Family Planning — Is It Just A Girl Thing?

All this month we’ve talked about families and one thing is crystal clear.

It takes more than one person to make a family and though technically, intercourse isn’t even necessary anymore to make a baby, people are still having sex. Somebody gets together with somebody else and creates a baby that’s either welcomed into that family, adopted to another or finds some other way into its waiting parent’s arms. Some babies are planned, others are not, but either way, some aspect of family planning (or lack of it) is part of every family on earth.

A hundred years ago there were virtually no readily available, effective family planning options for women outside of abstinence and women frequently had a dozen kids. That’s still how it is for women and girls in developing countries where access to basic contraception and any form of reproductive health education to teach how babies are made is limited, unavailable or culturally unacceptable. Even as recently as 50 years ago, contraception in the developed world boiled down to just the pill, diaphragm and condoms and still today, many families can’t even get their hands on those. In countries with high levels of poverty and low access to healthcare, babies come whether they’re wanted or not.

Unplanned and closely spaced pregnancies are major contributors to high rates of maternal death, injury and other disabilities. When babies can be planned and spaced however, mothers enjoy a higher quality of life because their health is optimal. But even though maternal health involves women’s bodies, don’t men have some responsibility here too?

Today, most sexually active adults know they have options for preventing unwanted pregnancies (even if they don’t have access to those options or choose to disregard them), but we still have a very narrow contraceptive point of view. The pill, patch, ring, injections, implants, IUD, cervical cap, diaphragm and spermicide, Plan B, and tubal ligation all require women to take full responsibility for preventing unwanted pregnancies. And none of them except the female condom prevents STDs.

It’s no wonder then that most people think of family planning as a girl thing.

None of the contraceptive options currently available to women are inexpensive or affordable to every woman unless insurance covers it or they have access to a clinic that provides it at free or reduced cost. Most are easy enough to use and effective but many come with decidedly un-fun side-effects. Considering the alternative, few girls or women ever consider “fun” a factor when choosing between methods because if your contraception doesn’t work your options are limited and becoming increasingly restricted.

But what about the men? They’re half of the family equation, yet short of vasectomy, they only have one contraceptive option. Condoms are cheap, easy to use and effective at not only preventing unplanned pregnancies, but also infection and transmission of sexually transmitted disease. But despite all that, guys don’t want to use them because they spoil the fun. They don’t like them. According to the Gates Foundation, only 5% of men globally wear condoms, even though there are 2.5 million new H.I.V. infections each year.

Getting guys to take responsibility for family planning and STDs is an uphill battle and for many it’s a foregone conclusion that condoms aren’t going to happen. That hasn’t stopped the condom industry and public health officials from trying to entice them. In fact, a recent New York Times article described the lengths marketers and manufacturers go to make condoms attractive to men. “It takes just a peek at the online store Condomania to appreciate the variety of condoms out there. Flavors like island punch, banana split and bubble gum. Vibrating condom rings with batteries that last up to 20 minutes. Glow-in-the-dark condoms promising “30 minutes of glowing fun.”

One would think that with all those options, getting guys to use the things wouldn’t be such a big deal. Yet guys complain and many downright refuse to use them. The “showering with a raincoat on,” analogy is old news, even in this new world where a generation has grown up with HIV/AIDS. This quandary has public health and business experts asking how to turn this attitude around.

The Gates Foundation is investing heavily in research and development by hosting a contest for designs and ideas for condoms that enhance men’s sexual pleasure and make condom use a desired sexual accessory. They’ve received over 500 applications and winners will be awarded with large jackpots. As exciting as all these new condoms may be, they don’t answer the question of how to change long-standing attitudes about men’s responsibility in family planning. Is it really all about the next great condom or is it about a new way of thinking about gender roles and equality. Is it about bells and whistles or re-education, the fun factor or personal responsibility?

While we agree that finding enticements to make guys more willing to participate in family planning is a factor, we’d argue that investments in education and changing the culture around family planning as primarily a girl thing is even more important. Bottom line, family planning affects every body, male or female and every family. When babies are born into families with all the resources available to welcome and raise them, that’s when we’ll be able to affect deep and positive change. What’s the next step in family planning? We think it’s a guy thing.