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Access to Sexual and Reproductive Health Services Remains a Gendered Issue: Here is How Lesotho is Changing the Narrative

In many African family settings, open discussions and seeking sexual and reproductive health services by men and boys continue to be regarded as taboo. These deeply ingrained social and gender norms hinder the uptake of SRH (Sexual and Reproductive Health) services among men and boys, often at the expense of their well-being and that of their families.

26 October 2023 by Limpho Sello

*Thabiso Lenka spoke to Uncensored News crew shortly after prostate cancer screening at LPPA Men’s Clinic. Credit: Limpho Sello.

*Thabiso Lenka, aged 55, stands just a meter away from the entrance of a Male’s Clinic at the Lesotho Planned Parenthood Association in Maseru.

His appearance is casual, in a blue t-shirt neatly tucked into a pair of matching jeans secured with a black belt. He completes the look with training shoes.

As he turns, he retrieves a half-covered green medical booklet from the back pocket of his jeans. Lenka is here for a prostate cancer screening, something he had never envisioned doing in his lifetime.

Lenka confesses, “I have never been one to willingly seek medical attention, especially when it involves sensitive matters like prostate cancer screening.”

In 2019, Lesotho reaffirmed its commitment to the 1974 Programme of Action of the International Conference on Population and Development (ICPD). This recommitment emphasised the importance of prioritising reproductive rights, addressing inequalities, and catering to the needs of both women and men for sustainable development.

According to the United Nations (UN) Resident Coordinator, Deepak Bhaskaran, the ICPD encourages men like Lenka to take responsibility for their sexual and reproductive health and family roles.

“The ICPD and several other international agreements empower states to develop gender-transformative programs and policies that engage men and boys in the contexts of family, sexual and reproductive health, violence, and health equity,” Bhaskaran explains.

Prostate cancer screening falls within the scope of sexual and reproductive health.

Toxic masculinity

Lenka’s visit to the Lesotho Planned Parenthood Association shattered his own misconceptions about seeking help.

However, toxic masculinity has long influenced Lenka’s attitude. For decades, he avoided doctors and left medical decisions to his wife. It was not until he contracted a sexually transmitted infection that he grudgingly considered seeking medical attention. The thought of explaining his condition to a female nurse embarrassed him.

“Even though we should seek SRH services, having to explain yourself is embarrassing, especially in front of a female nurse. For instance, when you contract an STI due to unprotected sex, it is humiliating to explain it to a nurse. I feel like I will be judged for being careless when I knew how to prevent unprotected sex,” Lenka said.

According to Lenka, nothing is more disheartening than presenting with STIs at clinics. A 2022 study titled “Impacts of Masculinity on Men’s Health in Maseru, Lesotho” reveals that men’s adherence to toxic masculinity contributes to health-damaging behaviours.

The study explains, “Masculine qualities include independence, invulnerability, sexual promiscuity, competitiveness, bravery, leadership, control, and physical strength. Men are often socialized to tolerate pain, be self-reliant, and make decisions independently, while avoiding feminine behaviors.”

Bhaskaran argues that Lesotho and other African nations need strategies to challenge harmful social and gender norms. These strategies should involve traditional and community leaders, faith-based organisations, and role models who can help men and boys break free from stereotypes tied to toxic masculinity.

“To achieve universal access to SRHR,” Bhaskaran states, “we must ensure that the diverse SRHR needs of men and boys are fully integrated into existing policies, strategies, and operational plans.”

He continues, “Evidence has shown that the health needs of young men and boys are not adequately addressed in East and Southern Africa. Studies from the region indicate that more must be done to meet the SRHR needs of men and boys.”

Bhaskaran’s remarks come from the United Nations Populations Fund (UNFPA) gathering held last month, which brought together SRH service providers and civil society representatives from Lesotho, Uganda, Zambia, Zimbabwe, and Malawi in Maseru.

The workshop highlighted how men and boys often delay seeking medical help when they are confronted with SRH needs. A regional rapid situational assessment reveals that a substantial 48 percentage of men in these five countries do not know about available SRH services, 37 percent do not see the need to access services related to sexual reproduction, and 31 percent simply lack the time to do so.

“22.9 percent distrust doctors and health providers. 38 percent (of men in the five countries are discouraged by) peer pressure from accessing services,” Prof Govender said.

Prof Govender says it is crucial to note that most available reproductive health programs in Lesotho and other countries have primarily focused on women of reproductive age. As a result, men remain an underserved population in terms of SRHR.

Lesotho on road to debunk stereotypes

The Lesotho Planned Parenthood Association (LPPA) Male Clinic, visited by Lenka, is part of a network of men’s clinics at high-volume health facilities across the country. These clinics aim to improve HIV treatment access for men, as traditional health facilities tend to be perceived as more women and child-friendly.

The United States President’s Emergency Plan for AIDS Relief (PEPFAR) says Lesotho’s Ministry of Health introduced the concept of Men’s Clinic at selected high-volume health facilities to scale up HIV treatment access for men. This is because men were less likely to be reached by provider-initiated and community-based HIV testing because of their health-seeking behaviour.

These clinics, known as Men’s Clinics, are male-friendly and have specific features, including services provided by trained male health care workers, extended hours of operation to accommodate working men, and appointments for services. These clinics also offer a male-only waiting area for privacy.

These enhancements have significantly increased men’s access to healthcare.Today, Lesotho is using these men’s clinics to integrate SRH services for men and it is working. “Because of the new male-friendly approach, there has been a significant increase in the number of men accessing health services,” PEPFAR said.

Lenka shares, “With a clinic like LPPA, where you know you will find a male nurse, it’s much more comfortable because we are the same gender, and he will understand me faster when I explain my concerns.”

These clinics have successfully addressed several public health challenges, such as low health-seeking behaviour among men. They have also helped curb HIV transmission and other sexually transmitted infections, primarily through STI screenings.

Silent death

However, 33-year-old *Lereko Lereko is concerned about the absence of doctors at these clinics. Despite this, Lereko emphasises the importance of seeking medical services without hesitation for the sake of men’s health.

Lereko, who visited the Men’s Clinic on the same day as Lenka, shares, “We don’t need to shy away from seeking any medical services as long as they promote our health. Sensitising men about services offered at Men’s Clinics will go a long way in preventing SRH-related deaths.”

He added: “I have a cousin who passed away last year and we only learned after his passing that he was HIV positive. Seeking services on time would have given him a second chance at life.”

According to LPPA Program Director, Tlali Matela, common cases at Men’s Clinics include STIs, which are drivers of HIV transmission, and erectile disorders.

“It is therefore important to channel our efforts towards educating men and boys on practising safe sex as a major of prevention. LPPA Male clinic has provided voluntary medical male circumcision to more than 10,000 men and boys since 2007 as a means of preventing HIV transmission and other STIs,” Matela said.

UNFPA SRHR Coordinator Blandina Motaung emphasises the need for stronger financial commitments and SRHR policies to facilitate access to services and uphold health rights.

“These priorities will guide the countries’ action plans and technical assistance to strengthen programming for men and boys,” Motaung concludes.

Lenka and Lereko’s names have been changed to protect their identity as requested.

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