INTEGRATIVE REVIEW
RIBEIRO, Ricardo Lennon Santana [1], SOUSA, Haigle Reckziegel de [2], MEDEIROS, Felype Hanns Alves de [3], COELHO, Rafael Vilanova [4], QUEIROZ, Patrícia dos Santos Silva [5]
RIBEIRO, Ricardo Lennon Santana. Et al. Nursing strategies for the inclusion of men in the family planning program: an integrative review. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 06, Ed. 09, Vol. 04, pp. 149-161. September 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/inclusion-of-men
ABSTRACT
Family planning is a theme addressed in primary health care and constitutes a set of actions that allow women, men or couples to have their children or not. Although reproductive or family planning is a space for men and women, the absence of male participation is visible. In this sense, what is the nursing strategy for the participation of men in family planning? The present study aimed to find in the literature publications that presented strategies of nursing professionals for inclusion of men in the family planning program. To achieve this goal, an integrative review was carried out in June 2021, using the Latin American databases on Health Sciences (LILACS) and the Nursing Database (BEDENF), without language restriction and published from 2011 to 2021. After the search in the scientific literature, five studies were selected for analysis regarding the strategies of professionals in the approach of the theme with the male public. All the publications found presented some suggestion related to health education and/or continuing education or professional training, some went beyond punctuating as an important strategy the capture or reception of men who attend other programs for different pathologies, in addition to health actions directed to the family and the community. It was possible to conclude that the health professional, especially nursing, should act in health education strategies, but directed to the local reality, in addition to continuing training to change outdated concepts fixed on the theme, aiming to include men in the family planning program.
Keywords: Family Planning, Responsible Parenthood, Health Education, Nursing, Primary Health Care.
1. INTRODUCTION
Although family planning is not fully disseminated, it has a specific law in Brazil, which regulates § 7 of art. 226 of the Constitution of the Federative Republic of Brazil of 1988 (BRASIL, 1988). This paragraph establishes that family planning is based on the principles of the dignity of the human person and responsible fatherhood, and the State is responsible for providing educational and scientific resources for the exercise of this right (BRASIL, 1988). Thus, this law, called Law No. 9,263, of January 12, 1996, provides for what family planning is about.
Family planning is a set of actions that allow women, men or couples to have more children or not. Although reproductive or family planning is a space for men and women, it is visible that the largest audience of participation present are women (MORAIS et al., 2014). This is due, consequently, to a historical construction of gender, social and cultural that still belongs to the woman the decision of contraception (CASARIN and SIQUEIRA, 2014). Consequently, the sole responsibility for unplanned pregnancies (CHIESA; SANCHES and SIMÃO-SILVA, 2019).
It is also necessary to consider the focus too restricted to women, since the 1980s, in family planning programs within the scope of health services, carried out in environments not inviting to the male public and that favor the mentality that the subject is exclusively theirs (CHIESA; SANCHES and SIMÃO-SILVA, 2019; MORAIS et al., 2014; SILVA et al., 2018).
Considering that conception is a natural and sexual result between a man and a woman, it is essential to implement educational actions that contribute to the construction of gender equality in the choice of the couple’s contraceptive method, for example (DIAS et al., 2017).
In this sense, assistance in family planning needs to include men, providing subsidies for their active participation and recognition of the couple and the family as a care unit (PADILHA and SANCHES, 2020).
With this, the present work has as a guide question: What is the nursing strategy for the participation of men in family planning? The general objective was to analyze publications that presented strategies of nursing professionals for inclusion of men in the family planning program.
2. METHODOLOGY
This is an integrative review study conducted in June 2021, which is characterized by the ability to group and synthetise relevant scientific evidence on a demarcated theme or fundamental issue, contributing to the deepening of knowledge and its better understanding by providing a picture of the literature at that time.
For the elaboration of the integrative review, some stages were performed, being the identification of the study question, search criteria in the databases, identification of information that responds to the theme family planning and finally inclusion of studies that present some nursing intervention for the participation of men in family planning.
First, the question that led to the study was defined, which consisted of: What is the nursing strategy for the participation of men in family planning?
The inclusion criteria were those articles that contained in their abstracts the following Health Sciences Descriptor (DeCS): Family planning and men, articles with abstracts and full texts available for analysis published from 2011 to 2021, in Portuguese, English and Spanish. As an exclusion criterion, book chapters.
Searches were conducted in the Latin American and Caribbean Literature databases in Health Sciences (LILACS) and in the Nursing Database (BDENF).
From the search, 355 studies were identified in LILACS and 175 studies in BDENF, after applying inclusion, only complete texts and family planning present in the title, 54 articles were obtained. Then, we selected those who presented some clue about male participation in family planning, finally obtaining six articles that were evaluated to answer the study question.
The objectives, results, and conclusions of these articles were distributed in a data collection spreadsheet to facilitate the identification of nursing interventions.
The synthesis of the studies was developed descriptively in relation to the objectives, results and conclusions.
3. RESULTS
The search for the strategies used by health professionals especially in nursing in the scientific literature resulted in the selection of six studies, as shown in Figure 1, below.
Figure 1 – Flowchart of the selection of studies retrieved in the databases, adapted from the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), on nursing strategies in the inclusion of men in family planning.
All publications found based on the search criteria were investigated regarding male participation in the family planning program and after the publications that presented some strategy of health and/or nursing professionals on the inclusion of men in the program were selected. The main findings of the studies found are presented in Figure 2 below.
Figure 2 – Characterization of the studies included in the integrative review regarding the objective, main results and conclusions on nursing intervention strategies.
| Code | Identification | Goal | Main results | Conclusions |
| E1 | Sauthier (2011) | Its objectives were to characterize the activities developed by health professionals, especially nurses in the implementation of the Family Planning Program, in addition to analyzing the professionals’ conduct regarding the integration of men. | He found that gender roles in society are concepts that hinder the inclusion of man in the program and are crystallized among health professionals. The author emphasizes that there should initially be a paradigm shift among professionals, in addition to educational actions in other spheres | The policy of bringing man to the center of discussions exists in the program’s proposal, but in practice it is flawed. Currently, the family planning program is implemented as an educational and clinical action in the institutions studied, and the educational action is carried out by nurses and social workers. |
| E2 | Dias (2017) | To know the reasons why the male population does not participate in Family Planning and understand the meaning of Family Planning for adult men of reproductive age, married or in consensual union. | The distancing of health services, ignorance about family planning and feminization of care. No less important is the training of professionals to deal with the male population, creating strategies of belonging with actions that are creative, motivational and educational. Health professionals have the task of informing man of the existence of artificial and natural methods, and offering all means of avoiding or having children, taking into account sociocultural and individual aspects of each family | They found that it is necessary to broaden the dialogue and reorganize planning and management strategies to encourage and confer the proper importance that men have in this scenario of dialogue and decisions about their own family. |
| Code | Identification | Goal | Main results | Conclusions |
| E3 | Alves (2019) | With the objective of finding in the literature guidelines on the role of the health professional in family planning, identified four articles | It identified four articles, three of which demonstrated that the guidelines on the theme, both individual and group, are carried out by nurses and directed solely to women, who are sometimes tasked with taking care or knowledge to the partner, and often these orientations do not reach men. In addition, the authors identified a lack of primary care professionals, attempts and strategies to include men in this care, showing little interest on the part of these professionals in changing this reality. As strategies, the authors cite the continuing education of health professionals and inclusion of men who attend primary care in programs such as diabetes and hypertension, for example | They concluded the need for educational actions, both to health professionals and to users of the services, which contemplate the needs of the user in their entirety, directed to conscious and autonomous choice as well as their reproductive planning. |
| Code | Identification | Goal | Main results | Conclusions |
| E4 | Reis (2013) | The objective was to identify the desire to have children and the strategies adopted for family planning and use of contraceptive methods. | They found that health professionals did not always present a welcoming attitude about the desire or not of conception and according to the authors family planning is insufficiently discussed among discordant serum couples. For them, professionals should be trained and sensitized to promote care and guidance to couples, addressing family planning and their reproductive decisions | Professionals should be trained and sensitized to promote care and guidance to discordant serum couples, addressing family planning and their reproductive decisions. |
| E5 | Silva (2018) | The objective was to analyze the access of the male population to family planning methods. | It found that the reduced supply of services and the low level of guidance are the main factors that hinder the participation of man. Many cultural background issues prevent man from seeking correct information on the subject. It was found that man is very far from the center of family planning policies both in Brazil and worldwide. The changes need to go through health education initiatives through lectures in the communities and information on different contraceptive methods without prejudiced biases. It is necessary to adapt the team of professionals so that it is prepared to receive this social and epidemiological change, because patients need to feel accepted and comfortable with the team. | Barriers were revealed in the analysis of publications and in the access of men to family planning related both by the lack of services and methods, as well as by disinformation. |
Source: own file.
4. DISCUSSION
Through the articles analyzed, as well as other published papers, it was possible to identify the reduced participation of the male population in family planning and several factors that contribute to this reality (ALVES et al., 2019; MOZZAQUATRO and ARPINI, 2017; SAUTHIER and GOMES, 2011; SILVA et al., 2013). As the objective of this study was to identify the contributions of nursing to face this reality, we can cite health education and continuing education as a tool for paradigm shift.
All studies present some suggestion related to health education (SAUTHIER, 2011; DIAS, 2017; ALVES, 2019; REIS, 2013; SILVA, 2018), others mention the importance of continuing education or professional training (DIAS, 2017; ALVES, 2019; SILVA, 2018). Some specificities were found in the studies by Alves (2019) and Reis (2013). Where Alves (2019), points out with an important strategy the capture or reception of the man who attends other programs for specific pathologies such as hypertension and diabetes, for example, Reis (2013) argues that health actions should not be restricted to men or women, but directed the family to better support.
The necessary actions also apply to the nursing team and other health professionals who sometimes approach the theme with the same prejudices and paradigms presented by users. In this process of professional training, the educational materials printed as tools that help in health education were highlighted, both in the professional’s and the user’s vision (ALVES et al., 2019)
Nurses involved in family planning should consider regional particularities as addressed by Silva (2018), since in economically disadvantaged regions man’s support is even lower when compared to more developed regions (PADILHA and SANCHES, 2020). Cultural aspects as well as economic development are implicated in a greater or lesser participation of man (SILVA et al., 2018).
In addition to individualized educational actions focused on the local reality, another important factor is the physical environment of health units that prioritize women and children, thus causing feelings of shame, prejudice and fear of flaunting fragility that act away from the male public from health services, negatively influencing the search for fertility control actions. The feminization of care in basic health units was addressed by Dias (2017) where men feel even some embarrassment in attending the programs (SAUTHIER and GOMES, 2011).
Health professionals have the fundamental task of encouraging the male public to participate actively in family planning, inviting both women and men without distinction to meetings on the subject, reinforcing the need for men’s access to public health care and avoiding the failure of the professionals involved, by inserting only women in the discussions related to planning (CASARIN and SIQUEIRA, 2014).
The distinction between men’s affairs and women’s affairs is an attitude that further crystallizes prejudices. In this sense, professionals should act promoting gender equity and stimulating a new form of male participation and the public authorities must provide space and professionals trained for the program (SAUTHIER and GOMES, 2011).
5. CONCLUSION
In relation to the family planning program, it is evident that little male participation can be explained by different sociocultural and/or socioeconomic factors. When answering about which strategies could be used by health professionals, especially nursing, it was found that they should act in health education strategies, but directed to the local reality, in addition to continuing training to change outdated concepts and fixed in these professionals on the theme family planning, aiming to include men in the family planning program.
REFERENCES
ALVES, A. M. et al. Planejamento reprodutivo nas orientações em saúde: revisão integrativa. Revista Família, Ciclos de Vida e Saúde no Contexto Social, v. 7, n. 3, p. 366–377, 1 jul. 2019.
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CASARIN, S. T.; SIQUEIRA, H. C. H. DE. Family planning and men’s health from nurses’ perspective. Escola Anna Nery – Revista de Enfermagem, v. 18, n. 4, 2014.
CHIESA, D. D. P.; SANCHES, M. A.; SIMÃO-SILVA, D. P. PLANEJAMENTO FAMILIAR COMO ASSUNTO DE MULHER!? PERFIL DE GÊNERO NA PRODUÇÃO CIENTÍFICA NO BRASIL. Revista Interdisciplinar de Estudos em Saúde, v. 8, n. 1, p. 221–235, 1 jul. 2019.
DIAS, M. G. et al. A participação masculina no planejamento familiar. HU rev, p. 349–354, 2017.
MORAIS, A. C. B. DE et al. Participação masculina no planejamento familiar: o que pensam as mulheres? Cogitare enferm, p. 656–666, 2014.
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PADILHA, T.; SANCHES, M. A. Participação masculina no planejamento familiar: revisão integrativa da literatura. Interface – Comunicação, Saúde, Educação, v. 24, 2020.
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SAUTHIER, M.; GOMES, M. DA L. B. Gênero e planejamento familiar: uma abordagem ética sobre o compromisso profissional para a integração do homem. Revista Brasileira de Enfermagem, v. 64, n. 3, p. 457–464, jun. 2011.
SILVA, G. S. DA et al. Partner’s participation in family planning from a feminine perspective: a descriptive study. Online braz. j. nurs. (Online), 2013.
SILVA, W. G. DA et al. O planejamento familiar para homens. Revista de Enfermagem UFPE on line, v. 12, n. 11, p. 3098, 6 nov. 2018.
[1] Graduating in Nursing. ORCID: https://orcid.org/0000-0001-6648-5184
[2] Master, Course Coordination and Teacher. ORCID: http://orcid.org/0000-0002-5803-2289
[3] Specialist in Intensive Care at FABIC and Master’s Student in Experimental Surgery at UEPA. ORCID: http://orcid.org/0000-0001-5026-1995
[4] Graduating in Medicine. ORCID: https://orcid.org/0000-0002-3672-8410
[5] Advisor. ORCID: http://orcid.org/0000-0002-9587-1786
Posted: August, 2021.
Approved: September, 2021.
