The Role of Men in Contraceptive Decision-Making: Current Knowledge and Future Implications. (Special Report).

Although contraception has traditionally been the responsibility of women, men have been involved in decisions about contraception for centuries: Withdrawal is described in the Bible; (1) periodic abstinence was reportedly used in ancient India; (2) and the precursor to the condom--a decorative sheath worn over the penis by Egyptians--dates back to 1350 B. C. (3) These methods cannot be used without the complete cooperation of men.

Female contraceptive methods have also been used for centuries, but women did not gain reliable control of their reproductive capability until modem methods--the pill and the IUD--became widely available in the 1960s and 1970s. Along with the sexual freedom women achieved with the use of these methods came the responsibility for preventing pregnancy. Men, no longer required to use condoms or to practice withdrawal, were essentially absolved from contraceptive decisions.

Consequently, both researchers and service providers have focused almost exclusively on women. Even in studies of couples testing the efficacy of condoms, the women were taught how to use condoms, while their partners had no contact with instructors. (4) "Most of our focus has been on women, and men have been the silent partners," says Jacqueline Darroch Forrest, vice president for research at The Alan Guttmacher Institute (AGI). "We don't even have a term for men who are involved in a pregnancy."

Although some studies of sexual activity and contraceptive use have included men, (5) few have examined men's attitudes about contraception and pregnancy. It was not until recently, in response to the outbreak of AIDS and other sexually transmitted diseases (STDs) and to high rates of unintended pregnancy among teenagers, that researchers and program directors began looking at men's role in contraceptive decisions. Men, who are now being asked to use condoms to prevent the spread of STDs and who are being held financially responsible for any offspring, are gradually corning back into the picture. The challenge today is to bring men back into a realm from which they have been excluded for years.

Many questions about men and contraception remain unanswered: Should men be involved in contraceptive decision-making and, if so, to what extent? Do men want to be involved, or would they prefer to leave this responsibility to women? What are men's concerns regarding contraception and how do they differ from women's? Can services for men be provided by family planning clinics, which have focused on women since the pill became available?

To begin to answer some of these questions, AGI convened several prominent researchers, policymakers and program directors in September 1993 to exchange information about men's needs, desires and concerns regarding contraception and how their attitudes affect their sexual behavior and that of their partners. The discussion, which is part of a larger project being conducted by AGI to learn more about men and contraception and to bring new attention to the issues facing sexually active couples, also provided a forum for researchers and program providers to determine future directions involving men and reproductive health.

"While everyone uses a contraceptive method at some time in their life, people are using them poorly and haphazardly," says Jeannie I. Rosoff, president of AGI. "We have looked at structural barriers to providing family planning services, contraception in particular, but also legislation and the mechanics of service provision. We have not spent much time examining personal behavior and what's behind it. What is the transaction between men and women when contraceptives are not used?"