I am biased, I suppose. The fact is that whenever I consider the terms “sexual and reproductive health,” I first tend to speak and think of women’s health, and as an afterthought, the health of men. Now on some levels, this is understandable. Most obvious I suppose is the fact that I am a woman, so health issues that have direct bearing on my life as a woman become most significant to me. Additionally, gender imbalances in our society have often unfairly targeted women, or have left women out of their analyses altogether. Shifting this trend calls for analyses that focus on redressing that imbalance, hence my tendency to focus first on the lives of women.
What I’ve recently begun to question are the ways in which governments, policy planners and experts in the field also share this “afterthought” approach to men’s sexual health. What has been and will be the impact of such oversights on the sexual and reproductive lives of both men and women? And how do we ensure that we don’t lose sight of the multiple ways in which the two areas are linked? What is men’s sexual and reproductive health anyway?
I asked a physician friend of mine this question and received vague and uncertain replies, which came into sharp contrast with his grasp of women’s sexual and reproductive health needs. Given the culture of masculinity often associated characteristics of strength, control, promiscuity, how do planners and practitioners effectively target men to meet their needs?
In Jamaica, with national elections around the corner, politicians are busily promoting their stated future agendas, with the necessary rhetoric being spun around their plans for the reproductive health of the society. In the manifesto of the now ruling party, reproductive health is briefly addressed, promising increased “access to reproductive health information and services to men and women.”
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It is important that the manifesto does not collapse men’s sexual health into that of women’s, specifically including men in their focus. It is however insufficient, even in a bulleted point such as this one, to do so without giving even passing mention to how such efforts will take into account the specific, different and multiple needs of women and of men.
I grew up hearing promiscuous men being described as “village rams” or “hard men,” men that you should stay clear of, but who were nonetheless desirable because of their elusive nature. I grew up hearing that men should not cry, that boys and men will sleep around, that men should not show weakness (physical or otherwise). I grew up hearing that “normal” men only slept with women. In the Caribbean (and beyond I am sure), many of these cultural values still exist, and are passed unquestioningly from generation to generation.
Research suggests that young men in Jamaica are more likely than young women to be sexually active with multiple partners and to engage in “outside” sexual relationships (with persons other than their committed partner). Despite the fact that women often bear the brunt of the associated risk as a result of these behaviors (for example, increased susceptibility to the transmission of HIV/AIDS and other STIs), it does however point to an urgent need to incorporate re-definitions of male sexuality and behaviors. It points to the need to examine the power dynamic which helps to shape men’s (and women’s) use of contraceptives. It points to the need to interrogate masculinity and its associated ideas of strength, if we wish to encourage men’s interest in, and responsibility for their sexual health.
Policies also need to urgently take account of the fact that men do not only have sex with women. In a cultural climate that still challenges the “normalcy” and acceptability of homosexuality and bisexuality, how do planners and practitioners provide care for what is often a hidden or hard-to-access group of men? Research is a key step towards building a knowledge base on the lives of men who sleep with men (MSMs), and must in all ways seek to build on the knowledge and experience of MSMs, and importantly, to work towards the elimination of discrimination on the basis of sexual preference.
Men’s sexual and reproductive health is a largely under-explored territory. It is however important territory, not only for the benefit of men themselves, but also because healthier, more knowledgeable and involved men also make more cooperative and open sexual partners. Co-operative partners make wiser sexual decisions, and wiser sexual decisions save lives.