Rural men show little interest in reproductive health

In Kyrgyzstan, where the vast majority of the population lives in rural areas, men demonstrate little to no interest in reproductive health. "I don't go to doctors. My wife goes there. It's her business. Why do I need to? I am completely healthy," Azamat, a 30-year-old carpenter in Kochi village of Kyrgyzstan's eastern province of Isyk-Kol, explained matter of factly. Such candor amongst men in this former Soviet republic of 5.1 million inhabitants is not unusual. Although Kyrgyz people are not averse to discussing sexual and reproductive health issues, officials say the majority of men living in rural areas are not interested in discussing the matter. "There are several reasons why men are reluctant to learn about reproductive and sexual health," Alessandra Pellizzeri, manager of the United Nations Population Fund (UNFPA) “Stronger Voices for Reproductive Health” project, said in Bishkek, the Kyrgyz capital, citing a lack of confidentiality within rural clinics and the fear that other residents of the village would find out. Still another reason, along with a lack of education and awareness, is an acute lack of trust in female medical practitioners. Men prefer to go to male doctors, but in rural areas of the former Soviet republic, the majority of health personnel are female. According to recent government statistics, the number of female doctors was 8,711 nationwide, while only 4,900 were men. "Usually women come here to get contraceptives rather than men. In our village the prevailing view is that sexual and reproductive health issues are the duties of the woman," Saken Baibolsunova, a doctor practicing at a rural medical point in Taldy-Suu village, concurred. Research carried out by UNFPA and financed by the Japanese government in 2003 in the north of Kyrgyzstan revealed that 44 percent of men never used condoms as opposed to 15 percent who reportedly used them often. Even more startling, one third of all male respondents thought that a woman had the capacity to prevent a pregnancy herself. Health officials cite a lack of awareness and information among men as the primary problem. Only half of men (about 57 percent) are aware of prostate problems and sexually transmitted diseases (STDs), while those remaining were largely unaware of other reproductive health issues. "What was surprising for me, men go to the veterinarian to get information or for advice on these issues,” Julien Pellaux, a UNFPA communications officer, remarked. But the UN agency acknowledges the problem. "In December 2004 we conducted a workshop on reproductive and sexual health education and surprisingly, no men participated in the event. It is a big problem of the mentality of people living in rural areas," commented Pellizzeri. To address this issue, UNFPA conducted research and organised seminars for urologists to improve their work with men. This year it continued such education workshops among another group of urologists, as well as religious leaders, who play a significant role in men’s life. "We started to pay attention to this issue three years ago and we conducted two research projects in pilot villages. There are many factors why men were reluctant towards reproductive and sexual health," Cholpon Asanbaeva, a senior adviser of UNFPA's reproductive health programme, said. "One of them is the social-cultural stereotype, whereby a man should always be healthy. Therefore one of the main tasks of our programme was to raise men’s awareness of reproductive and sexual health." But while in rural areas men remain reluctant to embrace these issues, Kyrgyz men living in cities were more open-minded. One reason cited for this was access to information as well as access to medical services in urban areas. "It is important to see a doctor for consultation at least once a year, even if you don’t have any problems," Alisher, a 28-year-old man, working with a computer firm, explained in Bishkek. Social class, however, also played a role here, with middleclass men more concerned of their health than those economically more deprived. Although making up the majority of the country's population, they are more concerned about immediate issues such as employment and sustaining themselves and their families. "To go to a doctor [on sexual matters] is expensive and I don't have time, I need to work," Joldosh, a 34-year old father-of-four, who came from southern Kyrgyzstan to the capital in search of better job prospects, said. Meanwhile, young people welcome such discussion, much to chagrin of their elderly peers who deem such discussion of sexual and reproductive health as inappropriate. "It is propaganda of shameful things. It is not appropriate for our culture," Kanagat, an elderly resident of Kochi village, remarked shaking his head. But the ingrained reluctance to discuss these issues can have consequences, as Maksat, a 28-year old father-of-three explained: "In our village, there was a case when two young people divorced because they could not have children. Everybody blamed the young girl, but later when that guy married again, it became obvious that the problem was him." The consequence of such a passive attitude towards their health was obvious. Men would suffer from different diseases, which finally would end with infertility, Asanbaeva maintained. According to Pellaux, vasectomies among men have become a common form of family planning in countries like Brazil, but never in Kyrgyzstan - where such discussion remains taboo. "In many developing countries I have been, men are more active in all spheres of life, including reproductive health, rather then women,” said Pellaux, adding vasectomies were also safer for men than they were for women. Yet despite the challenge of raising awareness of reproductive health in Kyrgyzstan, some men in the mountainous Central Asian state were catching on. “I have one son. My wife and I decided to use contraceptives to prevent another pregnancy because my wife has anemia and I know that a second pregnancy would be more difficult for her and the child's health. In the future I want my wife and my children to be healthy. In two or three years, we may think to have another child," Roman, a 28 year-old taxi-driver explained. Others, however, still need more persuasion. "What is family planning? If my woman becomes pregnant, it is good, it is a gift," another man from the same village asked surprisingly.