title: Troubling men: interrogating masculinities and sexual and reproductive health in Accra, Ghana
Creators: name: Strong, Joe
Publisher: name: London School of Economics and Political Science (LSE)
Year: 2025

description: Men are critical stakeholders in sexual and reproductive health (SRH); alongside their own needs and experiences, they can shape the choices and decisions that other people are able to make. However, men remain minimised and marginalised as a key population in SRH policies and there is a paucity of demographic research focused on men in SRH. Examining how masculinities and gendered power are embedded in men’s roles in SRH is essential for uncovering the mechanisms that drive ongoing SRH injustice and inequality. This thesis by papers demonstrates the significant role that masculine norms have in shaping men’s SRH attitudes and behaviours, including their involvement in women’s decision-making. I developed a conceptual framework that operationalised feminist approaches to research through the interlinking of the key tenets of Reproductive Justice and Critical Studies on Men and Masculinities. Using co-produced, methodologically innovative instruments, men aged eighteen and over in James Town, Accra, participated in a survey (n=306) and a nested sample participated in interviews (n=37). The findings in this thesis highlighted how a constructed masculine ideal rooted in (hetero)sexuality, reproduction, and fatherhood, was deeply embedded in men’s SRH attitudes and behaviours. Men constructed notions of needing to be ‘ready’ to meet expectations of fatherhood. This notion of ‘readiness’ was particularly constructed around the capacity of men to be financial providers, and a concern that failure to meet these expectations could led to public derision. Whether a man felt ‘ready’ directly linked to their non-/consensual involvement in abortion-related care as well as uses of other fertility regulation methods. The survey innovation allowed for critical insights into the role of relationality in SRH; men’s SRH attitudes and behaviours were not singular or static, but deeply rooted in the kind of relationship men have with a person and how a pregnancy or abortion would reflect on their masculine sense of self. Moreover, by interrogating the role of men in SRH this thesis troubles existing assumptions in demographic research and Global Health. Open text survey responses allowed men to locate their condom non-/use within a more holistic and broader conceptualisation of their sexual lives that went beyond reproduction and incorporated the importance of pleasure, 4 intimacy, and trust. Examining the role of men in emergency contraceptive pills (ECPs) emphasised the plural, varied, and nuanced meanings that they ascribed to these pills that went beyond the narrow framing of ‘appropriate’ use set out in Global Health policy recommendations. The framework and approach of the thesis allowed for the uncovering of how men operationalised gendered power, alongside conceptualising the usefulness of the observable nature of ECPs, to pressure their partner to use. These findings expose critical factors that shape SRH, including the significant role of men and the motivations behind these, that are frequently uncaptured and under acknowledged in demographic research and Global Health. Examining masculinities in this thesis provides essential evidence for understanding men’s own SRH behaviours. This includes how men shape and influence the decisions of others and create conditions of injustice and inequality. This thesis emphasises how men construct and operationalise masculine norms in relation to SRH and uses this evidence to trouble and critically engage with demographic research and Global Health policies. It highlights the need for greater attention to masculinities within SRH to better understand the mechanisms that drive ongoing SRH inequalities and injustices.