Male responsibility for reproductive health. Introduction.

PIP: Before the advent of the oral contraceptive pill, men were more involved in family planning and other aspects of reproductive health. Then, if a couple wished to practice family planning, they were largely limited to withdrawal, periodic abstinence, and condom use, all practices which require the man's participation. Hormonal methods for women and the subsequent development of IUDs and modern surgical sterilization fostered the development of a family planning services community focused upon women rather than men. The challenge is now to increase the degree of male responsibility for family planning by expanding services in ways which protect the reproductive health of both men and women, and by encouraging greater sensitivity to gender issues. Adding reproductive health services for men can be done without reducing the level of services available for women. However, while PROFAMILIA clinics, which offer a wide range of male reproductive health services, have found ways to encourage male participation, an enormous gap exists between the rhetoric of promoting male involvement and the actual realities of female-oriented reproductive health programs. Obstacles include men's reluctance to use services, lack of knowledge among men about their own and women's sexuality, lack of communication by men about sexuality in their relationships, male beliefs in sexual myths, health providers' and false assumptions and generalizations about men. The authors discuss the need to encourage men to support women's contraceptive choices, to increase communication between partners, to increase the use of male methods, to improve men's behavior for the prevention of STDs, to address men's reproductive health needs, and to encourage men to become more aware of related family issues.^ieng

Involving men in reproductive health: making the mandate a reality.

PIP: When men are provided with information about reproductive health issues, they are more likely to support their partners' family planning decisions. Such support is particularly important in cultures where women are unable to negotiate sexual relationships, and may therefore be exposing themselves to sexually transmitted diseases (STDs) and unwanted pregnancies. Good communication between partners ensures that women receive the reproductive health care they need. AVSC International developed the Men As Partners (MAP) initiative with the goals of increasing men's awareness and support of their partners' reproductive health choices; men's awareness of the need to safeguard reproductive health, especially through the prevention of STDs; and the use of contraceptive methods which require the participation and cooperation of men among couples who want to use them. In May 1997, AVSC organized the first-ever interregional workshop on men's involvement in reproductive health. More than 150 participants from 5 continents attended the event in Mombasa, Kenya, where they discussed ways to involve men in the health of their female partners. Main workshop themes were gender issues, reproductive health services for men, community outreach and workplace programs, access to services, and adolescents.^ieng

An evaluation of vital registers as sources of data for infant mortality rates in Cameroon.

BACKGROUND: Infant mortality rates have been widely used as indicators of health status and the availability, utilization and effectiveness of health services. Two principal sources of data for infant mortality rates are vital registers and censuses. This study was designed to evaluate the accuracy of vital registers as sources of data for infant mortality rates in Cameroon. METHODS: A household census of births and infant deaths that occurred in Buea Subdivision between 1 November 1991 and 31 October 1992 was conducted to determine the proportion that were registered and the reasons why the remainder were not registered. RESULTS: The registration coverage was found to be 62% for births and 4% for infant deaths. The most frequently reported reasons for not registering births were lack of money, lack of time and a complicated registration procedure. For infant deaths the reasons were lack of knowledge and no perceived benefits. CONCLUSIONS: Vital registers of birth and death are not an accurate source of data for infant mortality rates in Cameroon. Motivation for birth and death registration appear to be dependent on the perceived benefits. A mechanism of registration that uses medical institutions may substantially increase registration coverage for births and infant deaths.

PIP: The aim was to evaluate the accuracy of vital registers in reporting of infant mortality in Cameroon. Vital registration in Cameroon is dependent on parents filing the papers with the district attorney and paying 600 francs. Birth certificates are required for family allowance claims by employees, tax deductions, school attendance, applications for employment, national identity cards, and proof of paternity. Death certificates are required for insurance claims, inheritance, transportation only of the deceased, and cessation of family allowances. Data were obtained from the Buea Subdivision of the southwest province of Cameroon in November and December, 1992, from interviews from 30 high school and university students, and a household census of 6178 households in the 23 villages. All births and deaths were recorded that occurred between November 1, 1991, and October 21, 1992. Registration data from the councils was also obtained for the same period. The results indicated 1569 births and 106 infant deaths. 98% of births were in health institutions. 1% of urban births occurred at home and 4% of rural births occurred at home. 53% of infant deaths occurred in health institutions and 47% occurred at home. 44% of urban deaths occurred at home and 40% of rural deaths occurred at home. 62% of all reported births were registered: 69% in urban areas and 52% in rural areas. 80% of births were registered within a month after births. Only 33% of reported births could be confirmed by a birth certificate since they were kept by the father. 84% of births were registered by fathers or male relatives. 4% of infant deaths were reported to have been registered. 32% occurred prior to discharge from the health institution. Cross checking of reported and registered births was not possible, since anonymity was protected. The council had registered 1716 births, who ranged in age at time of registration, from 1 day to 59 years. 52% were under 1 year old at registration. Registration increased at aged 4, 10-13, and 17-20 years. 59 deaths were registered by the council, of which 90% were registered by the end of the 4th month following the death, but only 7% were infant deaths. Family allowance was found to be significantly associated with birth registration. Coverage and timeliness would be substantially improved by registration in medical institutions; elimination of registration fees would also increase coverage.