The visit to the Tunisian mobile health clinic took us out of the city past the Roman viaduct towards the mountain villages. Tunis disappeared behind a winding upward road. Sparse settlements dotted the slopes and draft animals poked along the road. I spotted a girl on a donkey heading our way to the edge of the mountain village. Her water pails were slung on its back. I thought: That’s progress; girls often have to walk while the boys get the rides. Crowds of Berber women, some wearing beautiful earrings and long skirts bustled around the mobile unit, a white truck.
Children and some men sat squatted nearby, watching us pull along side. I was impressed to see the health clinic. Modern, spotlessly clean and well equipped, it was hard evidence the government was serious about making contraceptives and reproductive health services accessible to everyone – even remote tribes. On this visit, I was particularly interested in the family planning policy and its emphasis on reaching men and boys. According to the director of the programme, by orienting the reproductive health services to both men and women, doctors have been much more successful. This was known as a “couple’s approach.” I wanted to know more from the men’s point of view.
I heard the inside story from the clinic’s physician. He was a young man who had left all of the trappings of a highly specialized career in order to complete a round of service to rural areas. When he talked about health services for men, he explained that ideally this clinic should start early by reaching out to boys. However, he said that was one of the most difficult parts of his assignment. Typically, girls come in with their mothers when they are very young so he establishes friendly relationships with them. When they reach puberty, he can count on seeing them as patients. Boys are different. They may tag along with their mothers as children, but when they grow up they shy away from his health center.
He thought that the problem was that boys do not confide in fathers or other adult male family members. Having no one to mentor them in the ways of life, they experience the mysteries of changes in their bodies’ functions and appearances on their own or with peers. The brave behavior associated with boys fails when it comes to mustering up the courage to walk into a reproductive health center. It seems boys will not always be boys. Few, if any, ever show up. Yet, the doctor said that he knows they suffer from many disorders including urinary tract infections and, occasionally, sexually transmitted diseases.
In most countries, the epidemiology of boys’ sexual and reproductive health problems is mysterious to health planners. The UN Population Fund (UNFPA), which has championed women’s sexual and reproductive health and rights, is also a strong advocate of the same rights for men and boys. It recognizes that cultural traditions can have gender-specific negative effects on boy’s rights and freedoms. As it turns out, boys, like girls, can grow up hidden behind a veil of social taboos. Even industrialized countries that pride themselves on modern approaches to youth problems have only begun to acknowledge that the health data on adolescent boys is dismal. With drugs, alcoholism and teenage pregnancy top on the list of priorities, boys’ sexual and reproductive health falls by the wayside – only to be picked up again when it is too late.
Let’s remember that just because doctors are available doesn’t mean that boys will consult them. A starting point would be to counsel men who attend family planning clinics to learn more about their sons’ needs and advise health administrators on how to best adapt services. Progress has to start with an admission of ignorance. We cannot assume that backward traditions affect only girls. Sometimes, boys are also the losers.