, but doing very little to recruit more.1
By the late 1990s, 87% of agencies providing publicly funded family planning services in the United States served at least some male patients, primarily through condom provision, contraceptive counseling, and testing and treatment for sexually transmitted diseases (STDs).1 Most of the facilities surveyed expressed interest in serving more men in the future; however, only one in five conducted activities to recruit more men, according to a report of the survey’s results.
"It appears that many men are unaware that family planning clinic services are available to them, or they may have the perception that clinics are the domain of women only," states Lawrence Finer, PhD, the report’s lead author and associate director for domestic research at the New York City-based Alan Guttmacher Institute (AGI). "In addition, agencies report inadequate funds to deliver services to men."
According to previous AGI research, men do not seek preventive services to the extent that women do, he points out. The fact that most men who do go to clinics are the partners of female clients means that those who are at greater risk, such as those whose partners are not receiving family planning and STD services, are exactly the ones who aren’t being served, Finer observes.
Men are at risk
Why it is so important to offer reproductive health services for men?
"The first reason for involving young men is that they have significant needs, and they have rights and needs that are not being addressed thoroughly as it relates to their own health," says Bruce Armstrong, DSW, director of the Young Men’s Clinic and associate clinical professor in the Heilbrunn Department of Population and Family Health, Mailman School of Public Health at Columbia University in New York City. "As it relates to women’s health, it is really just common sense that involving men in sexual and reproductive health care can enhance the health of women."
The Young Men’s Clinic is one of the first community-based programs for men, founded in 1987 in New York City. It provides medical, social work, mental health, and health education services to men ages 13-30, and it has been successful in reaching its target population.2
Many young men may receive some form of services during their high school years at school-based health clinics; however, when they reach their 20s, they may become "missing men" in the health care picture, says Armstrong. The absence of men at this point in time is troubling, he adds . Reported rates of chlamydia and gonorrhea reach 500-600 per 100,000 men in their early 20s, levels that are much higher than those of men in their 30s or older.3 Men in their 20s account for about half of births and half of abortions in the United States each year.3
There are opportunities to extend recent improvements found in adolescent male sexual behaviors if young men are better served, Armstrong points out. Recent surveys show a decrease in the proportion of adolescent males ever having sexual intercourse and an increase in the use of condoms among male teens.4
"Can you imagine the further change in terms of outcomes that could be achieved if we didn’t neglect the 20-24 age male so much?" asks Armstrong. "It would be amazing, I think."
Results from the AGI survey show that many publicly funded agencies that run family planning clinics are offering some form of services used by men. Almost all (95%) of the surveyed facilities say they provide condoms and STD counseling, contraceptive counseling (93%), and STD treatment (90%) and testing (89%).1
The number of male patients had increased at 53% of agencies, and four out of five agencies said they were interested in serving more men in the future, according to the survey. The most commonly reported barriers to serving men were their unawareness that services were available (58%) and inadequate agency funding (55%).
One way to promote male services is to talk with your existing female patients. At the Young Men’s Clinic, the male social worker talks with women in the family planning clinic waiting area, says Armstrong.
"It is a very obvious way to get the women thinking that maybe the men need to be involved, and they can be the linkage point," he explains. "Women can make an appointment for their boyfriend, husband, or brother, and he will be taken care of, because of their efforts."
The Young Men’s Clinic has developed a video that depicts the clinic and shows the providers in action. Former male patients are portrayed, with testimonials given about the care received at the facility. By seeing the video, some of the hesitation in visiting the facility is minimized, says Armstrong. The video is shown in school-based clinics and community organizations to help raise awareness of the facility’s services.
Break down the barriers
Since 1997, the Office of Population Affairs/ Office of Family Planning (OPA/OFP) has funded programs that address family planning and reproductive health information and services for males, and it recently has made males a priority population.5 However, men still represent a small proportion of all family planning clinic patients: They comprise just 4% all patients at Title Xfunded clinics in 2002.6
Armstrong praises OPA’s efforts in supporting access to male health services; however, the hunt for funding continues for the clinic, as it does for other agencies.
"It appears that agencies, their clinics, and the public health community as a whole need to develop new strategies for informing men about services and making them feel welcome; in addition, we need more research into which of these strategies are the most cost-effective," says Finer. "Finally, advocates need to make the case for increased funding for services in this area."
1. Finer LB, Darroch JE, Frost JJ. Services for men at publicly funded family planning agencies, 19981999. Perspect Sex Reprod Health 2003; 35:202-207.
2. Armstrong B. The Young Men’s Clinic: Addressing men’s reproductive health and responsibilities. Perspect Sex Reprod Health 2003; 35:220-225.
3. Alan Guttmacher Institute. In Their Own Right: Addressing the Sexual And Reproductive Health Needs of American Men. New York; 2002.
4. Santelli JS, Lindberg LD, Abma J, et al. Adolescent sexual behavior: Estimates and trends from four nationally representative surveys. Fam Plann Perspect 2000; 32:156-165, 194.
5. Office of Population Affairs. Male Involvement Projects: Prevention Services. Washington, DC: U.S. Government Printing Office; 2000.
6. Alan Guttmacher Institute. Family Planning Annual Report, 2002. New York City; 2003.
Special focus: Male reproductive health services
Men and women play equal roles in reproduction. While there has been an increased focus on men in recent years, their care still needs improvement, some family planning experts maintain. This issue of Contraceptive Technology Update offers a special focus on male reproductive health services. We highlight programs that are addressing young men and review promising research in the field of male contraception. We also have enclosed a list of selected web links to information on male health issues.
Don’t miss reading this special issue of CTU!