Status, Challenges and Prospects

(Executive Summary)

The involvement of men, one of the recommended courses of action in Cairo Conference (Ashford, 1995) and at the national front (Coliver, 1995; CLD, 1996; Ford Foundation, 1998), has been assessed as both important and urgent in women’s health initiatives. For one, almost all men (9 of every 10) are household heads (Population Reference Bureau, 1998) who exert considerable influence on dyadic and familial affairs impacting on women’s health. For another, men have greater propensities to bring problems to women, more specifically to their wives, because they desire greater sex, they multiple sexual partners, and they are the sources of violence.

This one-year national study which henceforth will be called MWPS98 (Men-Women Partnership Study 1998), is a pioneering attempt at documenting and examining the extent to which men are involved in women’s health project. With its findings, the study hopes to draw attention to and cultivate further interest in the integration of male in women’s health efforts in particular. The study examines the status, challenges, and prospects of male involvement in women’s health studies and action projects through a questionnaire survey, personal interviews, focus group discussions (FGDs), and document analysis.

The word “initiatives” pertains to research/studies or action projects/intervention. The term “women’s health initiative” refers to research or intervention where women from the communities were the target group or immediate beneficiaries. “ Male involvement” or “male participation”, is a defined using question: Were men included as respondents or discussants in studies in which women were the target group? Were they addressed as well as clientele in action projects where women were the target group? The women and men of interest in MWPS98 were aged 25 and older.

Although the national inquiry, through the questionnaire survey had identified women-related efforts from numerous health disciplines, the core concerns of MWPS98 were reproductive health (RH), STD/AIDS (SA), and domestic violence (DV). This limited coverage had to be adopted because of time and logistical constraints, but it was perceived sensible as well because two subjects - STD/AIDS and domestic violence - are relatively recent phenomena in the country, having been given greater social and scientific attention only during the early part of the 1990s. Reproductive health, which then was about family planning, has been a long-standing concern, with the national population program officially in 1970. In strict terms, reproductive health should subsume STD/AIDS and domestic violence, but this study had taken them individually because prevailing initiatives still see these three separately. At the health department, for instance, STD/AIDS and family planning are two independent programs. The studies and action projects or interventions covered were those completed or in progress between 1994 and the middle of 1998. To be considered as well as in study, interventions had to be community-based, and both research and interventions should at least have been of a one-year duration. MWPS98, while encompassing all the country’s regional urban centers and their peripheral communities for its questionnaire survey, delimited the geographic focus of its interviews and FGDs to five highly urbanized cities due to time and fund limitations. These cities were Metro Manila, Metro Cebu, Metro Davao, Iloilo City, and Cagayan De Oro, sites in which women’s health activities have been actively pursued.

Some of the salient findings of MWPS98 are:

Status

1. Of the 177 health projects surveyed, 51 or 29 percent were “women’s health projects” on RH, SA or DV, that is projects, which had women as the target group. Of the 51, the highest proportion were DV intervention (20) and RH studies (17).

2. These women’s health endeavors were undertaken in pursuit of predefined goals, some of which were broad and long -term; others were specific. Toward the fulfillment of their goals, programs and projects provided their target group with education, information, counseling, training, materials, or with temporary shelter and legal assistance, such as in the case of those in violent environments. A range of support strategies and approaches were utilized to reach stated projects goals, some of which, networking, advocacy and community outreach or organizing, were common across RH, SA, and DV projects. Other interventions, in their efforts to create greater impact on target groups, went to the extent of assisting individuals on matters concerning economic (livelihood or employment, for example), or domestic needs.

3. If interventions had either general or specific goals, women-related health studies on RH, SA or DV, on the other hand, had either basic or advanced goals. Most RH investigations were, in fact, basic: they delved into the descriptive examination of such subjects as sexual behavior, risk of childbearing, reproductive tract infections, contraceptives prevalence, nutritional and immunization status, and abortion. The few remaining RH studies were advance in that their focus was already on the assessment of program and projects services toward improving and expanding them, or toward determining their impact.

4. The overall implementers of these women’s health projects were NGOs and university-based research centers. Regardless of whatever it was RH, SA or DV, almost all research and intervention initiatives were undertaken in several cities across Luzon, Visayas, and Mindanao. A negligible number had regional, provincial, and/or rural geographic focus.

5. Were men involved in these women’s health projects? Of the 51 women’s project, 25 or 49 percent reported to have involved men. In RH, men had participated in nearly all 8 of the nine interventions, and six out of 17 studies. In domestic violence, male participation was considered in about a third (6) of 20 action projects, and the only two documented studies on the topic. All three STD/AIDS women-focused interventions were described to have taken into account men’s involvement.
The men involved were not necessarily the marital partners of female participants. Some were women’s co-residents (from varying economic and occupational backgrounds) residing in the communities where the programs or projects were being carried out.

6. In RH, male participation was peripheral in a number of instances: men as attendees in women’s on mothers’ classes or seminars, or recipients of information materials. On the other occasions, it was central, as in case of men whom attended counseling sessions together with their wives, served as resource speakers, or volunteered as community-based educators. In other circumstances it was substantive, certainly the most important, with men as condom and vasectomy acceptors.

7. In domestic violence action projects, the spheres f men’s involvement mainly consisted of men attending seminars or orientations, receiving educational materials, attending counseling or mediation sessions, or men becoming members of the community-based task forces or mediators. At other times, men were asked to encourage their wives to participate in relevant activities.

8. In STD/AIDS interventions, men, side from receiving educational materials, were motivated to use condoms or were users of condoms. In the majority of the other interventions (RH,SA, and DV), where men were the sole target group or co-target group of women, the patterns of their participation resembled many of those that characterized male participation in women’s health projects.

9. In research, Filipino men had assumed the roles of respondents, discussants or case study participants. A few had become members of the planning and implementing team of some studies.

10. Outside of the program and project context, men, at least in some dyadic and domestic relationships, were also reported to be giving their share in assisting their wives in household chores, and in child rearing and caring. Moreover, these men buy medicines for their wives; bring them, their children, and themselves to clinics for medical or physical check-ups; take care of their wives when they fall ill; or tell them not to overwork, or to eat properly and on time.

11. While efforts have been implemented, and a number of men have been involved in women-centered undertakings, the majority of Filipino men are still uninvolved in relevant programs or projects and in domestic chores. Men’s household-based roles have to be included as an added dimension of male involvement because these roles were the ones most strongly recommended by MWPS98 participants. Apart from this, the consideration of male participation in the household is apt because the assumption of such roles may help hasten men’s transition to assume other roles concerning FP practice, and SA and DV prevention.

Challenges

As to why few men participate in women-centered efforts, including domestics concerns, certain explanations were culled from MWPS98 interview and FGD data. These are categorized at either the a) community, familial, and psychological level, or the b) program or project level. Some core explanations:

a. Community, familial, and psychological

1. Men, due to cultural prescription, and through the school, family and media systems have the propensity to think that their roles are only to be economic providers. They thus see women’s health purely as their wives’ concern.

2. The involvement of many men in gambling, alcohol drinking, womanizing, or drug taking hinders them from engaging /n domestic activities or projects that have to do with their wives’ health, and also places their wives’ health at risk.

A handful of male respondents and discussants mentioned that some women were the sources other than the recipients of domestic violence, or that other women attend drinking or mahjong sessions more often than they do household and familial activities.

3. Men are uninvolved because they are preoccupied with other income-generating activities, or their employment. Men, as stressed, could not afford to lose a day’s income or economic opportunity to attend seminars or talks, or to visit clinics. Overall, there is a sense, as could be deduced from the interviews and discussions among men, that a number of them have the intention to be involved, but rigors of their occupation seem to over whelm and hinder them from carrying out such intentions.

4. Many men were generally regarded as plainly “ uninterested”, “lazy” or “unconcerned” about participating in RH, SA, and DV activities, research included the opinion was raised that it is the culture of the Filipinos to be forced so that they attend; that they are old to be taught; that they do not see any benefit to be derived from the activity; that they do not want their private life or personal secrets to be revealed and known by the whole community; that their masculinity may be threatened and questioned; that it is better for their wives to attend instead; that they do not know much about health and are not keen on knowing about it; or that they do not have any problem or do not see the issues being presented as problems.

5. Some managers and implementers attributed the lack of men’s participation to women themselves. They explained that there would be times when husbands would offer to assist their wives in household chores, or to use condoms, but their wives would easily dismiss such gestures.

6. Men tend to avoid women-centered activities for fear that their friends would ridicule them. Men are likely to succumb to the pressure, but there are those left unswayed.

b. Program and project level

1. Management does not recognize the importance and value of male participation, is seemingly reluctant about male involvement or unsure that male involvement will ever work, and is uncertain about male participation in women’s health concerns can be pursued.

2. At other times, the obstacle raised has nothing to do with the lack of management’s recognition, but with the inadequacy of resources to advocate or work for men’s participation. For instance, condom use cannot be promoted vigorously among sex workers and their male clients because sufficient condom supply for STD/AIDS prevention is not available. In domestic violence, as raised among male participants, there is a very limited number of male counselors.

3. Most men, according to MWPS98 participants and non-participants alike, do not attend women ‘s health project activities because they perceive that these activities are for women only, tackling purely women’s and not men’s issues.

4. Although few men would be supportive of their wives attending activities, the majority hesitates to give support to any effort aimed at making their wives aware of their rights and freedom, particularly in relation to domestic violence and reproductive health.

C. Prospects

The promises for the broadening of male involvement in women’s health initiatives requires macro-level efforts.

1. For the concept of male involvement to be recognized, applied, and then realized, the very first step is for organizations, at all levels, to integrate it into their aims objectives, and to consistently promote it whenever the opportunity exist. This suggestion may help organizations, at all levels, to integrate it into their aims and objectives, and to consistently promote it whenever the opportunity exists. This suggestion may help organizations increase their attraction and prospects for funding (of women’s health initiatives with male involvement) because it will convey that male is their core rather than just a consequential concern. It will also assist in modifying the image of many programs and projects, specifically RH and DV, about these being “for and by women only.”

2. It will be urgent that the groups conceptualizing and managing male involvement projects should be composed of both men and women; existing efforts are primarily women-led. It is even thought that a moderate male group can be formed. Moreover, it is felt that some women leaders currently active in RH, SA or DV initiatives should take moderate rather than extreme views about why men were being brought into picture.

3. There should be a corresponding and meaningful intent and action to develop and offer guidelines on what the concept is and how to carry out the strategy. Currently, national family planning and domestic violence programs have officially stipulated men’s participation as their strategy. Recently, the Department of Health announced its Philippine Reproductive Health Program, of which male involvement is its prominent feature.

Nowhere, however, in these initiatives has the meaning and definition of the concept, as a minimum requirement, been clarified.
A substantive protocol that will provide organization with ideas, insights, and recommendations on how to pursue and enhance the male involvement will heighten the promise of greater attention and action on the matter.

4. The immense networking and institutional linkages among these implementers, through which they share ideas, research and community organizing expertise and skills, will help ensure that male involvement will proceed as an issue within the development issue of women’s health.

MWPS98 data demonstrated that even with lack of technical and substantive guidance from the national programs, many of them had already initiated pertinent efforts. These groups are the ones that should be tapped to aggressively advance and realize male participation in women’s health activities. With the current national administration’s weak support of the population control program, it becomes clear that private sector has to take on a more vigorous participation in the implementation of RH projects.

5. It is enough that the program and project management and staff only have commitment and conviction. In MWPS98 and foreign-based data, increasing the prospects for male participation in women’s health calls for a thorough and substantive understanding of men, and numerous factors and conditions. This understanding cuts across varied and interrelated dimensions: psychological, individual, familial, economic, social, and cultural. The view is that the research community has only partially known the differing milieus within which Filipino men live, and this has hindered its consequent consideration in appropriate programs and projects. Nonetheless the few existing sets of data gathered from other countries and from MWPS98 suggest that knowledge on these milieus has to be integrated into design of the interventions.

Although the promise for expanding male involvement in women’s health activities may be enhanced by the foregoing approaches, corresponding work also has to be done at the societal level. It is underscored that much of the social realities inculcated among men and women - pertaining, for example, to gender roles and relationships, and to other beliefs and values - are conveyed among others, through the school and family system, and through the mass media. Some of these realities are beginning to communicate changing roles and relationships. For instance, a man on a television drama is being shown ironing or bringing a child to school. The mainstream messages, however, continue to perpetuate traditional beliefs and values, which are laden with all sorts of misconceptions.

It is the latter macro realities that are a cause for concern because they are incompatible with those conveyed by the program or project and deters the formation of desired values, beliefs, and behaviors. Condom use, for instance, is heavily promoted at the program or project level but men do not see or hear this behavioral norm among their male friends, nor do they see their favorite actor, while watching an action movie, reaching for a condom before making love to his leading lady. The whole idea here is that because society creates realities, there should be a macro-level effort to modify these realities and offer therein behavioral standards desired by programs or projects. The mass media, for one, can be used for this purpose. The whole concept does not require the development of special videos or media advertisements. Rather, it requires that ideas or situations be blended into appropriate life situations depicted on regular television dramas and comedies or movies.

Children and adolescents within the school system, they being future couples and parents, must be addressed in RH, SA or DV initiatives. Knowledge and value formation should be pursued among young. This is the opportune time to communicate to them appropriate messages so that these individuals grow up sympathetic to and accepting of RH, SA, and DV causes. When old and adult men seem to be unconcerned about and do not become involved in these social concerns, it is easy to understand them because RH, SA or DV are not part of their life schema, since they had no prior education on these matters when they were young. The promising note about young people nowadays, which can be crucial point for men’s involvement in the future, is that the gender relationships among them tend to be egalitarian.

In summary, men’s involvement in women’s health activities in the Philippines has already been initiated, but there are specific areas that necessitate attention and improvement. A committed and serious consideration of action on these areas likely to increase the prospects for greater funding of efforts with male participation, and the broadening of the number of male participants and the breadth of their participation.

FILIPINO MEN’S INVOLVEMENT IN WOMEN’S HEALTH INITIATIVES:
Status, Challenges and Prospects. Social Development Research Center, De La Salle University. Manila. A Philippine Council for Health Research and Development-Assisted Initiative.