Table of Contents
The Concept of Family Planning
For quite some time in developing countries, family planning services have been almost directed at women exclusively with little attention paid to men.
Family planning is the concept or a program of limiting the size of families through the spacing or prevention of pregnancies, especially for economic reasons. Family planning allows individuals and couples to anticipate and attain the desired number of children and the spacing and timing of their births.
Family Planning Methods for Men
Men may choose their own contraceptive method for a variety of reasons, but perhaps none more important than relieving themselves of the emotional and financial burden unwanted pregnancies bring. Family planning methods for men either prevent sperm from leaving a man’s body, block it from entering a woman’s body, or render sperm immobile or interfere with its ability to fertilize an egg.
Abstinence: Abstinence is the least invasive and one of the most effective methods of birth control. But not everyone can maintain this practice. The problems lack of sexual contact can cause a relationship concerning intimacy and happiness are barriers to the success of this strategy.
Condoms: Condoms act as a physical barrier between sperm and the woman’s reproductive organs. Condoms can tear and carry an average 14 percent failure rate. Because the condom sheaths the entire penis, one of the chief complaints concerning its use is a reported lack of sensation. Caution also must be taken in handling the used condom to prevent transmitting sperm from the condom, or objects in contact with the condom, to the woman’s genital area.
The Pill: The most promising combination currently in development for a male contraceptive pill involves either the synthetic hormone desogestrel, or gestagen, along with testosterone. During trials, sperm counts have been found to drop to zero, making the pill more effective than almost any other form of contraception. It carries almost no side effects, with only minor weight gain reported in a small number of men for the desogestrel version. There have been reports of reversible shrinkage of the testicles in the gestagen combination. The biggest drawback to this method is the need to take a daily pill. Research is underway on an implanted version, as well as a cream and patch. Cost is expected to be equivalent to that of condoms. The results are reversible, but the drop in sperm count may take from a few weeks to four months to occur.
IVD: An Intra Vas Device is a series of silicone plugs, sutured to the wall of the vas deferens, the passageway of the system that carries sperm from the testicles to the urethra. The device was designed to stop sperm from passing outside the body. The effects take place relatively quickly, within a few ejaculations. Setbacks in development have included leakage as the vas deferens duct expands around the plugs. While the sperm count achieved is low enough to be considered infertile and the escaping sperm were rendered mostly immotile, increasing the number and size of the plugs are being considered to better these results. This method is preferable for those who wish to avoid more invasive methods of contraception. It is easy to reverse; however, damage from pressure, which may affect future fertility, is a concern. The potential for this increases with the length of time the plugs are in place.
RISUG (SMA): Reversible Inhibition of Sperm Under Guidance uses a polymer in part to physically block the vas deferens passage, but through charges present on the surface, it also renders sperm immotile. There is less concern about leakage, so a smaller amount of material can be used than with plugs and there are fewer concerns with pressure or its resulting damage. This method is almost immediately effective, reversible and considered minimally invasive, as it is accomplished through an injection. Reversal is slightly more invasive.
Chemical Sterilization: Chemical sterilization is a mildly invasive procedure where an injection introduces chemicals into the vas deferens. The resulting scarring prevents sperm from passing from a man’s body. Drawbacks to this method include a waiting period of several months for its effects to be realized. This form of sterilization is on par with the vasectomy in rates of reversal because of the unpredictable amount of scarring.
Vasectomy: Vasectomy remains one of the most invasive forms of male contraception, despite much progress over the history of the surgery. While the procedure is considered a minor surgery and done on an outpatient basis, it involves cutting, cauterizing and suturing of the vas deferens. The failure rate is considered to be low. The biggest drawback for most men is mental or emotional trauma and the effect on their perception of manhood. After a vasectomy, sperm is eventually seen as an invader and the body will begin to form antibodies against it. This can lead to blockages or ruptures in some cases. Vasectomy has a better rate of reversal with advances in microsurgery.
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Ways of Involving Men in Family Planning.
Understand power dynamics: Tackling male involvement in family planning requires applying a contextualized understanding of power and gender role dynamics. Family planning programs usually give little attention to the way that societal and cultural expectations of what it means to be a man or how gender-related power dynamics impact modern method use. But gender norms affect couple’s ability to discuss and make informed decisions about family planning and influence access to information and services.
Own the reality: for better or for worse, men are involved. When it comes to family planning (and sex), men are involved in one way or another – whether positively or negatively. Gender synchronized approaches recognize this reality by reaching out to men as well as women the way they live their lives, sometimes apart, sometimes together, but always in relation to each other. Men are underserved, yet many want to be engaged fathers and supportive partners. The global evidence is clear –family planning programs rarely reach men, and many men desire greater involvement in reproductive health. They need information and the opportunity to form positive attitudes and communication skills. However, there is limited space for men in most family planning programs. Some providers are uncomfortable with male clients and fail to welcome them or provide information.
Other strategies include target male involvement messages in posters, flyers, radio programs and wall paintings. Reach men where they are, through their networks. It may not be easy to reach men in the clinic, but they can be found in the work place, community and at home, especially during weekends and evenings. This requires organizational commitment to monitor and reward efforts to reach men and offer flexible work hours. Research from many settings around the world suggests that men receive much of their information and influence through peer networks. Men can and do participate positively in family planning. Men learn about contraception and talk about it with their partners. When done right, involving men in family planning yields huge benefits for women and families. Research suggests that interventions that involve men can lead to more gender equitable attitudes, better couple communication and improved contraceptive use and continuation.