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.