Promundo (Shand), International Planned Parenthood Federation - IPPF (Zamir), Johns Hopkins University (Marcell), Greeneworks (Perlson)
"The Global Sexual and Reproductive Health Service Package... aims to increase the range and quality of sexual and reproductive services provided that meet the specific and diverse needs of men and adolescents boys."
This service package for providers of sexual and reproductive health (SRH) services from the International Planned Parenthood Federation and the United Nations Population Fund "takes a positive approach to SRH, seeing this not just as the absence of disease, but the positive expression of one's gender, sex and sexuality. In doing so, this service package contributes to efforts to ensure universal access to sexual and reproductive health and rights (SRHR) as prioritized in the Sustainable Development Goals."
Using a gender-transformative approach to scaling up the range and quality of SRH services tailored to men and boys to improve SRH for everyone, the intention is to engage men and boys in tackling gender inequality and promoting women's choices, in order that men and women are able to enjoy equitable, healthy
and happy relationships. The primary audience is clinical and non-clinical service providers. "The service package may be used in the following ways:
- To learn about the importance of addressing men’s SRH and the principles for this work;
- To understand the components of an organized approach to providing a package of SRH services for men and adolescent boys;
- To determine what SRH services for men and adolescent boys should be provided by an organization or where existing services should be improved;
- To scale-up and strengthen SRH service provision and programming for men and adolescent boys, through key building blocks and strategies to operationalize this package;
- To advocate for a stronger focus on this issue within the work of an organization; and
- To gain insights from country case studies on the work of IPPF and UNFPA in providing SRH services for men and adolescent boys."
Of the eight sections, section one is an overview; section two outlines building blocks to scaling up work on men and SRH; selection three outlines the SRH package; section four outlines elements in detail with links to guidelines, tools, and resources; section five looks at adolescent service delivery; section six provides steps for operationalising the framework; section seven provides case studies; and section eight provides resources for additional information and guidance.
As proposed in the service package, the seven building blocks to working on men's SRH are:
- Using a gender-transformative approach - to examine, question and change rigid gender norms and imbalances of power: "Gender-transformative approaches encourage critical awareness among men and women of gender roles and norms; promote the position of women; challenge the distribution of resources and allocation of duties between men and women; and/or address the power relationships between women and others in the community, such as service providers and traditional leaders."
- Delivering quality gender-sensitive SRH clinical services - that are available, accessible, and acceptable - safe, effective and reliable, acceptable/client-centred, timely, efficient and equitable, based upon client rights to information, choice, privacy, confidentiality, dignity, continuity and consistency. Services should encompass primary prevention and disease management.
- Meeting men’s diverse SRH needs often requires a different approach - recognising barriers that are economic, cultural, personal - including embarrassment, lack of knowledge, fear of shame and rejection, etc., and recognising the differing needs of men based on local disease prevalence and health issues of differing groups such as adolescents, bisexual and gay men, men who sell sex, men who live with HIV, men who inject drugs, and transgender people.
- Including a focus on young men and couples - adolescents and young men are establishing sexual norms, may be proving themselves within or outside cultural and religious beliefs, and may lack SRH knowledge. Group approaches and parent-child communication might be part of an approach to this age group. A couples approach can be a key entry point for engaging both partners in SRH care.
- Adapting to the context and local needs among men - "Important questions to consider include:
- What are barriers in the community to men accessing SRH services?
- Which national and local laws and policies advance men and adolescent boys’ SRH? Which national and local laws and policies hinder men and adolescent boys' SRH (e.g. criminalized relationships)?
- How and where is best to reach men?
- Among the components of this service package, what are best-suited to men’s needs within your context (given the need for services will vary by age and population, etc.)?"
- Building a committed organization and workforce - building policy and practice in an organisation can be done through existing templates (see Annex 6) "The IPPF Men-streaming Toolkit provides a helpful step by step guide to this process."
- Taking a primary prevention and integrated approach - A preventative approach increases men's knowledge at an early age and encourages engagement (including with partners) with the healthcare system whether local and/or clinic-based services.
Clinical and non-clinical services are described in section 3, and clinical services are detailed in section 4 with key activities and related guidelines and resources linked, for example: "Counsel client on how to support partner in preventing vertical transmission of HIV (if partner wants)" includes couples counselling and testing with a family-centred approach, supported by the document "Engaging men in HIV and AIDS at the service delivery level: A manual for service providers" from The ACQUIRE Project/EngenderHealth and Promundo. Section five lists service considerations: for adolescents, for example: combined fixed-site and mobile outreach; for clients of various sexual orientations, for example: take an open, non-judgmental sexual and social history; and for clients examining their gender identity, for example: get names and pronouns correct (ask discreetly if necessary).
Steps detailed in operationalising a service package include:
"Step 1. Assess your current situation
Step 2. Build capacity and skills, organizational commitment, and partnerships
Step 3. Design the programme
Step 4. Implement, monitor and evaluate the Action Plan."
Country case studies come from a vasectomy advocate in Togo, a participant of MenCare in Botswana who is fathering his two-month old, a couple in Bangladesh who delayed parenthood until they were ready, and an adolescent in Pakistan who sought treatment for a sexually transmitted infection (STI). Dpocument resources and annexes follow with links for supporting the service package.
UNFPA website, December 26 2017.