Family planning program not yet popular among men

Family planning program not yet popular among men

By Stevie Emilia

JAKARTA (JP): If you take a close look at a family planning
clinic in your neighborhood you will find that almost all of the
participants are women.

If you ask most men why they are reluctant to practice birth
control -- or, in the local jargon become an akseptor -- they
will probably say they support the state-sponsored family
planning program but are reluctant to actively participate in it.

Gunawan, an employee of a state bank, proudly said he joined
the family planning program three years after his marriage. Now,
he's been a member for nine years.

But it turns up that it is wife who is using one of the
available contraceptive methods for women, an intra-uterine
device (IUD).

"We both agree on the matter ... I told my wife I don't want
to use condoms because, you know, it will feel different...," the
37-year-old father of two told The Jakarta Post by phone.

The other recommended contraceptive for men -- a vasectomy --
is also not an option for Gunawan, although him and his wife have
no plans for more children.

"I won't do it for whatever reason .... What if something goes
wrong with the procedure? Or if the doctor is not skilled enough
(to perform the surgery)? I might get an infection. Or worse
still, if it's done wrongly, I'm history," Gunawan said.

According to a book titled Keluarga Berencana dari Perspektif
Perempuan (Family Planning from a Women's Perspective), a
vasectomy involves minor surgery with a low possibility of
failure and will not affect a man's sexual activity and desire.
It is also less complicated than a tubectomy.

However, due to the lack of information on family planning
which is targeted at men, it is little surprise that the program
is not popular among men. They are consequently reluctant to
become active participants.

"All this time, family planning services have been perceived
by the public as services intended for women," said
Attashendartini Habsjah, a senior researcher in a recent study on
male workers and reproductive health.

The study, whose results were presented during a recent media
discussion forum, was conducted by Atma Jaya Research Center in
cooperation with the Population Council Jakarta.

Based on research in Jakarta on five groups of 68 male
respondents aged between 25 and 35, the study aimed to explore,
among other things, male workers' knowledge of and perceptions of
reproductive health. Reproductive health does not only relate to
pregnancy or childbirth as is widely perceived, but also covers
issues like family planning, the health of the mother and child
and sexual health.

Reluctant

The study found that most husbands are aware of the issues but
their lack of knowledge of the programs, methods and side-effects
of contraception made them reluctant to practice birth control.

From in-depth interviews and focus group discussions held
during the study, it was found that the majority had never
thought of using contraceptives.

"In participating in the family planning program, wives are
the ones who are supposed to become akseptor. Some husbands were
willing to participate when their wives suffered complications or
problems," the study says.

Data also shows that condom is the most popular contraceptive
for men, while the vasectomy is not at all popular.

Apart from the lack of information, the lack of services and
facilities for men also contribute to men's low participation in
the program.

Male respondents revealed that family planning services and
counseling was directed at mothers and they had never been
invited to join counseling sessions, either at their work places
or in their neighborhoods. This has resulted in a limited
knowledge of male contraceptive methods apart from the use of the
condom.

"Knowledge of the vasectomy was minimal and often times
incorrect," said Attashendartini.

The study concluded there are several factors responsible for
low participation of men in family planning, namely, a minimal
knowledge of contraception; the unavailability of family planning
services for men and; the limited methods of male contraception.

Only 2 percent

According to the National Family Planning Board (BKKBN)'s
latest data, there are now over 27.7 million active members of
family planning program across the country. Out of these, only
541,651, or about 2 percent, are men.

Women can use either the contraceptive pill, contraceptive
injection, implant, IUD, or tubectomy as methods of avoiding
pregnancy.

Out of 27.1 million women who are taking part in the program,
over 9.7 million prefer injections, while 7.7 million take pills,
5.2 million use IUD, 3.1 million use implants, 1.2 million prefer
tubectomy and the remaining 9,957 use vaginal contraceptives.

Data from the Indonesian Planned Parenthood Association (PKBI)
-- a nonprofit organization founded in 1957 to educate the public
about population growth -- shows a similar trend: the low
participation of men in family planning programs.

Of 92,936 people visiting the association's clinics in 1999,
only 3,915 were men. Male participation has increased slightly
compared to 1998, when 2,329 out of 97,320 members were men. PKBI
data also shows that most of the men -- (3,034 in 1999 and 2,315
in 1998) preferred condoms to vasectomy.

Gender equality

"The problems which have arisen in Indonesia on the issue of
male participation in reproductive health are related to gender
equality issues. Moreover, men have the perception that their
participation in reproductive health is responsibility rather
than need," said Terence Hull, a senior researcher and lecturer
at the Australian National University's school of demography in
Canberra.

In a paper titled Engaging and Servicing Men in the Indonesian
Reproductive Health Program: Issues and Obstacles, Hull
highlighted several topics, including the need to popularize the
use of vasectomy and condoms.

"Vasectomies still need to be promoted directly to men,
including the benefits to their partners. The growing perception
is that vasectomy guarantees that men will not have children
anymore. With this perception, men tend to blame their wives in
cases of failure. In fact, technically, the failure rate with
vasectomy is between 5 percent to 9 percent," he said.

"Condoms, which have been perceived as reducing sexual
enjoyment, are associated with immorality. Condoms should be seen
as multipurpose devices -- contraception, disease control,
control of premature ejaculation and novelty in sexual
relations."

Reproductive health, however, does not only concern women.
Men, who have an important role in family decision-making
process, are urged to be actively involved in reproductive health
issues, including family planning.

In other countries, men's participation in family planning
programs is higher.

Pakistan's contraceptive prevalence survey in 1994-1995 showed
that out of 17.8 percent of those taking part in family planning
program, 14.1 percent of them were using male contraceptive
methods.

In Bangladesh, according to demographic and health survey in
1996-1997, 11.9 percent out of 49.2 percent of the family
planning program were male.

BKKBN's director in charge of promoting men's participation
Wandri Muchtar said his office was striving to improve the
situation.

"We aim to increase men's participation in the family planning
program to 10 percent by the year 2005."