Reproduction is tied to gendered social, economic, and political systems. Interrogating these connections is crucial for health policies and programmes that seek transformative change. Public health’s focus on biomedical vulnerabilities – how the body is susceptible to harm – is unable to capture the full and complex factors that contribute to reproductive inequities and injustices. Operationalising an understanding of vulnerability as a social process, this article examines how men conceptualise their own reproductive vulnerabilities and the implications this may have. This article draws on qualitative interviews with men, from a multi-method project on masculinities and sexual and reproductive health and rights in Accra, Ghana. Analysing men’s expressions of queerphobia through the lens of vulnerability, this article highlights the significant link between masculinities and reproduction. Masculinities are embedded in precarious, gendered economic systems and social and cultural institutions. Men’s experiences of the vulnerability of their masculinities in this context manifest as queerphobia and a (re)entrenchment of gendered norms around reproduction, which can perpetuate and exacerbate inequities and injustices. This article argues that using a more critical understanding of vulnerabilities makes visible the gendered systems and precarity that create key obstacles to reproductive health, rights, and justice.
The dominant conceptualisation of vulnerability in public health is susceptibility to harm, where harm is the risk and / or effects of illnesses or ill health, primarily on the body (Ford et al. 2024). Women – and anyone who can become pregnant – are therefore the focus of global health interventions and measurement indicators as the population who face morbidity and mortality risks associated with pregnancy and birth (Adams 2016, Davis 2020). This ‘feminised’ (Cunniff Gilson 2016, p. 71) conceptualisation of vulnerability has been useful for examining key health inequities among women but is limiting for examining the broader roles that gender and power may have in reproductive health, rights, and justice (Snow 2008).
More critical conceptualisations of vulnerability have sought to focus on vulnerability as a social process, in which people are made ‘vulnerable to a situation, a person, a social structure’ (Butler 2020, p.28). A person or a group’s capacity to navigate these factors results in different degrees of vulnerability (Cunniff Gilson 2016). Vulnerability, therefore, moves from an examination of the body’s susceptibility to harm towards understanding people within systems and structures of power (Ferrarese 2016). A focus on the social processes of vulnerability allows for reproduction to be understood as more than a biomedical process but a social, political gendered process, embedded in contextual norms (Colen 1995, Pillen 2023). These govern what constitutes un/acceptable reproduction and shape the conditions that render some people more vulnerable than others (Colen 1995, Nandagiri 2020).
Reproduction is nested in gendered power structures that are characterised by contestation, dynamism, and reformation (Connell 2005). These create contextual hierarchies of privilege that afford certain manifestations of masculinities and femininities more power over others. Men may express, enact, or encourage certain reproductive behaviours, attitudes, and healthcare practices as a means of performing a contextually dominant and socially sanctioned form of masculinity (Messerschmidt 2019). Men’s reproductive practices are often entangled with their enactment of heteropatriarchal normative ideals as well as a means to navigate the enactment of contextual gendered expectations (Daniels 2006, Dudgeon & Inhorn 2009, Hook et al. 2018, Kriel et al. 2019, Powis & Bunkley 2023, Strong 2022, Strong 2024). Accounting for the need to grapple with the role of masculinities, gender transformational programmes seek to engage more critically in the role of these practices in shaping sexual and reproductive health (Barker et al. 2007, Hook et al. 2018, Shand & Marcell 2021). Such programmes require a more nuanced understanding of how gender and health interact, including evidence of how gendered practices are constructed and maintained, to grapple with how transformational change may be achieved.
This article interrogates the relationship between masculinity, reproduction, and queerphobia through a critical vulnerability lens. Examining the ways in which vulnerability is perceived by men and the implications of this for their actions is important for two reasons. First, it exposes the motivations among men to perpetuate or continue harmful or violent behaviours that shape the reproductive lives of others. Second, it connects these behaviours to the gendered, racialised, and capitalist systems within which people live, making visible how these create and entrench reproductive vulnerabilities. This paper argues that a broader, critical understanding of how vulnerability may manifest in a population is essential for recognising the contextual conditions that are necessary to engage with for transformational public health.
Within the contemporary state of Ghana are a number of populations with different linguistic, cultural, and contextual histories and identities, including plural and diverse constructions of gender and sexualities (Miescher 2007). Through the violent British colonial regime, policies were developed to govern these populations in ways that aligned to hegemonic, Anglo-supremacist norms (Miescher 2007). This included the criminalisation of certain sexual and reproductive behaviours, such as abortion and ‘sodomy’ (Arimoro 2021). While some of these policies have since been removed or amended, such as exemptions for abortions (Lithur 2004), many of the population policies in the 1960s and 1970s onwards have (re)entrenched binary, gendered notions of reproduction and a colonial, heteronormative ‘family’ (Ashford 2020).
Political, social, and economic structures in Ghana reflect and (re)enforce social norms around sex, sexuality, and reproduction. Heterosexuality is embedded in dominant masculine norms, with penile-vaginal sex, notions of (male) virility, and fertility critical markers of what it means to be a man (Ampim et al. 2020, Ampofo & Boateng 2011, Atobrah 2017, Fiaveh 2020, Fiaveh et al. 2015). Biological fatherhood is a key component of masculinity, one that is foundational to the socialised notion of maleness and is a symbol of ‘phallic competence’ (Ampofo et al. 2009). Men in Ghana are often positioned into the role of ‘breadwinners’, and norms around fatherhood are located specifically in cultures of provision – predominantly financial – for children, with social consequences for men unable to meet these norms (Dery & Apusigah 2020, Ganle et al. 2016).
Queer people in Ghana navigate environments in which their sexualities and sex are placed outside the norm. This includes familial and social environments within which gender binaries and heterosexuality are socialised and disciplined (Dery et al. 2019). Policing of this ‘non-normative’ sex includes criminalisation, which has increased over the last decade (Peyton 2019). Queer people navigate neoliberal environments of contemporary Ghana (Otu 2022), couched in a racial capitalist global economic system founded and predicated on the exploitation and exclusion of racialised populations (Robinson 2019).
Recently, discrimination against queer people has culminated in the Promotion of Proper Human Sexual Rights and Ghanaian Family Values Bill, one of the most severe anti-LGBTQ+ bills in the world (Acquah et al. 2023). The Bill was first proposed in 2021, with a first reading in parliament in June of that year. The Bill was approved by parliament in February 2024, to be signed into law by the President. In conjunction with this Bill, there have been increasingly public attacks on queer communities (for example, the Ho 21 arrests in 2021). Following presidential elections in 2024, the Bill has been re-proposed by parliamentarians.
This article uses the language ‘queer’ and ‘queerness’ following the articulation of its salience in the region by Otu and Van Klinken (Otu & van Klinken 2023).
Data in this article come from a broader study project on masculinities and sexual and reproductive health, rights, and justice (Strong 2021). The project collected data with men in a community in Accra aged 18 and over through a respondent-driven sample survey (n=306) and in-depth interviews (n=37). Interviews used a nested sample of survey participants purposively selected for a range of ages and sexual and reproductive experiences. These data were collected between 2020 and 2021. The community is a suburb of the city, with low investment leading to infrastructural, economic, and health inequalities. This has been compounded by the volatility of the economy that has reduced access to paid work. The community is primarily Ga, hosting important cultural and religious events, and is also home to an increasing number of Ghanaians who have migrated to the capital from other areas of the country.
As a research team, we were particularly interested in obtaining data that provided insights into how the boundaries of un/acceptable reproduction were created. This was important to ensure that discussions about the margins of reproduction by respondents were not disregarded or considered too tangential for analytic use. Such an approach challenges the focus on a normative centre of reproduction that often pervades public health and associated population science research. We sought not just to understand how masculinities were constructed, but the ways in which men constructed and conceptualised ‘oppositions’ to dominant masculine ideals (Connell 2005).
Qualitative data from in-depth interviews were analysed using an abductive approach. This approach calls for a mixture of theory, literature, and data-driven approaches. Notably, an abductive approach focuses on ‘puzzles’ within the qualitative data (Timmermans & Tavory 2012). These could be topics or responses that are novel or uncaptured in existing literature and theory. During this analytic process, a small number of interview respondents answered questions around sexual and reproductive health in reference to queer communities and queerness more broadly. As authors, we were interested not only in the appearance of queerphobic rhetoric in interviews, but the timings and contexts within which these emerged. This was also because the interview guides (and project more broadly) did not ask about sexualities and queerness. We were also interested in the ways in which men connected queerness to masculinities, and the ways that vulnerability manifested in men’s narratives of their sexual and reproductive lives. The majority of the interviews occurred over eight months before the first reading of the Promotion of Proper Human Sexual Rights and Ghanaian Family Values Bill in 2021. Queerphobia is prominent in Ghana; we found that the ways in which men would operationalise specific contextual stereotypes and rumours in their responses was notable. To unpack this further, these transcripts were abductively analysed in conjunction with existing literature on masculinities and queerness, as well as the authors’ own experiences living and working within the community in Accra.
To analyse these data, we treated each reference to queerness and/or queer people as a ‘vignette’, in which the section of the interview related to queerness remains situated in the broader interview context. As an entire research team, we held an in-person workshop to interrogate each vignette in turn, situating the response both in the interview context as well as the community context. The interview context meant taking account of the questions preceding responses that were coded as discussing either queer people or topics. The community context required delving into language (both original and translated) to discuss the meaning of key words and their best explanation, as well as situating vignettes in the broader findings from the study. It also meant locating the interviews within the socio-cultural context of the community in Accra, which included understanding the responses in relation to community-level beliefs, rumours, historical and contemporary events.
The findings discussed in this article are the result of this team-based co-analysis. The vignettes presented are from multiple respondents; some vignettes come from the same respondent. The results locate the vignettes within broader contextual narratives that draw on the wider project data. Description presented in the results is not endorsement of the queerphobia expressed by respondents.
JS initially conceived this project as part of a funded PhD project at a UK-based institution. It was critical to ensure that his assumptions and biases could be challenged to confront and navigate his positionality (Dery 2020, Folkes 2022, Zempi 2016). Three researchers – NKQ, OT, and NKRO – working with a local partner organisation were hired and trained to work on this project. Together, the team was able to bring multiple diverse perspectives, from different socialised and epistemological positions. Regular meetings focused on acknowledging, challenging, and mitigating the biases and assumptions we all held around masculinities, sexual and reproductive health and rights, and research more generally. The research team co-produced the research instruments, discussed first in English, then written and formalised in Ga, before being back translated to Twi and English. This ensured the centring of concepts relevant to the Ga language and not English-language concepts that might otherwise have been irrelevant or complex to translate.
The primary analysis of the transcripts was conducted by JS while the analysis of the vignettes was conducted together as a whole team. Team based discussions allowed for complexities and nuances across interview languages to be interrogated and situated within their context. This process also included grappling with locating the research in its temporal context, ensuring that the quotes and the respondents were not inappropriately framed in relation to events that happened subsequently to data collection. Members of the research team were collectively cognisant of neither being able to explain or identify the motivations of respondents discussing these topics, nor speak for the diverse and plural experiences of queer people in the community.
The results are presented in three interconnected themes that were constructed during analysis. The three themes highlight the ways in which vulnerability is constructed and located within broader social, political, and economic systems. They also illustrate the way in which these respondents marginalise queerness and queer people and operationalise queerphobia.
Reproduction is deeply intertwined in gendered configurations of practices (Connell 2005). These are the attitudes, behaviours, and characteristics that are placed together in configurations that align to, or resist, constructions of masculinities and femininities. Respondents in this study had expectations of the ways in which men should behave and act in relation to reproduction, in order to meet dominant hetero-masculinist constructs within their community. These centred around having children, having access to (particularly financial) resources to support (female) partners and children, and dominance within a sexual relationship. Men’s behaviours were configured around seeking to achieve these goals. Published, mixed-methods evidence from this study highlighted how access to and control of financial resources was a critical component of men’s sense of masculinity and tied to their attitudes and behaviours towards abortion (Strong et al. 2022). Dominant masculinity was also explicitly linked to queerphobia, and men discussed how the desire to avoid being associated with queerness was a key motivation that underpinned their behaviour.
Vignette 1
Interviewer (IN): Okay. So please, how do you see pregnancy and childbearing? What is your opinion about pregnancy and childbearing?
Respondent (R): If you ask me about children, I would say that now when it comes to pregnancy and those things… you see that when you are a man and you are 30 or 35 without a child there is a name, they call you in Ga. When they see you, they would say this person is kojo besia. Being called this name forces men to do things that are not right. Maybe the man hasn’t made up the mind to give birth, he is not ready, but because of the things other men say about him, he is in a hurry to take drugs and sleep with a woman so that she becomes pregnant by force. (44-year-old)
The respondent in Vignette 1 explains that it is essential to have children to meet reproductive norms in the community, by describing the negative outcomes of not meeting those norms. Kojo besia uses two Akan words – Kojo which is the name given to a child assigned male born on a Monday, and besia which means woman or feminine. The Akan phrase is commonly used among Ga communities. While the term kojo besia has been reclaimed by some queer folks, it predominantly has negative, queerphobic connotations within the community. This respondent describes how the term is used in a derogatory manner to demarcate men who meet masculine expectations around having children and those who do not.
Given the negative connotations of being called kojo besia, the respondent indicates that the desire to not be labelled as such can manifest in sexual violence, using ‘force’, and having children without actually desiring them. The vignette provides two key insights. The first is how parenthood is an expectation for men in the community and that not being a father makes men vulnerable to queerphobic labelling. The second is that men’s behaviours to navigate this and avoid transgressing normative boundaries may translate into violence towards women, illustrating the connections between queerphobia and men’s perpetration of gender-based violence by men.
The respondent above highlights an important tension. The longer a man waits to be sexually active, and then to have children, the more he may risk being labelled kojo besia due to childlessness. Economic vulnerability was a key reason for men to delay becoming fathers, highlighting intersecting vulnerabilities. From across the sample of men in this project, the concept of ‘readiness’ was deployed in various circumstances and most commonly referred to readiness to become sexually active and to have children (Strong et al. 2022).
Vignette 2
IN: Okay. If I may ask, why is it that till now you have not had sex before?
R: What I am thinking about is that the way the economy is. When I try it [have sex] and it results in a childbirth I will be found wanting so I must be prepared before I try it.
IN: Okay. So, if you gather with your friends talking and the topic of sex comes up what do they say about it?
R: Some remember what they did and things. In order to tease people, sometimes they say that a person is kojo besia
IN: Why would they call someone kojo besia?
R: Maybe when he gets a girlfriend someone else will also have an affair with the lady behind his back. (18-year-old)
The respondent’s comment that he is ‘found wanting’ is located in this broader notion of readiness; here he connects the economic situation he faces with the decision that he should not have sex in case it results in a pregnancy and fatherhood in which he cannot financially provide.
Vignette 2 also highlights another way in which the term kojo besia is used derogatorily against men. This respondent describes how friends use this term, and that a man can be vulnerable to be labelled in this way if a friend and his sexual partner have an ‘affair’. This ties to existing evidence in Ghana on the importance among men of sustaining relationships and ensuring that a partner is satisfied (Fiaveh 2020), as well as the importance for men of ensuring that their sexual partner was monogamous. Kojo besia is weaponised by peers to police the boundaries of un/acceptable sex; men who are perceived as unable to ensure a partner’s sexual monogamy are vulnerable to being labelled as having failed to meet masculine norms.
In both vignettes, the language kojo besia becomes a tool through which men govern each other’s behaviours. This illustrates the importance of understanding men in relation to their peers and other men, and not just partners. Each vignette shows how men’s sexual and reproductive practices are gendered and boundaried by queerphobia. This manifests through the (potentially violent) need to have children, as well as to gatekeep the sexuality of a female partner. It highlights the gendered norms that expect men to be both fertile and virile.
Among men who participated in the larger study, heterosexuality was expressed through relationships and marriage, which were seen as foundational to the notion of the ‘ideal’ family. This reflects broader norms in Ghana, where marriage remains a critical and significant social institution (Mohammed 2019), within which reproduction is nested (Ampofo et al. 2009). For two respondents, their decision to discuss queer people and to articulate their queerphobia in interviews happened during discussions around their perception of the vulnerability of these social institutions.
Vignette 3
IN: In your opinion have you had a mind change about the way you saw sex in the past and now, or you see it as the same?
R: It is like I used to know it. I have not had any change of mind about it. The way I knew sex to be, it is the same. However, we see a lot of things about these homosexuals that shouldn’t happen. With sex, I personally think the same as I always have.
IN: If you say it is the same as you knew it in the past, then in the past how was it and how is it now?
R: Like I am saying, if you would see someone having sex with someone, then that meant that they are already in a relationship. Although, we have ashawo [female sex workers] and hii gbaꜧlↄi [men who have multiple partners] who cannot be with one woman, we know these things are in the system. But I used to know that it was always a man and woman who have sex. Now, however, gay issues have come and it is worrying us.
IN: What are some of the worrying things that it has brought?
R: It has made the respect in marriages lower and this is changing the character of humans. It is reducing the dignity and humanity and that is the big change it has brought. It is not good at all; it is destroying us. (45-year-old)
Throughout his interview, this respondent described his negative attitudes to the sexual and social changes he perceived to have occurred in the community, compared to when he was younger. He operationalises a queerphobic, ahistoric narrative that implies queerness as both new and as driving these negative changes. For this respondent, the centrality of marriage as a core social institution is reflected in his language that ties it to ‘dignity’ and ‘humanity’. He boundaries such an institution through the othering of queerness and queer people – ‘gay issues’. The respondent’s queerphobia is exemplary of his anxiety towards changes to heteropatriarchal social institutions that both govern reproduction and are key to expressing one’s masculinity. The respondent notes that sex workers and men who have multiple partners are part of the sexual and reproductive histories of the context – ‘these things are in the system’. This is not to suggest that sex work, for example, is not stigmatised within the community. Rather, practices that may not be monogamous or marriage-based, but are perceived as heterosexual, are framed as less threatening to norms, masculinities, or reproduction than queerness.
In Vignette 4 another respondent uses queerphobic logics to articulate a concern over changes to both marriage and to the gendered body.
Vignette 4
R: When you were born as a man and you want to be a woman by force… you are not a woman, and a woman also cannot be a man. For the men, then they cut off their penis so that they become women. And women also become men, so that we think that they are all men. But if a man dresses [like] a lady and also wants the same things that a woman wants, why is that happening? Because the community is spoilt everything has become useless.
In the past we had good chiefs. You couldn’t do what they are doing now, you couldn’t wear a woman’s dress and be walking with it, you would be lashed. But now the community has become useless, yeah it is useless, a man is doing that, a woman is marrying a woman, and everybody is doing what they want to. That shows that the community is now spoilt. It has become useless because a man would marry a man and a woman would marry a woman. Why should it happen so? Now no one can control anyone in this country. I don’t know if they are afraid or something. A woman cannot marry a woman, it is a man that must marry a woman. If a woman marries a woman, do they have a penis? If you don’t have a penis and you have married another woman and she says she wants a child, where would you get the child from? You get it? The country is now useless. So now the way the country is, no one can control the other, even the president cannot even control the country. (39-year-old)
The respondent explicitly ties marriage to reproduction, with reference to the need for the married partner of a woman to have a penis. The respondent presents a specific set of queerphobic logics, centred around the sexed and gendered body, to express a perception that a weakening of socio-political institutions has meant that queer practices made marginal are now able to undermine and destabilise key social institutions. He uses queerphobic language, particularly targeting trans, non-binary, or gender expansive / fluid individuals, to express a view that non-heterosexual and non-cisgender practices threaten marriage and, by extension, reproduction. The significance of marriage within dominant gendered practices and the entanglement of the institution with reproduction ties together men’s perception of masculinities as vulnerable and anti-queer discourses.
Men from across this study emphasised that their capacity to meet masculine expectations around ‘acceptable’ fatherhood was dependent on having sufficient financial resources. Yet, their access to financial and economic systems was extremely precarious. As reported elsewhere (Strong 2024), approximately half of the men in this study reported having a job that paid in cash or equivalent. Within Ghana, queerphobia is expressed through its gendering of certain professions and its exclusion of queer people from certain economic and financial opportunities (Mohammed 2019). Respondents discussed the gendering of jobs; wage earning connected to selling food or operating market stalls was linked to women, or men who were labelled kojo besia. This precluded men from taking on these jobs, regardless of whether they were able to find work that they perceived to be ‘acceptable’ for a man. This gendering of wage-earning opportunities intersects with limited access to the economy and wage earning among men in this community in Accra, compounding their economic precarity.
Throughout the vignettes, men’s vulnerability under macroeconomic systems of racial capitalism manifested as queerphobia. Queer people were made responsible for the impact of economic injustices and exclusionary financial systems on men’s abilities to meet masculine ideals and expectations of fatherhood. Vignette 5 is located in this complex interlocking of exclusionary racial capitalism, masculinities, and queerphobia.
Vignette 5
IN: So, if I may ask, in your opinion, how do men in the community see relationships?
R: There are some men who try and go into the relationships, and the girl does not agree, they assume that the woman has a kojo besia friend who the man has to deal with first.
IN: Why does that happen?
R: There are some men who, when they are going for a relationship, choose women who might be close friends with a gay man. Everything that woman wants, the gay man does it for them. All this is the work of the devil. If I am a woman and I am having a fight with my man, and you, a gay man, tells me you’ll be everything I want, I won’t agree. With all humility, why would I, as a woman, be interested in you? But some women are enticed by this offer. There are some women who are deceived by the fact that the gay man doesn’t have wives and stuff – they don’t worry about anything. They get fine food, sometimes too fine. But for a man with children he is taking care of, you should be worried about how those children will eat and not worry about anyone else. Yet, when you are in a relationship with one of these women [who is close friends with a gay man], then you end up giving her all your money, even though it would be better to give that money to your children. (39-year-old)
The vignette is illustrative of the ways in which experiences of economic precarity manifest as perceptions of sexual and reproductive vulnerability, which intersect with queerphobia to frame queer men as the source of this vulnerability. The respondent develops on a stereotype that queer men are rich or have access to finances that economically privilege them over non-queer men (Thomann & Currier 2019). Queer men are then framed as obstacles to men’s capacity to have a relationship and care for children in two ways. The first is that the respondent believes that queer men, by transgressing norms and not having children, therefore have more money than men with children and that this is appealing to women. The second, a result of the first, is that non-queer men are placed in a position where, in order to compete financially with queer men, they must give up on having children in order to provide more for a sexual partner. This disrupts their gendered role as fathers. Underlying this vignette are the economic conditions that the respondent feels undermine the ability for men to be in relationships with women, but this intersects with specific, queerphobic narratives.
In Vignette 6, a 27-year-old man further ties economic precarity to a rise in men engaging in anal sex. Specifically, he links the lack of wage-earning prospects and access to finances with his perception that men are either turning to, or being made to engage in, sex acts he associates with ‘homosexuals’.
Vignette 6
IN: Now let’s look at the men also, when you take a look, how do men in the community also see sex?
R: Now the men we have…. Now is the time of [anonymised of group]. We now have a situation where you go to them for money… they are homosexuals, and they would have sex [kε bo baawↄ] with you first. Yeah, those men want to have anal sex with you before they give you money. That is what is fashionable in the town now. Now the community kids are spoilt, the guys have become ladies. With all the work that they [anonymised group] do, if you are not strong then you are in trouble, because they will have sex with you and let people hear. That is what is going on.
IN: You said when they sleep with you they would let it be heard.
R: Yeah, they would let someone hear, someone would definitely hear it.
IN: So why do you think this thing happens so?
R: Money issues, money issues and because some young men are not working to make money. They would say they are doing cyber fraud, it is a lie, and this group would have anal sex with the person before giving him money.
IN: So, do you know the people who do that thing?
R: I know a lot of people, many people. (27-year-old)
This vignette is connected to a queerphobic rumour that is prevalent in the study community, according to which wealthy, older men are sexually exploiting younger men because of the latter’s inability to find paid work. The vignette highlights men’s perceptions of the vulnerability that younger men face in an increasingly exclusionary and difficult economy that fails to provide financial security. Moreover, the respondent describes the younger men who engage in anal sex as not ‘strong’, suggesting that they are failing to meet masculine expectations of manliness.
In the same interview, this respondent goes onto explicitly link how, in his belief, the increase in anal sex negatively impacts heterosexual relationships.
IN: What are some of the things that when you are a man you are not supposed to do in the community?
R: Like I said, some of the men I mentioned, they have sex with men to give them money. Nowadays, you would see someone dressed nicely who does not work. They would tell you they work but it is a lie, the [name of group] that are homosexual are the ones that walk [have sex with] those guys. Recently, a girl happened to chance on her boyfriend with a gay man and it became a quarrel, she disgraced the man.
IN: She chanced on them doing what?
R: The gay was standing with him on some corner, you understand? And it became a quarrel, and the man is being disgraced because his girlfriend says she has seen him with a gay on a corner, so what is that? He has disgraced himself. (27-year-old)
As with other respondents, this man frames anal sex as something unacceptable. There is no suggestion that younger men want to have anal sex, nor that they might be queer. Rather, the respondent believes that the economic disempowerment of young men is being exploited by older, gay men, and that this is having negative repercussions for sexual and reproductive norms and relationships. Through his queerphobia and erasure of the possibility that men may desire anal sex, he expresses his perception of the impact of economic vulnerability on the sexual behaviours of young people and their relationships. These have important implications for reproduction, which occurs within these contextual sexual and relationship norms.
By understanding vulnerability as more than biomedical risk, this paper offers an interrogation of the mechanisms that drive men’s gendered attitudes, behaviours, and practices towards sex and reproduction. It illustrates the interconnected processes through which vulnerability is constructed, and the ways that perceived vulnerability and enacted vulnerability operate. Mapping the boundaries of un/acceptable sex and reproduction makes visible what men perceive to be at stake if they do not meet normative expectations around reproduction. It provides insights for why there may be resistance to public health interventions and policies that are seen to disrupt these norms. Even more significantly, it offers critical evidence for the potential implications this may have for queer people. Understanding the complexities of how people perceive themselves to be vulnerable, and the ways in which this may manifest in violence towards other, more marginal, more vulnerable groups, is essential for public health.
This article disrupts public health approaches to vulnerability by instead looking at social processes beyond biomedical ‘harm’. In so doing, the article highlights the ways in which queer people are othered and framed as the consequence of precarity and the cause of vulnerability. By making this visible, it is possible to understand how attempts to (re)shape reproductive norms could become entangled with anti-queer logics and a (re-)entrenching of masculine norms around reproduction. Grappling with this – without giving credence to such ideas of vulnerability as caused by queer people – is fundamentally important for understanding the dynamics of sexual and reproductive health, as well as developing gender transformational programming.
The relationality of vulnerability – how it can be generated between populations and manifest differently – needs to be acknowledged in a field that often only considers women (and the female body) in isolation (Cunniff Gilson 2016, Snow 2008). By considering vulnerability as relational, this article shows the complex ways in which men perceive themselves as vulnerable in relation to queer populations, whilst at the same time enacting queerphobia that may heighten the vulnerability of those same queer populations. Vulnerability among men is constructed both against queer people but also between one another, as friends and community members utilise queerphobia as a means of policing acceptable behaviours. Without reifying men’s perceptions of their vulnerability to marginalised populations, it is necessary to understand this relationality as a means to examine the factors that shape sexual and reproductive attitudes and behaviours. This article highlights the need to interrogate and engage with gendered systems and configurations of practice across populations. The interconnectedness between reproduction and dominant masculine norms means that challenge, contestation, and change may be framed by men as threatening their capacity to navigate their gendered lives, privilege, and power (Messerschmidt 2019). This may limit the potential of public health to effectively engage and work with communities, as men may reject, undermine, or otherwise disrupt programmes and interventions. Men’s vulnerability does not wholly stem from biomedical vulnerability or the susceptibility of their body to harm, but also from their masculinity. Accounting for this in gender transformational health programmes, to improve reproductive health, rights and justice for all, is essential.
In this study, men highlighted how reproduction was tied to masculinities in their community. Men’s narratives complement existing evidence, as they configured masculinities around becoming fathers, being able to financially provide for children, as well as being both heterosexual and able to have sex. Derogatory and anti-queer language, particularly the term kojo besia, was used to police the boundaries of un/acceptable reproduction and to govern men’s behaviours. Language is a critical tool through which gender binaries and heterosexuality are enforced (Fiaveh & Mensah 2023). Not meeting gendered reproductive norms was perceived to have real and tangible repercussions through queerphobic labelling. The results evidence a critical motivation that men had for adhering to these norms and provides key insights into the motivations and incentives of men to maintain these norms.
Moreover, examining reproduction and masculinity through the lens of vulnerability makes visible how these are intertwined with social, political, and economic systems. This article shows how men in this community in Accra live within precarious economic systems, and how they conceptualise and perceive their vulnerability through queerphobic narratives. Understanding these connections is critical when engaging in gender transformational health interventions; it exemplifies the limits of public health that focus on individuals or partners alone. The evidence in this article highlights how economic precarity and vulnerable masculine configurations of practice translate into queerphobia, an entrenchment of norms, and (potential) violence. This contributes useful insights to the schema of masculinities offered by Matlon, in which Black men’s masculinities are made marginal and gay men’s masculinities are made subordinate to the hegemony with a racial capitalist system (Matlon 2016). Men’s desires to (re)stabalise their masculinities in the context of perceived changes to social and economic systems rooted in constructed the queer ‘other’ as threatening. Contextualising how these contestations and opposition politics manifest is necessary to consider the complex contextual implications that may arise from public health interventions around sexual and reproductive health and rights; in particular, around whose bodies and lives may be burdened with the consequences of efforts that engage with shifting normative systems and structures.
It is essential that public health engage with the contested and constructed nature of reproduction within a population and how this is embedded in precarious, gendered systems and structures. This article highlights the need for the field to grapple more fully with constructions of masculinities and apply a broader, more holistic understanding of vulnerability that incorporates social processes. It forwards the need to consider how gendered hierarchies and configurations of gendered behaviours and practices are constructed and the potential implications and conceptualisations of harm that emerge in efforts to adapt or transform these. Understanding how vulnerabilities are perceived differently within a population is necessary for considering how and why socially and biomedically harmful reproductive norms may persist.
We thank the generative and supportive comments from the Guest Editors – Dr Laura Sochas, Dr Kaveri Qureshi, and Dr Philip Kreager. We are immensely grateful to the community with whom this research was conducted. Thanks to the reviewers of this manuscript for their encouragement and to Prof Ernestina Coast and Prof Tiziana Leone for their supervision.
This study was funded by the Economic and Social Research Council (grant number ES/P000622/1)
There are no conflicts of interest.
Joe Strong https://orcid.org/0000-0001-8626-4020
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