Men take responsibility for partner’s reproductive health

Vinh, Hanh, Sinh and Toan form an unlikely, nervous group in the heat of a small waiting area at a health clinic in Viet Nam’s Song Hong (Red River) Delta region.

They are businessmen, workers, middle-aged, and in their twenties. What unites them – and distinguishes them from many of their peers – is that they have all come to a non-government-run clinic with their wives, and have committed to paying a fee to ensure their partners remain healthy.

Sinh, a slim, moustachioed man, drove 10km o­n his motorbike to bring his wife to the clinic, which until last year was supported by UNFPA, the United Nations Population Fund, and has since proved sustainable enough to run o­n its own finances.

"(My wife) is four months pregnant with our third child," says Sinh, 47, with a twinkle in his eye. "She had an IUD (intrauterine device), but her health was very bad and they took it out… After the IUD was removed, we used the traditional method of counting days."

The ideal family size in Viet Nam, a rapidly developing country of 85 million, is four: mother, father, son and daughter. Before the pregnancy, Sinh’s family met this ideal. He has an 18-year-old daughter and a 14-year-old son.

"Still, we feel quite happy (about the coming baby). However, because of my wife’s age – she is 40 – we have to come here quite regularly," he says.

In the future, Sinh is willing to consider whatever contraceptive method is suggested by his wife’s doctor. But if that recommendation is condoms, Sinh is not sure he will comply.

The IUD is by far the most common method of family planning in Viet Nam, where 67 per cent of married couples use modern contraceptives. Condoms carry a stigma of promiscuity – a connotation UNFPA and the government are working to eradicate as sex before or outside of marriage becomes common and the number of HIV infections increases.

Health workers say this message is easier to convey to younger generations, a statement confirmed by discussions with the men in the clinic waiting room.

Twenty-seven-year-old Toan has been married to his high school sweetheart for two months. For them, like many of their peers around the world, careers are their top priority; children are wanted, but later. "I want to be involved not o­nly in bringing up my children, but my grandchildren as well," Toan says with a big smile, adding that the responsibility for family planning rests o­n both husband and wife. He is not embarrassed to say that in his household, condoms are the primary form of contraception.

Compared with his father’s generation of men, who were young during the American War in Viet Nam, Toan says his generation is benefiting from a more open society, a stronger economy and better access to sexual health information.

"But I think both generations of men worry about the health of their wives and their family."

Men want to know

According to Dr. Nguyen Thi Thanh Mai, head doctor at the clinic, many men are interested and want more information o­n reproductive health, but lack channels of communication and activities that target them specifically.

"I think we should have clubs for men so that we can share their ideas, their knowledge, and also so that they can receive information from health officials and other sectors," she says.

Dr. Mai does her best to involve men in maternal health. About half the women who visit the clinic come with their husbands, and 30-40 per cent of the centre’s telephone counselling clients are men.

While many men are still shy about being involved in reproductive health, these figures indicate that male involvement has risen in recent years. Staff at the clinic encourage the husbands of women who come with symptoms of sexually transmitted infections to undertake tests, treatment and counselling. Men whose families put pressure o­n their daughters-in-law to have sons are also invited for counselling.

The Viet Nam Family Planning Association (VINAFPA), a national non-governmental organisation that runs the clinic where Dr. Mai works, has supported the creation of a Club for the Advancement of Women that provides a forum for women, and open-minded men, to share their experiences and learn about issues ranging from domestic violence and family planning to micro financing and preventing the spread of avian influenza.

While UNFPA support for the Club has ended, the original idea has spawned 10 other clubs. As well, at least in the Vu Le Commune of Thai Binh’s Kien Xuong District, the club’s activities and messages seem to have hit home with the male leaders – an important starting point for wider changes in attitudes and behaviour.

"Before the club activities, there was domestic violence here. In the club meetings they discuss it, they share information and education materials, it’s discussed o­n the radio… and incidences of domestic violence have decreased," says Nguyen Tap, who chairs the commune’s People’s Committee. "If there is domestic violence, as community leaders we must prevent it to protect our women and children. As husbands, we must take care of our wives."

While most now seem to understand the damage physical violence causes, work remains to be done to combat sexual and psychological abuse, as well as a traditional preference for sons and discrimination of girls. In addition, not all communes in Viet Nam have as progressive a leadership or as informed a community as this o­ne.

"The biggest risk for health in general is a lack of information. Women are at the most risk when men lack information and knowledge because it leads to behaviours such as son preference and violence," says Dr. Mai.