Background
Methods
Design
Setting
Data collection
Characteristics | mean (SD) |
---|---|
Age, years | 51.5 (11.0) |
Work experience from contraceptive counselling, years | 13.3 (11.2) |
No. of contraceptive counselling sessions/week | 15.4 (6.9) |
n (%) | |
Workplace | |
Public | 16 (73) |
Private | 6 (27) |
Type of clinic | |
Midwifery clinic | 17 (77) |
Youth clinic | 4 (18) |
Data analysis
Interview transcript | Initial coding | Category | Sub-theme | Theme |
---|---|---|---|---|
‘Well, I don’t want to close any doors. I think it’s good that women and men can come to the same clinic, you shouldn’t divide it like “you go there and you go there”, as if we are that different’. [FG1] | Good to not divide women and men | Men and women’s needs are intertwined | Beliefs about men and women: same, but different | In everybody’s interest, but no one’s assigned responsibility |
Results
Theme | Sub-themes | Categories |
---|---|---|
In everybody’s interest, but no one’s assigned responsibility | Organisational aspects create obstacles | Men have nowhere to turn |
Beliefs about men and women: same, but different | Different health seeking behaviour, interest and needs among men than women | |
Men and women’s needs are intertwined | ||
Mixed views on the midwife’s role and responsibility | Strategies to involve men | |
Being hesitant to provide consultation to men |
Theme: in everybody’s interest, but no one’s assigned responsibility
Organisational aspects create obstacles
‘But girls are called for pap smear tests and meet midwives where they get some contacts and... have another contact with health care providers, perhaps in a different way than what guys have.[FG5]
Men were perceived as hard to reach, and they seldom showed up at the midwifery clinic following adolescence. There was little confidence that parents would take on the responsibility to educate their children, as it was expressed that ‘parents are just getting more and more stressed today and do not have the energy’ [FG3].‘It is no wonder that more is put on the women, because where will they [men] go?! It might be a 24-year-old guy who has no ailments or anything but who has many thoughts, where should he turn with those? It's not so obvious who he should call’. [FG1]
Beliefs about men and women: same, but different
‘Surprisingly often, when we meet guys nowadays […] they don’t really know how someone becomes pregnant and common simple basic knowledge’.
The midwives also found it important to give young men the opportunity to talk about emotions and concerns, and to inform them about the juridical consequences of having unprotected sex (i.e. being responsible for paying child support). Men should take responsibility for their sexual life and not only trust the female partner to take care of the contraception. However, the midwives wanted men to be involved “just enough” [FG5]; he should not be “the fifth wheel” [FG1] during the visit, but if he was too involved then midwives started to suspect a controlling behaviour and intimate partner violence. Still, most men were perceived as taking a step back and letting the woman be in focus; consequently, letting the woman take major responsibility for their joint future.‘So, we have started to draw the menstrual cycle [on paper], which they might not need, but I believe it’s good that they become aware of how it works with guys and sperm…’[FG3]
‘I think it’s really great during contraceptive counselling, [or] with guys who are there for STI-testing, in whatever age they are, you can actually do this… you can bring this up and make them think […] it doesn’t matter if they are 18 or 40’. [FG1]
‘If they are together with a female partner... it is interesting for them too; they should be able to discuss this. If they don’t know that women's fertility goes down a lot at age thirty-five. I mean we need to talk about it in our relationship or about what we think because it's tragic for both if they don't have children, it's really bad for both’. [FG5]
Mixed views on the midwife’s role and responsibility
‘Well, I don’t want to close any doors. I think it’s good that women and men can come to the same clinic, you shouldn’t divide it like “you go there and you go there”, as if we are that different’. [FG1]
They suggested that other arenas for sexual and reproductive counselling were needed for men, in addition to or instead of midwifery clinics. They indicated that venereology or urology clinics, or specific clinics for men where male HCPs with training in andrology worked, were relevant arenas. It was also argued that teachers or school nurses should take on the responsibility to educate young men. In Sweden, school nurses are responsible for having a general health consultation with pupils, which was viewed as a good opportunity to reach boys with information about sexual and reproductive health. Sports clubs could also be involved. It was also suggested that men could be reached at postnatal check-ups and at infertility clinics.‘Yes, in nine cases out of ten, guys come to us to undergo chlamydia tests. They just want to get help ... get in quickly and take the test and be told how it works and then goodbye .... I think more if you could ... talk to guys at youth clinics’. [FG3]
‘There was a guy who wanted to show me some kind of rash [on his penis] and I just “No!” I kind of panicked […] Well, then I felt, I am not knowledgeable about this’ [FG5]
‘But I am a midwife and don’t know much about men's fertility! It is awful really. You are at an antenatal clinic, it feels like one should know this’. [FG1]