The first hospital to offer no-scalpel vasectomy services in La Paz, Bolivia, introduced its program in 1996. During the first year, one procedure was performed. The next year, there were none.

Why were the services so underutilized? Lack of available doctors was not a factor, since several doctors were trained in the technique before the program began. What was missing from the program, however, were other critical components, such as counseling, outreach, and use of educational materials.

The failure of this program reflects a larger problem throughout Bolivia, one relating to gender differences in access to and use of health care services. Though the national health and population policy mandates comprehensive reproductive health care for men and women, Bolivian men rarely seek health care services of any kind because most services are designed primarily for women and children. The only services offered to men are urology services, which focus on screening for sexually transmitted infections, and workplace-related services, such as for factory labor and mining.

To help fulfill the country's health care goals, nongovernmental organizations (NGOs) and health care administrators are now exploring ways to increase men's involvement in health care and family planning services.

Raising Gender Issues

There is a need to raise Bolivian men's awareness of gender issues as they relate to reproductive and sexual health. So says Jaime Telleria H., Executive Director of the Centro de Investigacion Social Tecnologia Apropriada y Capacitacion (CISTAC), a Bolivian NGO that focuses on research and training in health and social issues.

Discussions about gender issues and "macho" behavior are rare in Bolivia, where adherence to traditional gender roles is strong. But through research, training, and information dissemination, CISTAC aims ultimately to broaden the male role and identity in Bolivia, which will also affect men's access to and receipt of health care services.

Fostering Discussion

Taking a fundamental step toward achieving this goal, CISTAC and AVSC co-sponsored a workshop to educate health care program managers about the relationships between gender issues and men's involvement in reproductive health care.

In the three-day workshop, which was held last fall in La Paz, 30 men and women from public- and private-sector institutions discussed the effect of male socialization on men's development, the family, and the community; identified how these factors affect men's and women's health; examined the availability and use of health care services for men; and developed strategies to incorporate a gender perspective into these services.

Led by Benno de Keijzer, an educator and founder of Salud y Genero, a Mexican NGO, the training focused on male reproductive health, mental health, alcohol abuse, domestic violence, the development and exercise of male behavior, and the delivery and use of reproductive health and family planning services.

Action Plans

As part of the workshop, the participants developed action plans to incorporate what they learned into their programs.

After educating themselves further on these issues, they plan to alert policymakers and administrators of their institutions to the need for a balanced gender perspective in health care, as well as to the need to offer reproductive health services to men.

A working group formed to advance these issues at the political level, oversee research and training activities in male reproductive health and masculinity, and work with the media to disseminate information on these issues.

Changing Attitudes

Feedback on the workshop was extremely positive.

Telleria noted that the training helped the male participants see themselves as family planning users, partners in reproductive health, and active participants in their family's health, which many had not done before.

Rene Pereira, Bolivia's representative for Family Health International, found it valuable for the male participants to discuss and analyze how men help incorporate a gender perspective into health policy--not to increase machismo, but to work in concert with women. Specifically, he felt the training enabled the men to examine how they themselves have hindered or helped the delivery of services, as well as how they can contribute constructively to health policy based on a gender perspective.

He noted, however, that this effort will be fruitless unless a more concrete way to institutionalize these ideas is found. Though there is much work to be done, the workshop helped set the stage for future efforts aimed at fostering the greater participation of men and women in health care and family planning in Bolivia.

Andrea Eschen is assistant regional director for AVSC programs in Latin America and the Caribbean.