Today I have the pleasure of sharing with you approaches and results culled from ten years of service delivery research conducted by IRH. I hope that you find that these experiences represent useful models to inform future efforts to build gender equity and promote responsible fatherhood, and that they inspire and guide by demonstrating the feasibility, results and challenges of engaging men in family planning.
We are celebrating Father’s Day today- so why am I talking about family planning – something that could be considered a means to AVOID fatherhood? I think about it this way- beginning with the end in mind. If we want men to be involved in their families health, they should be involved in the planning of the pregnancy, not only its care.
Men who are engaged in this way will be more invested in the health of their children, and they will be….
better prepared to support their partners.
In order to effectively support their partners and children, men need positive attitudes, knowledge, the ability to communicate with their partners and access to services and information.
Global evidence is clear- men are not reached by family planning programs and many desire greater involvement in reproductive health issues. Most women also want their partners to be actively involved in supporting FP use, as well as other health promoting behaviors.
Ourresearch results suggest that the strategies listed on this slide can increase male engagement. It is possible, for example, to increase provider comfort serving men and couples through training and sensitization. Other strategies include offering FP services to men/couples, training male promoters and coaching women to negotiate with their partners during counseling sessions.It can be challenging to reach men through the service delivery system, not only for access reasons, but also due to the desire to maintain women’s privacy and autonomy.
Research from many settings around the world tells us that men receive most of their information and influence through male networks., so we tested strategies to work with these networks to reach men.
Results of this approach were encouraging. Significant improvements were seen in couple communication, contraceptive prevalence and attitudes supporting male engagement.
This slide shows results from a household survey conducted with men and women before and after the intervention. It shows, for example, that the percentage of men agreeing with the statement that men should NOT participate in family health decreased from 60 to 11%. In addition, the percentage of male respondents who had discussed men’s role in FP with their spouse over the last six months increased from 5 to 23%.Results for women were similar and regression analysis showed that all of the differences reported on this slide were significant after controlling for age, education and sex. Perhaps the most important result of this study, however, is that there were almost no significant differences between the scores of those who participated in a home visit or village talk and those who did not. This suggests that the intervention Planning Together began to change social norms, a finding consistent with Rogers’s theory of diffusion of innovation.
About 90% of men and women in rural India reported that SDM use had a positive influence on their relationship citing improved communication, affection and sexual relations. The quotes on this slide represent an example of how FP use can help men become more supportive sexual partners.
Building Gender Equity and Promoting Responsible Fatherhood in Family Planning Programs
Building Gender Equity and Promoting Responsible Fatherhood in Family Planning Programs Rebecka Lundgren, MPH
Begin with the end in mind:Involve men in planning their
Involved men will be investedin the health of theirchildren…
…and have the opportunityto be supportive partners
To be engaged fathers and supportive partners, men need to: Have positive attitudes towards healthy timing and spacing of pregnancy Be aware of FP methods and support their use Communicate with their partners about FP and family health Be linked with FP and other health information/services
Men are underserved Limited role for men in FP service delivery model Programs and providers exclude men Prevailing “anti-men” paradigm Provider bias against male clients, failure to welcome them or provide them accurate information
The Standard Days Method® Helps couples prevent pregnancy by knowing which days they should avoid unprotected intercourse Identifies days 8-19 of the cycle as fertile Works best for women with menstrual cycles from 26 to 32 days CycleBeads help identify fertile days, track cycle length & communicate with
Strategies Gender training for providers Counseling for men and couples Male promoters Communication & outreach Address partner issues with women
Provide information on FP and familyhealth to men through print and radio
Men obtain information from theirpeers rather than the healthsystem
Reaching men through men’s networksIn Philippines andGuatemala, FP infoprovided through: Agricultural cooperatives Microfinance groups Community development committees
CARE India: Male VolunteersMale and femalevolunteers provided: information to men’s and women’s groups counseling to men, women and couples
El Salvador: Incorporating FPintoWater and Sanitation Programs PCI included FP topics in water/ sanitation and agricultural education Home visits by volunteers SDM, OCP and condoms offered in the community with referrals for other methods
“Planificando Juntos” Results Increased couple communication among program participants, and throughout community Significant increase in contraceptive prevalence from 45% to 58% Increased support for: male involvement in family health women’s autonomy in FP choice
Attitudes, couple communicationand contraceptive use reported by menbefore and after “Planificando Juntos”* Attitudes Baseline Endline (%) (%) (n=175) (n=151) Men should not participate in family health 60 11 matters Discussed in the previous six months Number of children 38 47 Using family planning method 20 37 Which method to use 20 34 Men’s role in family planning 5 23 Risk of sexually transmitted disease 24 47 Contraceptive use Use of contraception 44 Lundgren63 al, 2006 et*Significant, p<0.001
Introducing SDM can help providers to… Broaden the FP paradigm to include men Address couple issues that influence FP use
Reaching Men with Family Planning Counseling Program Country % of male SDM users counseled by a providerProject Concern) El Salvador 39% (n=142) CARE Rural India 30% (n=431) KAANIB Philippines 88% (n=78)ASHONPLAFA Honduras 37% (n=82) Lundgren et al, 2006
Men participate in SDM use by… Using a condom or abstaining during fertile days Following wife’s instructions Keeping track of fertile days Purchasing CycleBeads and condoms
SDM Use Husband received counseling Yes No El Salvador (n=56) (n=86) Completed 13 cycles* 16% 7% Pregnancies* 5% 16%Unprotected sex during 2% 7% fertile days(p<.05)* Exit interviews with SDM users
SDM Continuation: Male Participation vs. Women Focused Villages 10 0% Misrikh Kha iraba d 9 0% 8 0% 7 0% 6 0% Porcentaje 5 0% 4 0% 3 0% 2 0% 1 0% 0% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Me se s de uso CARE India p < .05
In their words… Influence on their relationship“SDM has helped us to “I feel good that mycome closer, understand husband noweach other’s needs. Unlike understands how myearlier, we now discuss body works. He paysintimate things with each attention to myother and this has added suggestions and respectspleasure to our otherwise my wishes. For the firstmonotonous sex life.” time he asks me if we can have intercourse. I am- Male SDM user, India happy that he cares about me.” - Female SDM user, India
Principles of Success Work with men: male networks, change agents and providers Expand FP options/services for men Go to the men: community- based information and services, weekends and evenings Organizational commitment: monitor and reward efforts to reach men, flexible work hours
Reach out to menthrough theirnetworks to achievesupportive partnersand engagedfathers