Engaging Men: The Panacea for Achieving Gender Equality in Maternal and Child Health
By Helen John, Gender, Social Inclusion, and Community Engagement Advisor, Integrated Health Project (IHP) Bauchi State, Nigeria
Maternal mortality is unacceptably high. Globally, approximately 295,000 women died during and during pregnancy and childbirth in 2017[1]. The vast majority of these deaths (94%) occurred in low-resource settings, and most saddeningly of all, most could have been prevented[2]. Reduction of maternal mortality and infant mortality account for Sustainable Development Goals (SDG) objectives 3.1 and 3.2 respectively and are recognized as vital to ensuring more equitable and healthier lifestyles across age and gender by 2030. To improve maternal and infant mortality rates, improved access to and quality of health services is crucial. In Nigeria, men are seen as “gatekeepers” in the family, with the power over decision making and resources. One avenue to increasing women’s access to care is the increased engagement of their male partners in the pregnancy and general maternal, newborn and child health (MNCH) decisions within their families.
Unfortunately Sub Saharan Africa is noted as having high infant mortality rates compared to other regions and to date has had limited success in increasing the accessibility and equitability of maternal and child (MCH) services[3], particularly with regards to male engagement[4]. Sub-Saharan Africa alone accounts for approximately two-thirds of maternal deaths each year. Nigeria has a maternal mortality ratio of about 814 per 100,000 live births as of 2015[5] and in 2017, Nigeria was among the 15 countries considered to be on high alert for its maternal mortality rate[6].
The 1994 Cairo International Conference on Population and Development (ICPD) Programme of Action advocated for the active inclusion and shared responsibility of men in reproductive health and family planning; maternal, newborn and child health (RMNCH+NM) throughout the continuum of care (pre-pregnancy, pregnancy, labor and delivery, postnatal care, and infancy and childhood)[7]. Male involvement, an all-encompassing term which refers to “the various ways in which men relate to reproductive health problems and programs, reproductive rights and reproductive behavior,” is considered an important intervention for improving MNCH.
In many developing countries, men are the key decision-makers and chief providers, often determining women’s access to economic resources. This practice has significant implications for maternal health as can undermine the nutritional status of women during pregnancy, their access to vital pre- and post natal services, their financial agency to seek services (many of which require out-of-pocket expenditures), and their access to emergency MNCH and obstetric services, among others – all leading factors for the high burden of maternal and infant mortality in Bauchi State.
Research has shown that engaging men as supportive partners in MNCH has lasting benefits for families, communities, and gender equality, serving as an effective entry point to address a wide range of gendered health and development outcomes[8]. The involvement of fathers before, during, and after the birth of a child and throughout their life course can support women’s health outcomes by increasing their use of maternal health services, influencing their health behaviors positively, and providing emotional support[9]. Involving men in MNCH have shown improvements in health outcomes for women, newborns, and children through increased uptake of MNCH services, increased couple communication and improved relationships, increased value of girls, greater sharing of unpaid care work, and reduced intimate partner violence[10].
Male Engagement: Catch Them Young
Male engagement should start right from when men are boys. This means starting early to talk about acceptable sexual norms and behaviors and starting “where we can in any given context.” When gender sensitization begins at a young age, men and women tend to better understand the need for more equitable health services and gender norms[11].
Engaging men as allies is by no means an end in itself to achieving gender equality in maternal health, however. Male engagement does not mean just talking to men but also including girls and women to break deep-rooted norms at different levels. Men must build on women’s efforts and not replace them and effectively engage men as part of broader, intersectional approaches to creating more inclusive spaces in health facilities. Men and women working together for gender equality will ultimately bring benefits to all genders and to society as a whole.
It is vital that Bauchi take inspiration from initiatives like the United Nation’s #HeforShe solidarity movement, which has mobilized more than 2 million men as champions for gender equality across the world, and the MenCare global fatherhood campaign, which aims to accelerate men’s uptake of caring roles, health facilities are increasing integration efforts to engage men into existing gender-equality goals. Many of the core concepts of increasing gender-inclusive awareness and the significance of male involvement in MCH can be aligned with State and national efforts.
Seeing the importance of male engagement, in my opinion, men should be encouraged and supported to seek care, not only for themselves but for their families as well, as the benefits can extend beyond their own health. This enhanced health knowledge can translate into increased motivation and concern for the health and wellbeing of their partners and families. Interventions may also need to target health and education service providers to challenge the way services are delivered and highlight changes that can reduce gender inequalities, make services more accessible for men and challenge perceptions about the role that men may play in relation to the health of their families.
The involvement of men in MCH services facilitates the engagement with health service providers and therefore, presents an opportunity to acquire health education and access to health services for their own benefit[12]. IHP will work to ensure facilities are redesigned to include men by creating safer and more appealing spaces for male clients in the form of waiting rooms and male-friendly spaces, and working with service providers at facility level to actively engage men and encourage equal participation in prenatal and postnatal care through hands-on practical sessions, provision of postpartum family planning counseling to couples, and providing curtains and spaces for private deliveries so men can attend with their partners. By strengthening health systems to engage men at the facility level, Bauchi stands to make great gains in gender equitable services and improve the health and well-being of individuals, families and communities, particularly with regards to gender equality and MCH.
[1] WHO. (2017). Maternal Mortality Fact Sheet. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
[2] WHO, U. (2019). UNFPA, World Bank Group, United Nations Population Division. Trends in maternal mortality: 2000 to 2017. World Health Organization.
[3] Yargawa, J., & Leonardi-Bee, J. (2015). Male involvement and maternal health outcomes: systematic review and meta-analysis. J Epidemiol Community Health, 69(6), 604-612.
[4] Ditekemena, J., Koole, O., Engmann, C., Matendo, R., Tshefu, A., Ryder, R., & Colebunders, R. (2012). Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review. Reproductive health, 9(1), 32.
[5] World Health Organization, & Unicef. (2015). Trends in maternal Mortality: 1990-2015: Estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.
[6] Azuh, D. E., Azuh, A. E., Iweala, E. J., Adeloye, D., Akanbi, M., & Mordi, R. C. (2017). Factors influencing maternal mortality among rural communities in southwestern Nigeria. International journal of women’s health, 9, 179.
[7] United Nations Population Fund. 2008. International Conference on Population and Development. Retrieved from: https://www.unfpa.org/icpd
[8] Doyle, K., Levtov, R. G., Barker, G., Bastian, G. G., Bingenheimer, J. B., Kazimbaya, S., … & Shattuck, D. (2018). Gender-transformative Bandebereho couples’ intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: findings from a randomized controlled trial. PLoS One, 13(4).
[9] Peneza, A. K., & Maluka, S. O. (2018). ‘Unless you come with your partner you will be sent back home’: strategies used to promote male involvement in antenatal care in Southern Tanzania. Global health action, 11(1), 1449724.
[10] Comrie-Thomson, L., Tokhi, M., Ampt, F., Portela, A., Chersich, M., Khanna, R., & Luchters, S. (2015). Challenging gender inequity through male involvement in maternal and newborn health: critical assessment of an emerging evidence base. Culture, health & sexuality, 17(sup2), 177-189.
[11] Ghanotakis, E., Hoke, T., Wilcher, R., Field, S., Mercer, S., Bobrow, E. A., … & Mandera, I. (2017). Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale, Uganda. Global public health, 12(10), 1297-1314.
[12] Morgan, R., Tetui, M., Muhumuza Kananura, R., Ekirapa-Kiracho, E., & George, A. S. (2017). Gender dynamics affecting maternal health and health care access and use in Uganda. Health policy and planning, 32(suppl_5), v13-v21.