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."