[Documents/Docheader.htm]The involvement of men, especially young men, in reproductive health
Doc. 10207
10 June 2004
Report
Committee on Equal Opportunities for Women and Men
Rapporteuse: Mrs Rosmarie Zapfl-Helbling, Switzerland, Group of the European People’s PartyFor debate in the Standing Committee — see Rule 15 of the Rules of Procedure
Summary
Traditionally, issues of reproductive health have been considered “women’s issues”, an area where men are the forgotten factor. As women are the ones who become pregnant, they have, all too often, been made to deal alone with the potential consequences of being sexually active – be it decisions on contraception or even abortion, or bearing and rearing children. Many men, especially those in stable relationships, do take on their share of responsibility for reproductive health choices and fully support their partners. However, even after the advent of HIV/AIDS, some men – especially young men – shirk their responsibilities.
There are several areas of reproductive health which should (and do) concern men as much as women: family planning, men’s sexual health (sexually transmitted diseases, including HIV/AIDS, and other illnesses such as cancer) and men’s reproductive health (especially the rise in male infertility). Men should thus be encouraged to get more involved in family planning and in looking after their own sexual and reproductive health.
To this end, education, information and advice on reproductive and sexual health has to be specifically targeted at men, as well as at women, and their needs. In particular, family planning providers, governments and NGOs should look at ways of reaching out to young men and supporting them in their reproductive and sexual health choices.
I. Draft resolution [Link to the adopted text]
1. Traditionally, issues of reproductive health have been considered “women’s issues”, an area where men are the forgotten factor. As women are the ones who become pregnant, they have, all too often, been made to deal alone with the potential consequences of being sexually active – be it decisions on contraception or even abortion, or bearing and rearing children. Many men, especially those in stable relationships, do take on their share of responsibility for reproductive health choices and fully support their partners. However, even after the advent of HIV/AIDS, some men – especially young men – shirk their responsibilities.
2. There are several areas of reproductive health which should (and do) concern men as much as women: family planning, men’s sexual health (sexually transmitted diseases, including HIV/AIDS, and other illnesses such as cancer) and men’s reproductive health (especially the rise in male infertility).
3. The Fifth World Conference for Women (Beijing 1995) Platform for Action recognised the need for men’s participation in sexual and reproductive health when it stated that “Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences”. On this basis,
issues of reproductive health should no longer be considered “women’s issues”. Men should be encouraged to get more involved in family planning and in looking after their own sexual and reproductive health.4. To this end, education, information and advice on reproductive and sexual health has to be specifically targeted at men, as well as at women, and their needs. In particular, family planning providers, governments and NGOs should look at ways of reaching out to young men and supporting them in their reproductive and sexual health choices.
5. The Parliamentary Assembly thus calls on the governments of Council of Europe member and observer states, in co-operation with appropriate partners, to:
put into place special awareness-raising programmes to encourage men – especially young men - to take responsibility for their sexual behaviour, understand and support women’s contraceptive choices and increase communication between partners;
promote condom use as a protection against sexually transmitted infections (including HIV/AIDS) and ensure that effective contraception is easily accessible at low cost to women and men, but especially young men and boys; target sex education programmes at young men and boys including in schools by professionals (for example from family planning clinics), helping them to become aware of their own sexual and reproductive health needs and related family issues, such as the necessity to avoid teenage pregnancies; improve men’s access to reproductive health services, ensuring that family planning services offer men-only sessions at their clinics as well as encouraging men to attend clinics with their partners; testing, treatment, advice and counselling on a range of sexually transmitted diseases (including HIV/AIDS), other genitor-urinary conditions and family planning should be available at such sessions; actively pursue research into new male contraceptive methods, as well as into the causes of and possible treatment for male infertility and genitor-urinary conditions; evaluate and review policy and practice on encouraging the involvement of men, especially young men, in reproductive and sexual health, with a view to reducing the incidence of sexually transmitted diseases, HIV/AIDS and improving men’s and women’s health. II. Explanatory memorandum by the Rapporteuse, Mrs Zapfl-Helbling
A. Introduction
1. Traditionally, issues of reproductive health have been considered “women’s issues”. In this arena, men are the forgotten factor. As women are the ones who become pregnant, they have, all too often, been made to deal alone with the potential consequences of being sexually active – be it decisions on contraception or even abortion, or bearing and rearing children. Many men, especially those in stable relationships, do take on their share of responsibility for reproductive health choices, and fully support their partners. But even after the advent of HIV/AIDS, some men – especially young men – shirk their responsibilities.
2. The reasons for this state of affairs are manifold: Perhaps too much emphasis has been put in the past, by policy-makers and the women’s movement alike, on women’s reproductive health problems and rights, as women were perceived as those primarily concerned. It is also possible that women have not always been able or wanted to share the responsibility for reproductive health choices with men – as this is one of the few areas where they feel in control in a patriarchal society. The reasons for the lack of interest on the part of men are complex. While the absence of specifically male-orientated education, information and advice on reproductive and sexual health has been a key factor, there are other strong social influences. For example, many boys learn to be men in societies like the UK where it is rare for men to show their feelings openly, to ask for help or admit that they do not know something or look after their health.[1] In Sweden the experience of working with boys and young men has identified both feelings of inferiority and dominance, which need to be broken down and understood.[2] In Georgia men remain constricted in ‘male’ roles of leadership, authority and male dignity and think that talking about contraception spoils the emotion and spontaneity of sexual relations[3].
3. There are several areas of reproductive health which should (and do) concern men as much as women: family planning, men’s sexual health, and men’s reproductive health, to name but a few. In this introductory memorandum, I intend to briefly sketch men’s involvement in reproductive health choices (such as contraception, vasectomy and abortion), the situation as regards men’s sexual health (sexually transmitted diseases, including HIV/AIDS, and other illnesses such as cancer), and the rise in male infertility. As a way of addressing some of these concerns, I would like to look at examples of work and activities currently being undertaken with young men in a number of Council of Europe member states. I would like to extend my heartfelt thanks to Ms Dilys Cossey, consultant expert (United Kingdom), who has helped me draft this explanatory memorandum in a field I attach much importance to.
B. Men’s involvement in family planning
4. The range of contraceptive options designed for use by men or requiring their active participation has been defined by the Program for Appropriate Technology in Health (PATH)
[4] as follows:Condoms
Female condoms Vasectomy (male sterilisation) Natural family planning Withdrawal
5. Of these the male and female condoms are the only methods which protect both against pregnancy and sexually transmitted infections (STIs), including HIV/AIDS
[5]. In Europe there is little evidence of use of the female condom but there have been many studies of its use in developing countries[6]. Natural family planning and withdrawal have the advantage of being hormone-free, readily available at no cost to the user and of promoting communication and co-operation between partners. Vasectomy is safe and highly effective but is not widely used[7]: The United Kingdom and the Netherlands are among the few countries in which more than 10% of the population of married women of reproductive age report relying on their husband’s sterilisation for contraception. In four more countries (Switzerland, Spain, Belgium and Denmark) 5% to 10% of couples have chosen this permanent method. While the failure rate of a vasectomy is less than 2%, the method is generally regarded as permanent, not easily reversible and usually requires an operation.[8].6. However, we are in the era of HIV/AIDS and rapidly increasing incidence of STIs. If we are to be realistic about men’s involvement and responsibility in family planning then we must begin with promoting the use of condoms as the most effective barrier method for protection against HIV/AIDS, STIs and for planning pregnancies. Many socio-cultural barriers are associated with male condom use. Research shows that the numbers of couples who rely on this method and who use it correctly are consistently low
[9]. Using a condom correctly demands self-confidence and a degree of openness between two people. And myths about the condom die hard.[10] Vulnerable individuals can be easily dissuaded by authoritative voices putting out misinformation.7. Other methods of male contraception, including hormonal, are not yet commercially available, but experiments are being made with a variety of compounds, some of which sound promising
[11]. Research is continuing on the following permanent and reversible methods:Injections, implants and pills that provide hormones to alter men’s fertility
Methods that block the vas deferens Methods that use heat to inactivate spermatozoa Non-hormonal systemic methods Improvements in existing barrier methods. 8. However, PATH comments that methods under development will require at least 10 more years of research and testing before they are ready for introduction
[12]. A report in the UK paper The Guardian (21 February 2004) describes research trials on a progestogen implant for men taking place in London and Manchester. The outlook is, if these trials prove successful, that ‘the first male contraceptive could be on the market within five years’.9. While the development of male contraceptive technologies is an important component in promoting male partnerships in reproductive health, this is essentially long-term. A broader agenda also needs to be addressed immediately: one that would include social and behavioural aspects of men’s attitudes and roles in family planning. In the words of the report of the five-year follow-up of the implementation of the Programme of Action of the 1994 Cairo International Conference on Population and Development (ICPD): ‘all leaders at all levels, as well as parents and educators, should promote positive male role models that facilitate boys to become gender-sensitive adults and enable men to support, promote and respect women’s sexual and reproductive health and reproductive rights …. Men should take responsibility for their own reproductive and sexual behaviour and health
[13]’.10. It is in this spirit that men should be encouraged to support their female partners who wish to use a contraceptive method to plan their families, and/or to use a method of contraception themselves. In particular, men should be involved in the consequences of contraceptive failure
[14], i.e. unintended pregnancies. This is, in fact, a sensitive and difficult topic both for women and men, and where strong views are held. Once a woman becomes pregnant she has three choices: to carry the pregnancy to term and bring the child up afterwards either on her own or with a partner; to give up the child for adoption; to terminate the pregnancy. Ultimately such decisions can only be taken by the woman herself and will depend on her personal circumstances. Ideally, however, these decisions should be taken together with the father of the child, or at the very least, with the father supporting both psychologically and financially the woman’s decision. In any case, no woman should be coerced by a man into having an abortion against her will. Men should also be encouraged to take an interest in their child once born, and, if appropriate, to participate in its upbringing.11. It is important to point out that in a number of Council of Europe member states, abortion is a major method of fertility control. Women who resort frequently to abortion can suffer health consequences, including infertility. But evidence from countries like Russia demonstrates that provision of contraceptive services can significantly reduce the need to rely on abortion for planning families. Men’s involvement in family planning is an essential and highly desirable contribution to this reduction. It is thus very important that effective contraception is easily accessible at low cost to women and men, but especially young men and boys.
C. Men’s sexual health
12. Men’s sexual health is one of the last taboo subjects, even amongst men themselves. Greater openness on this issue could, in fact, save lives, as the survival rates for such illnesses as testicular cancer (which mainly affects young men) and prostate cancer (which mainly affects older men) are influenced by early diagnosis and treatment.
13. Men’s attitude towards looking after their health can be careless. The result is that they are more likely to die earlier than women. A study carried out by the European Men’s Health Forum on the state of men’s health across 17 Western European countries
[15] (15 EU countries plus Norway and Switzerland) showed that 50% of the 190,500,000 men across these countries would die before they were 75 compared with 25% of women. Three major factors were identified as influencing men’s high degree of premature death: their increased vulnerability to major diseases; their risk-taking lifestyles (alcohol consumption and smoking); their reluctance to seek help with health problems. In this scenario it is not surprising if sexual health is low on the agenda.14. Specific sexual health problems for men include: sexually transmitted infections (genital warts, genital herpes, gonorrhoea, syphilis, chlamydia), hepatitis B and C, HIV/AIDS, testicular cancer and prostate cancer. Alleviation of all these conditions can be significantly influenced by early diagnosis and treatment.
15. There has been a general decline in the incidence of syphilis and gonococcal infection over the last twenty years, but a reversal of this trend is currently being observed in several countries
[16]. UNAIDS comments that the ‘resurgence of other sexually transmitted infections in … Western Europe.. points to a revival of high-risk sexual behaviour – especially among young people, including men who have sex with men..’[17] In the UK there have been increases in gonorrhoea, chlamydia and genital warts[18]. While the incidence of syphilis in Sweden has remained at the same level, in the Russian Federation syphilis increased dramatically from <30 cases per 100,000 in 1978-1992 to 172 per 100,000 in 1995. Also in the Russian Federation gonorrhoea rose from 75 cases per 100,000 in 1987 to 236 cases in 1993 and while official figures indicated a decrease to 165 cases per 100,000 in 1995, UNAIDS states that ‘underreporting of gonorrhoea is believed to be substantial’[19]. Dramatic increases in syphilis have also taken place inEstonia: <10 cases per 100,000 in 1982-90 to 70 per 100,000 in 1995; Lithuania: <10 cases per 100,000 in 1983-91 to 86.5 per 100,000 in 1995; Ukraine: <10 cases per 100,000 in 1990 to 118 per 100,000 in 1995, with some regions reaching 220 per 100,000; in 1995 alone over 60,000 new cases were reported[20].
These figures are grounds for grave concern, as sufferers from STIs are more vulnerable to catching HIV/AIDS.
16. An associated health problem is the incidence of hepatitis B and C, an inflammation of the liver, which can lead to cirrhosis of the liver and liver cancer. It is transmitted through unprotected sex and contaminated needles. In 1997 WHO estimated that hepatitis B and C was moderately prevalent in Eastern and Southern Europe and the
Russian Federation.[21] However, a study in March 2003 reviewing the incidence of hepatitis B in St Petersburg between 1994 and 1999, concluded that it was ‘thought to be an expanding health problem in Russia’[22]17. According to the most recent AIDS epidemic update by the World Health Organisation
[23], HIV prevalence continues to rise in the Baltic States, the Russian Federation, Ukraine and Moldova. The report says: “Driving these epidemics is widespread risky behaviour – injecting drug use and unsafe sex – among young people. … Young people predominate in this region among reported HIV cases.”[24] In the Russian Federation, most HIV infections are occurring through the use of contaminated equipment when injecting drugs, with young men bearing the epidemic’s brunt – and, according to one survey in that country, fewer than half of teenagers aged 16 to 20 used condoms when having sex with casual partners[25].18. Over 1.5 million people are living with HIV in Eastern Europe compared to only 30,000 in 1995
[26]. In Western Europe, according to UNAIDS, the number of annual AIDS deaths has continued to slow due to the widespread availability of antiretroviral treatment. But UNAIDS also reports ‘mounting evidence that prevention activities in several high-income countries are not keeping pace with the changes occurring in the spread of HIV. Such shortcomings are most evident where HIV is lodged also among marginalized sections of populations, including immigrants and refugees’.[27] This view was underlined at the February 2004 Ministerial conference hosted by the Irish EU Presidency in Dublin ‘Breaking the Barriers – Partnership to fight HIV/AIDS in Europe and Asia’ by Dr Peter Piot, UNAIDS Director, when he said ‘Europe and Central Asia are at the centre of the fastest growing HIV epidemic in the world. There is no time to waste’[28]19. Figures indicate that of adults (15-49) living with HIV/AIDS at the end of 2001 the majority were men, for example:
The Russian Federation: 520,000 men out of a total of 700,000 adults;
Moldova: 4,300 of 5,500; Ukraine: 174,000 out of 250,000; Estonia: 6,200 out of 7,700; Latvia: 4,000 out of 5,000 Lithuania: 1,040 out of 1,300; UK: 26,600 out of 34,000; Sweden: 2,420 out of 3,300 Portugal: 20,900 out of 26,000[29] 20. The findings of the European Men’s Health Forum study showed that prostate cancer is becoming more common than lung cancer among men and is now the second most important cause of deaths through malignancy in men (over 3% of deaths in the 17 countries surveyed). Sweden has the highest proportion of total male deaths due to prostate cancer, while
Greece has the lowest. Although deaths from prostate cancer occur most frequently in the over 65-age group there is still a significant number of deaths in the younger age group. For young men, however, the incidence of testicular cancer, although small, is increasing. But the death rate is decreasing, as early diagnosis and treatment is almost always successful.[30]21. One of our colleagues, Mrs H�gg from
Sweden, has raised the issue of male circumcision. It seems that especially in some immigrant communities, male circumcision is carried out on young boys by unqualified practitioners in unsanitary environments, which can lead to sexual health problems for these boys later on in life. It is thus important that practitioners be suitably qualified and accredited.D. Men’s reproductive health
22. The Programme of Action adopted at the 1994 Cairo International Conference on Population and Development (ICPD) defined reproductive health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system …Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so…’.
[31]. In this context male infertility is relevant to the ‘capability’ of people to decide the number and spacing of their children.23. Male infertility can be described as the inability to conceive a child after 12 months of unprotected sex in the absence of female causes, a low sperm count, the presence of greater than 50% abnormal sperm and the inability of the sperm to impregnate the egg. The World Health Organisation (WHO) estimates that infertility affects more than 80 million people worldwide, and that, in general, one in ten couples experiences primary or secondary infertility
[32]. And while women’s fertility problems have been more fully investigated than men’s problems, men are the sole cause or a contributing factor to infertility in more than half of couples[33].24. Although most of those who suffer from infertility live in the developing world, there is growing concern that male infertility is increasing in Europe. Research from Denmark
in 1992[34] presented a worldwide perspective on the decline in male fertility. Further research from Denmark in 2000[35] which tested 708 Danish men reporting for a compulsory military medical examination found that 43% of them had sperm counts low enough to lead to decreased fertility. A study in Paris 1995[36] concluded that, during the past 20 years, there had been a decline in sperm concentration and motility and in the percentage of morphologically normal spermatozoa in fertile men, independent of their age. By contrast a study in Toulouse 1996[37] found that sperm concentration in the Toulouse area had not changed between 1977 and 1992; it was suggested that the discrepancy in the findings could be explained by different environmental conditions noted between the two areas. Geographical differences in male fertility were also demonstrated in a study of nearly 1000 young men in the Nordic-Baltic area examining a possible link between testicular cancer and infertility[38].The conclusions of a further study comparing Sweden and Denmark also bore out geographical differences[39]. Research in Spain in 1999 examining semen quality in 22,759 infertile men over a 36-year period showed no evidence of deterioration in quality although there was a statistically significant decline in percentage of normal spermatozoa[40]. A more recent study of 7,500 men attending a fertility clinic in Aberdeen, Scotland, between 1989 and 2002 showed that sperm concentration had fallen significantly[41].25. A number of factors underlie this decline in male fertility: sexually transmitted infections, personal lifestyles and environmental factors, including working conditions and pollution.
26. Infection by sexually transmitted infections (STIs) can impair a man’s fertility. For example, there are concerns that chlamydia (a ‘silent infection’ which has no symptoms), usually considered as particularly detrimental to women’s fertility, may also affect men’s fertility. While a recent review of literature
[42] to assess the evidence for and against the role of chlamydia in male infertility concluded that there appeared to be no conclusive evidence between infection and male infertility, this is a serious problem given the considerable risk of infecting the female partner. The incidence of chlamydia is currently rising, especially among young people. For example in the UK chlamydia is the most common bacterial sexually transmitted infection particularly among women aged 16-24 and men 20-29 years old[43]. Between 20001 and 2002 there was an increase of 14% in cases of chlamydia and 63% in cases of primary and secondary syphilis in England, Wales and Northern Ireland[44]. All STIs – including syphilis and gonorrhoea – are spread through unprotected sexual intercourse, that is, without using a condom.27. Personal lifestyles can also impair male fertility. There is evidence that both excessive smoking and alcohol consumption can have a detrimental effect on fertility and potency. The
UK National Guidelines for the Initial Investigation and Management of the Infertile couple identify both alcohol and smoking as factors in male infertility[45]. Working conditions and environmental hazards can be a significant contributory factor to male infertility. There is evidence that such factors as stress, weekly working time, occupational posture and metal welding can affect men’s fertility[46]. An American study[47] investigating 140 couples participating in in-vitro fertilisation treatment (IVF) showed that higher lead levels contributed to low male fertility rates. An important aspect of this study was that none of the men was in occupations likely to result in high lead exposure. There is disquieting evidence from Argentina that exposure to pesticides and solvents contributes to the severity of male infertility[48].28. Possibly the most important action to be taken in reducing harmful environmental impact on fertility (both male and female) is the monitoring of ‘endocrine disrupters’, which are found in the enormous number of synthetic chemicals and have the potential to alter hormone activity in the human body. These chemicals are present in plastics, carpets, fabrics, many cosmetic creams, soaps and perfumes and also emanate from exhaust, cigarette and combustion fumes. In 1994 the US General Accounting office estimated that there were more than 7 million recognised chemicals in existence, of which approximately 80,000 were in common use worldwide. These chemicals have been linked to breast cancer, low sperm counts and testicular cancer. In a recent authoritative overview of research linking environmental chemicals and human reproductive health
[49] in the British Medical Journal the authors conclude that action by government and industry is required to reduce exposure by reducing release of chemicals to the environment. The European Union is currently drawing up recommendations for action on the integrated monitoring of endocrine disrupters in the framework of the European Environment and Health Strategy[50]. A new EU regulatory framework for chemicals (REACH: Registration, Evaluation and Authorisation of Chemicals) is at the stage of referral to the European Parliament and the Council of Ministers, although it is unclear whether it will be finalised before or after the June 2004 elections.E. Working with young men and boys
29. In many Council of Europe member states young men are participating in sex education programmes and taking responsibility for their own sexual and reproductive health and for the health of their partners. Pioneered by NGOs, work started in some countries, like Sweden and the UK, some twenty or more years ago. In others, like Georgia
, Russia, Moldova and the Central Asian Republics, the work is more recent.30. The Swedish NGO Riksf�rbundet f�r Sexuell Upplysning (RFSU) took the initiative in 1983 with sexuality education for boys. Writing in Choices Erik Centerwall says that ‘if we are to get anywhere near changing men’s attitudes then we must understand that change can only be on men’s terms and through a deeper understanding of the dynamics that drive individual and group male behaviour’. In the last ten years sexuality education programmes have been introduced for boys and men in the Swedish army, the church, youth centres and schools; many youth clinics in Sweden have dedicated sessions for young men
[51].31. The Swedish experience from 50 years of sex education is that there is no connection between sex education and increased numbers of sexual partners. On the contrary, more information about sexuality leads to fewer partners, safer sex and young people delaying their sexual debut
[52]. WHO and UN-AIDS surveys show that young people’s self-confidence also increased when provided with accurate and appropriate information in this area, making it easier to make crucial decisions about their sexuality[53]. The inclusion of sex education on school curricula is also supported by the Sub-Grouping “Health-Sexuality NGOs” (regrouping nine international NGOs active in the field) of the NGO Liaison Committee in the Council of Europe[54].32. The UK Brook Advisory Centres, established in 1964 to provide contraceptive advice and information for young people, realised that young men were being seriously overlooked and started providing dedicated sessions for young men in the mid 1980s. In 2000 Brook held a conference ‘Don’t blame the boys: meeting the sex advice needs of boys and young men’, which examined the attitudes of health service professionals to young men, family relationships and young fathers. Currently two London Brook clinics run male-only sessions, with an emphasis on protection against STIs. In Northern England workshops are held with 16-17 year old boys from a Youth Training Scheme: ‘there is a stereotype that men don’t want to talk. Men do want to talk, most can for hours. All they need is an environment that they can feel safe and confident in..’
[55]. The UK Sex Education Forum, set up in 1987 by the National Children’s Bureau, publishes a wide range of material, including ‘Let’s hear it for the Boys! Supporting sex and relationships education for boys and young men’ and a fact sheet on ‘Men, Boys and Fatherhood: the role of sex education’.[56]33. Male involvement is on the agenda in countries like Georgia
, where the Family Planning Association and the International Planned Parenthood Federation European Network (IPPF EN) organised a workshop in September 2001 to contribute to greater understanding of the importance of gender equity within sexual and reproductive health programmes as a basis for promoting increased male involvement. This was the first step in a society where such issues are very difficult to address, but where family planning service providers recognise that the inclusion of men is essential. The outcome is that the Georgian FPA, encouraged by the positive findings of the workshop, is now working to create a broad-based coalition of national organisations to promote male involvement in sexual and reproductive health throughout the country[57].34. Research in Russia on young people’s views on sexuality and sexual behaviour indicates that there is widespread uncertainty among boys as well as girls on who should do what and who is allowed to take the initiative. It also indicates that Russian boys tend to dominate intimate relationships and think they deserve more freedom than girls in terms of sexual relations
[58].35. In Moldova the FPA’s social marketing COOL condom campaign offers opportunities for reaching young men with messages of responsibility in sexual and reproductive health. The FPA has organised lectures for male students in technical colleges around the country and some 1,600 male soldiers. The FPA’s own youth group was involved in a UNICEF sponsored anti-HIV/anti-drugs campaign, which included two huge rock concerts attended by some 35,000 young people
[59].F. Conclusions and recommendations
36. The Fifth World Conference for Women, Beijing, 1995, Platform for Action, recognised the need for men’s participation in sexual and reproductive health when it stated that ‘Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences
[60]. On this basis, issues of reproductive health should no longer be considered “women’s issues”. Men should be encouraged to get more involved in family planning and in looking after their own sexual and reproductive health.37. To this end, education, information and advice on reproductive and sexual health has to be specifically targeted at men, as well as at women, and their needs. In particular, family planning providers, Governments and NGOs should look at ways of reaching out to young men and supporting them in their reproductive and sexual health choices. Special programmes could be put into place to encourage men to understand and support women’s contraceptive choices and increase communication between partners. The condom should be promoted both as a protection against sexually transmitted infections (including HIV/AIDS) and as a means of fertility regulation.
38. Experience from a number of Council of Europe member states demonstrates clearly that sex education programmes for young men and boys can be successful and welcomed by the participants, helping them to become aware of their own sexual and reproductive health needs and related family issues. As the Executive Director of UNICEF, Carol Bellamy, pointed out at the Dublin conference ‘Schools are the best defence against HIV infection… they offer the best mechanism to deliver HIV prevention information, as well as the long-term education and social skills that protect against infection.’
[61]39. Men’s access to reproductive health services should also be improved. Family planning services should offer men-only sessions at their clinics as well as encouraging men to attend clinics with their partners. Sessions could include STD (including HIV/AIDS) screening, counselling and treatment, as well as the diagnosis of and treatment for genitourinary conditions. Research into new male contraceptive methods, as well as into the causes of and possible treatment for male infertility, should be actively pursued.
40. Based on successful work currently going on in many Council of Europe member states, It could perhaps be recommended to the Committee of Ministers that it look into this issue more closely and draft a recommendation to member states to evaluate and review policy and practice on encouraging the involvement of men, especially young men, in reproductive and sexual health, with a view to reducing the incidence of STIs, HIV/AIDS and improving men’s and women’s health.
Reporting committee
: Committee on Equal Opportunities for Women and MenReference to Committee
: Doc 9665, reference N� 2798 of 31 March 2003Draft resolution
unanimously adopted by the Committee on 24 May 2004.Members of the Committee: Mrs Cliveti (Chairperson), Mrs Zapfl-Helbling (1st Vice-Chairperson), Mr Dalgaard (2nd Vice-Chairperson), Mrs Curdova (3rd Vice-Chairperson), Mrs Aguiar, Mr Baburin (alternate: Mr Rudkovsky), Mrs Bauer, Mrs Biga-Friganovic, Mrs Bilgehan, Mrs Bousakla, Mrs Castro, Mrs Doktorowicz, Mrs Err, Mr Foulkes, Mr Gaburro, Mr Goldberg, Ms Hadjiyeva, Mrs H�gg, Mr Juri, Mrs Katseli (alternate: Mrs Damanaki), Mrs Konglevoll (alternate: Mrs Ringstad), Mrs Kosa-Kovacs, Mrs Kryemadhi, Mrs Lintonen, Mr Mahmood, Mrs Mikutiene, Mr Mooney, Mrs Morganti, Mrs Naghdalyan, Mr Neimarlija, Mrs Oskina, Mrs Paoletti Tangheroni (alternate: Mr Scherini), Mrs Patarkalishvili, Ms Patereu, Mr Pavlov (alternate: Mrs Stantcheva), Mrs Pericleous-Papadopoulos, Mrs Petrova-Mitevska, Mr Pintat (alternate: Mr Branger), Mr Platvoet, Mr Pullicino Orlando, Mrs Roth, Mrs Rupprecht, Mrs Schicker (alternate: Mrs Wurm), Mr Skarph�dinsson, Mrs Smirnova.
N.B. The names of the members who took part in the meeting are printed in italics.
Secretaries of the Committee: Mrs Kleinsorge, Mrs Entzminger
[1] Boys and Young Men, Family Planning Association Fact Sheet, January 2001.
[2] Eric Centerwall, Working with Men and Boys, Choices, IPPF EN, Autumn 2002.
[3] Poonam Thapa, Working Together for Gender Equity : a strategy for male involvement in Georgia, Choices, IPPF EN, Autumn 2002.
[4] Reproductive Health Outlook, Men and Reproductive Health, Key Issues, PATH: http://rho.org/html/menrh_keyissues.htm.
[5] Kirsten M. Vogelsong: A research agenda for male contraception, in: Choices, Autumn 2002, p. 4.
[6] Heidi Brown. The Female Condom: women control STI Protection. Population Reference Bureau March 2003 www.prb.org
[7] Ibid, p. 5.
[8] Long-term research into the possible link between vasectomy and prostate cancer is demonstrating no overall increased risk and other studies are showing no association between vasectomy and cancer or testicular cancer: Reproductive Health Outlook, Men and Reproductive Health, Key Issues, PATH: http://rho.org/htmo/menrh_keyissues.htm
[9] Kirsten M. Vogelsong : A research agenda for male contraception, in: Choices, Autumn 2002, p. 4.
In the UK it used to be said that there was a Government official sitting at the end of the production line sticking a pin into every tenth condom.(Dilys Cossey, The Case for the Condom, Brook Advisory Centres, 1979). Today there is another version of the rumour: the HIV/AIDS virus can pass through holes in the condom (Steve Bradshaw : Vatican: condoms don’t stop aids, The Guardian, 9 October 2003). Kirsten M. Vogelsong: A research agenda for male contraception, in: Choices, Autumn 2002, p. 5-6. Reproductive Health Outlook : Key issues : Men and reproductive health : http://rho.org/html/menrh_keyissues.htm[13]Overall review and appraisal of the Programme of Action of the International Conference on Population and Development : Report of the Ad Hoc Committee of the Whole of the Twenty-first Special Session of the General Assembly , 1999 para 50.
[14] � Contraceptive failure � being understood as a contraceptive method not working, or not being used in the first place.
Alan White and Keith Cash, The state of men’s health in Europe : conclusions of study by the European Men’s Health Forum across 17 countries in Western Europe, Brussels 2003, www.emhf.org. Alan White and Keith Cash (for the European Men’s Health Forum): A report on the state of men’s health across seventeen European countries, Brussels 2003, p. 58. UNAIDS, Fact Sheet on High-Income countries, December 2003 www.unaids.org/html/pub/publications[18] UNAIDS, Epidemiological Fact Sheets on HIV/AIDS and sexually transmitted infections, 2002 update, United Kingdom www.unaids.org/htmo/pub/publications/fact-sheets
Ibid, Epidemiological Fact Sheets for Sweden, Russian Federation. Ibid, Epidemiological Fact Sheets for Estonia, Lithuania and Ukraine. www.who.int/vaccines-surveillance[22] Ph. Beutels and others : Hepatitis B in St Petersburg, Russia (1994-1999) : incidence, prevalence and force of infection. Journal of Viral Hepatitis Vol 10 Issue 2 p. 141.
WHO, AIDS epidemic update, December 2003, available on-line www.who.int. Ibid, Chapter on Eastern Europe and Central Asia. Ibid, Chapter on Eastern Europe and Central Asia. WHO : AIDS threat growing throughout Europe, press release 23 February 2004. UNAIDS, Fact Sheet on High-Income countries, December 2003 www.unaids.org/html/pub/publications[28] WHO : AIDS threat growing throughout Europe, press release 23 February 2004 : www.who.int/mediacentre/releases/2004
[29] UNAIDS, Epidemiologican Fact Sheets on HIV/AIDS and sexually transmitted infections, 2002 update for Russian Federation, Moldova, Ukraine, Estonia, Latvia, Lithuania, UK, Sweden, Portugal. www.unaids/org/html/pub/publications
[30] Alan White, Keith Cash : The state of men’s health in Europe.
Programme of Action, UN International Conference on Population and Development, Cairo, 5-13 September 1994, para 7.2. Infertility. http://www.who.int/reproductive-health/infertility/index.htm[33] Reproductive Health Outlook. http://rho.org/html/infertility_overview.htm
Carlsen E, Giwercman A. Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ 1992 ; 305 : 609-13.[35] A G Andersen, TK Jenson, E Carlsen, N Jorgenson, AM Andersson, T Krarup, N Keiding , NE Skakkebaek : High frequency of sub-optimal semen quality in an unselected population of young men. Human Reproduction, Vol 15, no 2, 366-372, February 2000.
Jacques Auger, Jean Marie Kunstmann, Francoise Czyglik, Pierre Jouannet. Decline in Semen Quality among Fertile Men in Paris during the past 20 years : New England Journal of Medicine 1995 ; 332 : 281-5.[37] L Bujan, A Mansat, F Pontonnier, R Mieusset. Times series analysis of sperm concentration in fertile men in Toulouse, France between 1977 and 1992. BMJ 1996 ; 312-471-2.
Niels Jorgensen and others : East-West gradient in semen quality in the Nordic-Baltic area : a study of men from the general population in Denmark, Norway, Estonia and Finland. Human Reproduction Vol 17 No 8, 2199-2208, August 2002. J Richthoff, L Rylander, L Hagmar, J Malm, A Giwercman. Higher sperm counts in Southern Sweden compared with Denmark. Human Reproduction, Vol 17 No 9 2468-2473, September 2002. P Andolz, MA Bielsa, J Vila. Evolution of semen quality in North-eastern Spain : a study in 22,759 infertile men over a 36 year period. Human Reproduction Vol 14, No 3, 731-735, March 1999. ‘New study finds sperm counts of men in Scotland have fallen by 29 % between 1989 and 2002’ report of Aberdeen Fertiltity Centre research, UK Independent 4 January 2004. Krause W and others. Male infertility and genital chlamydial infection : victim or perpetrator. Andrologia : 35 : 209-216 (2003). UK Health Protection Agency www.phls.co.uk/topics . UK STD Statistics England, Wales & Northern Ireland 1996-2002 http://www.avert.org/stdstatisticuk.htm These Guidelines, first published in 1992 and updated in 2002, are based on a thorough review of the available evidence and are intended to ‘assist decisions about appropriate care in specific clinical circumstances’ and to serve as a basis for local protocols (www.nelh.nhs.uk/guidelinesdb/html/fulltext-introduction/InfertileCouple.html) . J Auger and others : Sperm morphological defects related to environment, lifestyle and medical history of 1001 male partners of pregnant women from four European cities. Human Reproduction, Vol 16, No 12, 2710-2717, December 2001. Susan Benoff, Asha Jacob, Ian R Hurley. Male Infertility and environmental exposure to lead and cadmium. Human Reproduction Update, Vol 6, No 2 pp,107-121, 2000. Alejandro Oliva, Alfred Spira, Luc Multinger. Contribution of environmental factors to the risk of male infertiltiy. Human Reproduction, Vol 16, No 8, 1768-1776, August 2001. Richard M Sharpe, Stewart Irvine. How strong is the evidence of a link between environmental chemicals and adverse effects on human reproductive health ? BMJ. Report on Actions and Recommendations for ‘Integrated Monitoring of Endocrine Disrupters’ in the framework of the European Environment and Health Strategy (COM02003)338 final), 23 February 2004. Erik Centerwall. Working with Men and Boys : the story so far. Choices, pp2-3, IPPF European Network, Autumn 2002. The Swedish Association for Sexuality Education. Breaking through: A Guide to Sexual and Reproductive Health and Rights, Stockholm, February 2004, p. 28.[53] Ibid, p. 37.
[54] Statement transmitted to the Secretariat by Mr Guy Schlaeder, Co-ordinator of the International Professional Union of Gynaecologists and Obstetricians on 6 May 2004.
[55] Brook Advisory Centres Annual Report 2002-2003, p. 9.
Sex Education Forum, 8 Wakley Street, London EC1V 7Q, www.ncb.org.uk/sef. Poonam Thapa. Working together for Gender Equity : a strategy for male involvement in Georgia. Choices, pp. 17-18, IPPF European Network, Autumn 2002. Elena Dmitrieva, Evert Ketting, Yuri Averin. The differences between Russian boys and girls. Choices. IPPF European Network, p. 12-14, Autumn 2002. Manana Blaja, Ala Spinei, Radica Sudavesvschi. First Steps to Male Involvement in Moldova. Choices. IPPF European Network, p29, Autumn 2002. Platform for Action, Section C, Women and Health, para 96. WHO ‘Aids threat growing throughout Europe’, press release, 23 February 2004.