Reproductive Health

reproductive system

Reproductive System

Reproductive system, also known as the genital system or the reproductive system, is a collection of organs and structures in the human body responsible for sexual reproduction.

Its primary function is to produce, store, and deliver gametes (reproductive cells) and facilitate the union of sperm and egg for the purpose of fertilization, leading to the creation of new life.

The male reproductive system

The Male Reproductive System

External genital organs 

External male reproductive organs are those outside and can be seen. They comprise of the;

  •  Scrotum. 
  • Testis. 
  • Penis.

The penis 

It is an organ that carries the semen with the sperm into the vagina. During sexual arousal, blood  is pumped into the muscles of the penis making it stiff/erect so it can easily enter the vagina. The penis additionally serves as the urethral duct. Although both semen and urine pass through  the urethra in the penis, at the time of ejaculation the opening from the bladder is closed so that  only semen comes out of the penis. After ejaculation, the blood quickly drains away into the  body and the penis returns to the normal state.  

∙ The penis is enclosed by a foreskin (prepuce) that protects the glans penis. Usually the  penis produces a white creamy substance called smegma, which helps the foreskin to  slide back smoothly. When smegma accumulates under the foreskin, it causes a bad smell  or even infection. Therefore for men who are uncircumcised need to pull back the  foreskin and gently wash underneath it with clean water everyday 

The scrotum 

It is a sac of skin containing two egg-shaped organs called the testes, found in front of and  between the thighs. It protects the testes from physical damage and helps to regulate the  temperature of the sperm. 

The testes 

They are two sex glands that produce sperm and the male hormones, which are responsible for  the development of secondary sexual characteristics in men. 

The male internal reproductive organs 

  • Epididymis. 
  • Deferent ducts (vas deferens).
  •  Seminal vesicles.
  • Ejaculatory ducts. 
  •  Prostate gland
  • Urethra-bulbous glands.(bulbourethral  glands)

Vas deferens 

  • Prostate gland. 
  • Urethra-bulbous glands.(bulbourethral  glands) 

They are tubes through which the sperm passes from the testicles and penis.  

Epididymis 

  • They are cord-like structures coiled on top of the testes, it stores sperm.  
  • When sperm matures, it is allowed to pass into the vas deferens before being released  during ejaculation. 

Seminal vesicles  

  • They are glands where the white fluid, semen is produced.  
  • Semen is fluid that is released through the penis during ejaculation.  
  • It provides nourishment for the sperms and helps their movement. 
  • The seminal vesicles do not store sperm cells. 
  • They secrete a thick alkaline fluid that mixes with the sperm cells as they pass into the  ejaculatory ducts and then the urethra.  
  • These secretions provide most of the volume of the semen.  
Arterial supply, venous drainage and nervous supply

Arterial supply, venous drainage and nervous supply

  • The arteries are derived from the inferior vesical and middle rectal arteries.
  • The veins accompany the arteries.
  •  Nervous supply is by sympathetic and parasympathetic nerve fibers.


Prostate gland 

  • This is the largest accessory gland of the male reproductive system.  
  • It is situated below the bladder. 
  • The prostate is partly glandular and partly fibromuscular.  
  • The prostate produces fluid that makes up part of the semen; it helps create a good  environment for the sperm in the penile urethra and vagina 
  • Enables movement of sperm and provides nutrients for the sperm. 

Cowper’s gland 

  • It comprises two small glands situated below the prostate with ducts opening into the  urethra.  
  • Its function is to produce some fluids, which helps create a good environment for the  sperm in the penile.

The Female Reproductive System

The female external genital organs 

  • The Mons Pubis 
  • The Labia Majora 
  • The labia minora. 
  • The vestibule of the vagina. 
  • The External Urethral Orifice 
  • The Vaginal Orifice 
  • The Greater Vestibular Glands 
  • The Lesser Vestibular Glands 
  • The Clitoris 
  • The Bulbs of the Vestibule 

The mons pubis 

  • The mons pubis is a rounded fatty elevation located anterior to the pubic symphysis and  lower pubic region.  
  • It consists mainly of a pad of fatty connective tissue deep to the skin. 
  • The amount of fat increases during puberty and decreases after menopause.  
  • The mons pubis becomes covered with coarse pubic hairs during puberty, which also  decrease after menopause. 
  • The typical female distribution of pubic hair has a horizontal superior limit across the  pubic region.  

The labia majora 

  • The labia are two symmetrical folds of skin, which provide protection for the urethral  and vaginal orifices.  
  • These open into the vestibule of the vagina.  
  • Each labium majus, largely filled with subcutaneous fat, passes posteriorly from the mons pubis to about 2.5 cm from the anus.  
  • They are situated on each side of the pudendal cleft, which is the slit between the labia  majora into which the vestibule of the vagina opens.  
  • The labia majora meet anteriorly at the anterior labial commissure.  
  • They do not join posteriorly but a transverse bridge of skin called the posterior labial  commissure passes between them.  

The labia minora 

  • The labia minora are thin, delicate folds of fat-free hairless skin.  
  • They are located between the labia majora.  
  • The labia minora contains a core of spongy tissue with many small blood vessels but no  fat.  
  • The internal surface of each labium minus consists of thin skin and has the typical pink  color of a mucous membrane.  
  • It contains many sensory nerve endings.  
  • Sebaceous and sweat glands open on both of their surfaces.  
  • The labia minora enclose the vestibule of the vagina and lie on each side of the orifices  of the urethra and vagina.  
  • They meet just superior to the clitoris to form a fold of skin called the prepuce (clitoral  hood).  
  • In young females the labia minora are usually united posteriorly by a small fold of the  skin, the frenulum of the labia minora.  

The Vestibule of the Vagina 

  • The vestibule is the space between the labia minora.  
  • The urethra, vagina, and ducts of the greater vestibular glands open into the vestibule.  

The external urethral orifice 

  • This median aperture is located 2 to 3 cm posterior to the clitoris and immediately  anterior to the vaginal orifice.  
  • On each side of this orifice are the openings of the ducts of the paraurethral glands  (Skene’s glands).  
  • These glands are homologous to the prostate in the male. 

The Vaginal Orifice 

  • This large opening is located inferior and posterior to the much smaller external urethral  orifice.  
  • The size and appearance of the vaginal orifice varies with the condition of the hymen, a  thin fold of mucous membrane that surrounds the vaginal orifice.  

The greater vestibular glands 

  • These glands are about 0.5 cm in diameter.  
  • They are located on each side of the vestibule of the vagina, posterolateral to the vaginal  orifice.  
  • They are round or oval in shape and the bulbs of the vestibule partly overlap them  posteriorly.  
  • From the anterior parts of the glands, slender ducts pass deep to the bulbs of the  vestibule and open into the vestibule of the vagina on each side of the vaginal orifice. 
  • These glands secrete a small amount of lubricating mucus into the vestibule of the  vagina during sexual arousal.  
  • The greater vestibular glands (Bartholin’s glands) are homologous with the bulbourethral  glands in the male 

The clitoris 

  • The clitoris is 2 to 3 cm in length.  
  • It is homologous with the penis and is an erectile organ.  
  • Unlike the penis, the clitoris is not traversed by the urethra; therefore it has no corpus  spongiosum.  
  • The clitoris is located posterior to the anterior labial commissure, where the labia majora meet.  
  • It is usually hidden by the labia when it is flaccid.  
  • The clitoris consists of a root and a body that are composed of two crura, two corpora  cavernosa, and a glans.  
  • It is suspended by a suspensory ligament.  
  • The parts of the labia minora passing anterior to the clitoris form the prepuce of the  clitoris (homologous with the male prepuce).  
  • The parts of the labia passing posterior to the clitoris form the frenulum of the clitoris,  which is homologous with the frenulum of the penile prepuce.  
  • The clitoris, like the penis, will enlarge upon tactile stimulation, but it does not  lengthen significantly.  
  • It is highly sensitive and very important in the sexual arousal of a female.
Arterial supply of female external genitalia

Arterial supply of female external genitalia 

  • The rich arterial supply to the vulva is from two external pudendal arteries and one  internal pudendal artery on each side.  
  • The internal pudendal artery supplies the skin, sex organs, and the perineal muscles.  
  •  The labial arteries are branches of the internal pudendal artery, as are the dorsal and deep  arteries of the clitoris.  

Venous drainage  

  • The labial veins are tributaries of the internal pudendal veins and venae comitantes of the  internal pudendal artery.  

Lymph drainage of the female external genitalia 

  • The vulva contains a very rich network of lymphatic channels.  
  • Most lymph vessels pass to the superficial inguinal lymph nodes and deep inguinal nodes.

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Introduction to Reproductive Health

Introduction to Reproductive Health

Reproductive health is defined as a state of complete physical, mental and social well being and not merely the absence of the disease or infirmity on all matters related to reproductive function  and its processes involved. 

This is a process concerned with peoples‘ ability to have a responsible satisfying and safe sex  life, their capability to reproduce and having the freedom to decide if, when and how often to do so. 

Reproductive health includes having: 

  1. Satisfying, safe sex life. 
  2. Ability to reproduce. 
  3. Successful maternal and infant survival outcome. 
  4. Freedom to control reproduction. 
  5. Information about and access to safer, effective and affordable methods of family planning. 6. Ability to minimize gynecological disease throughout life. 

The components of Reproductive Health 

  1. Safe motherhood: 
  • ∙ Preconception care 
  • ∙ Antenatal care 
  • – Maternal nutrition 
  • – Focused antenatal care 
  • – Immunization for tetanus, hepatitis B etc. 
  • – EMTCT of HIV/AIDS 
  • ∙ Clean safe delivery 
  • ∙ Emergency obstetric care 
  • ∙ Postnatal (newborn care) and postpartum care
  • ∙ Breastfeeding/ infant feeding 
  • ∙ IEC and community mobilization 
  • ∙ Post abortion care services 
  1. Family planning: 
  • ∙ Medical eligibility for family planning services 
  • ∙ Provision of contraceptives and natural family planning 
  • ∙ Emergency contraceptive 
  • ∙ Management and follow-up for side effects of contraceptives 
  • ∙ Infection prevention and quality care 
  1. STIs/HIV/AIDS: 
  • ∙ Behavioral change counseling 
  • ∙ Condom promotion and distribution 
  • ∙ Counseling and testing  
  • ∙ STI management and treatment 
  • ∙ Infection prevention and quality of care 
  • ∙ Partner notification and treatment 
  • ∙ Treatment compliance. 
  1. Sexual and adolescent health: 
  • ∙ Behavior change counseling 
  • ∙ Provision of adolescent friendly services 
  • ∙ Provision of contraceptive services 
  • ∙ Screening and management of STIs 
  1. Infertility: 
  • ∙ Investigation and treatment 
  • ∙ Partners‘ involvement 
  1. Reproductive organ cancers: 
  • ∙ Screening and referral 
  • ∙ Definitive management 
  • ∙ Palliative care 
  1. Gender related issues; such as gender based violence, sexual abuse, female genital  mutilation and fistulae. 
  • ∙ Advocacy 
  • ∙ Partner involvement 
  • ∙ Community involvement 
  • ∙ Specialized management
  • ∙ Multi-sectorial collaboration 
  • ∙ Legal support 
  1. Menopause and andropause: 
  • ∙ Symptomatic treatment 
  • ∙ Hormonal replacement 
  • ∙ Partner involvement 
  • ∙ Advise on exercise and nutrition

 Importance of reproductive health 

  1. Promotion of maternal and child health 
  2. Reduces maternal morbidity and mortality 
  3. Promotes free women‘s involvement in all matters related to reproductive health issues  e.g. family planning 
  4. Promotes prompt treatment and detection of life threatening cases throughout  reproductive life 
  5. It promotes safer sex practices and reduces the incidence of rampant sexual related abuses
  6. . Reduces on government expenditure on reproductive related health issues thus promotes  quality standard of living. 

Problems being faced during the implementation of Reproductive Health in Uganda 

The following are some of the problems being encountered during the implementation of  reproductive health services in Uganda; 

  1. Low socio-economic status (poverty): This is the major setback as many people in  Uganda live within poverty level which in turn makes them unable to access even the least  costly services. For instance, the Uganda Demographic Health Survey shows that  mortality rates are high in women from low socio-economic status as these women  are likely to be less privileged in the fields of nutrition, housing, quality education etc 
  2.  Improper/underutilization of the existing services 
  3. Delivery of substandard care i.e. when the care provided is below the generally  accepted level available at that particular coupled up shortages of resources and under-equipped facilities 
  4. Lack of communication and referral facilities: This could be due to poor coordination  between lower health facilities with the higher ones backed-up by geographical  barriers, transport means like ambulances etc. 
  5. Poor cultural perspectives on reproductive health; variety of cultural practices are the  basic obstacles to Reproductive Health Services for instance, female genital  mutilation, early marriages, denying women to eat certain foods etc. 
  6. Lack of awareness by the community on issues related to reproductive health.
  7. Inadequate supply of resources related to reproductive health. This therefore makes  the little existing services disproportionately consumed by the overwhelming  individuals who visit the health Centers. 
  8. Inadequate skilled staff specially trained on issues pertaining reproductive health.  The number of skilled staff to deliver various Reproductive Health Services in  Uganda is appalling as compared to the number of clients who desperately need the  scarce services. 
  9. Improper evaluation and supervision of reproductive health services to ascertain its  progress and successes 
  10. Lack of support from men, opinion leaders and development partners as they are  considered change agents in the community 
  11. Misappropriation and embezzlement of funds specially designed to facilitate  reproductive health services. 

Ways through which Reproductive Health Service can be improved in Uganda 

It is a coordinated long term effort within the families, opinion leaders, communities and health systems. 

It also involves the national legislation and policies where action may vary in respect of an  individual and the government ought to make Reproductive Health a priority of public  concern and to periodically evaluate the program to ascertain the successes. 

  1. A good quality of obstetric services and referral services are to be considered. 
  2.  Proper and timely evaluation of the Reproductive health related issues are to be taken  a priority. 
  3. Recruitment of skilled manpower at the functional referral points for proper  integration of reproductive health services to fill the pending gaps. 
  4. Decentralization of services to make them available in time. 
  5. Social inequalities and discrimination on grounds of gender, age and marital status  are to be removed. 
  6. Timely supply of essential reproductive health services to meet the overwhelming  number 
  7. Women should be empowered to gain access to education, economic and social status  in order to increase women’s decision making power in regards to their own health  and reproduction. 
  8. Sensitization to create awareness should be given to the community, society and decision makers about the values of reproductive health. 
  9. Improving on the standard delivery of care by organizing refresher courses (workshop  and for the health care personnel at various level others 
  10. Barriers to access of health facilities should be addressed 
  11. Proper utilization of services available
  12. Bad cultural practices and beliefs in the community should be discouraged. This can  be done by strict laws, for instance illegalization of female genital mutilation, sexual  gender based violence, early marriages etc. 
  13. Penalizing those who have been found culprits for misusing the funds. 
  14.  Encouraging men and community members to actively and wholeheartedly support  their partners through their active participation in RHS being provided 

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MALE INVOLVEMENT IN REPRODUCTIVE HEALTH SERVICES

MALE INVOLVEMENT IN REPRODUCTIVE HEALTH SERVICES

Male involvement is having men participating more in Reproductive health matters as clients and partners. 

This can be in the form of seeking and sharing reproductive health information and services with their partners and friends. Sharing domestic chores and child rearing responsibilities is another form of male involvement, joint decision-making between men and their partners will improve the utilization of family planning, STI and EMTCT services. 

Male involvement is embedded in the International Conference on Population and Development Program of Action which includes male responsibilities and participation as critical aspects for improving reproductive health outcomes, achieving gender equality, equity and empowering women. This mandate contributes to broadening the concept of gender so that it now includes men. 

Male involvement is critical in the reduction of maternal and infant mortality and morbidity in Uganda. Culturally men are the decision-makers in Uganda. Many women are not empowered (decision and economically) to seek health care without consulting their spouses. Some recognize danger signs during or puerperium but wait for their spouses to return home and consent to their seeking for health care. The decision on where to seek care primarily depends on the spouse and his relatives. Evidence from maternal death audits shows that this delay has contributed to the high maternal and infant mortality and morbidity rates in Uganda.  

  • Decisions to keep the family healthy and seek care involve gender power roles 
  • Where men control household resources indirect costs of care seeking are at their discretion 
  • Control of STDs/HIV is a key R.H issue for men, who are often involved in high risk behaviour 
  • Decision on number of children is often dictated by men 
  • SRH issues involve an emotional journey and both men women need the emotional support 
  • Since men control the resources, women often have to explain why they have go to facilities 
  • Preventive services are often harder to justify than emergencies that men need in equal measures are inaccessible to them 

Men have sexual and reproductive health problems which need to be addressed. Conditions of the male reproductive system including; – HIV/AIDs, fertility problems, midlife concerns, such as andropause and sexual dysfunction. Serious conditions include non- malignant genitor-urinary conditions and malignancies of prostate, testicles and genitor-urinary organs. 

Vulnerability of males to SRH problems, their roles and responsibilities in prevention and care, including the prevention of gender based violence, are important aspects of a gendered approach to prevention interventions. Empirical and anecdotal evidence indicates that often, cultural beliefs and expectations of manhood or masculinity encourage risky behaviour in men. Masculinity requires males to play brave by not seeking help or medical treatment if they are faced with ailments including HIV/AIDs. Violence against women is more common and arises from the notion of masculinity based on sexual and physical domination over women. Gender based violence is a cross-cutting issue in all the sectors, exists within family and community spaces, and is entrenched within the existing ethno-cultures and its consequences are grave. 

In the past, men’s involvement has sometimes been opposed by women’s health advocates, who understandably fear that adding these services will damage the quality of women’s services and create additional competition for already scarce resources. However, adding programs for men can enhance rather than deplete existing programs if the designers of these programs carefully integrate them into the existing health care structure in a way that benefits both women and men. 

Both the 1994 International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing endorsed the incorporation of reproductive health services that include men, mandating that men’s constructive roles be made part of the broader reproductive health agenda. 

In fact, neglecting to provide information and services for men can detract from women’s overall health. For example, men who are educated about reproductive health issues are more likely to support their partners in decisions on contraceptive use and family planning, support that may be essential if women are to practice safe sex or avoid unwanted pregnancy. Moreover, if men are knowledgeable about reproductive health issues and can communicate about them with their partners, they are more likely to be supportive during pregnancy and may make better health care decisions: for example, by ensuring that their partner receives emergency obstetric services when needed, rather than delaying recourse to such care. The effect of men’s attitudes and behavior on women’s health is perhaps most obvious in regard to the pandemic of AIDS and other STDs. Programs that educate, test and treat only one partner will not be effective in safeguarding the continued health of both. Men need to share the responsibility of disease prevention, as well as the risks and benefits of contraception. 

Importance of Male Involvement

Involving men in reproductive health services benefits men and women, community and the service provider 

                Reasons for Involving Men in Reproductive Health

  • Provides male support for female actions related to reproduction and respect for women’s reproductive and sexual rights
  • Increases access to male contraceptive methods and hence helps on expanding the range of contraceptive options
  • Promotes responsible and healthy reproductive and sexual behavior in young men
  • Involves men with their spouses during counseling and other FP/RH information
  • Helps in preventing the spread of HIV/AIDS and STDs
  • Helps inform men of the ill effects of men’s risky sexual behaviour on the health of women and children
  • men approve of family planning and hence supporting women’s contraceptive use
  • men make decisions that affect women and men’s health 
  • demands from women for more involvement
  • involving men in reproductive health is to use the forum of reproductive health programmes to promote gender equity and the transformation of men’s and women’s social roles

Factors limiting male participation in reproductive health 

  1. Primary health center (PHC) programs not geared to meet men’s needs
  2. Unfavorable social and cultural climate. Cultural factors have limited men’s abilities to take an active role in family planning practice and reproductive health decision making.
  3. Services aimed at women and children. Most family planning and reproductive health services are designed to meet women‘s or children‘s needs and, as a result, men often do not consider them as a source of information and services. Many may be inconvenient or unwelcoming to men, and providers may not have the training or skills necessary to meet men‘s reproductive health needs. Men also may be embarrassed about visiting a facility that primarily serves women. 
  4. Limited number of male contraceptives available. As mentioned above, available male methods are limited to condoms, natural family planning, vasectomy, and withdrawal. Like contraceptives for women, each of these methods has advantages and disadvantages and each potential client will have to decide for himself whether a particular method will meet his needs. While research is ongoing on new methods for men (including hormonal injections and implants), it is unlikely that a new method will be widely available for several years. 
  5. Rumors and misinformation. Because of the general lack of access to accurate information about male contraceptive methods, many men and women may not know how to use them correctly or may have misperceptions and fears that prevent them from using the methods. For instance, men may be un- willing to consider using vasectomy because they equate it with castration or believe that it leads to impotence; similarly, they may be unwilling to use condoms because they believe condoms will reduce sexual satisfaction or cause an allergic reaction. 
  6. Provider bias against male methods. Providers also may have misconceptions or biases about male methods or men‘s roles in family planning. As a result, they may not present information about male methods or assume that men are not interested. Concerns about the lower effectiveness of some male methods can be addressed through counseling about correct and consistent use as well as by offering emergency contraceptive pills to users as a backup in case condoms are not used properly or break. 
  7. Unfavorable social or religious climate. In societies where sexual matters are not discussed openly, men may feel uncomfortable talking about their family planning needs and sexual concerns with their partners and with health educators. Young men may face particularly strong social pressures that prevent them from seeking reproductive health information and services. In addition, some men may believe that practicing 
  8. contraception is contrary to the teaching of their religion. Priority given to women‘s health services. Many programs are reluctant to invest time and money to reach men with information and services when their female clients have significant unmet health and family planning needs.
  9. PHC service providers are mostly female
  10. Priorities to women and child care services
  11. Health workers attitude were some Providers have bias against male involvement
  12. Lack of information and knowledge
  13. Limited communication between spouses about FP needs
  14. Health centre resource constraints such as lack of enough male H/W, lack of male clinics
  15. Psychological factors (mindset and shyness of men)
  16. Difficult reaching couple with health information before pregnancy 

Reproductive Health Needs and Services for Men (Male reproductive health needs) 

  • Information: 
      • Basic sexual and reproductive health education 
      • Genital health and hygiene 
      • Healthy relationships 
      • Pregnancy prevention 
      • STI including HIV 
      • Fatherhood 
      • Where and how to obtain other services (violence, sexual abuse, genetic counseling etc.)
      • Contraception
      • Reproductive physiology 
      • Sexuality
      • Pregnancy
      • Birth preparedness
      • Male reproductive cancers
      • Sexual and gender based violence
      • Fertility and infertility 
  • Skills: 
      • Pregnancy and STI prevention and sex/sexual skills 
      • Fatherhood skills 
  • Preventive health care services: 
      • Sexual and reproductive history 
      • Cancer screening 
      • Substance abuse screening 
      • Mental health assessment 
      • Physical examination 
      • Links to other services, if needed 
  • Clinical diagnosis and treatment 
    • Testing for STIs, including HIV 
    • Diagnosis of and treatment for sexual dysfunction 
    • Fertility evaluation 
    • Contraceptive services (vasectomy) treatment of urologic disease: vasectomy reversal 

Social and Reproductive Health Responsibility of Men 

  1. Discussing contraceptive with the partner 
  2. Discussing and  utilizing STI/HIV screening services with partners 
  3. Escorting partners to antenatal care, delivery and postnatal care services 
  4. Men should only marry partners who are 18 years and above 
  5. Abstain from sex until marriage 
  6. Use condoms to prevent STI/HIV and unwanted pregnancies 
  7. Have good relationship with partner especially during pregnancy, labor and puerperium 
  8. Provide moral and financial support to the partners during pregnancy, child birth and postnatal 
  9. Provide support to the partner for infant feeding choices 
  10. Help bringing up children 

Social Norms, Beliefs, Practices and Taboos: 

  1. Promiscuity 
  2. Power imbalances where male dominance is the norm 
  3. Inadequate dialogue(lack of communication between spouses) 
  4. Inadequate participation of men in child care 
  5. Assigned roles due to gender biases example men do not cook therefore cannot assist   their wives during pregnancy 
  6. Early marriage is culturally accepted 
  7. Wife inheritance 
  8. Polygamy 
  9. Competition among wives 
  10. Poverty 

Strategies to Increase Male Involvement in Reproductive Health 

  1. Working with young men to influence gender biases for better reproductive health (e.g. in school) 
  2. Integrate the desired services to address needs of men in the existing services 
  3. Improved services at existing clinics.
  4. Sensitize the general community to re-address gender biases which have negative impacts on reproductive health 
  5. Build capacity of health workers to involve men in reproductive health services 
  6. Develop information, education and communication and advocacy materials, address male involvement/responsibilities in reproductive health services.
  7. RH information and services should focus the couple rather than the individual. 
  8. Remove myths about condom and vasectomy.
  9. Service providers to be sensitized for men’s reproductive health needs. 
  10. In RH health clinics, a arrangement health services may increase the male clientele.
  11. Separate clinic for males.
  12. Workplace services.
  13. Community-based services.
  14. Commercial and social marketing.
  15. Increase contraceptive choice for men.
  16. Train providers about male FP/RH needs.
  17. Culturally appropriate messages
  18. Male health workers
  19. Engaging different institutions such as MoH and NGOs
  20. Develop guidelines on male involvement in RH

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