Claiming the Right To Health

“My heart can’t be cured is because I’m too poor to pay my son’s school tuition—and that is breaking my heart” (Korean village woman)

The visit to the Tunisian mobile health clinic took us out of the city, past the Roman viaduct and toward the mountain villages. Tunis disappeared behind us on a dusty winding upward road. Sparse settlements dotted the slopes, and draft animals wandered 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 the donkey’s 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 a white truck, the mobile unit. Children and some men sat nearby, watching us pull up. I was impressed to see the health clinic. Modern, spotlessly clean, and well equipped, the clinic was hard evidence that 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 program director, doctors had been much more successful in their efforts by orienting reproductive health services to both men and women. This was known as a couple’s approach.

I wanted to hear more from the men. 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 to complete a round of service to rural areas. When he talked about health services for men, he explained that this clinic wanted to start education efforts early reaching out to boys. However, that was one of the most difficult parts of his assignment. He established friendly relationships with girls, as they came in with their mothers since they were young and could count on seeing them as patients when they reached puberty.

However, boys were different. They may tag along with their mothers as children. Yet, when they grew up, they shied away from his health center. He initially thought that boys had no one to mentor them in the ways of life and did not confident in adult male family members. As a result, they experienced the mysteries of changes in their bodies’ functions and appearances on their own or with their peers. The brave behavior stereotypically associated with boys failed when it came to mustering up the courage to walk into a reproductive health center. Few boys, if any, ever showed up. Yet, they suffered 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 a mystery to health planners. The United Nations Population Fund, 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 effectives, often negative, on boy’s rights and freedoms.

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 at the top on the list of health priorities, boys’ sexual and reproductive health has fallen by the wayside, only to be picked up again when it’s too late.

Let’s remember that the availability of doctors doesn’t automatically mean that boys will consult them. A starting point for this issue would be counseling 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.