The role of men in providing care and support for improved newborn outcomes. June 2018

Transcription

1 The role of men in providing care and support for improved newborn outcomes. June 2018

2 Introduction PPP imitative to prevent preterm birth funded by GoC and JNJ Implemented in Ethiopia, Mali and Bangladesh by a consortium of there NGOs: World Vision, Plan International and Save the Children Prioritizing prevention of preterm birth the leading cause of death in children under age five Addressing risk factors before and during pregnancy Unhealthy Lifestyle, Maternal Infection, Inadequate Nutrition and Lack of Contraception (LINC)

3 Pillars of BOT interventions to prevent PTB: Pillar 1: Improving health service delivery Training healthcare providers and community health workers to provide quality and gender responsive MNH/SRH care that addresses LINC factors for adolescent girls and mothers before, between and during pregnancies Improving local health facilities with essential equipment and supplies. Strengthening referral systems for high risk pregnancies and deliveries, and preterm, low-birth weight babies.

4 Pillars of BOT interventions to prevent PTB: Pillar 2: Increasing uptake of health services Promote behavior change on lifestyles, taboos related to preterm birth and improve uptake of MNCH services (ANC, family planning, newborn care ) by working with community/religious leaders, traditional birth attendants, youth groups and radio broadcasters to raise awareness. Tackling issues of gender inequality through empowering women (self-confidence, economic, negotiation and leadership skills) and engaging men.

5 Pillars of BOT interventions to prevent PTB: Pillar 3: Strengthening data collection and utilization Improving data collection and registration on birth, death and still birth at community and health facility level and the capacity to utilize the data for MNCH planning and management at national and subnational levels.

6 GE as BOT s strategy to prevent preterm birth The rational: Nearly all of the lifestyle risk factors have significant gender inequality and discriminatory/oppressive gender norms/roles as the underlying factor. Subnational statistics and BOT s baseline and gender assessment findings show high prevalence of lifestyle risk factors that are directly related to gender inequality. BOT approaches: Empowering women and girls Engaging men and boys as active partners for change (community level interventions) Engendering maternal and newborn health services (facility level interventions)

7 Men engagement as one of the approaches in BOT s GE strategy The rational : Men are the as holders of positions of power are the ones who usually make decisions on maters that affect MNH/SRH outcomes of women and girls. The social institutions that are gate keepers of the norms/traditions that directly impact on MNH/SRH outcomes are dominated by men. Men have direct roles in some of the lifestyle risk factors of PTB (IPV, EFCM, smoking, etc) and as such modifying these risk factors will require change in attitudes and behaviors among men. Sexual and reproductive health issues seen as women s only issues leaving out the key players. MNH/SRH services not welcoming for men to accompany their partners during pregnancy and during birth, thereby distancing men from active fatherhood right from the beginning. Providers lack of skills to engage male partners during provision of MNH/SRH

8 The role of men in participatory care and support for improved newborn outcomes: BOT experiences. BOT is implementing interventions to promote male engagement with their partners and the health system on MNH/SRH issues with promising early results. BOT s approaches on male engagement are designed for both short term outcomes on behavioral change as well as longer term and more transformational changes on attitude, relationships and social institutions/structures. Engaging men through multiple platforms such as community groups, religious institutions, health systems etc is likely to yield greater results. Recognition and rewarding (e.g. certificates) men for their positive contribution to MNH/SRH outcomes is likely to result in stronger and sustained engagement.

9 BOT experiences of promising early results Men supporting their wives/partners in accessing MNH/SRH services: e.g. providing financial support, facilitating referrals and accompanying their wives to ANC services Men participating in the uptake of MNH/SRH services to prevent infectious risk factors of PTB (STIs). Male discussion group members from Yifag village with traditional litters made for their graduation ceremony.

10 BOT experiences of promising early results contd Supporting their wives/partners to alleviate workload and improve nutrition intake during pregnancy. Adopting behavioral change to reduce lifestyle risk factors of PTB (IPV, EFCM).

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12 BOT experiences of promising transformative changes: Aweke Marsha (husband) reflected that: Before I took male engagement dialogue session, I didn t care about my wife health, her workload even at times of her pregnancy. I did not help her in any of her house cores nor did I have sympathy. I used to drink, beat my wife and expend extravagantly. Today let alone drinking, I don t pass by the alcoholic drink house. Peace is reining in my home now. I assist my wife with any of the house cores and I don t spend anything without her consent Laichilu (Aweke s wife) said: His attitude is entirely changed and repaying me for all the wrong doings. My broken heart is now repaired. He assists me with every household chores. He makes me coffee, cooks food and do everything a woman can do. He is sharing his experience to other men to be like him. Our neighbors are amazed of the change in his behaviour

13 BOT experiences of promising early results Adopting behavioral change for participatory decision making for better MNH/SRH outcomes including PTB. E.g. use of contraceptives Many participants and their wives have expressed how participation in these discussion groups have had a positive impact on their relationship with men playing greater roles in helping their wives with common household chores and caring for children.

14 BOT experiences of promising transformative changes: Religious leaders making a difference: Making progress on reducing EFC Banned EFCM in 115 Christian congregations and 11 mosques under their leadership in Wogera woreda (district) Reports of 49 arranged marriages of which 44 were canceled in the past 12 months Changing perceptions and attitudes towards preemies: Premise were not considered to be full human beings and as such weren t expected to thrive- this is changing with religious leaders educating their congregations. The language that was used to describe death preemies ( lost ) was one that objectified them and this is also changing with religious leaders banning the use of such language.

15 Men engagement as one of the approaches in BOT s GE strategy Facilitated discussion sessions of purpose formed male groups/clubs Working with Religious Leaders to influence men Targeting male organizations and associations Working with local male champions as agents of change SBCC interventions - Like Theater for Development, radio etc - to reach out to men with GE messages Advocating with political leaders and local authorities to be champions of male engagement

16 Facilitated discussion sessions of male groups/clubs Approaches vary slightly between the BOT countries but sessions are guided by manuals to ensure quality and consistency of messaging: Ethiopia: Men s group of 35 members (married/unmarried men, influential figures, young adults, elders, DA members, couples with/out children, girls) 8 biweekly sessions of 2 hrs of participatory and facilitated conversations including group works, role plays and presentations. Bangladesh: Each group was formed with 15 married men/father (newly married, have one child). The sessions included key issues to ensure male engagement through sensitizing them following the Fathers Club manual.

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18 Working with religious leaders Religious leaders are trained on the key MNH/SRH messages with the focus on myths and misconceptions of PTB, the risk factors of PTB and harmful traditional practices that contribute to PTB such as EFCM. Trained religious leaders cascade the training down to lower level leaders All trained religious leaders educate their congregations

19 Working with health facilities to support men s involvement in MNH/SRH BOT has trained large number of health workers (nurses, midwives, doctors, etc) on gender response MNH/SRH services including the skills to engage male partners during joint visit. Health facilities are also supported to create a friendly environment for men to accompany their wives/partners to MNH/SRH services

20 Critical questions: Are the changes that we are seeing truly transformational or men trying to behave in a socially desirable way? What are the incentives for me to adopt transformational changes on gender roles and relationships and also push for structural changes?

21 Thank you!