Engaging Men to Empower Women: the emerging role of husbands and fathers in child health in Tanzania & UgandaThursday, August 19th, 2010
Over the past three decades community-based public health programming focused on promoting the wellbeing of women and children in East Africa have created positive partnerships between local governments and western NGOs. Together, these organisations have primarily focused on improving the health of children in East Africa by supporting women through educational programming and empowering their independence. These organizations are working in communities and societies where men have traditionally perpetrated, and continue to perpetuate, the very gender inequalities that compromise the health of women and children. Through focusing early efforts on direct partnership with women, these initiatives have greatly improved health equality. However, this approach has led to the inadvertent exclusion of men within many child health projects. Involving men has not been overlooked, but rather it has been greatly underutilised.
Improvements that will build upon past successes of such programs should include targeted curriculum focused on empowering men to become more involved in maternal and child health issues. Moreover, these programs would benefit from actively supporting and encouraging the positive roles men do fill within their communities. In doing so, international public health organizations would be able to more effectively utilize the familial and social resources within the communities that they serve.
The role of men within community-based Integrated Management of Childhood Illness (c-IMCI) programs throughout East Africa has traditionally been through their training as community health volunteers, as their status as community leaders has important influence on the success of these projects. A recent Lancet World Report on child health in Uganda reports on how expanding the role of men within these programs has positively influenced the c-IMCI underway in the Mbarara district . By framing the roles that men play as resource gatekeepers in these communities and emphasizing how they could become more proactive in the area of maternal health, this project has successfully expanded its volunteer base and has encouraged many men to lead the way in areas of child health education and promotion. The importance of this direct partnership with men in the areas of child health became clear to me on a recent trip to Tanzania.
After finishing my first year of medical school, I spent the summer of 2009 working with a US-based public health NGO conducting a mid-term project evaluation of a USAID-funded c-IMCI program in the Karatu district of Northwest Tanzania. My time there brought me into the lives of many families and gave me a brief, but broad, perspective on the various social, cultural, and economic factors that have both positively and negatively influenced the impact of the health education initiatives of this c-IMCI project. One experience, in particular, emphasized the emerging need for international public health agencies to become more proactive in engaging men within the area of maternal health.
After a day of interviews in the small farming village of Rhotia, a few dozen miles east of Karatu, we agreed to squeeze in the eldest of the midwives into our land cruiser and give her a lift into town. On our way home, she told us a story of a recent, and in her view, potentially avoidable disaster. A few weeks prior to our visit, she had been working with a young first time mother-to-be as she prepared for delivery. The midwives in this village serve as support during the delivery and liaisons between local health facilities. When the day came for this young mother to deliver the midwives helped prepared her house for the arrival of the new baby and took care of the mother after her water broke. At this first sign of delivery, the young husband was so unsettled that he quickly gathered his up his cell phone and money and fled, leaving the women stranded. Without the phone they couldn’t coordinate a car to pick them up to take them to health facility, without the money they couldn’t pay for the car, and without him, she emphasized, they couldn’t experience this important event in their lives together as a family. Fortunately, the midwives delivered the baby safety at home. The lesson, she wanted to impress upon us, was that it was time that we start teaching fathers about child delivery and supporting them in becoming more involved in this process.
Similar stories of injustice and societal complications were narrated by my friend, a fellow public health student who recently worked with a women’s group on a mosquito net distribution program in the Masaka district of Uganda. All of these issues are leaving lasting negative impact on child health. There is an opportunity for western-based NGOs implementing the Maternal and Child Health (MCH) and c-IMCI in these regions to rethink how they are integrating men into their programming to improve health outcomes.
The evidence exists to support the involvement of men in MCH programming. In Tanzania, a study found that pregnant women were more likely to deliver in a healthcare facility if both partners were involved in the decision-making process of the delivery location . In Uganda, a UNFPA led program focused on including male elders in the decision making-process was able to reduce female genital cutting by roughly 35% . New doors of opportunity could open for men to expand their responsibilities within the healthcare of their children, as has already been found to be working in Haiti and Kenya in areas such as breastfeeding and neonatal care [4,5].
The acceptance and response of integrating these gender-inclusive training programs will certainly vary from region to region depending on cultural differences and educational resource availability. These successful programs noted above demonstrate the balance between preserving the sensitive culture-specific gender dynamic while focusing on making changes to improve the health of young women and children through education-base interventions. With knowledge comes responsibility. The education and involvement of men in MCH issues may consequently increase the call for men to become more specifically invested in the health of mothers and infants.
The idea of involving men in MCH issues is not new. In 1994, the International Conference on Population and Development in Cairo, men were beginning to be included in the conversation surrounding reproductive health . A snowballing effect has occurred since, and now there are a number of organizations and programs that highlight the need to include men in the area of MHC.
A global alliance of NGOs and UN agencies emerged over the past decade to promote the role of men in gender equality and women’s health. These organizations include: the International Center for Research on Women, International Planned Parenthood Federation, WHO, UNFPA, UNDP. Moreover, many useful web-based resources such as EngenderHealth.org and MenEngage.org have been created to outline actionable strategies that organizations can adopt to expand their current programs. The formation of MenEngage.org has made it clear that there is a growing call for the inclusion of men and fathers in MCH issues. Taking advantage of these resources and proven models will be essential for future MCH programming throughout the world.
Beyond improving safe delivery and rearing practices, such programming can empower men in other important and new ways. When interviewed about his experience with one such program in northwest Tanzania one husband’s response was:
“What I have appreciated most is accompanying my wife to the health centre for her antenatal clinic visits. That way, I will know if she has complications, and I can budget in advance to take her to a bigger hospital. I never went with my wife to the antenatal clinic when she was pregnant with our other children. I think I missed out. But in the past, men were not allowed. Now, if you go with your wife, the clinic staff treat you like someone important.”
Joseph, age 42, a resident of northwestern Tanzania’s Geita District 
In East Africa and across the globe, there is an opportunity to start recognizing men as partners in the health of women and children. This need is slowly being addressed in pockets of East Africa; perhaps the most recently successful is an on-going USAID-supported breastfeeding campaign started in 2009 in Western Kenya that has encouraged men to support their wives as they breastfeed . By reshaping MCH programming with the aid of such successful models and available resources, we may hope to include more men like Joseph in MCH interventions. This will consequently facilitate a greater and more widespread dissemination of information and skills. To continue improving the health and wellbeing of the women and children who benefit from MCH and c-IMCI project we need to begin integrating creative and meaningful ways that engage both parents in a manner that empowers women and men to work together on the shared goal of improving the health of the next generation.
Ben Pederson* & Tyler Weber T.W.
University of Minnesota School of Public Health, MPH2; B.P. University of Minnesota School of Medicine, MS2. *corresponding author: ben.pederson(a)gmail.com
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