The fact is that our efforts to heighten awareness and recognition of men's sexual and reproductive health have not been enough. If we want to move forward with policies and programs to reach young men, we need to start taking our agenda beyond the safe and familiar confines of the reproductive health community. Only then will we reach the health care providers, educators, youth group leaders, policymakers and other dedicated professionals who care about young men's sexual and reproductive health.
Realistically, we have to make the best of a situation in which men's sexual and reproductive health is not yet a high priority, certainly not when it comes to funding. The second-best solution, then, is to see how we can use existing funding streams directed at men and add a critically needed sexual and reproductive health component.
One area of particular promise may be the rapidly expanding federal and state initiatives to promote healthy marriage and responsible fatherhood. Congress has budgeted up to $150 million per year for five years for programs to help couples form and sustain healthy marriages, up to $50 million of which may be used to encourage responsible fatherhood. Unfortunately, sexual and reproductive health advocates and practitioners largely have been on the sidelines of these efforts, in part because these initiatives are backed by many of the same social conservative groups that promote abstinence-only education. It may be time to overcome our reluctance, however well-founded it may be. As our colleague Cynthia Dailard argued more than two years ago, we have much to contribute and need to take a seat at the table (PDF). Let's not just talk amongst ourselves, but start new conversations with folks who might not be used to chatting about reproductive health.
So, how can we link marriage and fatherhood initiatives with male sexual and reproductive health? One step to linking agendas is highlighting areas of common concern. Both the marriage and fatherhood initiatives strive for men's greater involvement in intimate family roles and behaviors. We share this overarching goal. We also share a belief in the value of efforts to improve relationship skills for adolescents and young adults, and we have valuable experience in teaching these skills. But as researchers and practitioners in reproductive health, we also know that making good decisions about when to become a father and being prepared in advance for that responsibility are just as important as being involved in your children's lives once they arrive. And we know that the promotion of contraceptive use and the prevention of unintended pregnancy (and unwanted or too-early fatherhood) are pathways to greater male involvement and to healthier relationships. These are messages that reproductive health advocates across the country need to take to their local crop of marriage and responsible fatherhood programs. Promoting these ideas can be an area of collaboration and can invigorate a positive view of male sexual and reproductive health. And that would be something to talk about!
]]>That perception, however, doesn't square with the facts. In the first place, teen males have become less and less sexually active ever since the late 1980s. Among 15-19-year-olds, the proportion who had ever had sex declined from 60 percent in 1988 to 46 percent in 2002, the same rate as among 15-19-year-old females. And it's not just the issue of whether they are having sex that has changed. Teen males are also having fewer sexual partners and are much more likely to use condoms.
So young men are making real strides toward greater sexual responsibility. But they're getting almost no credit for it, and, worse, a snapshot of current policies shows that we're actually making it more difficult for them to continue their progress as they make the transition toward adulthood and eventual fatherhood. As Father's Day (June 17) marks the culmination of "Men's Health Week," let's talk about how we could do a better job of supporting young men's health.
Consider these troubling facts: Only two out of three teen males received formal instruction about birth control in 2002, down from four out of five in 1995. At the same time, federal and state governments keep pouring millions of dollars into rigid abstinence-only-until-marriage programs that discourage contraceptive use, and that a major government-commissioned study has just found to have no beneficial impact whatsoever. And sadly, there is no comparable federal program to promote comprehensive sex education, which has not only been proven to delay the age of first sex, but also to promote protective behaviors for those teens who do become sexually active.
School-based sex education is a particularly important way to reach young males, since they are less likely than their female counterparts to talk with their parents or a doctor about sex. Boys lack the symbolic events that puberty brings for girls—bra shopping, for instance, or their first period that can start conversations with the adults in their lives. Comprehensive sex education can go a long way in getting young males the information they need to delay sex until they are more mature, and to protect themselves and have fewer sexual partners once they start having sex.
But inadequate sex education policies are far from the only way that we're failing to help young men. As boys cross into manhood, they often simply drop off the reproductive-health map. While most women in their 20s at least get annual checkups from their ob-gyns, their male counterparts have much poorer access to healthcare in general and sexual and reproductive health services in particular. There are several reasons for this, the most alarming being the fact that men in their 20s are the group most likely to be uninsured in the United States.
Some will say that 20-something men tend to be healthy and therefore have little need to see the doctor. But that view is shortsighted, considering that sexually transmitted diseases among men peak when they are in their 20s. Also, many men in their 20s settle down in relationships that require them to be partners in avoiding unplanned pregnancies and planning their families. And even when men aren't sick, think of all the preventive healthcare and screenings these men are going without.
So what's to be done? First and foremost, let's hear it for the boys and acknowledge the progress they've already made. And then let's start thinking about how to help them continue to move forward. This means more focus on reality-based sex education and better access to healthcare, in particular sexual and reproductive health services targeted at teenage and young adult men.
Such straightforward information and skills ultimately enable men to build healthy relationships and, among many other positive outcomes, to have children when they are financially and emotionally ready. We can help men continue the positive trends they are making, thus improving the lives of the men, their partners and their families.
]]>Editor's note: Originally published in The Boston Globe on June 12.