IMPLEMENTATION GUIDE

IX. Conclusion

Reaching Men to Improve Reproductive Health for All Conference, 2003
Meeting objectives

The conference demonstrated the impressive progress that has been made in male involvement programming since the International Conference on Population and Development (ICPD) in Cairo (1994) and even since the Symposium in Oaxaca (1998). Presentations were chosen through a call for abstracts which attracted a response that surpassed all expectations. Almost three hundred abstracts were submitted for selection and over 80 of them were approved.

Feedback from participants and donors through word of mouth and formal evaluations indicates that the conference met its objective of increasing knowledge about effective strategies to work with men on reproductive health issues with a gender-equity perspective. This response came particularly from participants from developing countries, who represented local NGOs, rarely participate in international fora, but are working with men to reduce the spread of HIV/AIDS and address the problem of violence. Participants - especially those working in isolation - were grateful to connect with colleagues worldwide working on similar programs and for the opportunity to bring home IEC materials and other useful resources that are difficult to obtain in the field.
Such opportunities, together with a day of training workshops (which were well-attended despite the significant difficulties posed by Hurricane Isabel), furthered the third objective of the conference: to increase skills and access to tools for implementing program strategies.

Building consensus

To get rivulets to become streams to become tributaries to become great rivers will require for many if not most of us changes at the policy level to give national sanction to the work we do.
--Barry Chevannes

The conference confirmed the complexity of programming for men and the increasing awareness by program managers, designers, activists and gender equitable men and women that all levels of society have to be involved in institutionalizing these changes. This is evidenced by the involvement of stakeholders in the projects presented which ranged from political to religious and military leaders, to parents and adolescents.

Furthermore, the conference solidified general agreement on key factors of programming for men. Certainly, one of its most important contributions was to move towards broader consensus. There were a number of aspects where there was common agreement which were repeatedly mentioned. These were:

Programs can involve men in ways that support women and promote gender equity, but we are not there yet (Barker Introductory remarks, September 2003);
Knowledge is only the first step, changing attitudes and behaviors require long-term follow-up and support (Mosena, Peer Advocates for Health, September 2003);
Both men and women are interested in men's involvement during maternity care (Kunene, Men in Maternity Project, South Africa, September 2003);
Forming strategic alliances is critical to program success (Shrestha, MAP in four countries, September 2003);
The work of male involvement is personal and requires self reflection (Das, Keynote address, opening session, September 2003) at the individual and organizational level;
Men have to be engaged by allowing them to set their own agenda. They must be allowed the space and time to shape their own discourse (Chevannes, Keynote address, closing session, September 2003);
There is an urgent need for quantitative indicators to rigorously evaluate programs.

The conference succeeded in achieving a consensus by implementing several strategies that facilitated communication across countries, cultures and disciplines. The call for abstracts and its response served to consolidate the wealth of diverse experiences (e.g., country wide programs, pilot projects, or operation research studies). Once their abstracts were chosen, presenters worked with partners from the Task Force and Conference Advisory Group to assure high quality focused presentations. These peer to peer exchanges initiated relations between professionals working on common themes, yet strangers to each other. It helped raise the bar of expected outcomes months before the conference opened. Defining at the outset key issues that inform on program implementation facilitated disseminating information about what works, how to circumvent obstacles, who are critical stakeholders, how and when to attract them and convert them into advocates, the importance of monitoring and evaluation and what rigorous assessment and supervision entails. The "wrap-up" sessions at the end of each day, which challenged participants to apply what they learned, gave non-presenting participants an opportunity to share their knowledge and experiences. Finally, the firm belief among participants that mainstreaming gender in RH requires integrating men and that such an approach will reduce the spread of HIV/AIDS, unintended pregnancies, violence against women and improve the well being of men, women and children enabled participants to focus on lessons learned from current experiences and focus on the next steps that are critical for sustaining and institutionalizing such programs. The consensus building that permeated is reflected in the outcomes of a session held immediately after the closing ceremony where participants were charged with determining follow-up and next steps.

Future Directions for Involving Men in Reproductive Health

Before dispersing, participants met to discuss future directions for involving men in reproductive health and were divided into five groups: programming, policy and advocacy, networking, funding, and evaluation. The recommendations presented by each group are summarized below:

A. Programming

Although interventions should target men in different age groups, a special focus should be on youth aged 10-14 since this is the group that is most open to change and can help to facilitate new gender paradigms in the long-term. Additionally, programs should target not only young boys, but other groups in the community who play influential roles in their lives, such as caregivers, siblings, families, role models/ motivators.

The following approaches/strategies were suggested by participants for programs focusing on involving men in RH:

A focus on leadership development, specifically for men to be different kinds of men/leaders.
Programs should be based on the needs of young men/youth themselves and should recognize the different needs of men over their lifecycle.
Programs need to involve the community. Programmatic strategies should be "demand driven" and developed in dialog with the community, focusing on the issues that the community identifies.
Programs should encourage behavior change, but should build on positive behaviors that already exist. Other new and positive behaviors can emerge from the community itself.
Programs should focus on capacity building at the local level, with both with groups and individuals.
For programming related to HIV/STIs, activities should go beyond the Abstinence, Be Faithful, Condom Use (ABC) strategy, which participants considered to be narrow and "top down". Additional activities proposed included examining gender roles, social norms, educating and informing men and women about joint decision-making and communicating about such sensitive issues as safer sex.
Programs should encourage both same-sex as well as mixed sex groups in activities.
There should be a strong focus on sexuality and gender in programming for men's involvement in RH.

B. Policy & Advocacy

Provide advocacy training and capacity building around advocacy for those working in the field.

Strategies

Form a network of conference participants to develop a draft statement for the Commission on Status of Women (focus of which is men and boys and gender equality). The issue of men's roles as fathers is already being discussed. An immediate step would be to link with other advocacy groups working in this area such as Fathers Direct from the UK, which has developed documents for the UN on positive ways of engaging men as fathers.
Recruit legal communities, lawyers, faith-based organizations (FBOs), labor orgs, First Ladies (important in Latin America and Southeast Asia), visible leaders (e.g. Desmond Tutu).
Work with members of the social and economic justice community in Africa and in other parts of the world.
For policy leverage, focus on areas in which traditional versions of manhood lead to loss of human capacity, capital and lives (e.g., ask health economists to look at the costs of hegemonic masculinities such as men and substance use, accidents.) Use cost-benefit analyses as an advocacy tool.
Create innovative policies and frameworks that inform and obligate stakeholders to advance issues of men and RH across sectors (e.g., CEDAW).

Issues to Focus On

Advocacy around the inclusion of sexuality education in schools (focusing on gender issues/gender equity).
Antenatal parenting classes for men and women.
Violence prevention training for police, both preventing men's violence against women as well as effective ways of reducing violence between men.
Research existing multilateral lending, poverty reduction structures and health and education initiative to assess their possibility of being entry points for promoting male involvement and gender equity by involving men.
Draft a policy framework on the issues.
Advancing men as part of agenda using existing frameworks, including Education for All, CEDAW, among others.

C. Networking

Compendium of best practices and resources from this conference should be translated broadly and disseminated regionally (Best practices should be classified by categories).
Follow up with regional, sub regional and national groups working on this issue. If national groups do not exist, they should be created. Information exchanges at the regional or sub regional levels should be carried out by an organization that works directly in the area of men and RH, gender issues.
A global listserv could be created with regional subsections of this listserv; similarly, a web group could be created to focus on specific issues within male involvement.
The Reproductive Health Outlook (RHO) website could be made more accessible, perhaps a website could be created that focuses directly on men and RH.
Information should be shared with concerned groups, police, military, justice sectors, etc. Information packets should be developed for these groups.
Specific events (e.g. Father's day) should be used as moments to share information and to share information between large civil society groups of men. Rallying symbols should be found to unite such groups (e.g., White Ribbon Campaign).

D. Funding

Donors should be actively involved in leveraging other funds. Funders can challenge other donors, particularly private sector funders, to encourage other private sector groups to do the same, and to also serve as donors.
Donors should closely screen pilot efforts; look at how to scale up existing work by finding out what has already been done.
Donors should fund partnerships between NGOs and the public sector. Instead of funding only one sector, donors should fund a consortium of NGOs working with the public sector to engage the public sector to scale up. Community and youth should be included in this.
Donors should provide a long-term commitment especially to look at sustainability over a longer period of time and, in terms of research, to fund multi-year studies.
Donors should focus on funding collaborations between countries and sharing of information.
Donors should use various evaluation methods/multiple methods, not just narrow quantitative measures. Measures/methodologies should be developed in collaboration with grantees.
Donors should assist grantees to look at alternative income-generation/revenue generation.
Agencies should work with donors to inform them about this issue by finding opportunities to examine donor agendas and find ways that can match program goals and objectives.
Donors and agencies need to examine linkages broader developmental concerns and broader social justice issues that impede local development efforts.

E. Evaluation

Overall, there is a need for more assessment and use of biological markers as outcomes; less costly, more feasible.
A priori research should be built into programs as part of more rigorous evaluation.
Programs should triangulate evaluations by using both quantitative and qualitative indicators.
Evaluations should not only focus on indicators looking at attitudes but also on behavioral changes.
Programs should strive to identify some common indicators across projects; if possible, try to identify some measures/indicators that can be used across settings
Evaluations examining ranges of variation within a country are more important than comparing variations across countries.
Scales are useful to measure variability such as a range of gender norms in a given setting, but the scales must be relevant and grounded in a given cultural setting.

Chapter 8 | Annex
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