Family Planning Groups Find It Tough to Involve Men in Process : Population: Conference attendees say many males are threatened by concept of shared responsibility.

Walk into a typical family planning clinic, and the last thing you’re likely to see is a man--unless he’s the doctor, or the guy sweeping the floor.

The reason? Men don’t like to talk about birth control and they certainly don’t like to practice it, say many women attending the International Conference for Population and Development here.

“My husband says he feels like he’s being strangled,” a young Egyptian woman whispered when talk turned to condoms. And mention of another male birth-control method, vasectomy, can be a conversation-stopper in many parts of the world.

Of the wide array of family planning programs sponsored over the past three decades, the overwhelming majority have focused on women. In developing countries, only 26% of all contraceptive users adopt methods requiring men’s compliance. Condoms are used by 19% of people in industrialized countries who practice birth control and by only 6% in the Third World, despite their efficacy in preventing AIDS.

But a U.N. plan for population control under review in Cairo this week says it is time to change all that--time to get men more involved not only in contraception, but also in bearing moral and financial responsibility for the children they have.

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“Changing gender roles is threatening. Men and women are afraid of how these changes are going to affect them,” said Nafis Sadik, executive director of the United Nations Population Fund and secretary general of the Cairo conference. The primary strategy of the U.N. plan--reducing birthrates by empowering women--implies that men have some ground to give.

Three separate workshops have been scheduled to promote male participation in family planning, all centering around the same question: Besides reminding men of the threat of AIDS, how do you interest them in participating in birth control?

Repeatedly, men emphasized that they must be given an opportunity to learn more about family planning--from other men, not from women--and they want to be reassured that practicing birth control will threaten neither their power nor their pleasure.

“You’ve got to talk about his pleasure, and you have to talk about his partner’s pleasure,” said Errol Alexis, a Planned Parenthood worker from Grenada. “Because sometimes that’s where his fear comes from.”

Alexis said most men are guilty of ignorance when it comes to sex.

“Men know very little about their sexual selves, as if they believe it’s not important to know these things,” he said. “And they don’t know very much about women: They know very little about menstruation, very little about ovulation. They believe once you have the ability to get an erection, then you’re OK. . . .

“The core of getting men involved is not to attack them or blame them, but to encourage them to get involved in a family setting.”

Florence Chikali, a Zimbabwe family planning worker, started working as far back as 1976 to establish the country’s first “male motivation” program, which only really got under way last year with funding from the World Bank and the United Nations.

She said it was set up with the idea in mind that men were “the real decision-makers” in society, and no family planning program could ultimately be successful without involving them.

“I have always asked myself, ‘Who is the owner of the uterus?’ ” she said. “I have not yet found the answer. Sometimes the husband. Sometimes the mother-in-law.”

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In surveys connected with the program, Zimbabwe officials learned that men are not willing to discuss contraception with female clinic workers but could easily be approached by other men. When surveyed about why they feared birth control, the reasons they most often cited were that their wives would begin running around with other men, or that the couple would be rendered infertile, or would have deformed children.

Most men were more readily persuaded when the socioeconomic, rather than health, benefits of birth control were pointed out to them, Chikali found.

Now, the campaign uses TV spots, movie ads, testimonials from key political leaders, musicians and sports figures. The U.S. ambassador, Chikali said, had a news conference and announced that he had had a vasectomy.

Rosemary Wamae, a Kenya family planning worker, stood up and quietly confronted Chikali’s optimistic assessments.

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“You asked who owns the uterus. I wonder why don’t they ask who carries the thing that has the seeds?” she demanded. “I have been just wondering why men are sidelined? Don’t they have any say about their children? Don’t they care about their children who get aborted?” A Kenyan physician, P.H. Mwalali, said he has only gradually begun to succeed at persuading men to get vasectomies, after years of cringing at the idea himself.

“Vasectomy is associated with a social stigma, and we have to remove this,” he said. “I was in the U.S. in a group discussion one time, and a colleague of ours from a southern country stood up and said, ‘I won’t be with you tomorrow, I’m going to have a vasectomy.’ I just told him, ‘How dare you talk about this!’ ”

Now, Mwalali finds himself apologizing that a vasectomy is one of the only methods of birth control he has to offer his male patients. “Men say they’re not involved because the methods are limited. At this point, we say, ‘Yes.’ But it’s because of the reproductive anatomy of the man.”