Male engagement guidelines in antenatal care: unintended consequences for pregnant women in Tanzania

Background The meaningful engagement of male partners in antenatal care (ANC) can positively impact maternal and newborn health outcomes. The Tanzania National Plan for the Elimination of Mother to Child Transmission of HIV recommends male partners attend the first ANC appointment as a strategy for HIV prevention and treatment. This recommendation seeks to increase uptake of HIV and reproductive healthcare services, but unintended consequences of these guidelines may negatively impact women’s ANC experiences. This study qualitatively examined the impact of policy promoting male engagement on women’s ANC experiences. Methods The study was conducted in two urban clinics in Kilimanjaro Region, Tanzania. In-depth interviews were conducted with 19 participants (13 women and 6 male partners) attending a first ANC appointment. A semi-structured guide was developed, applying Kabeer’s Social Relations Approach. Data were analyzed using applied thematic analysis, combining memo writing, coding, synthesis, and comparison of themes. Results Male attendance impacted the timing of women’s presentation to ANC and experience during the first ANC visit. Women whose partners could not attend delayed their presentation to first ANC due to fears of being interrogated or denied care because of their partner absence. Women presenting with partners were given preferential treatment by clinic staff, and women without partners felt discriminated against. Women perceived that the clinic prioritized men’s HIV testing over involvement in pregnancy care. Conclusions Study findings indicate the need to better assess and understand the unintended impact of policies promoting male partner attendance at ANC. Although male engagement can benefit the health outcomes of mothers and newborn children, our findings demonstrate the need for improved methods of engaging men in ANC. ANC clinics should identify ways to make clinic settings more male friendly, utilize male attendance as an opportunity to educate and engage men in pregnancy and newborn care. At the same time, clinic policies should be cognizant to not discriminate against women presenting without a partner.

A long way to go: engagement of men and boys in country family planning commitments and implementation plans

Background: To reach global goals related to women and girls’ access to modern family planning (FP) and gender equality, evidence shows that it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in six countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women’s access to and use of FP services, and improve their knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men’s and women’s health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.

A Qualitative Endline Evaluation Study of Male Engagement in Promoting Reproductive, Maternal, Newborn, and Child Health Services in Rural Kenya

Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced RMNCH in rural Kisii and Kilifi.Methods: The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions (FGDs) with 82 community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews (KIIs) with facility health managers, and sub-county and county officials who were aware of the AQCESS project.Results: Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning (FP), spousal/partner accompaniment to facility care, and defeminization of social and gender roles.Conclusion: This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children's health as well as in improving spousal support for use of FP methods.

When Men Who Dislike Feminists Feel Proud: Can Self-Affirmation and Perspective-Taking Increase Men’s Empathy Toward Feminists?

Abuse against women’s rights activists is a serious concern, but there is a lack of research into strategies on how to reduce this. Past research has identified self-affirmation (i.e., thinking about one’s valued traits) and perspective-taking as promising strategies to reduce minority target backlash. Through one pilot study ( n = 98), and one two-part experimental study ( n = 202), we tested the effect of perspective-taking and self-affirmation on empathy toward feminism among men. Fictional Facebook profiles were manipulated to encourage perspective-taking, perspective-taking with self-affirmation, or were neutral in content. Participants then rated feelings toward individual feminists as well as feelings (in the context of perspective-taking emotions) toward abuse faced by feminists more generally. Results indicated that perspective-taking combined with self-affirmation promoted empathetic feelings (as represented by perspective-taking emotions) toward feminists experiencing abuse. The impact on empathy was particularly strong among men with high initial prejudice toward feminists. These results suggest that self-affirmation could potentially reduce online abuse of feminists through an increase in empathetic feelings. This research has broader implications for male engagement within feminism, and we recommend that educators and male allies of feminism promote positive, affirming roles for men (e.g., as fathers), as this may encourage empathy toward feminist issues. Policy makers could consider this strategy in the context of promoting policies such as shared parental leave.

A long way to go: engagement of men and boys in country family planning commitments and implementation plans

Background: Evidence shows that, to reach global goals related to women and girls’ access to modern family planning (FP) and gender equality, it is critical to understand and account for the role of men and boys as users of reproductive health services, as partners for millions of women & girls around the world, and as advocates in their communities. Under the Family Planning 2020 (FP2020) partnership, countries were encouraged to develop costed implementation plans and action plans in an effort to provide 120 million additional women and girls with contraception. As FP2020 becomes FP2030, reviewing these previously-developed strategies helps understand the extent to which countries considered the engagement of men as an important aspect of their family planning portfolios. Methods: We conducted textual analysis on commitments and implementation plans related to achieving FP2020 commitments in seven countries in Africa and one in Asia to determine the extent to which male engagement was incorporated into country or subnational family planning goals, with particular focus on FP policy, program, and financial commitments. Results: Some of the documents analyzed included robust plans for including male engagement in their efforts to expand access to FP. The strongest aspects of male engagement programming were those that sought to engage men as advocates for women’s access to and use of FP services, and improve men’s knowledge and attitudes related to contraception and reproduction. The weakest aspects were engaging men as users of services and, vitally, tackling underlying gender norms which hamper men’s and women’s health-seeking behaviors and attitudes. Conclusions: Developing FP programs that target men and boys as people deserving of reproductive health services, as partners with women in building their families, and as social activists in their communities, will complement and strengthen existing FP programs as well as promote broader goals related to gender equality.

Male Involvement in Reproductive and Maternal and New Child Health: An Evaluative Qualitative Study on Facilitators and Barriers From Rural Kenya

Male involvement in reproductive, maternal, newborn and child health (RMNCH) is known to improve maternal and child health outcomes. However, there is sub-optimal adoption of male involvement strategies in several low- and middle-income countries such as Kenya. Aga Khan University implemented Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), a project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC), between 2016 and 2020 in rural Kisii and Kilifi counties, Kenya. A central element in the interventions was increasing male engagement in RMNCH. Between January and March 2020, we conducted an endline qualitative study to examine the perspectives of different community stakeholders, who were aware of the AQCESS project, on the facilitators and barriers to male involvement in RMNCH. We found that targeted information sessions for men on RMNCH are a major facilitator to effective male engagement, particularly when delivered by male authority figures such as church leaders, male champions and teachers. Sub-optimal male engagement arises from tensions men face in directly contributing to the household economy and participating in RMNCH activities. Social-cultural factors such as the feminization of RMNCH and the associated stigma that non-conforming men experience also discourage male engagement.

Men, the Missing Link in Gender-equitable Family Planning

Background: Across societies, gender norms often allow men to hold key decision-making power within relationships, households and communities. This extends to almost all domains, consisting of family planning (FP) as well. FP programmes have largely engaged men as clients and rarely as equal partners or influencers although across lower and middle income countries (LMICs), and especially in South Asia, men hold key decision-making power on the domain of family planning. The objective of this article is to explore couple dynamics through the lens of spousal communication and decision-making and unpacking male engagement and spousal dynamics in family planning.Methods: This review presents a synthesis of evidence from two peer-reviewed databases, PubMed and Jstor, and and insights from programmatic documents to shed light on gender equitable engagement of young married men in family planning. Inclusion and exclusion criteria for both these databases was set and search strategies were finalized. This was followed by title and abstract screening, data extraction, synthesis and analysis.Results: Study participants included unmarried men (16%, n= 8), married men (19%, n= 9), married women (19%, n=9), married couples (25%, n =12) or more than two respondent categories (21%, n= 10). Almost three-fourth (71%, n=34) of the studies selected had FP as the primary area of inquiry. Other prominent thematics on which the studies reported were around norms (n=9, 16%), couple dynamics and intimacies (n=12, 22%).Conclusion: The evidence presented provides sufficient impetus to expand on gender-equitable male engagement, viewing men as equal and supportive partners for informed, equitable and collaborative contraceptive uptake and FP choices by couples.

"You Can Collaborate and Go Together to Do Family Planning”: A Qualitative Endline Evaluation Study of Male Engagement in Promoting Reproductive, Maternal, Newborn and Child Health Services in Rural Kenya.

BACKGROUNDGlobally, male involvement in reproductive, maternal, newborn and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University has been implementing the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Towards the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced reproductive, maternal, newborn and child health in rural Kisii and Kilifi.METHODSThe study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions with the community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews with facility health managers, and sub county and county officials who were aware of the AQCESS project.RESULTSMale engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning, spousal/partner accompaniment to facility care and defeminization of social and gender roles.CONCLUSIONThis study supports the importance of male involvement in RMNCH in facilitating decisions on women and children’s health as well as in improving spousal support for use of family planning methods.

"You Can Collaborate and Go Together to Do Family Planning”: A Qualitative Endline Evaluation Study of Male Engagement in Promoting Reproductive, Maternal, Newborn and Child Health Services in Rural Kenya.

BackgroundGlobally, male involvement in reproductive, maternal, newborn and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University has been implementing the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Towards the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services.AIM This paper presents the endline evaluative study findings on how male engagement influenced reproductive, maternal, newborn and child health in rural Kisii and Kilifi.METHODSThe study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions with the community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews with facility health managers,and sub county and county officials who were aware of the AQCESS project.FINDINGSMale engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning, spousal/partner accompaniment to facility care and defeminization of social and gender roles.CONCLUSIONThis study supports the importance of male involvement in RMNCH in facilitating decisions on women and children’s health as well as in improving spousal support for use of family planning methods.