A post-2020 Imperative: Help Boys and Men Embrace Sexual and Reproductive Health and Rights

The birds and the bees.

It is spring, and we are surrounded by sweet-smelling flowers and chirping birds — is it unreasonable to imagine harmonious, egalitarian relationships in which communication and mutual respect contribute to the achievement of health and reproductive goals? This Mother’s Day, my desire is that our world be transformed into a place where gender inequality and restrictive gender norms have become a thing of the past…everywhere. Getting to that dream requires that we do a better job addressing sexual and reproductive health and family planning, and that we integrate gender equality into all aspects of health, education, and other elements of human capital development. In 2030 I want gender equality and social norm change to be a mobilizing issue for young men — from my own adolescent son to all the young men around the world — from Maharashtra to Mississippi, from Washington to Ouagadougou.

As the sexual and reproductive health rights (SRHR) field has increasingly recognized, gender inequality and restrictive gender norms harm everyone by creating avoidable damage to health and wellbeing. Whether through norms that encourage male sexual exploration and female reticence; norms that constrain women’s access to information and the outside world; norms that sanction men’s physical, emotional, or sexual dominance over women; or norms that prioritize the nutritional needs of boys over girls, restrictive norms result in damage to health and wellbeing all around the world.

One important aspect of restrictive gender norms has been the tendency to highlight girls’ and women’s sexual and reproductive roles and sideline boys’ and men’s. While it’s true that the realities of reproductive physiology limit pregnancy to female bodies, so much of what conditions that experience is normative and cultural. Yes, girls and women give birth but in light of what we know about how conception happens, and the lasting implications of sexually transmitted infections, pregnancy or parenthood, how can sexual and reproductive health be treated as something only women should be concerned about?

The answer lies in norms: Gender norms pervade all aspects of our sexual and reproductive lives; they shape what it means to be “feminine” or “masculine”, and these meanings and expectations give rise in turn to behaviors, practices, and even institutions. The concept of gendered social norms can shed light on many aspects of relationship context, contraceptive use, health systems, and so on.

Between the sexual double standard (the moral code that permits sexual freedom for men and demands sexual restraint from women), the societal emphasis on women’s sexual and reproductive lives and men’s professional contributions, and the orientation of reproductive health services toward women, it is not surprising that men and boys do not see sexual and reproductive health as central to their lives. Changing this picture and engaging with men and boys more fully requires addressing norms on multiple fronts. As we think about the post-2020 global family planning agenda, advancing boys’ and men’s interest, caring and commitment requires us to prioritize engaging men and boys in sexual and reproductive health. Specifically, I think five key areas need special attention — not just to advance family planning, but to foster a more gender-equitable world.

First, comprehensive sexuality education must be expanded dramatically. It needs to start at an early age and extend into adulthood. Adults in many settings — parents, community leaders, political leaders — need comprehensive sexuality education at least as much — if not more — than younger people. Their lack of information and understanding prevents them from caring for themselves, informing their children, and developing care and solidarity for the younger generation. Age-appropriate content and adult support are essential to driving greater ownership of sexual and reproductive health among girls and boys.

While we are expanding comprehensive sexuality education, we also need to figure out how to talk about sexuality more openly and more readily, so that it doesn’t subliminally limit our actions and our programs. Sexuality is such a politically charged topic that programs that avoid it often cannot fully achieve their actual objectives. If we paid more attention to sexuality and pleasure, our lopsided focus on women would be more visible. And we could more effectively address a range of issues related to contraceptive use, including concerns about male sexuality that impede male method use, especially vasectomy.

Third, the sexual and reproductive health and rights field needs to find ways to pursue health and rights for all, while recognizing women’s greater needs in specific areas. Without simply adding men as additional clients, services need to orient themselves to everyone, not just women of childbearing age. We are still struggling with what constructive male engagement in sexual and reproductive health looks like in a program context — and it needs to be more than men as clients and men as supportive partners. We must identify ways that men can occupy more active roles as promoters and advocates for reproductive health and rights and gender equality.

Fourth, the programs currently working to address gender inequality and expand restrictive gender norms need to be documented and replicated. The sexual and reproductive health field has a comparatively large number of gender-transformative programs that improve a range of health outcomes. The close intertwining of gender norms and ideas about sexuality tells us that we have much to gain from addressing the norms that harm health. 
 Finally, research and measures of sexual and reproductive health and well-being need to reflect boys and men’s place more fully and realistically. The perception that attention to men and boys takes efforts and support away from efforts for women and girls is not entirely unfounded. We need to rethink how we approach the research, measurement, and program efforts and recognize that making big changes requires new ways of thinking and additional resources.
 As I think about the post-2020 global family planning agenda, it is clear to me that addressing gender norms and the engagement of men and boys needs to be prioritized. Without these changes, we won’t see the progress we hope for in advancing sexual and reproductive health. It’s easy to talk in the abstract, but let me come back to basics. Ultimately, the responsibility for changing attitudes toward gender equality, sexuality and reproduction is up to each of us. As the mother of a 13-year-old son, I am working hard to ensure that he knows all about sex and sexuality, that he communicates and prioritizes consent and mutuality, that in all of his relationships he lives out respect and affection for his partners, and that he recognizes the lifetime of impact his sexual and reproductive health decisions will have for him and for others. In short, that he sees sexual and reproductive health and rights as HIS BUSINESS. No small order, but we can do it.