Who’s drawing men into the contraceptive picture?

When it comes to choosing and using contraceptives, a recent national survey shows most men and women believe men should play a larger role in the decision-making process.

At least one-third of both sexes say men feel left out when it comes to birth control and pregnancy prevention, according to a March 1997 survey conducted for the Henry J. Kaiser Family Foundation of Menlo Park, CA.1 The random-sample survey polled 503 American men and 502 women ages 18 and above. (See graphs of survey responses, p. 77.)

But how many men are being drawn into the reproductive health services scene? Family planning services traditionally have focused on women, with few targeted to men. A 1993 Urban Institute survey of publicly funded clinics found that male clients constituted, on average, only 6% of their total patient population.2 With limited funding and staffing, many clinic administrators may see expanding the scope of their services as a daunting task.

Take a look at how one facility has been able to incorporate and sustain male reproductive health services. While your clinic set-up may differ, perhaps you can learn how to "draw the circle wide" to bring more men into your facility. (Get pointers on providing such services effectively, p. 78.)

Services for men only

By day, the Family Planning Clinic of Columbia Presbyterian Medical Center in New York’s upper Manhattan is buzzing with the usual activities found in a female-centered program: patient examinations, contraception counseling, and testing for sexually transmitted diseases (STDs). During a few hours on Monday nights and Friday afternoons, the same office space is used for the same types of services — but for young men only.

The Young Men’s Clinic is one component of the family planning program at Columbia Presbyterian Medical Center. It is run by the Center for Population and Family Health, a division of Columbia University’s School of Public Health, and Presbyterian Hospital’s Ambulatory Care Network Corp.; both are in New York City.

The Young Men’s Clinic evolved from focus groups conducted by Columbia’s School of Public Health in the mid-1980s on the beliefs about contraception services and contraceptive use by Hispanic adolescent males and females, says clinic founder Bruce Armstrong, DSW, associate clinical professor with the School of Public Health and head of the school’s Center for Population and Family Health.

Researchers found that many of the young men thought family planning clinic services were for women only. If men were to go to such a clinic, it would be considered a threat to their manhood, so confidentiality and anonymity were cited as high service priorities, Armstrong notes.

Once they saw that the teens were thirsty for knowledge about reproductive health issues, researchers continued their community outreach through discussion sessions held at the hospital.

Federal Title X special initiatives money helped start the Young Men’s Clinic, which met one-night a week. Since that time, the clinic has expanded its hours and extended its services to include physical exams for sports, employment, and school; diagnosis and treatment of sexually transmitted diseases; HIV counseling and testing; individual and group health education; condom distribution; and social work services.

The clinic started slowly, initially seeing eight to 10 young men per session, Armstrong recalls. Now, about 30 are seen each night, with more scheduled for the next session.

The Family Planning Center, home to the Young Men’s Clinic, is a freestanding facility within New York City’s Washington Heights neighborhood. Approximately 75% of the young men who attend the clinic are Hispanic; the other 25% are African-American.

The clinic sees male partners of patients in the family planning program, ranging in age from 13 to 30. Many patients come from word of mouth, but referrals from the family planning clinic get top priority at the men’s sessions. Seeing both partners ensures a strong continuum of care, says Catherine Quinn, MSN, CNP, a nurse practitioner with both programs. For instance, in the case of sexually transmitted diseases, both partners get treatment and education from the same source.

"Then, of course, you have a perfect captive audience to get into different types of contraception," Quinn notes. "I learn so much more culturally from my male patients, because I always have the female point of view during the day. When I get to see my male patients, I find out why they don’t like to use a certain method. Then I can either clear up a myth, or I can give them more information."

All these patients need is an opportunity to learn more about reproductive health, say Armstrong and Quinn.

"I find that they are really open," Quinn says. "They’re like sponges. It’s just that nobody’s bothered to give them the information."

Armstrong agrees. "When people are talking about male responsibility, I always try to flip that around to helping them to be able to respond," he says. "And that requires some communications skills, condom use skills, a check of the beliefs that may be getting in the way, and taking a look at the attitudes a little bit more to stress that, in fact, women do appreciate men who care this way."

References

1. Kaiser Family Foundation/Market Facts, Inc. Kaiser Survey on Men’s Role in Preventing Pregnancy. Menlo Park, CA; 1997.

2. Burt MR, Aron LY, Schack LR. Family Planning Clinics: Current Status and Recent Changes in Services, Clients, Staffing, and Income Sources. A report prepared for the Kaiser Family Foundation. Washington, DC; 1994.