SOME ELEMENTS TO INTERPRET THE PRESENCE OF MALES IN
PROCESSES OF REPRODUCTIVE HEALTH

by

Juan Guillermo Figueroa Perea

Centre for Population Studies and Urban Development

NOTE

This text was originally published in spanish in Cadernos de Saúde Pública, Brazil 1998

 

Summary

 

The objective of this study is to identify analytical approaches to situate males in the processes of reproductive health. In discussion relating the dynamics of health and reproduction, males are interpreted as actors who can support improvements in the health of women and children. It is only very recently, however, that there has been concern to redimension their role, thinking of them as beings that reproduce and face risks in their reproductive biology, behaviour and process.

One possible way of explaining the presence of males in these processes is to identify in the diagnostic descriptions of reproductive health that are available, where their absence and presence is a condition of favourable consequences or otherwise for women and children. Without necessarily altering the interpretation of the reference population, or the relationships of power that underlie masculine and feminine experience of sexuality and reproduction, the aim is to see how they complicate or help to improve conditions of maternal morbidity and mortality during pregnancy, childbirth and the puerperium.

A second possibility is to explore the relational, social and potentially conflictual character of "sexualized" reproduction. This means recognizing times and types of confrontation between men and women, and between the different actors in social reproduction, situating them in specific heterogeneous contexts, so as to avoid simplistic readings of a process as complex as reproduction. It means approaching analysis of reproduction as a relational process and not as isolated events for men and women, at the same time recovering the specificity of both men and women. In the study it is proposed to use the gender perspective as an assumption, so as to imagine these processes without negating the dimension of power. Thus the issues of sexuality, reproduction and health are posed in terms of interaction, with a view to constructing clearer references for the male population in regard to the dynamics of reproductive health. In the second approach, we draw on the aspects already outlined, that is, attempting to construct reflections on males in relation to the dynamics involved in reproductive health, recognizing the need to continue to advance in what is known about reproductive health, explaining the presence of males.

Key words: reproductive health, males, gender.

 

SOME ELEMENTS TO INTERPRET THE PRESENCE OF MALES

IN REPRODUCTIVE HEALTH PROCESSES

Juan-Guillermo Figueroa-Perea

Health and reproduction with reference to males

The objective of this article is to identify some analytical approaches to situate males in the processes of reproductive health, which was originally defined as four basic elements: "for individuals to have the ability to reproduce, and to regulate their fertility; for women to have safe pregnancies and deliveries, for the results of pregnancy to be successful in terms of survival and maternal and child welfare; and for partners to have relations free of the fear of unwanted pregnancy or diseases" (Fathalla 1987; Barzelatto and Hempel 1990). At the Cairo Conference on Population and Development freedom to enjoy a satisfactory sex life was also emphasized and it was agreed that reproductive rights include the highest level of reproductive health; this lends support to the possibility of rethinking gender relations in the sphere of reproduction.

One possible way of explaining the role of males in these processes is to identify in diagnostic descriptions of reproductive health the places in which they are absent and present and how they condition favourable consequences for women and children. That is to say, without necessarily altering the interpretation of the reference population, or the relationships of power that underlie the experience of sexuality and reproduction, it can be seen how they affect morbidity and mortality during pregnancy, childbirth and the puerperium, in processes of fertility regulation and in the occurrence of abortion, inter alia. One variant of this is to imagine the biological risks of males attaching to the reproductive processes.

Ample experience exists in the elaboration of surveys of family planning, maternal and child health, and to some extent of sexually transmitted diseases, all of which are components that are considered to contribute to the shaping of reproductive health. Although in some cases these surveys lapse into reductionism, the indicators used in them reveal dynamics that can help to interpret some processes of health and disease in the reproductive sphere. These surveys, however, have given little attention or have ignored the relational dimension of sexuality and reproduction, as well as the specificity of males. The assumptions made to interpret phenomena are not independent of the social actions constructed to work for health in the reproductive sphere.

A second possibility for analysis is to explore the relational, social and potentially conflictual character of "sexualized" reproduction; this involves recognizing times and forms of confrontation between men and women, and between the different actors in social reproduction, situating them in specific heterogeneous contexts, so as to avoid single and simplistic readings of a process as complex as reproduction. This alternative means approaching the analysis of reproduction as a relational process and not as isolated events for men and women, at the same time recovering the specificity of both men and women. It is not sufficient to reconstruct the participation of men in the health of women, but it is necessary to think of them as actors with sexuality, health and reproduction and concrete needs to be taken into consideration, both in their interaction with women and in their own specific right. This approach seeks to explain processes of exclusion in the study and experience of these dynamics.

We have seen, for example, that demography and medicine, as disciplines that have studied reproduction, have not devoted any special attention to analysis of the reproductive process in men, so that such basic times in the reproductive process as pregnancy are not predicated in regard to the male population. Moreover, there are no indicators for the study of fertility that incorporate men in the way in which social constructs have been validated in which maternity is presented as a central dynamic in the gender identity of women. In both disciplines there is recourse to interpretations that reflect a vision of dominion and distance by men in the reproductive process and a receptive and passive attitude for women: "men make women pregnant and women get pregnant". As fathers are also not expected to have such direct contact with newborn children, at least until they start to walk or talk, one of the central actors in reproduction is marginalized by experience (with the complicity of men) at a time that has a central influence on the infant’s personality.

The other component in the term of reproductive health has to do with the health-disease binomium; the causes of death in men reflect a process of self-destruction and exposure to danger, very often deliberate and intentional, so that some authors have classified man as a risk factor for his own health, the health of women, children and other men (De Keijzer 1992). The causes of women’s death, on the other hand, reflect social and personal abnegation in regard to the right to care and prevention of situations that put their health at risk, since they assume responsibility for the health of their children and their partner before themselves. Basaglia (1984) talks of women as "a being for others", while the literature on males depicts them as "beings who live for themselves". A process of healthy interaction between the persons participating in reproduction presents considerable complexities and suggests discrepancies which need to be explored in theory, analysis and practice.

Another dimension explicitly raised in reproductive health is sexuality, stressing that reproduction should be seen in parallel to a satisfactory sex life. In the studies on women a process of negation of sexuality has been found, in terms of the possibility of enjoyment and pleasure, so that it is experienced with guilt or in terms of the pleasure of others, whereas studies on men show that the characteristics of their sexuality include competitivity, violence, homophobia and experience as a drive and source of power. This confirms differences in reproductive experience and interpretation between men and women, which are not easily reconciled when imagined as independent processes.

We propose to use the gender perspective as a frame of reference to imagine the

processes involved in reproductive health in a relational sense, not denying the exercise of power, but showing that this presupposes the existence of a free being over whom power is exercised and who may potentially react to this relationship (Foucault 1988). Such power also implies relations of permanent tension that need to be validated in some way through the participation of those involved in the different moments of the relationship (De Barbieri 1992).

Scott (1996) points out that gender is one element in the social relations based on the differences perceived between the sexes, at the same time as being a primary form of significant relations of power. Gender reveals the character of permanent tension in social relations and raises questions about many histories of reproduction, sexuality and health that have been regarded as obvious and ultimately go unquestioned, and we assumed and reproduced. To speak from a gender perspective implies recognizing that there are culturally available symbols that support normative concepts and processes, political and institutional concepts that guard these processes and that these symbols shape the subjective identity of individuals; hence it is not easy to recognize them.

The gender perspective as an option for theory, methodology and practice, as it is now incorporated into discussion of sexuality and reproduction, allows us to question the value attributed by men and women to reproductive events, as well as reconstructing the historical process that has led to differential assignment of rights and responsibilities, so that actors can be identified in any process of validation, and also of transformation of the norms that have moulded the area of reproduction in specific contexts. In other words, the incorporation of males appears a forced exercise, since the practice and conceptualization of reproduction is not radically questioned.

 

Notes for the conceptualization of reproduction as a relational problem

We understand reproductive behaviour as a complex process of interrelated biological, social, psychological and cultural dimensions directly or indirectly connected with procreation. In a broadly comprehensive sense, it includes behaviours and events relating to courtship, sexual pairing, union of the couple, expectations and ideals for a family, planning of the number and spacing of children, the use or not of some method of contraception, the relationship of the couple during pregnancy, childbirth and the puerperium, participation in the care and rearing of the children and economic, educational and emotional support for them (Figueroa and Liendro 1995). This global conception suggests the presence of relationships and specific dimensions both for women and for men that have been exploited in most analyses.

In spite of this multiplicity of dimensions women continue to be at the centre of analysis concerning reproduction; this has repercussions on the type of indicators used to interpret changes in fertility and the type of policies defined to influence this. The statistics used to characterize fertility can hardly be imagined to apply to males, not only - as often argued - because of the practical difficulties of determining how many children they have had, but because little theoretical effort has been made to conceptualize the reproduction of a population differently, not limiting it to what happens with women.

From an extensive review of articles on fertility, nuptiality and the family published in the journal Demography, Watkins (1993) comments that women are analysed as producers of children and services for them, which they do with little help from males and are socially isolated as they carry out these tasks. The author concludes that what is known about men in respect of these matters is minimal.

In demographic analysis of reproduction there is limited interpretation of the issue of power between members of the two sexes and analytical models are reproduced of relations between men and women involving, like conventions on gender, separate and opposing spheres. Analysis has characterized men as defining the socioeconomic context in which biological reproduction takes place, so that these exclusions do not depend solely on the social action of men when they detach themselves from biological reproduction and concentrate on social reproduction, but also on the models of interpretation of the different disciplines that have studied the reproductive processes, and the policies and programmes constructed on the basis of this knowledge.

In the case of medical knowledge and practice, Castro and Bronfman (1993) analyse the criteria for epistemological interpretation and give examples of how the concepts of nature, the body, subjectivity, the private domain, feelings, emotions and reproduction are associated with the "feminine", while culture, the mind, objectivity, the public domain, thought, rationality and production are associated with the "masculine". Medical knowledge not only ignores relationships of power, reinforced by social constructs, but validates exclusive gender specializations.

Further complexity for relational analysis of reproduction derives from the sexist elements to be found in policies and programmes connected with the interpretation of reproduction, via contraception. For example, in the government institution with widest service coverage in Mexico, doctors are trained with educational materials affirming that "there are practically no contraindications for bilateral tubal occlusion, but certain conditions in women may mean that this procedure should be deferred (but not ruled out)", (AMIDEM 1986a, p.30), whereas "vasectomy is contraindicated for subjects who are in doubt about their decision, biologically or psychologically immature, afraid of the possible effects of the operation on their health, whose decision has been reached on the basis of insufficient or erroneous information, or psychopaths" (AMIDEM 1986b, pp. 26-27). Sexist elements may be observed in institutional prescription and practice, overprotecting the men and stimulating the presence of women.

In the logic of certain studies with demographic data, such as the text prepared by ECLAC and CELADE (1993) as background for the Cairo Conference, the percentage of women of childbearing age who are married and are users of contraception with "responsibility for use" is discussed. The methods are artificially divided into women’s and men’s methods and the focus is on the person affected rather than the process of interaction between the man and the woman. Furthermore, the methods in which the man is most obviously present, such as the condom, rhythm and withdrawal, are regarded as less effective and hence the fact that they are not promoted by family planning programmes goes unquestioned. It is not too much to say that the medicalization of fertility regulation, supported by sexist processes in analytical interpretation, standard-setting and the pursuit of greater demographic impact, has discouraged male involvement in the processes of reproduction beyond the limits of the understanding built up between men and their partners.

Males and the experience of contraceptive use

When we think of the practice of fertility regulation as another of the basic components in the ability to reproduce and influence reproduction, the presence of men is very contradictory since they are usually seen as obstacles to or supporters of fertility regulation in their partners, but not as beings who are able to regulate their own fertility; when they are asked, it is also found that they reject the need to assume responsibilities in the reproductive sphere.

One example is documented by Arias and Rodríguez (1995) who analyse the use of condoms in the Mexican context and try to identify changes in sexual values in male experience as a result of condom promotion. The authors find that men continue to live "in readiness for coital relations" and that they also differentiate in their use of condoms depending on the "type of woman" with whom they are having relations. Women they know and whose cleanliness and non-promiscuity they take for granted do not require the use of a condom, but this is not the case for unknown women, who may be promiscuous and may similarly be having coital relations with many other men. In spite of the pejorative connotation, many men say that it is not necessary to use a condom with their partners, since "they are faithful and only have relations with them"; thus there is a double moral standard inherent in the male identity.

Although different studies have revealed men’s opposition to the use of contraceptives there is work that documents the acceptance of vasectomy in Latin America and suggests that men are prepared to become involved and indeed that they hope to do so, but that there have not been methods and programmes directed specifically towards them (Alvarado 1995, Castro 1995). Evidence compels us not to be naive in this reading and to be more critical in interpreting the male reproductive context.

In studies by Bean et al. (1983) and Miller et al. (1991) on how couples decide on the use of contraception for the long term, the authors report that the interaction between the partners and agreement between them is significant in determining what type of method they will use definitively. With greater communication within the marriage they will opt for vasectomy and when communication is poor they will have recourse to bilateral tubal occlusion; the authors document the social experiences that increase the possibility for the woman to negotiate the decision on the type of method to be used. Andres et al. (1984) find that decisions on sexuality, reproduction and contraception are better explained in terms of the characteristics of the couple’s relationship, especially liberal attitudes.

Diaz et al. (1992) analyse men and women’s participation in family planning in the context of Latin America and comment that certain family planning and maternal and child health programmes have focused on demographic efficiency, which in conjunction with excessive authoritarianism in the relationship between the service provider and the client has generated unequal participation in the field of fertility regulation. To this must be added excessive powers of decision on the part of males and the lack of an integrated view of women as human beings, with neglect of their sexual welfare. Nevertheless, there are few studies that give theoretical consideration to the influence of health service providers on negotiation between men and women prior to the selection of a particular contraceptive, in spite of the fact that these institutional personnel play a central role in some settings in Latin America (Cervantes 1993, Figueroa 1994).

Males and the practice of abortion

Another way of controlling fertility, not regarding it as a method of contraception but as a recourse for the termination of an unwanted pregnancy, is abortion. Leal et al. (1995) document in the case of Brazil a thoughtful liberal attitude to their experience of sexuality by men, but conservative in regard to abortion as a women’s right. At the same time, the comments of women on sexuality are more conservative but they are more liberal in their reference to abortion as forming part of their rights. This differentiated moral value judgement is confirmed in Mexico, where the findings of Núñez and Palma (1991) show that abortion is more often declared by adolescent males than females, possibly because the former are subject to less moral and legal sanctions. There are also some males who say they do not know the outcome of some pregnancies in which they know they have been involved; they do not appear to be accustomed to give any account of what occurs in their sex life.

In discussing the role of men in the decision to abort Tolbert and Morris (1995) give examples of how different models of gender relations can influence the various decisions that are taken concerning abortion: the greater the equity in the different spheres of social undertaking, the more transparency there is in negotiations between man and woman on abortion; nevertheless, this has been very little documented.

Contraception as well as the practice and discussion of abortion raise questions for the man-woman relationship, perhaps more for the man, as they are faced with a person with new possibilities arising inter alia from the use of contraceptives but also from the enrichment of their options in life. According to Castro and Miranda (1995) contraception challenges the identity of women by enabling them to develop projects other than maternity, but constitutes an even greater challenge to the male population by reopening the issue of the way they interact with persons of the opposite sex, without necessarily altering the components of their gender identity.

 

The dimensions of sexuality and health in males

The relational dimension of reproduction requires explicit explanation of male experience of sexuality and health.

Sexuality in males

Kaufman (1987) interprets sexuality in males as an exercise of power and refers it to obsessive masculinity, which he advances as an ideology, as the personification of the power of men; but the need to be constantly proving that one is a man generates a process of fragility among males and permanent doubt about their own manliness, which they combat with interiorized violence that ensures or supports the assumed fulfilment of virility. The author analyses the triad of male violence as a moment in the constitution of masculinity, at the same time as it also helps to interpret their experience of their sexuality. This violence is focused on women and children, on other men and may include violence against the self. In another article, Kaufman (1994) documents contradictory experiences in the exercise of power by men and recognizes that the experience of masculinity can be painful.

Horowitz and Kaufman (1989) add the dimension of conflicts and tensions to thinking on male sexuality, describing it in terms of being a way of exercising power over women, over homosexuality and even over the body: masculinity has been construed as an unconscious renunciation of bisexuality in the face of which conflict and fear are experienced, so that this should be given a heterosexual reading. This regulation is facilitated by a process of reification which includes a permanent attraction for women and a reification and commercialization of their bodies as a product to be consumed, so that women end up being debased and dismembered as a function of the sexual interests of men.

In reconstructing the stereotype of male erotic sexuality in a patriarchal culture, Lagarde (1994) assigns it the attributes of an actively experienced behaviour, generating pleasure and personal well-being; the assumption of male domination defined by the exclusivity and multiplicity of heterosexual relations; a disintegrated view of the female body as a privileged partial object of male desire; the restriction of satisfaction in erotic genital relations and coitus, homophobia as a reaction to behaviours that elude the accepted paradigm, and rejection of feminization of their behaviour. In analysing reproductive processes it is very important to take account of these characteristics since they condition male erotic sexuality, which is difficult to distinguish from reproductive sexuality, while it is not the same among women, for whom eroticism and reproductive sexuality are very often bound up together.

Kimmel (1994) explores masculinity in depth as homophobia and discusses the fears, shame and silences in the construction of gender identity, commenting on the fear men have of each other in the process of constructing this identity. The endeavour "not to be homosexual", as one of the central aspects of the process of being male, generates a deep fear of not being a real man and being humiliated by other men, so that violence is generated as a feature of manliness and masculinity, in so far as it is a source of power over women and over other men. The author argues that it is an irony that men hold virtually all power and still do not feel that they are powerful, so that they continually have to demonstrate it. Artificial competition with other men is produced, so that they end up living closed in on themselves in their own discourse. From childhood on a solitary confrontation with other men is generated, limiting the development of solidarity as feature of personality.

Horowitz and Kaufman (1989), while they recognize that male sexuality has been interpreted as something that needs to be moderated, controlled and contained on account of its capacity for aggression, reification, domination and oppression of women, feel that it is feasible to construct proposals for a theory of liberation. To this end they propose explanation of repression and "excess aggressivity" in males, the identification of areas of sexual conflict, discussion of activity, passivity and bisexuality and, as an important element, discussion of the process of social repression of an innate human polysexuality.

Analysis of "sexualized reproduction", as we have come to call it, is complicated when what is known of male sexuality is incorporated. In a heterosexual logic, it is confronted with the sexuality of a "being for others", whose sexual exercise is negated by self and by society, which enormously complicates any possibility of satisfactory, pleasurable and equitable interaction. Nevertheless, to ignore these references would enormously limit any comprehensive view.

Health in males

The specifically male dynamic of health is a reflection of male life patterns, their

processes of socialization, the roles assigned to them by society, the social interpretation of their emotions, and ultimately, of the stereotyped form of the "male being" (De Keijzer 1992). In analysing male morbidity and mortality we discover trends that are very different from those of women and cannot be explained in purely biological terms. Bonino (1989) observed that three out of every four young people dying from violence in a Latin American context are males. The author talks of personal imprudence deriving from the physical and psychological violence of males, in addition to the recklessness of the adolescent period and the myth of the hero, as references for the construction of the male persona.

This is confirmed by Fagundes (1995) and Gastaldo (1995) in their discussion of the construction and social perception of the male body as an active body that is prepared for exposure to risks, that is resistant and that seeks respect through violence and confrontation with others; risk-taking use of their own bodies gives males a story to tell and allows them to characterize their life as heroic, a sign of individuality.

In analysing disease and death among men, De Keijzer (1992) reveals the existence of problems common to both sexes, as well as distinguishing problems specific to men; he nevertheless emphasizes problems connected with gender status, such as the risks deriving from a differential socialization process. From here he goes on to note that men take no care of themselves, abuse their physical capacities and suffer excess mortality, especially after the age of fifteen; he also comments on the suicidal neglect of their own lives by many men. This picture contrasts with the case of women, in whom the causes of death are associated with processes they assume as inevitable and for which they do not "allow themselves" to look after themselves and prevent problems, because of social constructs whereby they deny themselves and live for others, as well as on account of social obstacles to the prevention of these health problems.

De Keijzer (1995) suggests that if homicides and accidents were classified in relation to the presence of alcohol, the use of alcohol would be the principal factor accounting for male mortality. This author suggests interpreting "man as a risk factor" for his own health, for that of women, other men and his own children, both through the links formed with them and the violence of these interactions. On this premise he proposes to discuss the causes of the real and symbolic violence that shape the hegemonic model of masculinity.

In spite of these references, studies on male reproductive health needs in Latin America (Rogow et al. 1991) continue to discuss the subject in terms of programmes relating to contraception and family planning, while analysing in particular the conditions necessary for the use of vasectomy and responsible male participation in the rearing of children. However, discussion of sexuality and self-destructive processes in men are left aside, which hampers understanding of the relationships of power in the reproductive process.

Possibilities for recovery of the male presence

To talk of reproductive health in the male dimension implies questioning the symbolical and real discrimination of women in the sphere of sexuality and reproduction, together with the processes of exclusion of men, from the standpoint of a logic of power that has influenced the assignment of differential responsibilities and rights. Lamas (1994) points out that the symbolical efficacy of the process lies in its ability to mask relations of power and institutionalize inequality. Nevertheless, the feminist paradigm has contributed to an "awakening of consciousness" in many women and has had an influence on the vital process of not a few men as well.

By questioning the obvious, explicitly positing the limits of unilaterally defined stereotypes and standards, the gender perspective has helped to identify leads for the reconstruction of the social environment. Reproductive health presents as a category that challenges the manner in which health and reproduction are analysed, partly by directly involving sexuality and explaining the presence of males in this dynamic. The concept of health as a right of all persons compels recognition of gender equity as a basic premise for its attainment, calling in question the models of social and institutional relations that have been constructed to shape the setting for reproduction.

The gender perspective offers the possibility of rethinking the manner and significance of being a man and being a woman, explaining discrepancies in the moral authority acknowledged for individuals who are actors and authors of the social environment, reformulating standards and even "reshaping our significance as persons". Nevertheless, when only superficially incorporated it may give rise to a process of collective manipulation in which we complacently feign to change and are simply familiarizing ourselves with the discourse that is preventing us from reconstructing the reality in which we find ourselves. To incorporate the gender perspective into reproduction means venturing into a painful process of rethinking our identities, and this is no easy matter since it involves recognizing differences, negotiating freedoms, assuming responsibilities and, above all, settling conflicts collectively. It is not confined to interaction between members of the two sexes, but between members of different social groups and the institutions and persons with which they relate.

In an earlier study (Figueroa 1995a) we proposed to imagine strategies for analysis of the reproductive process in the context of the relationships of power between men and women; for this we attempted to interpret males as persons who construct a way of reproduction involving interaction of their body with their sexuality and the way in which they live their masculinity, without overlooking but without becoming completely consumed in their relation with women. The aim was to document, inter alia, the man’s relations with his body, his follow-up to the consequences of his coital relations, the type of interaction established to prevent pregnancies, the transactions built up around reproductive preferences, male self-esteem in regard to reproductive capacity, and the role of the "feminine" in the construction of masculine identity.

We also proposed some lines around which to construct more specific processes of research on the male population in the sphere of reproductive health, such as documenting conditions in which it is possible to negotiate with oneself and with the ambient social models; documenting the contradictions generated by the dichotomy between being a man and being a woman; generating a critical understanding of the "culture of exclusion" surrounding the behaviour of human beings; documenting our relationship with the body and constructing new discourse to cover the realities we are trying to explain.

At this juncture it is possible to explore this reading in greater depth, on the basis of the four components identified in the definition of reproductive health cited in the first paragraph, on the assumption that we are aiming to counteract imbalances in each of these spheres, at the same time envisaging comprehensive well-being. The central proposal is to analytically schematize the interactions occurring between different social sectors and document the experience of men and women in their interaction.

Review of sexuality, health and reproduction in the specifically male dimension permits recognition of important discrepancies permeated by relations of power, social norms that feed and justify these unequal relations, and the actions of individuals who by not questioning.

At this junoture it is possible to explore this reading in greater depth, on the basis of the four components identified in the definition of reproductive health cited in the first paragraph, on the assumption that we are aiming to counteract imbalances in each of these spheres, at the same time envisaging comprehensive well-being. The central proposal is to analytically schematize the interactions occurring between different social sectors and document the experience of men and women in their interaction.

Review of sexuality, health and reproduction in the specifically male dimension permits recognition of important discrepancies permeated by relations of power, social norms that feed and justify these unequal relations, and the actions of individuals who by not questioning.

Review of sexuality, health and reproduction in the specifically male dimension permits recognition of important discrepancies permeated by relations of power, social norms that feed and justify these unequal relations, and the actions of individuals who by not questioning, repeating, watching for, punishing and sanctioning transgressions, lend these norms their strength. Hence research strategies on the presence of males in reproductive health may be centred on documentation of the different moments in reproduction and the main conflicts at each of these stages that constitute obstacles to the well-being of men, women and the products of their relations. It is necessary to identify the type of norms that exist in this regard, how individuals of both sexes find themselves affected, for that reason, and how they participate in the resolution of conflicts, how the experience of their sexuality increases the risks of such conflicts and how institutional norms and disciplinary interpretations of the processes have posed difficulties for equity in relationships (Figueroa 1995b).

Another possibility is to document cases which in practice appear to transgress the stereotypes and moulds that have proved to be existentially inadequate, to see how to approach and manage their social costs. This involves reconstructing the way in which specific people see themselves as having the capacity, authority and social support to question such stereotypes. It also means that men and women must live in readiness to reinvent themselves as persons and redefine their gender identity, going beyond exclusive specializations.

At this point males need to be made present in real, symbolic and scientific terms in the relational processes of health, sexuality and reproduction. This will permit reconstruction of the reproductive and sexual specificity of males: in talking of themselves, documenting transgressions, learning to recognize needs, decoding the history of inequities, generating collective care of our bodies, in "recreating ourselves with nurture", constructing new discourse and, ultimately, promoting a renewed encounter of subjectivities.

Nevertheless, there will be those who would simply prefer not to question roles or take gender to its ultimate consequences, but confine themselves to improving the health conditions of some populations, which is valid but can hardly be expected to ensure the presence of males in a comprehensive sense, that is, as beings who reproduce themselves in a contradictory, affective, complementary and painful interaction with women and with other men.

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