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Helping the health system to respond to men's sexual and reproductive health needs

By Dr. Farah Mahjabeen

The aim of the research was to understand the sexual and reproductive health concerns of rural married men and their access and use of formal and informal providers under the Universal Access theme of the RPC.

The study was conducted in 8 unions in Chakaria, in rural Bangladesh and took place from February 2007 – June 2008. Health care services are usually provided by a formal and informal, a mixture of government, private, and non-governmental services. The methods were both quantitative and qualitative.

429 of the 771 male respondents (60%) said that they had/were suffering from sexual and reproductive health concerns; of this group (63%) of 429 received treatment but the majority of them sought care from the private sector (formal and informal) leading to underutilization of the government health facilities.

The main concerns reported by men ranged from poor duration of sexual intercourse, frequent urination, nocturnal emissions, loss of semen before and after urination, burning and pain when urinating, inability to maintain an erection, itching or burning in genitals, ejaculation before intercourse, pain during sex and general anxieties about the size and shape of the penis.

In terms of seeking care male respondents mentioned a range of providers, 83.4% said they visited independently practicing medical doctors (unclear whether qualified or unqualified); 65.7% mentioned kabirajis (traditional healers); 61.9% said homeopathic practitioners; 61.1% said pallichikitshak (village doctors, drug sellers) and 51.1% street vendors of folk medicine of their area provide this service. Rather than recognizing the vulnerability to transmission of STIs, concerns were mainly about sexual performance, size of penis and loss of semen. There was a strong desire of men to preserve and nourish seminal vitality which was also reinforced by kabirajis (traditional practitioners) as a major sexual health concern.

This study revealed that sexually active married men in rural Bangladesh are concerned about their sexual health and majority of them seek care for their concerns. Poor utilization of government and NGO facilities highlights the existing gap in services for men in the mainstream health care delivery system and the vacuum which is filled up by the informal sector. While majority of the men had culturally embedded psychosocial concerns these facilities are only equipped to treat patients with STIs. The sexual and reproductive illnesses are beyond and larger than biomedical models and this requires wider recognition in the health sector: both in curative care and prevention. One needs to design interventions focused on sexual health – i.e. concerns voiced by men themselves – as the entry points to providing care and address men’s SRH problems.

 

Dr. Farah Mahjabeen is a Communications Team Member for Realising Rights in Bangladesh

The Research Team that undertook this study include: Ilias Mahmud, Research Associate, Dr. Sabina Faiz Rashid, Assistant Professor, Dr. AMR Chowdhury, Dean, and Nabil Ahmed, Intern, James P Grant School of Public Health, BRAC University, and Advisors: Dr. Hilary Standing, IDS and Dr. Kaosar Afsana, BRAC, Bangladesh. 

 

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Our work is building the evidence base on improving access to sexual and reproductive health services and technologies.


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BRAC is undertaking workshops with formal and informal health care workers in order to communicate their research and improve the service that the providers offer.