Advancing Sexual and Reproductive Health and Rights


In Their Own Right: Addressing the Sexual and Reproductive Health of American Men


The Importance and Implications of Men's Sexual and Reproductive Behavior

In recent years, awareness has grown of the need to address the sexual and reproductive behaviors and health of men. This recognition reflects the advent of HIV and the critical role of condom use in preventing sexually transmitted diseases (STDs), concerns about the role of men in teenage pregnancies and births, and the failure of many divorced and unmarried fathers to fulfill their parental responsibilities. The result has been programs' efforts to bring men - particularly the partners of women clients - into the existing reproductive health system.

Still, the sexual and reproductive health needs of men in their own right - as individuals and not simply as women's partners - have been largely ignored. The family planning, public health and contraceptive research communities have learned to regard and treat women as individuals, not just wives and mothers. It is time to do the same for men: to recognize that their reproductive health is, above all, about their own well-being and their ability to engage in healthy, fulfilling sexual relationships.

In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men aims to take some initial steps in that direction by providing an overview of some fundamental patterns in men's sexual and reproductive lives, and their implications for policy and programs. It focuses on men 15-49 years old, because during these years, men typically pass the main sexual and reproductive milestones, from the initiation of sexual activity to marriage and fatherhood. And it underscores both gaps in what is known and obstacles to serving men effectively. This summary presents some of the report's key findings.

Men 15-19: Initiating Sexual Relationships

Adolescence - the transition between childhood and adulthood - is a time of promise for most young men, a stage at which they want to discover and establish an identity independent of their family. And often, the heart of discovering who they are involves young men's exploration of romantic and sexual relationships. However, there is great variation in when and how safely teenage men experience the transition to sexual activity.

Fewer than one-quarter of American men are sexually experienced by age 15, but nine in 10 have intercourse before their 20th birthday.

Poor and minority youth initiate intercourse somewhat earlier than more affluent and white teenagers.

Slightly more than two in 10 sexually experienced men have had only one partner by their late teens, and about three in 10 have had six or more.

Slightly more than two in 10 sexually experienced men have had only one partner by their late teens, and about three in 10 have had six or more.

Sexual activity in adolescence is often sporadic, and many relationships do not last very long.

Sexual activity in adolescence is often sporadic, and many relationships do not last very long.

Most men use a condom the first time they have intercourse, but condom use subsequently declines and reliance on female methods increases.

Very few adolescent men are married, and only 3% are fathers. Only 7% of births each year involve teenage men.

Six in 10 pregnancies involving teenage fathers end in a birth; four in 10 end in an abortion. Thirteen percent of abortions each year involve teenage men.

Men 20-29: Settling Down

In their 20s, many men first establish an independent place in society. Often, they have completed their education, started working full-time and set up their own households, frequently in the context of marriage or a cohabiting relationship. Nevertheless, many have not yet assumed responsibility for families of their own.

Twenty-seven percent of men in their early 20s are married or cohabiting, but this proportion doubles by the late 20s.

Black men are much less likely than white or Hispanic men to marry in their 20s, and poor black men are half as likely as better-off black men to do so.

Condom use is more common among men not in a union than among those who are cohabiting or married. It is therefore not surprising that men in their early 20s are more likely than those in their late 20s to use condoms.

One-quarter of men have fathered a child by age 25, and one-half have done so by age 30. Minority men and those with the lowest incomes and least education are the most likely to become fathers in their 20s.

Men in their 20s account for about half of births and half of abortions in the United States each year.

Roughly eight in 10 births involving men in their early 20s, and half of those involving men in their late 20s, are nonmarital.

Men 30-49: Forming Families

Most men in the 30s and 40s have married and become fathers. However, because of separation, divorce, nonmarital childbearing and children's starting to leave home, some men who have had children are not living with them.

Seven in 10 men in their 30s and eight in 10 of those in their 40s are married or living with a woman.

In their 30s and 40s, poor men are the least likely
to be married and the most likely to be separated or divorced.

During their 30s and 40s, men's use of condoms for contraception declines, and their reliance on male and female sterilization grows.

By age 49, the average man has had about two children. In addition, many men are fathers to stepchildren, adopted children or foster children.

Men in their 30s and 40s account for 44% of births and 34% of abortions each year. The number of men who father children after age 49 is very small.

Eleven percent of men in their 30s have biological children but do not live with them.

Sexually Transmitted Diseases and Condom Use

The personal, societal and economic costs of STDs are enormous and growing. The spread of these diseases is determined partly by the level of infection within a community, the ability of infected individuals to obtain treatment and the prevailing patterns of sexual behavior.

Eight in 10 adults living with AIDS in the United States are men. More than one in 10 men who had AIDS diagnosed in 1999 were exposed to HIV through heterosexual activity.

Reported rates of chlamydia and gonorrhea reach 500-600 per 100,000 men in their early 20s, levels that are much higher than those of men in their 30s or older.

Compared with white and Hispanic men, black men have twice as high a level of infection with herpes, and probably have several times the rates of bacterial STDs.

Nine in 10 men have heard of HIV, AIDS, gonorrhea and syphilis, but far fewer know about genital warts and are aware that chlamydia can infect men. Men's knowledge of effective measures for preventing STDs is sketchy.

Half of men who use condoms do so for birth control, not STD protection.

Sexual and Reproductive Health Information and Services for Men

From adolescence on, most men need information and counseling about sexual and reproductive matters, and they need somewhere reliable to go for related education and health care.

There is no commonly agreed upon definition of sexual and reproductive health care for men, and many barriers impede the provision of such care.

Obstacles to care include the tendency of many men not to seek regular, routine checkups; the fact that health insurance often does not cover the services men need; and the high proportions of men - particularly poor men - who do not have health insurance.

Few health professionals are specifically trained to provide men with sexual and reproductive health education and services.

The older men get, the more likely they are to need medical sexual and reproductive health services rather than information.

At all ages, sexually active men, particularly those who do not use a condom and have multiple partners, need regular screening for STDs.

Summing Up

It is essential to recognize the sexual and reproductive health care needs of American men and to increase their access to services addressing those needs, including counseling, educational and medical services. Movement toward a more holistic and broad-based approach to sexual and reproductive health care for men should enhance their well-being, equip them to make responsible decisions, result in lower levels of STDs and unintended childbearing, and help make men better fathers. Thus, what is increasingly seen as good for men in their own right should turn out to be just as good for women - to the benefit of men and women as individuals, couples, families and society as a whole.


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