Research has been a critical part of AVSC's Men As Partners initiative. As one part of the initiative, a series of case studies were conducted in four countries, each on a different continent: Colombia, Pakistan, Uganda, and the United States. Over the past year, AVSC has collaborated with local organizations to chronicle the lessons learned while serving male clients in reproductive health sites in each of these locations.

Different Approaches

All of the case studies offer insight into serving men, both as part of a couple and as individual clients.

In each location, AVSC partnered with local organizations and interviewed a cross-section of providers - including physicians, nurses, counselors, and outreach workers. Some of the organizations have a network of services throughout their country, others provide services in one city or one facility.

Different Kinds of Services

The local organizations that participated in the case studies provided very different kinds of services for men. Some of the organizations focus on reaching male clients in certain age groups, whereas others are trying to reach them at all stages of their lives. While some are specifically trying to include men in family planning, others are trying to bring men into the larger arena of reproductive health.

The organization of services was also approached differently by the institutions in the studies. While some have experimented with integrated models for men's services - housing services for both women and men in the same facility - others have chosen to keep men's and women's services separate. Some use the provision of men's services as a way to subsidize services for women who cannot afford to pay, whereas others consider offering men's services as one step toward an ultimate goal of offering services to couples.

Whatever the rationale, location, or model, these programs are pioneers. They are fundamentally changing the landscape of reproductive health services.

Challenges to Conventional Wisdom

Gender of Provider

Many clinic administrators reported that, before establishing services for men, they felt that male clients would only be comfortable interacting with male providers.

However, findings from each country illustrated that clients most value a provider whom they feel is honest, respectful, and competent. Though cultural factors appear to play some role in whether men prefer to interact with a male provider, the gender of the provider was significantly less important than these traits.

In Colombia, Uganda, and the United States, the sex of the provider was never cited as a reason for a man to seek (or not seek) services. In fact, no male clients interviewed felt strongly that they would prefer to be seen by a male provider.

In Pakistan, cultural norms concerning the interaction between men and women suggest that male providers may be necessary, at least in the short term.

Services for Couples?

Although services designed for couples may be ideal in some settings, men and women may prefer to seek services as individual clients rather than as part of a couple, even when they are in a steady partnership or marriage.

A new focus on caring for couples as a unit has been gaining currency in the field of reproductive health, yet providers in the organizations in these studies advised caution.

According to a counselor in a Bogota clinic, it is critically important to respect the individuality of a client who seeks services and to let the client decide whether it might be beneficial to bring his or her partner into counseling. He stressed that couple-friendly care is an ideal that works for some clients, but not for all, and possibly not even for many.

Cultural Factors

In each country, cultural factors - usually religion or gender - were initially considered insurmountable barriers to serving men. Yet, in each location, providers expressed surprise that a cultural factor they expected to be an obstacle in fact was not.

In one high-crime, low-income neighborhood in New York City, a provider reported his own initial hesitation about beginning a program for young men, assuming that few would be interested in coming to the clinic. He was surprised at the program's success - the program now not only has a larger case load of male clients than it can possibly serve but has also fundamentally changed the neighborhood. This provider reported that the program had created a place where "young men can...come together [in a safe environment] socially...as well as taking care of their health care needs." "If we have a well-informed patient, we'll build a well-informed community," he reasons.

Outreach Programs

In addition to challenging some of the conventional beliefs about services for men, these programs have also provided lessons about new ways to reach and incorporate men constructively in reproductive health.

Many men, although they are interested in learning more about reproductive health - both for their own sake and for the sake of their partner - would not consider stopping by a clinic. Thus community outreach is a crucial part of providing services for men.

Traditional approaches to community outreach are effective in programs for men, but the case studies highlighted some other approaches as well.

For example, peer educators have traditionally played an important role in health outreach programs for adolescents and women. However, the programs studied suggest that satisfied male clients and their partners are also critical messengers for getting men constructively involved in reproductive health.

Another example concerned location of outreach services. The case studies showed that, if a health educator goes into areas where groups of men congregate, the men appear to be more likely to eventually visit a clinic for services.

Allocation of Resources

One of MAP's concerns is to protect women's health programs while building programs for men. This concern was also addressed in the case study research.

Although many argue that the allocation of resources for services to men ultimately takes away from services for women, two of the organizations studied consider services for male clients to be a revenue-generating mechanism for the administration of services for both women and men.

For example, a clinic in Bogota uses profits from their male-only clinic to subsidize services for women who cannot afford to pay full fee. As one provider explained, "The way I see it, we're in the business of helping as many people as we can ... if that means that some of the fees from men pay for some of the women to receive services, that's fine with me."

Sharing Lessons Learned

The case study data are now being fully analyzed so that a complete report can be made available to participants at the first MAP workshop, which will be held in Mombasa, Kenya, in May 1997.

Additional case study research from the Americas is now being developed for the second MAP workshop, which will be held in Latin America in 1998.

Mary Nell Wegner is special programs manager for AVSC International.