For thirty-five years, family planning strategies to reduce unplanned pregnancy and STDs have focused almost exclusively on women: over 95% of Title X patients are female.

Young men with reproductive health concerns are generally referred to STD clinics. But as long as male reproductive health services are synonymous with STD screening rather than more comprehensive clinical services, it should come as no surprise to us that men take a diminished role in both preventing pregnancy and embracing fatherhood. In the wake of our country's recent celebration of Father's Day, we should examine the services we provide to young men if we want them to share in planning their families and the responsibilities of parenthood.

In 2003, Planned Parenthood of South Texas (PPST) received a five year grant from the Office of Population Affairs to explore how to increase male utilization of clinic services and increase male involvement in family planning.

PPST's initiative found men eager to be involved in family planning and willing to access traditional Title X clinics that make modifications to meet their needs. From 2003 through 2007, PPST's unduplicated male patients increased from 163 annually to 1,009. Changes in service delivery necessary to increase males' use of clinic services improved care for both male and female patients. While male clients grew from 4% to 17% of total patients, female patients increased by 34% from 3888 to over 4,883. Instead of driving women away, the addition of male services resulted in significant growth in female patients.

What does a family planning clinic offer that an STD clinic may not?

Clinicians in family planning clinic settings discuss not only condom use and STDs affecting men, but also specific information on female reproductive health, contraception and family planning. While a noninvasive STD/HIV check often is the "hook" that brings males in, male patients wanted to know how female methods of contraception work and how to share responsibility for prevention of pregnancy and STDs. Men expressed interest in becoming better partners by learning how to support a female partner's use of different contraceptive methods and how to communicate with women about sexual health issues. In addition to sexual health information, almost all men wanted the more comprehensive care available in family planning clinics.

Our clinic emphasized a theme of empowerment to overcome male reluctance to seeking care. Males responded to the idea they could control their health, that knowledge about contraception and STD prevention was powerful, and they could know their status regarding HIV, STDs, hypertension, cholesterol and diabetes. The project reinforced the positive benefits of regular preventive checkups for men at the family planning clinic -- as opposed to STD clinic visits, which all patients would rather avoid.

While community outreach by the clinic was important, the most effective marketing strategy to increase male patients was internal: female patients refer men to the clinic. These referrals included not only male partners but also brothers, family members and friends. Because women tell men when and where to get health care, both internal and external marketing targeted males and females.

How did our clinic become a comfortable and effective health care provider for men? First, the project conducted a "male friendliness" assessment, including a review of its mission statement, education materials, facility, clinical protocols, lab services, referral networks, job descriptions, staff attitudes and staff training. We opened a Men's Clinic within the Title X clinic, offering male-only hours and also accepting males any time the clinic was open. No new clinic personnel were hired; instead, women's health care nurse practitioners and medical assistants received training in male reproductive health care. Most importantly, the agency budgeted for non-invasive lab screening for Gonorrhea, Chlamydia and HIV. An inexpensive marketing campaign using fliers, posters, and free media targeted current patients and the community. Staff manned information tables at health fairs, concerts, sports events, work sites, clubs, the beach, prisons, military installations and campuses.

Minimal changes were made to the clinic's environment to be more welcoming to males, including the addition of magazines, posters, sports banners, and images that portray men positively. We changed the TV channel to something other than Lifetime. In exam rooms, staff hid the stirrups, which many men found frightening.

How was treating men different from treating women?

The highest priority for men was to be seen quickly: offering male-only hours was less important than being accessible. Because males walked out if the wait was too long, PPST had to streamline patient flow to reduce in-clinic waiting times by cross-training all staff in all services, including HIV, to increase efficiency. Male clients preferred shorter, more focused clinical services. If the male patient's immediate needs were met, he would come back for other services. The "shopping list" approach of education messages did not work well; it was important not to information dump.

Male patients were more anxious than females who know what to expect in a family planning visit. Staff needed to be more reassuring and anticipate questions men did not readily verbalize. PPST used both male and female clinicians, and many men preferred females.

Data gathered from male clients before their visits and through follow-up calls showed men had increased likelihood to seek preventive health care, increased awareness of emergency contraception, improved attitudes towards regular use of condoms, and increased knowledge of STDs and HIV prevention.

The clinic received new community support from donors interested in supporting male health services. Community partners who worked with the male target population also referred female clients, causing rapid growth in all clients. Most importantly, the males themselves referred female patients. The concept of shared responsibility for pregnancy and STD prevention became clearer to agency staff, male and female clients, and community supporters.

PPST's project demonstrates that providing male reproductive health care can attract new patients and broaden community support. It improves men's health status and can increase family planning compliance. Men who are included in family planning clinical services, who understand how female birth control works, who remind their partners to take the pill, who help pay for contraceptive costs, who accompany their partners to the clinic and accept shared responsibility for family planning are more likely to become good fathers than those whose first introduction to reproductive health care is the delivery room.

If we are going to solve unplanned pregnancy and prevent STDs, family planning providers must advocate for male clinical services: we are failing to serve half the population! It is a good investment for men, for women, and for public health.