Men at Family Planning Clinics: The New Patients? (Special Report).

The overwhelming majority of family planning clients in the United States axe women. A recent Urban Institute survey of publicly funded family planning clinics found that in only 13% of clinics do male patients comprise more than 10% of the total clientele; on average, just 6% of all clients are men. (1) Men represent an even smaller share of clients who receive family planning services subsidized by the federal government's Title X program (2% in 1991) or by Medicaid (2% in 1990). (2)

The family planning clinic system, when it was first developed in 1965, was oriented toward meeting the reproductive health needs of low-income women. Most of the clinic staff were women, their professional background was in women's reproduction, and the primary method prescribed was the pill. Indeed, the system's strengths were a sensitivity to the health and personal needs of women clients, a commitment to counseling and educating women, and a desire to promote the professional development of women clinicians and program administrators. Concentrating publicly supported reproductive services on women appeared to be good policy, because most effective contraceptives were female medical methods. Moreover, women are disproportionately affected by the negative consequences of unplanned pregnancies.

Now, however, there are several good reasons why family planning clinics might consider expanding their services to men. The rise in rates of sexually transmitted diseases (STDs) among clinic target populations has put pressure on clinics to serve men in two ways: to provide STD) testing and treatment for the partners of infected female patients; and to target men in condom education and distribution efforts, since condoms are the only effective method of preventing infection with the human immunodeficiency virus (HIV) and other STDs.

Another new pressure on clinics is the rapid expansion of managed care in the health care market. Medicaid, the largest single source of funding for subsidized family planning services in 1992, (3) has expanded the proportion of recipients who are enrolled in some type of managed care program from 2% in 1982 to 24% in 1992. (4) Some clinics are responding to these market pressures by broadening the scope of their services or by forging relationships with preferred provider systems. In some cases, providing services to men is part of this strategy.

A final change in the policy environment has been the recent emphasis on male responsibility in welfare and child support enforcement programs. Strengthening child support is an integral part of every welfare reform package currently under consideration by Congress. Some argue that if men will have to pay for the consequences of unplanned pregnancies and births, then it is time to provide publicly funded family planning services to them as well.

We know little, however, about how to deliver reproductive health services to men. Resource restrictions, predominantly female staff, negative staff attitudes and a lack of staff training are thought to be major barriers to including men in family planning services. (5) Only a handful of programs targeted to men or to couples have been tested, (6) and the one national initiative--a few demonstration projects to encourage male involvement funded by the Office of Family Planning in the late 1970s -- was deemed a failure because it did not attract many clients. (The exception was in San Francisco, where the gay population used the demonstration services for STD screening and treatment. (7)) Yet some evidence suggests that programs for men, especially adolescents, may be effective. (8)

This special report describes research that addresses the lack of knowledge on how to meet men's reproductive health needs. Using a national clinic survey, we identified family planning clinics that had made substantial efforts to serve men, and then documented how these clinics recruit male clients, deliver services to them and pay for these services. We hoped to uncover promising models of service delivery that could be adopted by other clinics interested in expanding their services to men.