The eight innovative projects highlighted in this volume sought enhanced male participation and responsibility in three areas: family planning, other reproductive health areas and gender equality (Table 1).  In family planning, the participation was for interspousal communication and shared decision-making regarding contraception, and responsibility for using contraception.  In other reproductive health areas, it was for facilitating women's reproductive rights and responsibility for safe sexual behaviour.  Men were expected to support women in achieving gender equality and share in the consequences of their behaviour including household responsibilities and child-rearing.  In addition, men have their own needs for information and guidance regarding sexuality and reproductive health services.  To be supportive, men would need to acquire skills on how to make participative decisions and negotiate choices, skills which are often not intrinsic to male upbringing and socialization in many cultures.

The eight projects in this volume have emphasized men's participation, responsibilities and needs differently (Table 2).  The YPP project in Indonesia emphasized male participation and responsibility but did not focus on meeting men's needs.  The PSPI in the Philippines emphasized men's responsibility for contraception and safe sexual behaviour and established male clinics to meet their needs.  PROFAMILIA's emphasis was also similar to that of PSPI but, in addition, included men's participation in joint decision-making and guidance on sexuality.  The PPAG in Ghana has established Daddies' Clubs with a focus on family planning and safe sexual behaviour.  However, the topics covered reflected the perceived needs of men, and it now proposes to meet their information and guidance needs on sexuality.  The ZNFPC campaigns also emphasized family planning.  Although the social marketing project in Pakistan addressed the broad themes of male responsibility and participation, in Vietnam and Philippines the focus was on use of contraception both for family planning and of condoms for safe sexual behaviour.

None of the projects described here addressed issues of gender equality in a comprehensive manner.  Only the YPP and, to some extent, the social marketing project in Pakistan, emphasized the supportive role of men in gender equality.  The shared responsibility for household or child-rearing tasks or the effect of an altered gender power balance on men were not addressed.

Identification of Target Groups

The targeting decisions depended on the objectives, context and the nature of intervention.  The YPP addressed husbands of women farmers because of its context in the rural agricultural community.  The information activities of PSPI targeted tricycle drivers and factory workers, and the social marketing project in Philippines focused on the likely customers of commercial sex workers as one of their objectives is to promote safe sexual behaviour.  The PPAG project formed Daddies' Clubs in work places as a feeling of belonging is important to keep the clubs operating.  By virtue of their approach and intervention, the PROFAMILIA and PSPI male clinics, ZNFPC, and the social marketing projects in Pakistan and Vietnam did not target any specific groups but, instead, focus on the general male population.

Research as a Basis for Programming

As little was known about the male attitudes and behaviour from traditional health surveys or other information sources, research formed a basis for programming in all the projects.  However, the type of research varied:

• YPP used participatory action research to create awareness about reproductive health and rights, and empower women in protecting their own reproductive health.  A Participatory Rural Appraisal (PRA) research methodology was used to identify problems and needs, generate community participation and design programmes together with the community.
• PSPI used services of an independent anthropologist to study attitudes and behaviour of men as well as conducted formative research for tailoring communication messages and programme strategies.
• Extensive formative research is the basis of all social marketing efforts.
• The need for involving men was the motivation for PPAG, PROFAMILIA and ZNFPC.  They found that, although they had considerable influence over women's decisions to use contraception, men were not participating in family planning activities.  Therefore, both PPAG and PROFAMILIA began pilot projects and learnt from their experiences before expanding activities.
• The ZNFPC campaigns were carefully evaluated.

Strategies to Meet Information Needs

Provision of information was the major component of all the eight projects and included mass media campaigns, IEC activities in the community, advocacy, and counselling.  The ZNFPC and the three social marketing projects relied on mass media campaigns and used IEC materials and counselling as a back-up.  The clubs in the PPAG programme organized their own IEC activities and included a variety of means including lectures, group discussions, counselling, debates, symposia, film video shows and competitions.  The PROFAMILIA and PSPI male clinics emphasized counselling to meet men's information needs.  The research itself was used as a means of information provision by YPP.  In addition, it used training, extension, gender conscientization, assertiveness and self-reliance to deal with husbands and health providers, group dynamics, and consultation/counselling.  The PSPI conceptualized its communication materials with the guidance of an advertising agency, and all IEC materials were pretested to ensure sensitivity to local culture, language, and ease of comprehension.  Many programmes used social events for IEC/advocacy activities such as football tournaments (ZNFPC) and festivals (PSPI).

Several lessons can be learned from these experiences.  First, as mentioned earlier, formative research as a basis for IEC strategy and development of materials is a key to success.  Second, IEC activities have to be carried out at places where men are likely to congregate such as sports events or special events have to be created such as birthday meetings.  Third, cultural adaptation of IEC messages through experimentation is needed.  The messages may not always achieve what they are intended for.  The IEC materials need to focus on the characteristics, perceptions and expectation of men, even taking into account cultural diversity of regions where potential clients live.  Fourth, social marketing is an important strategy in condom promotion and utilization and should be a component of any national STD/AIDS prevention and control programme.  Fifth, men appreciate, even more than women, 'privacy' in counselling.  Finally, male staff are needed as communicators to men.

Services through Markets and Male Clinics

Unlike women, men have mobility in all cultures and can be reached in almost all public domains including markets. Home visits, a common feature of family planning programmes targeting women, are not necessary to reach men.  In principle, this should make it easier to reach them.  But the messages to be conveyed to men are sensitive, and therefore, services have to be unobtrusive.  Information and services should be available where men may go for other than reproductive health services such as for trading, recreation, and so on.

As men will also not like to go to places where women's services are provided unless accompanied by their wives or partners, male clinics are an important means of service delivery.  They can be stand-alone clinics, if the volume of services demanded makes them financially viable.  Otherwise, they have to share facilities and other resources with regular clinics, as the PROFAMILIA experience shows.

Reorientation/Recruitment of Staff

Most programme have historically recruited only women service providers.  Therefore if they are to reach men, then they have to recruit men to be service providers.  Although, as the PSPI experience shows, it is possible for paramedical women to counsel men, but programmes would need to recruit men for IEC, counselling and service provision.

It is necessary that the staff are not only motivated and understand the importance of male participation and responsibility, they should also have enough knowledge about sexual and reproductive health issues as well as beliefs, habits, needs and expectations of those served.  If they are to promote gender equality, then they must themselves be committed to that goal.

Mobilization of Financial Resources

As the experiences of innovations in this volume show, they are not financially self-reliant.  Although men have better access than women to money, it does not follow that they are willing to spend it to promote their participation or responsible behaviour with respect to family planning or reproductive health.  Thus it would be necessary for programmes to provide for the initial investment for creating demand and institutionalizing such needs and behaviour in the community.

Can the service delivery for men's contraceptive and other repro. ductive health needs become financially self-reliant?  The comparative experiences of PSPI and PROFAMILIA are instructive in this regard.  If there is sufficient demand and effective cost reduction measures are taken, then the subsidy requirements of these services will be minimal.  This suggests that the more comprehensive services are provided to both men and women through an outlet, the more likely it is to be financially viable.

Thus, although subsidy requirements of male-targeted programmes may be less than those for reaching women, they are not likely to be financially self-reliant at least in the near future.

Participatory Approach is a Must

In the PROFAMILIA, PSPI and social marketing projects, men have to act to avail themselves of the services.  They are not only passive recipients of services.  In the PROFAMILIA programme, while men attending services do not reveal this fact in public, they share in confidence their experience with friends or relatives.  In this way they not only promote the clinic's services but also bring up the issue of family planning and reproductive health as relevant topics of conversation among men.

The male involvement project of PPAG has shown that the best approach is the participatory method of involving men in family planning and reproductive/sexual health issues.  The education begins when people are willing to share and discuss their concerns freely and collectively work out action plans for resolving these concerns.  After the PPAG field workers have established a rapport with the target group of men, a Daddies Club is formed.  The staff and club members collectively draw up a workplan for the programme year.

The YPP approach goes even further.  It used participatory approaches to involve both men and women.  In the social mapping process, men became aware of the complaints experienced by women due to contraceptive devices.  In the community mobility discussion, the men realized that they were more mobile than the women.  Based on this analysis, the men agreed that their behaviour was not accepted and their needs on how to have better selfcontrol, and need for training in STDS, including HIV/AIDS, were identified.  Ranking of priority of problems to be tackled and needs to be met was developed by the community under the facilitation of YPP field workers.

Conclusion: Men Can Be Reached

The eight innovative projects documented here show how men can be reached (Figure 1).  Setting objectives would lead to targeting either specific segments of the male population or men generally.  Research would then be needed as a basis for designing specific programme interventions.  The programmes could consist of information provision through IEC and counselling, and services through special clinics.  Having appropriate human resources and financial investment for at least the initial phase will be necessary.  Careful evaluation of what is achieved would be necessary as the experience in the field is very limited.

These innovative projects prove that men can be reached, and once reached, they will enhance their participation and responsibility.  "Responsiveness to and support by the overall community for male programmes are evident and positive", as the PROFAMILIA experience shows.  It further shows that, "While it is true that those attending (clinic) for the first time show a frightened attitude, they usually express their gratitude and acknowledgment for the attention received by the time they leave the clinic"(pp 52).  As proven by the PSPI project, there is a market for male family planning acceptors in the Philippines.  The PPAG concludes that, "Men, when provided with adequate and appropriate information on family planning, and sexual/reproductive health issues will act positively to ensure the success of family planning programmes".  Witness the fact that condom sales through well conducted social marketing programmes continue to grow.

The ZNFPC campaign increased inter-spousal communication.  Before the campaign, only 41 percent of men and 37 percent of women reported discussing family planning often with their spouses or partners.  After the campaign, more than half (51 percent of men and 57 percent of women) did.  The joint decision-making for contraception also increase . In campaign areas 61 percent reported joint decision-making, as compared to 41 percent in noncampaign areas.  The YPP records that the process and results imply that men's participation can facilitate women's empowerment to enable them to exercise their reproductive rights.

However, there is a long way to go.  There are very few examples of the large-scale government programmes reaching men systematically.  Even NGO programmes are few and most. are small-scale efforts.  But as the documentation in this volume shows, men can be, and need to be, reached.