Monthly Archives: August 2016

Men, Depression and Sex

Men, Depression and Sex


It is an incredibly complex condition which brings with it a whole slew of emotional, mental and physical symptoms with it. For men and women both, part of the problem can revolve around their sexuality – and this in turn can cause problems in a relationship at the time when the depressed person most needs the support.  Fortunately, there are ways to help treat this particular problem and restore intimacy and pleasure to a relationship.

Depression and Male Sexuality

It is common for both men and women to experience sexual problems as part of their depression – but the ways in which this presents itself can be different.  Healthline notes that in men, depression will often express itself as feelings of low-esteem, anxiety and guilt and this, in turn, can cause problems with erectile dysfunction, delayed orgasm, premature ejaculation or just a loss of interest in sex itself.

There is still a lot we just don’t know about exactly how depression affects the brain. But according to Net Doctor, researchers have learned that the chemical changes which take place when someone has this condition can lead to an increase in emotional withdrawal and low energy levels so that activities like sex, which require a connection to your partner as well as physical energy to perform, can become a challenge.  This can be hurtful for the person’s partner and make them feel unwanted or unloved, putting a strain on the relationship that can, in itself, be difficult to deal with.

To make matters worse, many antidepressants are notorious for their side effect of causing sexual dysfunction or loss of interest.  Included in this group are MAOI inhibitors, SSRI’s and SSNRI’s and both tetracyclic and tricyclic antidepressants. 

What to Do

So the long and short of it is, both depression itself and some of the treatments for depression can both put a damper on a guy’s sex life. So what are some solutions to the problem?

Get the Treatment You Need

Depression is not a choice that people make – and it is usually not a problem that goes away by itself. If you have not yet been diagnosed, talk to your doctor about the symptoms you are having and get started on a plan of care that involves the combination of medications, therapy and lifestyle changes that are right for you.

If you are already being treated for depression and suspect that your anti-depressants might be putting the kybosh on your sex life, find out if you can switch medications. While it might take a little time to take effect, there are some drugs which do not seem to effect one’s libido, including Wellbutrin and Remeron.


Both Healthline and Everyday Health recommend regular exercise – preferably with your partner – as part of a program to help reconnect sexually. First, it gives you and your partner time together doing something enjoyable and this alone can be good for a relationship. It also helps to release feel-good chemicals like endorphins that help fight depression naturally and keeps you in good shape so that you feel good about yourself and the way you look. All this can go a long way to enhancing your sex life.

Take Your Time

According to Everyday Health, sex therapist Dr. Sandra Caron also has a few tips for couples who are struggling to overcome the barrier that depression has placed on their sex lives.  She recommends, first of all, that couples engage in more foreplay and other physical expressions of intimacy – hand holding, caressing, massage – before engaging in intercourse itself.  Depression tends to slow down all responses, so taking this extra time to achieve arousal can help enhance the pleasure for both partners.  She also recommends the use, if needed, of estrogen creams or lubricants and even erotica (like lingerie or sexy movies) to help spark the mood.

Open Up

Probably the most important advice for men who are trying to reconnect with their partner sexually is to open up and communicate with your partner. This can be more difficult for men to do in general, but is even more of a challenge when it comes to talking about intimate issues like sexuality, desire and arousal. But being honest about how you are feeling and letting your partner know that it is the depression that is a problem and not a loss of interest or a loss of love can be an incredibly powerful way to overcome this challenges and get support from your loved one at a time when you need it the most.  Also, partners can be more understanding and supportive if they understand more about what is going on – otherwise, it is easy to interpret a low mood or lack of responsiveness as being hostile or unloving.

In short, depression is a difficult condition with a whole slew of symptoms that go far beyond just feelings of sadness or being blue.  And when depression begins to affect a person’s sexuality, this in turn can lead to a strain on intimate partner relationships.  However, while there are no quick solutions to this problem, getting on a treatment program that is tailored to someone’s individual needs as well as exercising regularly, spending time with a partner to engage in more foreplay and simply opening up and talking about the problem can all help to reignite the sexual spark in a relationship – and hopefully make the battle against depression that much easier.

About Dr. Brian W. Wu

Brian W. Wu graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology. He earned his Ph.D. in integrative biology and disease for his research in exercise physiology and rehabilitation. He is currently an M.D. candidate at the Keck School of Medicine (University of Southern California). He is the founder, a media company changing medicine one story at a time through narrative medicine. Read more at his personal website:

Do boys know more about sex than girls?

Do boys know more about sex than girls?


WHAT do Malaysian youths know about sex? Not a whole lot, according to the findings of a survey on Malaysian Youth Sexual and Reproductive Health (SRH). The little that they know about SRH is gleaned from a hodgepodge of sources, including school, the Internet and friends.

Forty-two per cent believe that withdrawal before ejaculation is effective protection against unplanned pregnancy. Thirty-five per cent believe a woman cannot become pregnant when she has sex for the first time. The survey also reveals that boys know more about SRH than girls.

For instance, when asked whether standing up during sex will prevent pregnancies, 51 per cent of the female respondents said they do not know, compared with 20 per cent of the male respondents. Fifty-one per cent do not know that a woman can get pregnant during menstruation.

Many respondents do not know how to protect themselves from sexually transmitted infections and 25 per cent believe that protection is not required when there is mutual trust between partners.

SRH knowledge-driven programmes are focused on helping youths to understand their bodies, protect themselves and inculcate respect for everyone, but 25 per cent of those surveyed have the impression that SRH education is about teaching them how to have sex.

However, the Women’s Aid Organisation (WAO) says the findings of the survey may not be representative of young people in Malaysia as “we must keep in mind that the survey results are based on a limited pool of respondents”.

A WAO spokesman says it is likely that boys are better informed about sex because it is a greater taboo for girls. “In Malaysian society, girls are expected to keep their virginity, abstinence is the only option that is encouraged and sex before marriage, let alone early sexual activity, is not openly acknowledged.

These factors may result in girls being less educated about sex than boys.” All Women’s Action Society (AWAM) programme officer Choong Yong Yi says it is not enough to only promote abstinence to prevent unwanted pregnancies and sexually transmitted infections.

“It is much better to implement comprehensive and age appropriate sex education for teens where they are taught about consent, peer refusal skills, safe sex and how to value their bodies. Contraceptives must also be made available.”

Her colleague, information communications officer Evelynne Gomez says the taboo over sex education must be broken. “It is a big taboo in Malaysia and it is going to be a difficult issue to approach, but looking at how unsure young people are in the survey, there should be more comprehensive sex education for youths on their sexual and reproductive health.

“There’s scarcely any information on sexually transmitted diseases and many sexually active youths would rather not deal with the issue.” The survey found that 11 per cent of sexually active respondents have had a sexually transmitted infection and 24 per cent did not seek treatment.

Federation of Reproductive Health Associations Malaysia (FRHAM) executive director Mary Pang says the organisation has been advocating sex education for a long time. “In fact, the topic of consent is a chapter on its own in our Life’s Journey module, which is a manual on sexual and reproductive health for adolescents.

“We use the module in all our training sessions at FRHAM centres, as well as in outreach sessions.”

In the chapter on consent, titled Are you ready for a sexual relationship?, Pang says the key messages are:

• Every right comes with responsibility.

• Make an informed choice. Think, before you act. Don’t just do it.

• Sexual relationships should be pleasurable and not under pressure.

• Pregnancy should be intended and desired.

Read More :

School-based reproductive health services linked to higher birth weight for teen mothers

School-based reproductive health services linked to higher birth weight for teen mothers

Availability of reproductive health care services at high schools may prevent adverse birth outcomes among adolescent mothers, including low birth weight, according to study findings.

“In 2011, there were 31.3 live births for every 1,000 women aged 15 to 19 in the United States,” Aubrey S. Madkour, PhD, associate professor in the department of global community health and behavioral sciences at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote. “Infants born to teen mothers are at an increased risk of both low birth weight and preterm birth compared with infants born to adult mothers. For instance, in 2010, the proportion of infants born with low birth weight was 12.08% among mothers aged less than 15 years, 9.63% among mothers aged 15 to 19, and 8.15% among all mothers.”

The researchers pooled data from Waves I and IV of the National Longitudinal Study of Adolescent Health to assess whether reproductive health services offered at high schools were linked with infant birth weight. Adolescents and women in Wave I were younger than 20 years (n = 402) when they gave birth in the 1994-1995 school year. Participants were interviewed in 1996 (Wave II), 2001 (Wave III) and 2007-2008 (Wave IV). School administrators from the institutions the girls attended at the occurrence of Wave I reported on whether onsite family planning counseling, diagnostic screening, STD treatment andprenatal and postpartum care were available.

Few high schools offered onsite reproductive health care services in Wave I; 8% offered diagnostic screening, 3% STD screening, 9% family planning and 4% prenatal and postpartum health care. Multilevel analyses indicated the availability of prenatal and postpartum health care (est. ß = 0.21, 95% CI 0.02%–0.40%; P < .05) and family planning counseling (est. ß = 0.21, 95% CI 0.04%–0.38%; P < .05) correlated with increased infant birth weight. There was no significant difference linked with an increase in gestational age.

“Attending schools that provided onsite reproductive health services was related to better subsequent birth outcomes in subsequent pregnancies among this nationally representative sample of adolescents,” the researchers said. “In particular, availability of family planning counseling and on-site prenatal/postpartum care were related to increase birth weight, and availability of family planning counseling was borderline associated with increased gestational age.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.


  • School-based health centers (SBHCs) provide convenient, accessible and comprehensive health services for children and adolescents where they spend the majority of their time: in school. The range of services offered by SBHCs varies widely, typically including basic primary care and preventive interventions like immunizations, as well as urgent care services, integrated mental health, nutrition, and sexual and reproductive health (RH) services. They can also be involved in schoolwide education and health promotion campaigns, and they often are linked to other health care organizations in the community.

    The Affordable Care Act appropriated $200 million from 2010 to 2013 to expand SBHCs, and currently more than 2,400 SBHCs are serving students and communities in 49 states and Washington, D.C. As SBHCs have doubled during the past 15 years, there is a tremendous need for further research informing best practices and health impacts of SBHCs. A persistently controversial question about SBHC care has been whether RH services should be provided on school grounds.

    Madkour and colleagues highlight the public health potential for SBHCs to not only prevent early and unplanned pregnancies, but also to avoid poor obstetric outcomes among pregnant adolescents.

    The scope of RH services offered by SBHCs varies widely depending on regional policies and sponsoring organizations. More than 80% of SBHCs self-report offering abstinence counseling while less than 50% offer contraceptive services.

    In the last decade, first-line contraceptive options for adolescents have expanded to include highly effective, long-acting reversible contraceptive (LARC) devices — specifically intrauterine devices and subdermal contraceptive implants. Thus, some SBHCs have begun to implement LARC placement, management and removal services, reducing adolescents’ barriers to LARC access. Unfortunately, in many regions, SBHC administrators continue to cite barriers to provision of contraceptive services, including school district or building policies, restrictions from sponsoring health care organizations, or restrictive state laws.

    A small, but growing body of evidence supports SBHCs as a key strategy to improve access to RH services and reduce teen pregnancy rates. Broader provision of RH services in SBHCs is warranted, yet these initiatives may need to be combined with other health education interventions to achieve desired health outcomes. Importantly, studies have shown that offering RH services in SBHCs does not increase rates of sexual activity among adolescents, but rather is associated with increased reports of abstinence and less unprotected sex.

    Beyond expanding their scope of services, an important priority for SBHCs is to address the current gaps in SBHC coverage found in rural school districts and schools for special populations, and in all schools during summers and holidays when services are severely limited. Strategies are needed to consistently measure service utilization and health outcomes among adolescents with access to SBHCs and understand barriers to utilization. RH services are a key component of preventive health interventions for adolescents, and expanding access within SBHCs should be a priority to ensure better health and social outcomes for our nation’s adolescents.

    • Andrea J. Hoopes, MD, MPH
    • Assistant professor, department of pediatrics, adolescent medicine section
      Adult and Child Consortium for Health Outcomes Research and Delivery Science
      University of Colorado School of Medicine

Sex mis-education: What young people ask their sexual health nurse

Sex mis-education: What young people ask their sexual health nurse



A nurse at a university health centre, Susan* has learnt not to judge the students who appear in her office.

Occasionally, however, she will lean forward, raise her eyebrows, and ask: “Really?”

While she’s often surprised by young people’s lack of knowledge, she’s understanding.

“Our youth have underdeveloped brains yet we are asking them to decide careers, manage money, live away from home for the first time, deal with drugs, sex, alcohol, stress, loneliness, university work load … no wonder they let their hair down.

“Plus they don’t understand consequences. They don’t. That’s why we need to teach good old fashioned communication skills, like talking.”

er day-to-day job involves “a lot of sexual health appointments and smear tests”. It also involves answering a lot of questions. And asking them.

I’m here for the Emergency Contraceptive Pill

Student: “I’m here for the ECP.”

Susan: “Why?”

Student: “I got drunk last night and I think I had sex.”

Susan: “Do you know who you had sex with?”

Student: “Not really”, or, “I woke up beside a guy in bed”, or, “I feel like I’ve had sex but I can’t remember it”.

At this point Susan is wondering if the young woman was drugged, if she passed out, if she gave consent. Susan keeps asking questions. Of course she will give the student the ECP.

Sometimes, Susan will use a diagram to explain basic female anatomy to her patients.

“You tell more than one woman they’ve got three holes. I show them pictures. I explain what a cervix is. There are a lot of things they just don’t get.”

Student: “I think I have chlamydia.”

Susan: “Why do you think that? Are you sexually active?”

Student: “Yes. I’m in a relationship.”

Susan: “How long have you been in a relationship for? And are they your first partner?”

Student: “About 18 months, and yes, she’s my first partner, and I’m her first partner.”

Susan: “Are you using contraception?”

Student: “She’s on the pill.”

Susan: “What makes you think you have chlamydia? Is it because you don’t trust her?”

Student: “Oh no, we’ve just never used condoms. At school we were told if you don’t use condoms you get chlamydia.”

Susan feels for the guy – obviously he had a hard-line health teacher.

I want an STI check

One of the main reasons young men visit a sexual health nurse is for STI checks.

“They might be starting a new relationships and want the all-clear, or their ex-partner has said they’ve got chlamydia, or they’ve had unprotected sex, or they’ve been in a relationship for a while and they want to stop using condoms …”

Student: “I want an STI check.”

Susan: “Why’s that?”

Student: “Because I had sex the other night and we didn’t use condoms.”

Susan: “Why didn’t you use condoms?”

Student: “Because she’s on the pill.”

Susan: “What’s that got to do with anything?”

Student: “Oh.”

Susan: “Why aren’t you using condoms?”

Student: “I don’t need them.”

Susan: “Obviously you do if you think you’ve got an STI.”

If it becomes clear he’s been mistreating a woman, Susan doesn’t hesitate to ask: “How would you like if that was being done to your sister?”

That really gets them, she says. “They can get quite aggressive but most just sit back and go, ‘woah’.”

Peer pressure is often to blame, she says. “That’s the biggest thing kids have got to rise above.”

Many parents ring the clinic to try to get the goss on their kids – details which the centre is prohibited from releasing. A better strategy, Susan says, is to stay in touch with your kids and discuss “the ups and downs”.

“It’s got a lot to do with your parents … being taught about respect and morals and staying safe and that sort of thing.

“Maybe as parents we do have a lot to answer for, in that our kids are being sent out into the world unprepared.”

*To protect the nurse’s identity and that of her patients we have used a pseudonym.

 – Stuff


Even a Small Interruption in Blood Flow Affects Male Fertility

Even a Small Interruption in Blood Flow Affects Male Fertility



Blood flow is important for the proper formation of sperm. What is known as the spermatic cord carries blood to and from the testicles. But when a varicocele forms, it can limit blood flow, affecting a man’s fertility. Medical experts still aren’t sure why this disruption occurs. But a varicocele is a blockage that prevents proper blood flow out of the testicles. Researchers believe a valve becomes faulty in a vein, inhibiting blood from moving through freely. This makes the vein dilate, which can cause damage to the testicles and affect fertility.

A varicocele often occurs in adolescence. It usually happens on the left side, but can affect sperm production in both testicles. Now, a consortium of researchers from Europe have found that even a small varicocele can affect male sperm production in a big way. 7,000 army recruits from six different countries participated in the study. Ulla Nordström Joensen, MD, PhD was its lead author. She hails from Roskilde Hospital in Denmark.

Dr. Joensen said that even the mildest interruption in blood flow had a significant impact on a man’s fertility, particularly in semen quality. This led to less sperm concentration. But for those with varicocele, motility problems are common. This is the sperm’s ability to swim energetically for long periods in order to reach its destination. Even if a man has a problem such as this, he is unlikely to recognize it himself. How to overcome the issue in men with this condition is still a point of contention, however. Surgery can fix the issue.

But 15% of men are said to have a varicocele. That is certainly too many to operate on. Of course, only those who want to have children would be interested. In this study, 7,067 men from Germany, Denmark, Estonia, Latvia, Lithuania, and Finland took part. They were all recruited between 1996 and 2010 to serve in their country’s military. Their average age was 19. 1,098 were diagnosed with varicocele, or 16% of the total. Quizzically, Dr. Joensen points out that some men with a varicocele are also fertile. It does not necessarily lead to infertility but can. If a man and his partner have been trying for up to a year without conception, it is important that the couple each seek a fertility specialist. For the hopeful father-to-be, this means an appointment with an urologist.

Porn is damaging young men’s sexual health and causing erectile dysfunction, expert warns

Porn is damaging young men’s sexual health and causing erectile dysfunction, expert warns



Young men are increasingly suffering sexual health problems as a direct result of their porn addiction, an expert has cautioned.

The NHS has seen a rise in the number of young men in their late teens and early twenties complaining of erectile dysfunction, which therapist Angela Gregory attributes to online porn.

“Our experience is that, historically, men that were referred to our clinic with problems with erectile dysfunction were older men whose issues were related to diabetes, MS, cardiovascular disease,” she said.

“These younger men do not have organic disease, they’ve already been tested by their GP and everything is fine.

“So one of the first assessment questions I’d always ask now is about pornography and masturbatory habit because that can be the cause of their issues about maintaining an erection with a partner.”

Nick (not his real name), found his porn viewing habits quickly escalated once he got his first laptop aged 15, leading to him watch videos every day. At his lowest point, he was watching around two hours daily.

“What I was watching, it definitely got more extreme over a short period of time in my case. There was nothing that would give me a kick,” he said.

“Normal stuff didn’t do anything any more, so I had to get more and more extreme material. [It was] disturbing stuff that disturbed me that, in normal life, I wouldn’t dream of doing.”

Watching porn divorced from human contact had a dramatic effect on Nick’s libido, making it difficult for him to perform in real life.

“I found that when I was lying next to a girl a lot that I just wouldn’t be horny at all, despite being really attracted to the girl and wanting to have sex with her, [because] my sexuality was completely wired towards porn.

“At my peak I was probably watching up to two hours of porn every day.”

Nick approached a doctor for help, who told him a lot of men his age were suffering the same type of problems.

He eventually managed 100 days without watching porn, and saw his sexual health markedly improve.


“My libido came back with a vengeance and I met this girl and it was great. For the first time in ages I was able to flirt and within quite a short time I was able to have normal sex,” he said. “I was feeling so balanced and happy.”

An anonymous young woman told BBC Newsbeat she has spent over £2,000 on laser hair removal after a one night stand criticised her pubic hair, which she believes is down to the influence of porn.

“I think porn has definitely had an impact on what men expect women’s body hair to be like,” she said.

Bob, who is married to Rachel, first watched porn when he was nine or 10.

“I really started to look at it actively in probably year eight, and quickly found myself addicted. Since then I’ve been trying to work my way away from it, and remove it from my life,” he said. Obviously, it’s hard. It is an issue for me and my wife.”

“It makes me feel rubbish about myself. If you sometimes look at porn, now that we’re married, I just feel like ‘Am I not giving you something that you want?’” Rachel said. “I don’t think you can masturbate to porn and then pretend that it’s not part of your sexuality.”

If you think you’re having a problem related to porn, Angela Gregory advises talking to your GP.

Men and Contraception: A Necessary Disruption of the Status Quo

Men and Contraception: A Necessary Disruption of the Status Quo


When men are well informed, they can become active participants in the health and well-being of their partners and children- by

James Ngugi is proud of his vasectomy.

The father of five lives with his wife Leah and their children in Kayole, a poor section of Nairobi, Kenya. Leah had suffered complications with each of her five pregnancies, and went on the pill after the couple’s youngest child was born. But she worried constantly about missing a dose.

Then James had a breakthrough realization.

“For too long, I assumed this problem was hers and hers alone,” he says. “But then I realized I could take on the burden myself.” James opted to get a vasectomy through Tupange, a family planning program funded by the Bill & Melinda Gates Foundation in partnership with Jhpiego and the government of Kenya. Tupange means “let’s plan” in Kiswahili, and the program is dedicated to making modern contraceptive methods available to the urban poor to improve maternal and newborn survival and empower couples and youth to plan their families and their lives.

For James and Leah, a vasectomy was the perfect choice. They were so happy with the results—and with the impact of the vasectomy on their family and their marriage—that they now work with Tupange to educate others about the benefits of voluntary male sterilization.

“I never knew how much James loved me until he had this vasectomy for me,” Leah says simply. “It is the most generous gift he has ever given me.”

James and Leah are a family planning success story. They’re also a reminder that men are a critical part of the family planning equation. Enlisting the support and involvement of men like James is essential if we want to expand the benefits of modern contraception to women and their partners all over the world.


That’s especially important to bear in mind now, as we observe the midpoint of the global Family Planning 2020 (FP2020) movement. FP2020 was launched at the 2012 London Summit on Family Planning with an ambitious goal: to deliver modern contraception to an additional 120 million women and girls in the world’s poorest countries by the year 2020 without coercion and discrimination. Four years later, we’ve made enormous strides, reaching an additional 24.4 million women and girls and securing commitments from more than half of the 69 FP2020 focus countries. While our actions are strong, they have not caught up with our ambition yet and we risk falling short of achieving the transformational changes we promised: that women and girls, regardless of where they live, should have the same access to life-saving contraceptives.

To accelerate progress urgently, we need to continually and critically examine our strategies, review the data, and break the mold of doing business as usual. We must challenge ourselves to think creatively, disrupt the status quo positively, act on innovations and identify new partners with bold ideas to urgently expand access and use of contraceptive information, products, and quality services.

One area where we’ve fallen short is male engagement: getting men and boys to actively participate in frank conversations about sex, consent, contraception, and sexual and reproductive health and rights. We know that male opposition, power dynamics, lack of communication and gender equity remain serious barriers to expanding quality, access and improving the uptake and continuation of contraceptive use. Tackling these barriers head on will help drive progress forward.


Globally, the vast majority of family planning programs are oriented towards women and girls. Programs focusing on male engagement in family planning have fewer dedicated resources, even though men are often the primary decision makers about family size, health services, and family planning methods. But if we’re going to reach our FP2020 goal—let alone our long-term goal of universal access to reproductive health—we’ll need to expand the dialogue and involve men and adolescent boys as valuable and effective partners. Programs that optimize the positive engagement of men can improve health outcomes for women, men, and their families.

Stories of progress in family planning are often stories of innovative partnerships with governments, civil society, service providers and the private sector. And one bold attempt to ratchet men’s involvement up is World Vasectomy Day, an innovative partnership designed (by men) to proactively take charge of their own health and well-being. Launched in 2013, World Vasectomy Day has quickly grown into the largest male-focused family planning event in the world. The information isn’t limited to vasectomies though; conversations also focus on preventing HIV and other STIs, male circumcision, gender equality, and the importance of men in family planning.


The innovation of World Vasectomy Day is that it isn’t just a one-day event. It’s a larger movement aimed at encouraging men to become agents of change in their communities; to take an active role in their sexual and reproductive health throughout their lives. Men tend to be negligent of their own health, and the gender dynamic in many cultures means that men are unaccustomed to thinking about how their actions affect their partners and children. Masculinity norms also make some men unsure about family planning.

That’s why it is so critical to secure men’s engagement on this issue. When men are well informed, they can become active participants in the health and well-being of their partners and children. Their involvement can also foster joint decision-making and improve communication between partners that lead to shared decision making about family size and method choice. Men can also play a powerful role in transforming rigid gender norms, promoting women’s and girls’ empowerment and well-being, and ending gender-based discrimination and violence.


This year the Government of Kenya is stepping up to host World Vasectomy Day on November 18. Kenya is a country that is on the forward edge of family planning, actively embracing new ways to broaden the dialogue around contraception. In 2014 Kenya showed a dramatic increase in its modern contraceptive prevalence rate for married women, which rose from 32% in 2003 to 53%, thereby exceeding its FP2020 goal.

Another important trend globally and in Kenya, is the number of women and men who have achieved their family size and want to stop childbearing. Half of married women age 15-49 and 42% of currently married men consider their families complete. The Government of Kenya is responding to this trend and is moving forward to innovate and forge strong, bold partnerships with NGOs and local communities to improve quality, access and choice.

While the gains are worthy, challenges remain in Kenya. Almost 20% of teens aged 15-19 are mothers or pregnant with their first child – numbers that have remained stagnant over five years. The modern contraceptive prevalence rates for all women including those who are unmarried, sits at 39.1%. In terms of male engagement, condoms represent only 2% of modern contraceptive use and less than 46% of married women had even heard of male sterilization.

Let’s be clear: to deliver on the promise of FP2020, we need to reach 120 million additional women and girls and their partners to promote family planning, expand access to information, services and supplies in order to accelerate contraceptive uptake and reduce discontinuation.


We need to design programs with men and adolescent boys to address myths and misconceptions and help get them on board to become champions, users and supportive partners. Many men are like James: they see their wives suffering with fear of pregnancy or contraceptive complications, and they long to step up and relieve them of the burden. For other men it’s about their children: they want to give them the best possible chance in life, and that means making sure they can support them fully. These are positive, heroic instincts. If we are going to hold ourselves accountable to the promise we made back in 2012, we must take a closer look at men’s needs, develop an evidence base, cultivate different partnerships and gear more information towards men and adolescent boys.

When James opted for a vasectomy, he knew he was taking a risk of being one of the first men in his community to get the procedure done. And now, with only four years left on the clock to reach the FP2020 goal, the family planning community must take some risks too. That means we’re going to have to try new approaches, bring new partners to the table, listen to fresh voices and move out of our comfort zones to get things done and ignite real, lasting change.

The kind of change that involves all of us breaking down silos and building bridges – working together with men and adolescent boys so we can go further faster.

We don’t want no sex education

We don’t want no sex education

In the age of the Internet, gender, sexuality, puberty and sexual health remain taboo topics in schools and homes.-Vangmayi Parakala

vangmayi-kqAB--621x414@LiveMintAdolescents using tools made by the Thoughtshop Foundation. Photo: Thoughtshop Foundation

During a workshop on puberty awareness targeted at 10- to 12-year-old boys, sex educator Anju Kishinchandani was faced with a curious situation. When they were talking about the growth of pubic hair, one of her students thought he would have to stop going to school. Perplexed, she asked him why, and he said that since he wore shorts to school, hair might grow out from under them.

“We take for granted that the child would know things. But (puberty) is completely new for them. It can cause so much worry,” says Kishinchandani, who conducts workshops in Mumbai schools and neighbourhoods through her company, Out of the Box. These include a “My Body is Mine”, a child-friendly workshop for five- to eight-year-olds, and “Let’s Talk”, a complete sex education session for 13- to 15-year-olds, designed to encourage informed decision making.

Kishinchandani and other gender and sexual health educators have a tough job—in rural and urban India, social and cultural stigmas make it difficult to discuss sex, gender and sexual health issues with children and young adults.

A report on sexuality education in India by the Youth Coalition for Sexual and Reproductive Rights, an international organization, noted that “most schools—private and public-affiliated state boards of secondary education—don’t have any form of sexuality education in their curricula”. The Adolescence Education Programme (AEP) launched by the government in 2005 ran into trouble with state governments and didn’t quite take off. Three years ago, in a vision document for education in Delhi schools that the Bharatiya Janata Party’s Harsh Vardhan prepared in the run-up to assembly elections, he stated that “So-called ‘sex education’ (is) to be banned”. A year later, Harsh Vardhan, who became Union health minister for a while, added that he “wholeheartedly supported pedagogy that is scientific and culturally acceptable”.

The magnitude of the problem is all too visible. According to Unicef’s “The State Of World’s Children, 2016” report, India’s adolescent population (10- to 19-years-old) is over 250 million. That’s a lot of children who have to rely on misinformation, misdirected peers, pornographic material that is sexist and demeaning, and risqué Bollywood and regional cinema, to find out about the birds and the bees. Of them, the report reveals, around 71.5% of adolescent girls and 88.2% of adolescent boys use mass media.

There are, however, a handful of non- governmental organizations, parents and educators keen to hold constructive and informative conversations with children. Delhi-based not-for-profit Talking About Reproductive and Sexual Health Issues (Tarshi), for instance, has been running a helpline for sexual and reproductive health since 1996. It conducts workshops, issues publications, holds e-learning courses on sexuality, and engages with organizations to highlight the importance of such learning for young people.

“There has been a general denial of access to information on sexuality and bodies and this is especially acute with regard to younger women and girls,” says Vinita Sahasranaman, director of programmes and advocacy at the YP Foundation, a youth organization set up in 2002 to influence policy on issues of gender and sexuality, art, health and education.

The Thoughtshop Foundation, set up in 1993, creates communication tools for those working on issues like gender equity and adolescent health. It is run by Himalini Varma, a designer from the National Institute of Design, Ahmedabad, along with fellow designer Santayan Sengupta.

Over the years, Varma has found that well-meaning health workers, even those with decades of on-ground experience, are uncomfortable discussing topics of reproductive health with adolescent girls. The problem is a complex one, tinged with social taboos, assumptions that children will figure things out eventually and, paradoxically, that they aren’t old enough for this information.

Their kits are picture-intensive, with a storyline and easily relatable characters designed to address children from differing educational backgrounds. Their two adolescent health kits—“Champa” for girls, and “Shankar” for boys—which initially came out in Bengali, are also available in Telugu and Hindi now. “We design our kits keeping in mind not just the end recipient (the children), but also the grass-roots users (trainers),” says Varma. She recounts a session when a card with the picture of a teenage girl holding a little baby fostered a discussion on issues of child marriage and teenage pregnancy, as the adolescent girls related it to events in their own lives.

The YP Foundation follows a “peer educator model” for its target audience—marginalized young people, in institutional homes and government schools. “We induct and train older young adults, say 15- or 16-year-olds, to (conduct) sessions with us. This is premised on the comfort level that a peer group shares. We (have) observed that children clarified misconceptions around menstruation with less hesitation with peers than with much older adults,” Sahasranaman says.

“The backlash begins only with contentious issues like shame around menstruation, education on gender relations, sexually transmitted infections (STI), or contraceptives,” she says.

Despite this, sexual health educators like to keep things real. Gaurav Kumar, 22, currently a postgraduate student at Delhi University, facilitated sex-education sessions at a private New Delhi school for children of classes IX-XII in the last academic year. His sessions brought up several topics—sexual and reproductive health, awareness of the rights of sexual minorities, the relation between law and sexuality, the issue of Section 377 of the Indian Penal Code and notions of “natural” versus “unnatural” sex. Kumar’s programme at the school also included organizing sessions with activists and film-makers such as Pramada Menon.

“The focus was to make the students more aware and to sensitize them to these issues, even as they are growing up. To do this, I would also bring in pop-culture references, especially stories of celebrities that the kids would read about often. Because the challenge was to make the topics interesting and relatable in a non-awkward way,” says Kumar.

To keep pace with India’s children—literally, the country’s future—sexual health experts are constantly and rapidly modifying their ways of reaching out and providing healthy, much needed information. Regardless of whether they work in rural or urban areas, trainers say the children are brimming with curiosity and ready for information. The question is, are we willing to provide it to them?



Getting Ahead of the Global Urbanization Curve in Reproductive Health

Getting Ahead of the Global Urbanization Curve in Reproductive Health

According to the United Nations, around 66 percent of the world’s population will live in urban areas by 2050. If those projections hold, that means an additional 2.5 billion people will be living in cities, with 90 percent of them in Asia and Africa. With this predicted expansion of human populations toward cities, funders are feeling the pressure to get ahead in all manner of global health and development challenges.

The Gates Foundation has its eye on meeting the growing need for urban reproductive health programs—a matter in which the foundation and its partners have been looking into since 2009 with its Urban Reproductive Health Initiative (URHI).

Armed with funding from Gates, the URHI pilot program was launched in 2009 in Kenya, Nigeria, Senegal, and India. The overarching principle of the program was to increase women’s access to modern contraception. Implementing partners in each country then expanded on that basic principle. For example, URHI in Senegal worked with project partners to develop cost effective family planning programs, increase awareness for family planning in local communities, and inform policy making related to family planning. The pilot ran from 2009 to 2015.

Now, the Bill & Melinda Gates Institute for Population and Reproductive Health, which is based at the Johns Hopkins Bloomberg School of Public Health, is launching a new urban reproductive health program, called The Challenge Initiative, or TCI.

The Gates Foundation has made a $42 million grant to support TCI which aims to scale the “tools and approaches developed and lessons learned in URHI to more cities and geographies.” TCI will focus its work on cities that demonstrate a high need for modern contraceptives, family planning information, and sexual and reproductive health services.

Given that TCI is taking a demand-driven approach, it asking participating cities to “self-select” and work with in-country partners to develop full proposals that include family planning and reproductive health interventions that are cost effective and accessible. From there, chosen cities will have access to a chunk of Gates’ $42 million.

Family planning and sexual and reproductive health isn’t just about women having increased control over their own sexual and reproductive health choices. Expanding choices, education, and accessibility here can have a significant impact on a variety of global health and development challenges such as economic security, education, poverty alleviation, and women’s empowerment.

The Gates Foundation is a key funder in the global family planning space—last year, it committed nearly $300 million to related programs—but there are a few other big names here, like the Hewlett and Children’s Investment Fund foundations. Of course, also, the Susan Thompson Buffett Foundation is a major player here.

Hewlett is a heavy funder of projects related to reproductive health rights advocacy and research to inform policymaking, rather than those focused on health care delivery services. This funder has been committed to helping women gain autonomy over their bodies, and their sexual and reproductive health choices for decades.

Hewlett’s International Women’s Reproductive Health program aims to decrease unwanted pregnancies, increase access to basic reproductive health services, and ensure that no woman or girl dies from unsafe abortions. Recent grants coming out of Hewlett include a $1.25 million give to Pathfinder International for its work which includes providing sexual and reproductive health services including maternal health, HIV prevention, and safe abortion provision. Pathfinder is also committed to strengthening national and international health systems, advocating for increased policy making in the sexual and reproductive health arena.

Hewlett, like most funders in this space, connects family planning and reproductive health into broader global health and development goals.

The Children’s Investment Fund Foundation (CIFF) takes a bit of a different funding tack than Hewlett and Gates, focusing squarely on adolescent reproductive health. To date, the UK-based funder has invested $75 million in projects related to HPV vaccinations for adolescent girls in sub-Saharan Africa. HPV is currently the leading cause of cancer-related deaths for women in the region. Other major grant include a $13.5 million to prevent unwanted teen pregnancy in Kenya, and $14.2 million to scale and increase access to the contraceptive, Sayana Press.

Incidentally, earlier this year, CIFF and partnered with the Gates Foundation earlier this year to launch Adolescents 360. The program which was funded by a multi-year, $16.5 million grant from the CIFF and matched by Gates for a total give of $33 million aims to “reinvent sexual and reproductive health services,” with a focus on girls at the center of the program’s development and design.

Upon making the $42 million announcement, Christopher Elias, president of the global development program at the Gates Foundation. “Meeting the growing demand for voluntary family planning, particularly among the urban poor, will allow more women and couples to plan their futures and break the cycle of poverty.” And he’s not wrong.

Multiple reports have found that when women have fewer children or wait longer before having more children, their families are able to invest more in their education, nutrition, and healthcare. Also, women who wait longer to get married or at least have babies, are more likely to continue their educations, which then leads to not only increased economic security, but improved gender equality.

In other words, there’s a lot at stake here.

STD Risk Increases in Women Who Use Long-term Contraceptives

STD Risk Increases in Women Who Use Long-term Contraceptives



We usually think that in the decades before the Sexual Revolution, there were far less cases of teen pregnancy in the United States. But according to the CDC, the teen pregnancy rate in has dropped steadily in the U.S. since the 1950s. Even so, it is still far higher than most other developed countries. There are lots of reasons for this decline including better sex education, the sheer breadth of birth control options, and that protection is widely available. Some options that have gained in popularity in recent years include hormonal implants and intrauterine devices (IUDs).

Although they are very effective in preventing unwanted pregnancy, they do nothing to protect against STDs. The problem is, some couples for whatever reason, may forgo a condom, if this method of birth control is employed. The fact is, STDs have been on the rise, including some worrisome ones, like antibiotic resistant gonorrhea. The most effected population are those between ages 15 and 24. But an uptick in all demographics, including seniors, has taken place.

The 2013 national Youth Risk Behavior Survey assessed sexually active teens on condom and other contraceptive use. Researchers conducting the survey asked during their last bout of sexual intercourse what birth control method young women used. Researchers inquired about condoms, birth control pills, IUDs, and hormonal implants or injections. Another question was whether they had used a condom during their last sexual encounter. 2,300 teen girls answered the survey. 57% were Caucasian. 34% were seniors in high school. Of those who used long-term contraception, 16% said they never used condoms.

Researchers hypothesized that those using long-term contraceptive methods would be less likely to opt for or push for a condom, and more likely to contract an STD. They were right. These young women were 60% less likely to use condoms. The takeaway is no matter what your age or the stage you are at in your love life, if you are going to have sex outside a long-term, monogamous relationship, use a condom. What’s more, all sexually active adults should be tested once a year for STDs. If your time is up, be sure to go see a doctor or urologist and get screened.