Involve young men in preventing teen pregnancy: Draw them into your clinic
Young men open to message, but they aren't getting it from providers
Good news: More young men are using condoms for prevention of pregnancy and sexually transmitted diseases (STDs). More good news: Most teen males believe preventing pregnancy is a male responsibility and express a desire to use contraceptives.
The bad news? Although young men are interested in using contraceptives, they aren't using them consistently. And a national survey shows that only 32% of sexually experienced teen-age males and 17% of male virgins say they have received their contraceptive information from a health care provider. Instead, they say, the majority of the information comes from television or school.1 (See charts, pp. 99-100.)
If young men are willing to hear reproductive health messages, as well as put them into practice, why aren't there more young men in family planning examination rooms?
Only about 2% of federal Title X and Medicaid dollars are allocated for reproductive health services for young men, says Freya Sonenstein, PhD, director of the Population Study Center at the Urban Institute in Wash ing ton, DC, and lead author of the institute's Involving Males in Preventing Teen Pregnancy, a national reference guide for family planners.2
"Those amounts of money are really tiny," she says, "especially when you contrast it with the amount of money we are spending on the consequences of unintended pregnancy Just look at paternity establishment, how much we are paying on all of that. We should be paying sooner rather than later to prevent some of these pregnancies."
While family planners may agree that more money needs to be allocated for male services, many may hesitate in light of the risk of stretching already-thin dollars now spent on female services, says Claire Brindis, DrPH, director of the Center for Reproductive Health Policy Research at the University of California, San Francisco.
"The struggle in the field of family planning is that we have too little money to do programs," Brindis observes. "There are people who are concerned that now we are starting to think about how do we engage and integrate men more into the picture, [and] does that take away from the little resources that we have available to provide services for women?"
Given such funding restrictions, Brindis asks, how can family planners involve men in the partnership toward contraceptive utilization and disease prevention?
Involving the community
Many family planning clinics are finding innovative ways to partner with other community resources to reach young men. The commitment to providing male services means a clinic must be prepared to find alternate resources to fund its efforts, says Peggy Smith, PhD, director of the Baylor Teen Health Clinic in Houston.
"Very little reimbursement is for the male, so we have to find funding for male services," Smith says. "We do scramble for private funding. Anybody who raises money tells you it's not rocket science, but you have to have persistence, you have to have a good program, and you have to be persuasive."
Planned Parenthood of Southern New Jersey in Camden has been fortunate in securing grant money from the William Penn Foundation of Philadelphia to run its male-focused Teens on Track program, says Joyce Kurzweil, the agency's executive vice president. The annual budget for the program runs about $100,000, with the grant covering most of the operating costs. As the program matures, however, Planned Parenthood will be expected to find matching funds, says Kurzweil. (Read more about Camden and Houston's male teen programs, p. 101.)
Guide fills knowledge gap
The Urban Institute's new publication profiles 24 programs around the United States that have involved young men in pregnancy prevention efforts. Those programs, located in 14 states, have been in operation for at least three years, serving at least 50 males in the last year. Pregnancy prevention is an explicit primary or secondary objective, and the programs include information on the male role in reproduction.
Many of the programs have joined other facilities, such as recreation departments, to offer sports physicals and other services to get the message out on reproductive health care. By providing "value-added" services, family planners can reach beyond the clinic walls, tap into established community programs, and communicate directly with males on reproductive health services, Brindis says.
"We need to assess where there are places where men congregate already, and what are ways we can begin to integrate our messages with what is going on," she explains.
This assessment may lead family planners to connect with such diverse audiences as incarcerated youth or football teams. Going "where the boys are" is the key to engaging men in clinic services, whether they are provided on site or in the community, she says.
One common message shared among established programs is the need for male staff to put teens at ease about entering what many perceive as a "female-only" space. A study of California family planning clinics conducted by Brindis and other research associates found this strategy pays off in drawing young men into a clinic.3
"One of the things that was very effective was when men recognized when there were other men on the clinic staff," she recalls. "This begins not just within the clinic walls but also in the outreach in the community."
Once male outreach workers introduce young men to the clinic, the actual reproductive health services can be delivered by female providers. Brindis acknowledges that although it takes a financial commitment to hire male staff, the extra effort pays off by attracting more young men to the clinic. Male workers can serve as role models, which often are lacking in many young men's lives. That leads other community programs to seek out the male clinic outreach workers as well.
"We have found that, particularly for the school system, they very much appreciate the idea that we have males who can come in and talk to their kids," Kurzweil says. "The school nurses and school social workers have been extremely happy and have referred [young men] for one-on-one counseling."
With welfare reform's emphasis on child support enforcement, the strengthening of statutory rape laws to reduce teen pregnancies, and the efforts to stem the rise of HIV/AIDS comes a refocusing of national attention on the role of young men, Sonenstein says.
The emergence of new programs to engage young men in pregnancy and disease prevention can address those issues and, in turn, focus on the need to allocate more funds to male services without subtracting from female-directed dollars, Brindis adds. "We need to recognize that resources may be limited. The question is, how do we begin to build into the structure of a community a message that says, 'Hey, young men, you have a very valuable role to play. You can play it by putting on a condom, and/or you can play that role by being supportive of your partner by being sure you have a pregnancy- and disease-free adolescence or young adulthood.'"
References
1. Urban Institute. 1995 National Survey of Adolescent Males. Washington, DC; 1998.
2. Sonenstein FL, Stewart K, Lindberg LD, et al. Involving Males in Preventing Teen Pregnancy: A Guide for Program Planners. Washington, DC: Urban Institute; 1997.
3. Brindis C, Boggess J, Katsuranis F, et al. A profile of the adolescent male family planning client. Fam Plann Perspect 1998; 30:63-66, 68.
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