CONSTRUCTIVE MEN S ENGAGEMENT IN REPRODUCTIVE HEALTH: A TRAINING-OF- TRAINERS MANUAL

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1 CONSTRUCTIVE MEN S ENGAGEMENT IN REPRODUCTIVE HEALTH: A TRAINING-OF- TRAINERS MANUAL Cuple Cmmunicatin and Shared Decisinmaking Related t Reprductive Health MAY 2009 This publicatin was prduced fr review by the U.S. Agency fr Internatinal Develpment (USAID). It was prepared by the Health Plicy Initiative, Task Order 1 in cllabratin with Keneya Ciwara and the Mali Ministry f Health, Divisin f Reprductive Health.

2 Suggested citatin: USAID Health Plicy Initiative, Task Order Cnstructive Men s Engagement in Reprductive Health: A Training-f-Trainers Manual. Washingtn, DC: Futures Grup Internatinal, Health Plicy Initiative, Task Order 1. The USAID Health Plicy Initiative, Task Order 1, is funded by the U.S. Agency fr Internatinal Develpment under Cntract N. GPO-I , beginning September 30, Task Order 1 is implemented by Futures Grup Internatinal, in cllabratin with the Centre fr Develpment and Ppulatin Activities (CEDPA), White Ribbn Alliance fr Safe Mtherhd (WRA), Futures Institute, and Religins fr Peace.

3 CONSTRUCTIVE MEN S ENGAGEMENT IN REPRODUCTIVE HEALTH: A TRAINING-OF- TRAINERS MANUAL Cuple Cmmunicatin and Shared Decisinmaking Related t Reprductive Health MAY 2009 The views expressed in this publicatin d nt necessarily reflect the views f the U.S. Agency fr Internatinal Develpment r the U.S. Gvernment.

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5 TABLE OF CONTENTS Intrductin...1 Wrkshp Overview...2 Sessin 1: Intrductin...4 Sessin 2: Vte with Yur Feet...5 Sessin 3: Cnstructive Men s Engagement in Reprductive Health...6 Sessin 4: Cuple Cmmunicatin and Shared Decisinmaking...7 Sessin 5: Key Questins Abut Reprductive Health Amng Cuples...9 Sessin 6: Applying Lessns t Health Educatrs Wrk...10 Sessin 7: Next Steps...11 Sessin 8: Wrkshp Evaluatin...12 Appendix 1: Suggestins fr the Welcme and/r Wrkshp Intrductin...13 Appendix 2: Vte With Yur Feet List f Pssible Statements...14 Appendix 3: Images Related t Cnstructive Men s Engagement...15 Appendix 4: Imprtant Pints abut Cnstructive Men s Engagement in Reprductive Health...18 Appendix 5: Advice fr Gd Cuple Cmmunicatin and Shared Decisinmaking...20 Appendix 6: Scenaris fr explring Strategies t Imprve Cuple Cmmunicatin and Decisinmaking...21 Appendix 7: Tpics f Discussin Amng Cuples Related t Reprductive Health...22 Appendix 8: Applying Lessns t Health Educatrs Wrk...23 Appendix 9: Rle Playing...24 Appendix 10: Elements f Mnitring and Evaluatin...25 Appendix 11: Bull s-eye Evaluatin...26 iii

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7 INTRODUCTION This curriculum was develped as part f a USAID Health Plicy Initiative, Task Order 1 prject 1 fcused n building an enabling plicy and institutinal envirnment fr cnstructive men s engagement (CME) in reprductive health in Mali. The prject wrked with the Ministry f Health and ther partners in facilitating the prcess f creating natinal guidelines t integrate CME in family planning and reprductive health (FP/RH) and t imprve wmen s and men s uptake f FP/RH services. The prject brught tgether the assembly f a large, multisectral grup f stakehlders t develp, refine, and validate Mali s natinal guidelines in supprt f the natinal Reprductive Health Strategic Plan. The Minister f Health quickly apprved the guidelines and signed them int effect n May 20, At the dnr level, the prject helped t institutinalize supprt fr CME by assisting USAID in integrating CME int its existing FP/RH prgrams. This effrt invlved partnering with a lcal rganizatin, CARE s prject Keneya Ciwara. This grup was wrking with men in reprductive health t design and pilt an innvative mdule t train cmmunity peer educatrs (relais cmmunautaires) in cunseling cuples n jint decisinmaking and cmmunicatin n RH matters. The prject trained a grup f trainers, wh have since cnducted tw highly successful pilt wrkshps 2 with relais cmmunautaires. The trained educatrs wrk has already affected men s rles and imprved the uptake f FP services this is evident by the findings f a field assessment in ne pilt-test site in the regin f Diïla. This dcument cntains the manual 3 used in the pilt wrkshps with relais cmmunautaires. It is designed t enable cmmunity health educatrs t incrprate activities related t cnstructive men s engagement in reprductive health (CME-RH) in their daily wrk. This includes prmting dialgue amng men and wmen t increase cuple cmmunicatin and shared decisinmaking related t FP/RH. As such, it can be adapted in ther settings, based n lcal needs. 1 See the fllwing dcument fr mre infrmatin n the prject: Dggett, Elizabeth, and Britt Herstad Men Matter: Scaling Up Appraches t Prmte Cnstructive Men s Engagement in Reprductive Health and Gender Equity. Washingtn, DC: Health Plicy Initiative, Task Order 1, Futures Grup Internatinal. 2 Fr mre infrmatin n the results f these wrkshps, see the dcument referenced abve. 3 The cntent fr this manual was largely derived frm materials develped by Health Plicy Initiative staff: Hannah Frtune- Greeley, Ken Mrrisn, Mary Kincaid, Britt Herstad, Mdib Maiga, cnsultant Timthé Da, and frmer POLICY Prject staff Elizabeth Dggett and Elizabeth Neasn. 1

8 WORKSHOP OVERVIEW Objectives Increase knwledge f the cncepts and results f cnstructive men s engagement in reprductive health. Reinfrce the capacity f cmmunity health educatrs t undertake cunseling fr imprved cuple cmmunicatin and decisinmaking. Reinfrce the system f mnitring and evaluatin f educatrs wrk t clarify and dcument results and lessns learned. Length f the Wrkshp The training-f-trainers wrkshp will last three days. Resurces Needed (1) Lcatin a. Suitable rm r village meeting tree (lcatin large enugh t allw peple t mve arund) b. Rm r lcatin with easy access (2) Equipment a. Chairs/benches (in a circle) r mats b. Blackbard (3) Organizatinal material a. Flip chart stand r chalkbard b. Paper flip chart, ntebks, cards c. Pencils, pens, chalk, markers d. White paper e. Images f aspects f reprductive health f. Tape and glue g. Pst-it ntes Suggestins fr Organizers (1) Facilitate an interactive prcess. a. Take participants ideas int accunt b. Make a summary after each sessin (2) Accmmdate differing levels f cmprehensin amng participants. (3) Be flexible regarding time and take int accunt participants needs. (4) Lead warm-up r icebreaker exercises t put the participants at ease. 2

9 Suggested Agenda (1) Intrductin 30 minutes a. Welcme b. Wrkshp bjectives c. Participant intrductins and expectatins d. Agenda e. Grund rules (2) Vte With Yur Feet 45 minutes a. Exercise b. Tw statins: Agree and Disagree in respnse t several statements (3) Cnstructive Men s Engagement 90 minutes a. Exercise: Men s Dmain Wmen s Dmain b. Discussin abut CME (4) Cuple Cmmunicatin and Shared Decisinmaking 120 minutes a. Discussin b. Presentatin c. Rle playing (5) Key Questins Abut Reprductive Health Amng Cuples 90 minutes a. Small grup exercises b. Setting pririties fr men and wmen (6) Applying Lessns t Health Educatrs Wrk 120 minutes a. Methdlgy b. Strategies t imprve cuple cmmunicatin c. Rle playing (7) Next Steps 30 minutes a. Technical supprt b. Expected results, mnitring, and evaluatin (8) Wrkshp Evaluatin 15 minutes (9) Breaks (schedule where needed) 120 minutes 3

10 SESSION 1: INTRODUCTION Time: 30 minutes Objective: Clarify the fllwing pints: wrkshp bjectives, rder f events, participants intrductins and expectatins, and grund rules. The training shuld begin with a wrd f welcme frm a representative f the hsts r rganizers. Materials: Flip chart stand, paper, markers Prcess: (1) Invite a representative f the hsts r rganizers t say a wrd f welcme and talk abut the significance f trainers wrk, the imprtance f fstering better cuple cmmunicatin, and the value f cnstructive men s engagement in reprductive health. (2) Facilitatrs shuld intrduce themselves and explain the purpse f the wrkshp. They shuld als explain sme imprtant aspects f the agenda (such as the schedule, breaks, and the anticipated end time). It s als imprtant t explain that the wrkshp is brken dwn int tw parts (divided int eight sessins): ne part t explre the cncepts and the ther t develp and explain cncrete strategies. (3) Ask participants t briefly intrduce themselves (fr example: name, village r emplyment lcatin, and an expectatin r belief related t the wrkshp). (4) Explain the bjectives and agenda f the wrkshp. Nte the key wrds r images t describe the guidelines. If there are sme expectatins that fall utside f the wrkshp subject, address them nw. Make nte f these expectatins n paper s they can be addressed at the end f the wrkshp. After reviewing the bjectives and agenda, ask participants if they have any questins r suggestins fr changing r imprving the wrkshp. (5) Establish sme grund rules. a. Examples f sme rules i. Facilitatrs will call n participants wh raise their hands. Only ne participant will speak at a time while thers listen respectfully. All participants will have an pprtunity t speak if they want but d nt have t speak if they feel uncmfrtable. ii. Participants shuld be encuraged t vice cnfusin r disagreement in a respectful manner. iii. The training sessin shuld be a safe space that welcmes participant cntributins. It must als remain a cnfidential ne. iv. Remind participants that wrking n questins f reprductive health is nt always easy and that they will be discussing sensitive subjects. b. Elect a leader frm amng the participants t help mderate the wrkshp. Additinal resurces: Appendix 1: Suggestins fr the Welcme and/r Wrkshp Intrductin 4

11 SESSION 2: VOTE WITH YOUR FEET Time: 45 minutes Objective: Fster understanding and acceptance f diverse pints f view. Materials: Tw signs, with the labels Agree n ne and Disagree n the ther (the distinctin can be indicated by a check mark and an X). Prcess: (1) Ask participants t mve t the middle f the rm (r t ne side, with enugh space t allw all participants t mve freely). (2) Mark tw distinct spts next t the Agree and Disagree signs. (3) Explain that yu are ging t read a statement, and the participants will decide if they agree r disagree with it. They will then mve t the space by the sign that expresses their pinin. It s imprtant t say that there are n right r wrng answers there are simply differing persnal pinins. (4) Read the statement clearly and repeat it s that all f the participants can hear. Explain nce again that participants shuld mve t the sign indicating their pinin. (5) When the participants have split int the tw grups, facilitate a discussin abut the reasns why they agree r disagree with the statement. (6) Only chse three r fur statements. Fr example: It s easier t be a man than a wman in daily life. See Appendix 2 fr a list f pssible statements (yu can add thers accrding t the situatin and the participants). (7) After the activity, the participants shuld return t their seats. (8) Facilitate a discussin arund the fllwing questins: a. What d yu think f this exercise? b. Were there any surprises? c. What lessns will yu take away frm this exercise? (9) In summary, explain that a. The questins arund reprductive health ften tuch n sme f the mst difficult (sensitive) questins in life. b. Our experiences and beliefs abut gender can have an effect n the frmulatin and success f ur prgrams. c. It is imprtant t be pen t different pinins when wrking n issues related t gender and cmmunicatin between men and wmen. Additinal resurces: Appendix 2: Vte with Yur Feet List f Pssible Statements 5

12 SESSION 3: CONSTRUCTIVE MEN S ENGAGEMENT IN REPRODUCTIVE HEALTH Time: 90 minutes Objective: Increase participants knwledge abut CME in RH. Materials: Images, Pst-It ntes Prcess: (1) Facilitatrs shuld print ut the prepared images related t different aspects f reprductive health and family planning (see Appendix 3 fr examples). Place these arund the training rm, either n the wall r n tables. Prvide different clred Pst-It ntes fr participants. (2) Explain t participants that yu are ging t examine the traditinal rles f men and wmen in relatin t activities linked t reprductive health. (3) Explain that there are multiple clrs f Pst-Its, and assign ne clr t represent the man and ne t represent the wman. (If there are three clrs, ne can be used t represent activities related t bth men and wmen.) (4) Ask the participants t place the Pst-It ntes beside the displayed images. (5) The participants shuld stick their Pst-Its beside each image accrding t which dmains are traditinally thse f men r wmen. Fr example, if the image represents a dmain where wmen traditinally are present, the participant will place the Pst-It f clr X. If this image represents a dmain where men and wmen bth are traditinally present, the participant will place bth clr Pst-Its (r a Pst-It f the third clr). Please nte: if there is nly ne clr f Pst-it, yu can mark men r wmen in anther manner (with r ). If there are a lt f participants, they can wrk in grups (tw wmen tgether, tw men tgether). (6) Cnduct the discussin as a grup where all the participants can see the images clearly. Yu can chse sme examples that are clearly the dmain f either the man r the wman and chse sme that are mixed. Ask the participants why they made the chices they did. Explre tgether the difference between sex and gender (see Appendix 4). (7) Give an intrductry presentatin n CME. See Appendix 4 fr the pints. a. What are the three aspects f CME and their cntent? b. What des the wrd cnstructive mean? (8) Ask participants t explain why the engagement f men is particularly imprtant. Explain hw this can affect the health f wmen, men, and children. Additinal resurces: Appendix 3: Images Related t CME Appendix 4: Imprtant Pints abut CME in RH 6

13 SESSION 4: COUPLE COMMUNICATION AND SHARED DECISIONMAKING Time: 120 minutes Objective: Increase the participants knwledge f the key elements f gd cmmunicatin and the imprtance f shared decisinmaking. Materials: Flip chart stand, paper, markers, tape Prcess: (1) Discuss with participants several questins related t cuple cmmunicatin: a. What is the gal f cmmunicatin amng cuples? b. What are the advantages f cmmunicating within the cuple? c. What are the risks? d. What are the bstacles t gd cmmunicatin? e. Hw can yu vercme the bstacles? (2) Discuss advice fr gd cmmunicatin and shared decisinmaking (see Appendix 5). (3) As ften as pssible, put the key wrds and images f essential elements nt the paper r blackbard. (4) Create small grups fr a rle-play exercise. If yu want t make five grups, cunt ff 1, 2, 3, 4, 5, 1, 2, 3 etc., and put all f the 1s tgether, all f the 2s tgether, etc. If yu dn t have enugh space r time, yu can simply grup the participants as they re seated. Each grup shuld have between five and eight peple. If, fr example, there are 20 participants, frm three grups f six r seven. (5) Assign each grup a scenari invlving a cuple cmmunicatin prblem and have them discuss strategies fr cunseling (see Appendix 6). (6) Tell the grups hw much time they have t discuss (between 15 and 30 minutes, depending n the size f the grup). Give clear instructins: a. Have ne member read the situatin. b. Assignments i. Determine three elements f a gd strategy fr cunseling the cuple. ii. Prepare a shrt presentatin f fur r five minutes summarizing the situatin and giving elements f the chsen strategy. Explain why this strategy was chsen. iii. Duratin: minutes, depending n grup size. (7) Have the grups reprt ut. (8) Discuss and summarize the exercise. Additinal resurces: Appendix 5: Advice fr Gd Cuple Cmmunicatin and Shared Decisinmaking 7

14 Appendix 6: Scenaris fr Explring Strategies t Imprve Cuple Cmmunicatin and Shared Decisinmaking 8

15 SESSION 5: KEY QUESTIONS ABOUT REPRODUCTIVE HEALTH AMONG COUPLES Time: 90 minutes Objective: Understand differences between men s and wmen s RH needs. Materials: Cards, tape Prcess: (1) Explain t participants that yu are ging t explre RH tpics that cuples may want t discuss with ne anther. (2) Ask participants t name the RH tpics that shuld r culd be subjects fr discussin. (3) Write the tpics n the cards (if pssible, in the frm f an image r key wrd) and put tape n them. (4) At the same time, have anther trainer write the same tpics n different cards (t have tw sets f identical cards). (5) With the participants, remve repetitive suggestins s that yu dn t have t many themes. Yu can rewrite sme in rder t regrup certain themes. (6) Divide the larger grup int tw: men and wmen (if there are mre men than wmen, yu can ask sme men t jin the wmen s grup t balance ut the grups, and vice versa). (7) Ask each grup t classify the tpics frm tp t bttm, by rder f imprtance (the mst imprtant at the tp). Men shuld classify them by imprtance fr men; wmen by imprtance fr wmen. (8) Each grup can then lk at the results f the ther grup. (9) Have the grups return t their places and discuss a. What is different? What is the same? Why? b. What are the effects f these tpics n cmmunicatin? (10) Resume the discussin. The cnsideratins culd include the fllwing: Additinal resurces: a. An issue is mre difficult t understand if it is less imprtant t ne persn than it is t the ther. b. When cmmunicating, it is imprtant t remember that we d nt always share the same cncerns. c. Gender can influence what is imprtant t us. It can be linked t the spheres f ur experiences, ur rles in sciety, ur bdies, etc. Appendix 7: Tpics f Discussin Amng Cuples Related t RH 9

16 SESSION 6: APPLYING LESSONS TO HEALTH EDUCATORS WORK Time: 120 minutes Objective: Explain hw cmmunity health educatrs can wrk with cuples t develp cncrete strategies fr imprving their cmmunicatin. Materials: Flip chart stand, paper, cards, tape, markers Prcess: (1) Grup discussin n the wrk f cmmunity trainers. Yu can, fr example, discuss the fllwing questins (see Appendix 8): a. Hw ften d yu wrk with cuples? (Daily? Or during specific ccasins?) b. Are the strategies f male educatrs different frm thse f female educatrs? c. D yu ften encunter difficult situatins with cuples having t d with cmmunicatin and decisinmaking? What d yu d during these situatins? (2) Split the grup int smaller grups f fur participants and give each grup a case study that analyzes a strategy used fr cunseling. Have them prepare a rle-play fr the case study (see Appendix 9) and present it t the entire grup. (3) After each rle-play, cnduct a brief discussin reinfrcing the strng pints and engaging in cnstructive criticism abut the weaker pints. (4) List the strategies suggested by each grup n a flip chart. (5) Summarize the strategies that received the mst attentin frm the grup. (6) Review the distinct aspects f educatrs wrk. Fr example: Additinal resurces: a. During hme visits, bserve cmmunicatin between cuples, understanding the challenges and pprtunities f wrking n cuple cmmunicatin issues. In evaluating the situatin, identify and accunt fr the cncerns f bth men and wmen. b. During individual cunseling sessins, define the prblem frm the beginning, assure the persn that what he/she says is cnfidential, identify their needs and cncerns, clarify the advantages and disadvantages f the ptins cmpared t the prblem, and help the persn t make a decisin. c. During the cuple cunseling sessins, remember that this sessin is similar t the individual sessin but is smetimes mre cmplicated. Often, the first step is t pen the dr t gd cmmunicatin. Appendix 8: Applying Lessns t Health Educatrs Wrk Appendix 9: Rle Playing 10

17 SESSION 7: NEXT STEPS Time: 30 minutes Objective: Clarify the next steps t put the lessns frm the wrkshp int actin, identify strategies used by trainers, and discuss mnitring and evaluatin and dcumentatin prcedures. Materials: Flip chart stand, paper, markers Prcess: (1) Remind participants that they shuld nt add activities t the wrk they already d but they can simply put greater emphasis n cuple cmmunicatin and shared decisinmaking. (2) Review resurces and supprt systems available (fr example, the images that illustrate the aspects f CME, the need fr supervisin, and mnthly meetings). (3) Reinfrce the idea that wrking n cuple cmmunicatin is part f a larger prcess f CME in RH. (4) Review key indicatrs fr mnitring and evaluatin (see Appendix 10). Participants shuld add these t their activity ntebks (i.e., fr use in hme visits, cunseling sessins), as well as the reference sheets. (5) Ask participants if they have questins r suggestins. Discuss what they shuld d if they encunter prblems t which they dn t have answers. (6) Nte the tpics f discussin fr the next mnthly meeting (fr grups that meet n a regular basis). Additinal resurces: Appendix 10: Elements f Mnitring and Evaluatin 11

18 SESSION 8: WORKSHOP EVALUATION Time: 15 minutes. (If yu wuld like t discuss the wrkshp further, yu can add a few minutes t ask what the participants enjyed and what they wuld like t change abut the wrkshp.) Objective: Evaluate the wrkshp. Materials: Flip chart stand, paper with a bull s-eye drawn n it, markers Prcess: (1) Draw a bull s-eye n the flip chart paper. (2) Separate the bull s-eye int three r fur parts (ne part fr each bjective and, as a functin f the discussin abut the participants expectatins, yu can add a sectin marked expectatins ). (3) Explain that each participant shuld put an X (a crss) n the circle that marks their degree f satisfactin with the achievement f the bjectives. The middle circle represents very well, and the three thers represent well, well enugh, and satisfactry. Make sure that everyne understands the system f evaluatin. Yu can illustrate hw t place the X as an example. (4) Put the flip chart in an area where the participants can mark it withut being seen by the thers. (5) One by ne, the participants shuld g up t the flip chart t mark their Xs (with the same clr marker). (6) At the end, yu can lead a discussin abut the wrkshp and the evaluatin. Additinal resurces: Appendix 11: Bull s-eye Evaluatin 12

19 Appendix 1: Suggestins fr the Welcme and/r Wrkshp Intrductin Cnstructive men s engagement in reprductive health is an essential element t the imprvement f the lives f Malian men and wmen. Keneya Ciwara participated in the develpment and cnstructin f a natinal guide n CME in RH. The fcus f this prject is the imprvement f cuple cmmunicatin and shared decisinmaking as ne f the key elements f CME in RH (e.g., infant mrtality rates, etc.). Mali is an African cuntry where cmmunicatin abut questins f reprductive health is very weak. We are lking at this prject as a way t imprve the reprductive health f men and wmen. Tw cmmunities in Mali (Kati and Diila) have been chsen t take part in a pilt prject, and we hpe t learn frm their experiences in rder t apply the same lessns t ther regins in Mali and West Africa. Acknwledgments: USAID Health Plicy Initiative, CARE, Keneya Ciwara, the Ministry f Health, the Ministry f Scial Develpment, etc. (depending als n wh is present). 13

20 Appendix 2: Vte With Yur Feet List f Pssible Statements It is easier t be a man than a wman in daily life. Family planning is the respnsibility f the wman. Sexuality is mre imprtant fr men than it is fr wmen. A man is nly a real man if he has a child. A wman nly has value if she has a child. It is nrmal fr the man t take care f the children and the kitchen. A man has the right t frce sexual activities with his wn wife even if she desn t want t. Female circumcisin is harmful t the health f girls and wmen. A male child is mre valuable than a female child. Men wrk mre than wmen. A wman can d any wrk a man can d. 14

21 Appendix 3: Images Related t Cnstructive Men s Engagement 4 Example 1 Example 2 4 All illustratins by Ken Mrrisn. 15

22 Example 3 Example 4 16

23 Example 5 Example 6 17

24 Appendix 4: Imprtant Pints abut Cnstructive Men s Engagement in Reprductive Health Discussins f cnstructive men s engagement in reprductive health shuld include the fllwing pints: Gender is mre than men and wmen Gender is ften cnfused with sex. Hwever, they are different terms with different meanings. Sex refers t bilgical and physical characteristics that ne is brn with. These are generally unchanging. When referring t ne s sex, the terms male and female are used. Gender refers t scially cnstructed rles that are seen as acceptable fr men and wmen in a given sciety r culture. These rles can change ver time and vary within r between cultures. When referring t gender, the terms men and wmen are used. Ensuring gender is integrated int ur wrk Undertaking a prcess called gender analysis can help us address gender in ur prjects. Gender analysis includes lking at these particular areas: What are rles, nrms, and vulnerabilities f men and wmen cncerning their health? What kind f access d men and wmen have t resurces? Wh cntrls these resurces? Wh has the pwer t make decisins? When designing r revising a prject, answering these questins can help yu pay attentin t hw men and wmen can be engaged in the prject. We als want t think abut whether r nt ur prjects perpetuate gender equity r favr gender inequity? Gender equity is the prcess f being fair t men and wmen thrugh the distributin f benefits and/r respnsibilities. Framewrk fr engaging men in reprductive health Three key aspects Men as clients f health services Men as supprtive partners t wmen Men as agents f change in family and cmmunity Men as clients f health services Men are encuraged t use reprductive health services t reduce reprductive health cmplicatins fr their partners and t imprve their wn reprductive health. Many prjects seek t encurage men t use reprductive health services, including family planning services, vaccinatin, vluntary cunseling and testing (VCT), and sexually transmitted infectins (STI) services. Men as supprtive partners t wmen The prgrams cncentrate n the psitive influence that men can have n the reprductive and sexual health f wmen. The prgrams recgnize that men play imprtant rles in decisinmaking, planning, and the distributin f resurces. 18

25 It is imprtant t engage men as supprtive partners fr maternal health, family planning, nenatal care, and HIV. Prgrams must cnsider men as allies and resurces fr imprving reprductive health. Many prjects take int accunt gender inequities that are harmful t health but d nt implement activities t reduce them. Men as agents f change in family and cmmunity This apprach is mre effective because it fcuses n the gender nrms that put men and wmen at risk. The prgrams require men t examine gender nrms that negatively affect their lives and thse f their partners and families. The men are invited t develp mre effective slutins. An implicit assumptin is that mre prgressive nrms abut masculinity and gender translate int imprved reprductive health results. These prgrams are ften intensive and difficult t implement because they ask men t undertake individual changes in indifferent and smetimes hstile cmmunities. Sme prgrams that use this apprach require that men engage ther men within their cmmunities in rder t prmte gender equality in reprductive health. Prmtin f cuple cmmunicatin fr shared decisinmaking Objective: Increase the number f cuples wh speak penly abut RH within the family and the cmmunity. Targets: Men Wmen Girls and bys Obstacles: The majr bstacles are scicultural barriers, lack f infrmatin n cuples, pr quality f cmmunicatin between men and wmen abut reprductive health, and men s perceptins that reprductive health is the cncern f wmen. Strategies: Increase cmmunicatin t prmte behavir change at all levels and by mdern and traditinal means f cmmunicatin n RH rights Invlve religius netwrks in prmting dialgue abut the rle f shared decisinmaking amng cuples Increase cmmunity educatrs and health wrkers cmmitment t the prmtin f cuple cmmunicatin Increase adherence f cuples t family planning thrugh the testimny f satisfied clients/cuples wh have used RH services Cnstructive: Psitive, practical, cncrete the mst imprtant thing t emphasize is the fact that a man can influence his friends, cmmunity, and yuth as a rle mdel. 19

26 Appendix 5: Advice fr Gd Cuple Cmmunicatin and Shared Decisinmaking Advice fr cmmunicatin Express yurself (the first step is talking) Listen (listen well t the ther persn) Cnsult/ask (asking questins demnstrates respect fr the ther persn) Understand/sympathize (explring differences in rder t see the cmmnalities) Use bdy language (gestures) as well as wrds Means f cmmunicatin Feeling + Behavir + Reasn I feel bad + when yu ignre my mther + because she is imprtant t me. I dn t like + that yu leave me t g t the health center alne + because I nly want t avid prblems with my pregnancy and have a healthy baby. It s imprtant t include all three elements in a statement. Often smene will demnstrate that they are nt happy withut explaining why. Decisin Have time and a quiet, private place Agree n the decisin that needs t be made Sum up the aspects and their effects Weigh the ptins: advantages and disadvantages Cnsider feelings and cncerns Killer bees (Elements that harm gd cmmunicatin) Assuming Aviding Criticizing Blaming Being n the defensive Benefits and risks f wrking n cuple cmmunicatin Benefits: mre exchanges, increased understanding, shared decisins, clarity f differences Risks: time, misunderstanding, annyance Advice frm a mther t her children There are three essential things in life: laughing, dreaming, and sweating. Cmmunicatin is like this: yu need t be patient, begin with the psitive, let peple express themselves, and finally see hw this translates int actin. 20

27 Appendix 6: Scenaris fr explring Strategies t Imprve Cuple Cmmunicatin and Decisinmaking Scenari A: (1) A man des nt want t let the wman talk. She isn t capable f talking in frnt f him, and he has frbidden her t speak with ther men. (2) During a hme visit, the wman reveals she wishes t space her pregnancies. She already has five children, the ldest f which is nine years ld. (3) Instructins: a. Have everyne in the grup read the cuple s situatin. b. Tasks: (1) Identify three elements f a gd cunseling strategy fr the cuple. (2) Prepare a shrt presentatin (fur t five minutes) fr the entire grup, summarizing the situatin and giving elements f the chsen cunseling strategy. Explain why the strategy was chsen (if pssible, write the key wrds r images n paper). c. Time alltted: minutes (depending n the trainer). Scenari B: (1) A nurse at the health center tells yu that there is a prblem in the hme f a cuple that yu ve already visited. (2) The wman was t underg sterilizatin but her husband has frbidden it. (3) Instructins: a. Have everyne in the grup read the cuple s situatin. b. Tasks: (1) Identify three elements f a gd cunseling strategy fr the cuple. (2) Prepare a shrt presentatin (fur t five minutes) fr the entire grup, summarizing the situatin and giving elements f the chsen cunseling strategy. Explain why the strategy was chsen (if pssible, write the key wrds r images n paper). c. Time alltted: minutes (depending n the trainer). Scenari C: (1) Neighbrs tell yu in cnfidence that there are prblems at hme with a cuple and that they believe that the husband hits his wife. (2) Yu have nt yet visited the huse, but it is n yur list f huses t visit. (3) Instructins: a. Have everyne in the grup read the cuple s situatin. b. Tasks: (1) Determine three elements f a gd cunseling strategy fr the cuple. (2) Prepare a shrt presentatin (fur t five minutes) fr the entire grup, summarizing the situatin and giving elements f the chsen cunseling strategy. Explain why the strategy was chsen (if pssible, write the key wrds r images n paper). c. Time alltted: minutes (depending n the trainer). 21

28 Appendix 7: Tpics f Discussin Amng Cuples Related t Reprductive Health Dialgue within the cuple HIV/AIDS Pstnatal cnsultatin Using cndms Duble prtectin Traditinal cntraceptive methds Childrearing Prenatal cnsultatin Standard Days Methd Birth spacing Female genital cutting Breastfeeding/Lactatinal Amenrrhea Preparatin fr delivery Child vaccinatins Fidelity/infidelity Weaning Other examples and pssible discussin tpics Dmestic vilence STIs Access t resurces Access t health services 22

29 Appendix 8: Applying Lessns t Health Educatrs Wrk Elements f trainers wrk (t be clarified during the wrkshp) Hme visits Individual cunseling Cuple cunseling Infrmal cnversatins Wrk with men s grups/men s scial netwrks Cmmunity-based distributin Scial mbilizatin Activities reprt Mnthly meetings Strategies fr imprving cmmunicatin and shared decisinmaking within the cuple (t be clarified during the wrkshp) Hme visits Emphasizing cmmunicatin and shared decisinmaking, as well as the benefits f men s engagement in reprductive health. Observing the cuple s cmmunicatin and shared decisinmaking (interest in the subject, prblems, cnflicting pinins, etc.). Listening actively and encuragingly. Cunseling sessins Identifying the prblem at the beginning. Identifying the availability f the service prvider fr cunseling, and urging the client t tackle and discuss the prblem. Assuring the client f cnfidentiality. Knwing the needs f the persn r cuple. Explaining the benefits t slving the prblem psed. Helping the persn, r cuple, t make a decisin. Verifying with the client, r cuple, the applicability f the decisin. Infrmal cnversatins and men s grups/men s scial netwrks Discussing the imprtance f cmmunicatin within the cuple. Insisting n the benefits f gd cmmunicatin within the cuple. Examples: Advantages t birth spacing Child develpment Fewer health prblems fr the child if the mther is healthy Lwer prescriptin csts Harmny within the family Mre time fr incme-prviding activities Cleanliness 23

30 Appendix 9: Rle Playing Instructins (1) Read the situatin. (2) Decide which strategies t undertake t imprve the situatin. (3) Prepare a shrt rle-play t illustrate the strategy (10 minutes maximum). (4) The rle-play can be abut anther case utlined by the grup r a cunseling sessin with several f the trainers (ne man and ne wman). Situatin 1 During a cunseling sessin, nly the man speaks fr mst f the time. He interrupts his wife and he always answers first r speaks fr his wife. He might say, We are here because She desn t understand the prblem etc. Situatin 2 The man is hesitant t share infrmatin r seems uninterested in the sessin and lets his wife d all the talking. He might say things like, I dn t knw, Everything s fine, I dn t have any prblems, That s her respnsibility, etc. Situatin 3 During the sessin, ne persn reveals infrmatin that surprises the ther. The man might say, Why didn t yu tell me this befre? I thught yu didn t want t talk abut that, I can t believe that yu hid that frm me, etc. Situatin 4 The partners dn t agree n a plan f actin r they need mre infrmatin n a subject (fr example, cntraceptin). The man might say, We dn t need t wrry abut that, That methd is a sin (nly fr prstitutes, desn t wrk, nt nrmal) etc. Situatin 5 The partners dn t agree n a plan f actin r they need mre infrmatin n a subject (fr example, birth spacing). The man might say, A man shuld decide hw many children he needs, It s her respnsibility, She s afraid that I ll take anther wife, etc. 24

31 Appendix 10: Elements f Mnitring and Evaluatin Key Indicatrs (1) Level f acceptance a. Perceptin f the imprtance f cmmunicatin and shared decisinmaking within the cuple (cnstructive men s engagement) b. Acceptance f cnsidering and discussing cmmunicatin and shared decisinmaking within the cuple (specifically fr men) and within the hme c. Means and surces f verificatin: Perceptin and feedback f cmmunity trainers during mnthly meetings (2) Prcess a. Number f trainers trained wh implement cunseling within the cuple b. Number f hme visits made during which CME in reprductive health and/r cmmunicatin within the cuple is discussed c. Number f cunseling sessins during which CME and/r cmmunicatin within the cuple is discussed d. Means and surces f verificatin: Trainers activity reprts/mnthly meetings (3) Results a. Perceptin f changes in quantity and quality f cmmunicatin and shared decisinmaking within the cuple b. Examples f changes (in the frm f anecdte r testimny) c. Means and surces f verificatin: Perceptin and feedback f cmmunity trainers during mnthly meetings and/r perceptin and feedback f health wrkers during mnthly meetings (fr example, perceptins f men frequenting the health centers, changes in demand, etc.). (4) After three mnths, d a cmplete review (with the participatin f Health Plicy Initiative, if pssible) 25

32 Appendix 11: Bull s-eye Evaluatin Wrkshp Objectives Increase knwledge f cncepts and results f cnstructive men s engagement in reprductive health. Reinfrce the capacity f cmmunity health educatrs t undertake cunseling fr imprved cuple cmmunicatin and decisinmaking. Reinfrce the system f mnitring and evaluatin f educatrs wrk t clarify and dcument results and lessns learned. Increase knwledge f CME and cmmunicatin within the cuple Reinfrce mnitring and evaluatin Reinfrce trainers capacity Or: Add anther line fr the participants expectatins. Participants expectatins Increase knwledge f CME and cmmunicatin within the cuple Reinfrce trainers capacity Reinfrce mnitring and evaluatin 26

33

34 Health Plicy Initiative, Task Order 1 Futures Grup Internatinal, LLC One Thmas Circle, NW, Suite 200 Washingtn, DC USA Tel: (202) Fax: (202) plicyinf@futuresgrup.cm

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