Chapter 2, Section 5: Male Involvement

Boys and men are increasingly recognized as an important part of adolescent pregnancy prevention efforts and reproductive health programs in the United States, as well as in many countries around the globe. Male involvement programs are still relatively new and rigorous research evaluating these programs is lacking, but we do have some information about the role male involvement programs can and should play in preventing teen pregnancies.

Adolescent boys tend to initiate sexual behaviors earlier than girls do and have more sexual partners over their lifetimes (Sonenstein et al., 1997; Henry J. Kaiser Family Foundation, 1998). Most males have monogamous sexual relationships and over half of those who are sexually experienced have one or no sexual partners in a year (Sonenstein et al., 1997). Yet young males are much less likely than girls to access health care in general, or reproductive health care specifically (Armstrong et al., 1999). This is in part because there are so few services crafted specifically to meet their needs. More and more efforts are being made to reach boys in effective ways that build on their strengths and develop them more holistically.

Since teenage girls often have sexual relationships with males who are older than they are, more programming is needed for young men in their early 20s, who are more likely to be sexually experienced, more likely to be involved in a teen pregnancy and have higher rates of sexual risk behaviors than teen boys (Bradner, Ku & Lindberg, 2000). Programs that partner with local medical and healthcare clinics should assist providers in using any contact with male clients as opportunities to address reproductive health care and provide prevention information to young men.

Male involvement programs often take more of a youth development approach. One study of a multi-component youth development program that was highly successful for females found that the same program was unsuccessful for the males who participated (Philliber et al., 2002). The recommendations based on this study of the Children’s Aid Society-Carrera Program are that better outcomes may be achieved if programs begin working with males in pre-adolescence. The negative perceptions of providers have also been obstacles in being able to reach men in effective ways. Young males have often been seen as irresponsible or “the problem,” rather than part of the solution and possessing their own valid needs (AGI, 2002). New health care standards need to be developed for the reproductive and sexual health of males.

In order for male involvement programs to have more wide-reaching success, it is vital that they reach out to young men in alternative settings beyond school and health clinics, where they may spend more of their time and where those most disenfranchised can be found. Male involvement programs vary widely in scope and often involve crucial community partnerships and coalitions. In order to fully address the issue of men’s role in pregnancy prevention, it is important to provide a safe, comfortable, and culturally competent space for young men to get information and access to services.

Research Demonstrates

The following are important factors for successful male involvement programs: • Avoid stereotypes and tailor your message carefully to address the specific needs of males (Armstrong et al., 1999). Many young men are open to changing their reproductive health behaviors if given the information and opportunity. Scolding them or assuming they do not want positive outcomes is not helpful for
engaging them. Creating a clear male-positive philosophy and making sure everyone working in the program supports it is crucial so that message comes across in every encounter. A program’s ability to attract and maintain “a critical mass of male participants” may largely depend on the philosophical approach (Sonenstein et al., 1997).

• Design programs that are exclusively for teen boys and young men, not simply add-on services in a program designed for females (National Campaign to Prevent Teen Pregnancy, 1999). Tailor programs to the audience; males are different from females developmentally, emotionally, and physically. The Young Adult Clinic in New York City found that the only way to get men and boys in the door was to create the Young Men’s Clinic, a male-only session held once per week (Armstrong et al., 1999). Males need to know that their health needs are a priority in and of themselves.
• Offer job training and career services in addition to reproductive health services (National Campaign to Prevent Teen Pregnancy, 1999). Prevention programs that provide job training opportunities for young men increase self-esteem and respect, which helps them avoid teen pregnancy. Additionally, Armstrong et al. (1999) found that young men are more likely to access reproductive health care clinics when the social, economic, cultural, and health needs they consider to be important are addressed as well.
• Offer free condoms. There have been huge shifts in condom use among teenage males. In fact, condom use doubled between 1979 and 1988 with further increases in the 1990s (Sonenstein et al., 1997). Boys who participated in a high school condom availability program in Los Angeles reported using condoms every time they engaged in vaginal intercourse during the past year (Schuster, Bell, Berry, & Kanouse, 1997). Armstrong et al. (1999) found in their study of 529 young men who use the Young Men’s Clinic in New York City that repeat clinic visits were associated with increased condom use at the last sexual intercourse and increase partner communication about reproductive health matters. Still, many young men do not know how to properly use a condom (AGI, 2002), so it is important not to assume they do and to include information and practice whenever possible. Indeed, condoms are a primary and direct link between males and pregnancy prevention efforts.
• Hire male staff or “male friendly” female staff (National Campaign to Prevent Teen Pregnancy, 1999). It is important for all program staff to examine their attitudes and beliefs about adolescent males and their roles in adolescent pregnancy. Negative attitudes transmitted through nonverbal behaviors can quickly give a program the reputation of being “unfriendly.” Hire male staff to let participants know they are welcome and that they belong. Male staff are important role models for any program aimed at reaching young men.
• Assist young men in healthy fatherhood. Men need guidance and space to reflect
  on and develop their own positive roles as males, to define masculinity that supports responsible sexuality and parenting, and to work towards healthy relationship skills (Oregon Department of Human Services, 2003). Young fathers need communication and relationship skills to be a positive force in their children’s lives. Fathers who are involved in their children’s lives are less likely to have sons who become teen fathers themselves (Furstenberg, 1996). A study from The University of North Carolina found that daughters are less likely to engage in early sexual activity when their fathers spend time with them in activities and develop warm, close relationships with them (Harris, 1998). Responsible and engaged fathers can have positive effects on the reproductive and sexual lives of their children.
• Utilize mass media, especially television, to reach males (Bradner, Ku & Lindberg, 2000). Television and other media are a common source of health information for young males. One study showed that 91 percent of sexually experienced males ages 15 to 19 said that they got most of their information about contraception from television (Sonenstien et al., 1997). If the resources are available, savvy media campaigns can be an important tool for outreach to males, although it should not be the whole of prevention efforts or a substitute for interpersonal communication with service providers. Media may, however, be a first step in getting males involved in services. Media campaigns that include prevention messages around STI or HIV/AIDS may be helpful by addressing more pressing concerns of young men. Messages about STIs and HIV may get them to access health services. Once they are in the door, pregnancy prevention messages and overall reproductive health nurturance and guidance can occur.
• Work with teen couples to help them maintain responsible behaviors and communicate well (National Campaign to Prevent Teen Pregnancy, 1999). Few programs work with couples as units even though this approach is likely to have a positive effect because it puts the burden to prevent pregnancy on both partners and allows for both partners to hear the same information. Programs should work with young couples around communication skills and encourage them to make decisions about contraception use if they are becoming sexually active.
• Address substance use proactively. Teens who engage in one type of risky behavior are more likely to engage in other risky behaviors. Youth who start drinking or experimenting with drugs at an early age are also likely to have early sexual experiences (Kandel, 1990). Of teenage males who report using illegal drugs in the past 12 months, including marijuana, cocaine, crack, and injection drugs, three-fourths are sexually experienced (Sonenstein et al, 1997). The National Center on Addiction and Substance Abuse at Columbia University (1999) reports that nearly one quarter (23 percent) of sexually active teens and young adults ages 15 to 24 report having unprotected sex because of the use of alcohol or drugs at the time. Additionally, 29 percent said they “did more than they had planned” due to alcohol or other substance use. Males are more likely than females to report using alcohol or drugs at their last sexual encounter (CDC, 1999), which underlies a need to address connections between drug and alcohol use and sexual behavior with males.
• Deal with complex issues contributing to violence and sexual assault. A study showed that of women who reported experiencing a rape, 54 percent were younger than 18 at the time, while 22 percent were 12 years old or younger (Tjaden & Thoennes, 2000). The same study showed that nearly 75 percent of the men involved in rape or sexual assault against women were their intimate partners–be they husbands, boyfriends, or cohabiting partners. Complex social, cultural, and other factors pertaining to specific events contribute to male violence directed at women. Unfortunately, violence against women is common during pregnancy. In a survey of 14 states, it was found that 9 percent of women who had had a child in the previous 2 to 6 months had experienced some form of physical violence or abuse during their pregnancy. Women were more at risk for violence during pregnancy if they were teenagers (19 percent), if the pregnancy was unwanted (15 percent) or mistimed (13 percent), if they were black (14 percent), or unmarried (18 percent), if they were Medicaid recipients (21 percent), and if their partners did not want the pregnancy (24 percent) (Gazmararian et al., 2000). Violence is associated with unintended pregnancies and while further research is needed in this area, it is important to develop prevention strategies and interventions that can address the complex emotional and social issues that affect men who may cause a pregnancy. In addition to addressing men as perpetrators, men are also targets of sexual assault, which certainly affects men’s reproductive and sexual health.
• Create an inviting, male-positive environment. The environment of a clinic or other service center should display positive images of men and be an engaging space that men can feel comfortable and have fun in (Oregon Department of Human Services, 2003). Involve men in making the space their so that it truly reflects who they are and becomes a place where they want to spend their time.

Implementation Tips

• Gather information about the community and the male population before implementing your program through formal needs assessments, focus groups, or other informal feedback. Find out what participants are interested in.
• Consider the things that are important to males in your community and connect with those activities.
• Partner with a local sports league or community center that already has programs that attract males.
• Develop strong ties with the community and work to build trust and a positive working relationship.
• Use messages that are positive. Negative messages may put young men on the defensive and be ineffective.
• Hire and retain male staff.
• Create opportunities for young males to redefine “manliness” or what it means to “be a man” in their own terms. Having a male facilitator who can act as a positive role model and who is perceived by the young men as “manly” is important.
• Offer incentives for participation that appeal to males (movie tickets, gift certificates, music, CDs, etc.).

Male Involvement Program Assessment .pdf

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