Men are missing from fertility debates and crucial support services because they are often not included in studies and, when they are, it is usually only married, heterosexual men who are asked for data.
New research, 'Missing men, missing infertility: The enactment of sex/gender in surveys in low and middle-income countries' has been completed by a team at Lancaster University in the UK.
Dr Jasmine Fledderjohann and Professor Celia Roberts from the Department of Sociology say it is vital to explore the gender issue in in/fertility research as men are often missing.
Their study focused on the Demographic and Health Surveys (DHS), which have been widely-used in low and middle income countries over the past several decades to understand demographic processes and family building.
The study finds these important data engage in unintentional yet highly consequential practices of designing the surveys differently for men versus women, producing gender inequalities.
"First, we wanted to know, across time and place, were men included in the surveys at all? Then, if men were included, which men were included?" explained Dr Fledderjohann, a lecturer in Sociology and Social Work.
"And how did choices about which men to include line up to choices about which women to include? Finally, where men were included, what kinds of questions were they asked and how did the kinds of questions asked shape what kinds of conclusions we could draw from the data?"
The research identified two processes through which surveys had the potential to render male infertility invisible: identifying who to survey in an exclusionary way and asking survey questions in a way that selects out some groups/issues.
Compiling information about survey samples in the DHS, and combining this with a qualitative examination of survey design, they identified areas of men's invisibility across time and place.
While inclusion of men in DHS samples had increased over time, some men (e.g. single, divorced and transgender) remained missing in many survey settings.
This, said the authors, was problematic from a reproductive justice perspective. Survey results, which both reflect and contribute to men's invisibility, are widely used as an evidence-base for family and population policies. Men's invisibility from data and research therefore has the potential to make them invisible in policy discussions about family building, too.
Reproductive health services are typically only made available to those whose reproductive health needs are recognized. Men's exclusion from the reproductive debate, the authors argue, contributes to gender inequalities in who is supported in (and held accountable for) family building within families and societies.
"The good news is, the availability of data for men has increased over time, although men in some regions are comparatively neglected," adds Dr Fledderjohann. "For example, relative to the availability of surveys for women, there is less data available for men in Latin America, North Africa, and parts of South Asia than for sub-Saharan Africa.
"Even where men were surveyed, however, often not all men were surveyed and, where they were surveyed, the way questions were asked limited our ability to understand some family building processes - for example, infertility in the context of polygyny.
"There are some negative consequences to being left out of data for men. For example, support for difficulties conceiving is available only to those whose needs are recognized.
"However, there can also be some benefits to invisibility. Where reproduction is not seen as men's domain (a view reinforced by their absence from data) the blame for reproductive failure tends to fall on women's shoulders.
"In short, this is an issue that impacts men and women alike. It both reflects and creates a specific notion of who should take responsibility for family building and there's great potential for both men and women to be disadvantaged in this process."
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