Barriers to translating evidence intopolicy and practice: male involvementin maternal and child healthDr Wendy Holmes, Jes...
Why do we need to engage men?• Sexual, reproductive,   maternal and newborn health   concerns are major causes of   morbid...
Why should we involve men in MCH?• Men play a critical role in decisions   around:    – Finances, transport and mobility  ...
Why should we involve men in MCH?                                   • Pregnancy is a significant life event for           ...
Expected benefits•      Greater uptake and ongoing       use of contraception1•      Less risk of STIs and HIV for       m...
Expected benefits                cont…..• Improved couple communication1• Healthier children2• Increased communication and...
Need and benefit are clear, but….?• 1994: ICPD, Cairo - highlighted need to involve men more in SRH• Many key documents re...
Learning about the barriers• Barriers at community and health   service level• Barriers at level of international   and na...
Consultations with policy makers • We consulted 17 senior MCH policy makers and planners                                  ...
Consultations with policy makers • We consulted 17 senior MCH policy makers and planners • Part of broader research focuse...
Findings• Strong recognition of benefits of male involvement• Male involvement features in some national sexual and  repro...
Perceived barriers     P                                                                                                  ...
Perceived barriers     P                                                                                                  ...
Perceived barriers                                                   “…antenatal care and clinics…are                     ...
Perceived barriers Cultural & social        Pregnancies         Under-resourced,       Inappropriatebarriers but culture  ...
Perceived barriers         Lack of male staff &        staff training on how            to include men Cultural & social  ...
Perceived barriers                                               “[There is the] attitude of the service                  ...
Perceived barriers         Lack of male staff &       Staff attitudes in         Inflexible clinic        staff training o...
Perceived barriers         Lack of male staff &       Staff attitudes in         Inflexible clinic       Men in MCH       ...
Perceived barriersTendency to conceptualise    male involvement asrelevant to family planning,or STIs and HIV, or (when pr...
Perceived barriersTendency to conceptualise       Viewed as an ‘add-on’    male involvement as            project requirin...
Perceived barriers                                              “When provision of ANC per se is grossly                  ...
Perceived barriers                                              “Have tried to encourage women to bring                   ...
Conclusions• Our informants all believe that engaging men is                                                       Tibet, ...
What do we need to do?• Need to re-frame greater engagement of men in                                                     ...
References•    Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal     attendan...
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Barriers to translating evidence into policy and practice: the example of greater involvement of men in maternal and child health

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Dr Wendy Holmes and Ms Jess Davis, Centre for International Health, Burnet Institute

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  • UNICEF State of the World’s Children report in 2009 noted: “In the field of maternal and newborn health, men are generally missing from the literature” (p. 41). 10 WHO. Counselling for maternal and newborn health care: A handbook for building skills. Rome: WHO Department of Making Pregnancy Safer; 2009. In the section on prevention of STIs the standard is: “All women seen during pregnancy, childbirth and the postnatal period should be given appropriate information on the prevention and recognition of STIs and reproductive tract infections.”, without mention that expectant fathers should also receive this information. WHO have produced a useful new manual on counselling for maternal and newborn health care. 101 This recognizes that ‘it is as important to talk to partners as it is to talk to women about self-care during pregnancy because they play an essential role in support and care of the pregnant woman and are often the key decision-makers.” It also has many illustrations of couples and the counsellor is encouraged to think about the general practices for care of the pregnant women in their community, including sexual practices and taboos. However, there is an assumption throughout that it is primarily the woman who practices self-care during pregnancy and will be counselled, rather than the couple, and there is no suggestion that there may be a specific couple visit. The section on providing group information to women does not suggest that expectant fathers could also usefully receive information in groups. UNFPA State of the Wold Pop 2005 has a chapter on partnering with men and boys to achieve MDGs Syphilis strategy.
  • This study aim to understand the views of senior maternal and child health PM/P regarding the benefits, challenges and risks of male involvement and the approaches to overcoming obstacles to male involvement. aim to understand the views of senior maternal and child health officials and practitioners regarding the benefits, challenges and risks of male involvement and the approaches to overcoming obstacles to male involvement. Informal interviews were conducted with policy makers and health professionals working in the Pacific, including PNG.   We conducted informal interviews with 17 senior MCH policy makers and planners in the Pacific. As you can see here on the map, our informants worked in Vanuatu, Fiji, Cook Islands, Solomon Is, PNG, New Zealand. Interviews conducted via telephone or in person when possible.   Asking MCH officials about benefits, challenges, risk and approaches to greater MI in the Pacific.    
  • Part of broader research focused on the benefits, barriers, risks and program strategies for greater male involvement, including:   Literature review Consultations Collation of evaluated strategies for increasing MI
  • Barriers to translating evidence into policy and practice: the example of greater involvement of men in maternal and child health

    1. 1. Barriers to translating evidence intopolicy and practice: male involvementin maternal and child healthDr Wendy Holmes, Jess Davis, Dr David SimonCentre for International Health, Burnet Institute4 April 2012
    2. 2. Why do we need to engage men?• Sexual, reproductive, maternal and newborn health concerns are major causes of morbidity and mortality• Common underlying causes and shared solutions Tibet, Photo by W Holmes• Areas of life with great cultural and social significance, of intimate concern to women, yet often governed by men• Men have a right to information
    3. 3. Why should we involve men in MCH?• Men play a critical role in decisions around: – Finances, transport and mobility – Family planning – STIs and HIV Bali, Indonesia, Photo by E Sulaeman – ANC attendance, and nutrition and workload during pregnancy – Birth preparedness and institutional delivery – P Postnatal care and breastfeeding
    4. 4. Why should we involve men in MCH? • Pregnancy is a significant life event for both men and women: – Men likely to be open to behaviour change – Contact with health service an opportunity to link men into health services that will benefit their ownMumbai, India, Photo by W Holmes health
    5. 5. Expected benefits• Greater uptake and ongoing use of contraception1• Less risk of STIs and HIV for men, women and children2• Better ANC and PNC coverage, birth preparedness and institution delivery3 Phonsali, Laos, Photo by W Holmes• Better maternal nutrition and decreased workload during pregnancy41 Shattuck et al. 2011, Varkey et al. 20042 Becker et al. 2010, Aluisio et al. 20113 Shefner-Rogers et al. 2004, Mullany et al. 2007, Varkey et al. 20044 Sinha 2008
    6. 6. Expected benefits cont…..• Improved couple communication1• Healthier children2• Increased communication and counselling skills among health workers (and more job satisfaction) Aceh, Indonesia, Photo by J Lawson1 Kunune et al. 20042 Aluisio et al. 2011
    7. 7. Need and benefit are clear, but….?• 1994: ICPD, Cairo - highlighted need to involve men more in SRH• Many key documents recognise need to involve men• But many fail to mention men’s role at all• 17 years later: only small steps towards greater male involvement in most developing nations
    8. 8. Learning about the barriers• Barriers at community and health service level• Barriers at level of international and national policy makers and planners Phonsali, Laos, Photo by W Holmes• Some studies of the views of men and women at community level and of health care providers• We investigated the views of regional and national policy makers and planners
    9. 9. Consultations with policy makers • We consulted 17 senior MCH policy makers and planners Regional
    10. 10. Consultations with policy makers • We consulted 17 senior MCH policy makers and planners • Part of broader research focused on increasing male involvement in maternal and newborn health, including: • Literature review • Consultations • Strategies for male involvement
    11. 11. Findings• Strong recognition of benefits of male involvement• Male involvement features in some national sexual and reproductive health policies and at least on constitution• A growing interest in involving men in MCH• Limited progress in implementation Tibet, Photo by W Holmes
    12. 12. Perceived barriers P “Regarding culture, its not how it used to be, but culture is very dynamic, it’s open to new ideas.”Vientiane, Laos, Photo by W Holmes Cultural & social Mumbai, India, Photo by W Holmes Bali, Indonesia, Photo by E Sulaeman Melbourne, Photo by M Tennant barriers but culture dynamic
    13. 13. Perceived barriers P “The antenatal clinic is the entry point to family planning. There is unfortunately no opportunity before the first pregnancy.”Vientiane, Laos, Photo by W Holmes Cultural & social Mumbai, India, Photo by W HolmesBali, Indonesia, Photo by E Sulaeman Pregnancies Bali, Indonesia, Photo by E Sulaeman barriers but culture unplanned/no prior dynamic contact with health services
    14. 14. Perceived barriers “…antenatal care and clinics…are massively under-resourced and under- staffed. There is literally no space to involve men, no space on the floor, or time…Nurses andphealth staff are already under great stress.” Cultural & social Pregnancies Bali, Indonesia, Photo by E Sulaeman Under-resourced, Bali, Indonesia, Photo by E Sulaemanbarriers but culture unplanned/no prior over-stretched dynamic contact with health services and staff services
    15. 15. Perceived barriers Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    16. 16. Perceived barriers Lack of male staff & staff training on how to include men Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    17. 17. Perceived barriers “[There is the] attitude of the service providers, especially in the older generation, that it is the women’s arena.” “Staff are not the issue here.” Lack of male staff & Staff attitudes in staff training on how some settings to include men Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    18. 18. Perceived barriers Lack of male staff & Staff attitudes in Inflexible clinic staff training on how some settings opening hours to include men Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    19. 19. Perceived barriers Lack of male staff & Staff attitudes in Inflexible clinic Men in MCH staff training on how some settings opening hours not included in to include men information system Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    20. 20. Perceived barriersTendency to conceptualise male involvement asrelevant to family planning,or STIs and HIV, or (when prompted) clinical MCH services Lack of male staff & Staff attitudes in Inflexible clinic Men in MCH staff training on how some settings opening hours not included in to include men information system Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    21. 21. Perceived barriersTendency to conceptualise Viewed as an ‘add-on’ male involvement as project requiringrelevant to family planning, additional funding oror STIs and HIV, or (when requiring a major prompted) clinical MCH overhaul of MCH services system Lack of male staff & Staff attitudes in Inflexible clinic Men in MCH staff training on how some settings opening hours not included in to include men information system Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    22. 22. Perceived barriers “When provision of ANC per se is grossly inadequate then male involvement just not a priority.”Tendency to conceptualise Viewed as an ‘add-on’ Seen as a competing male involvement as project requiring priority and thatrelevant to family planning, additional funding or other things need toor STIs and HIV, or (when requiring a major be done first prompted) clinical MCH overhaul of MCH services system Lack of male staff & Staff attitudes in Inflexible clinic Men in MCH staff training on how some settings opening hours not included in to include men information system Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    23. 23. Perceived barriers “Have tried to encourage women to bring partners, but it’s not practical.”Tendency to conceptualise Viewed as an ‘add-on’ Seen as a competing Fatalism/ male involvement as project requiring priority and that too hardrelevant to family planning, additional funding or other things need toor STIs and HIV, or (when requiring a major be done first prompted) clinical MCH overhaul of MCH services system Lack of male staff & Staff attitudes in Inflexible clinic Men in MCH staff training on how some settings opening hours not included in to include men information system Cultural & social Pregnancies Under-resourced, Inappropriatebarriers but culture unplanned/no prior over-stretched physical layout of d dynamic contact with health services and staff clinics services
    24. 24. Conclusions• Our informants all believe that engaging men is Tibet, Photo by L Renkin important and were aware of potential benefits• Identified many of the community level barriers in terms of cultural beliefs and health service problems that we identified through the literature review• The sense of fatalism prevents progress in adapting services• Conceptualising men’s involvement in terms of SRH rather than MCH, and in relation to clinical care rather than health promotion, limits attempts to ensure that men are well informed about maternal and child health
    25. 25. What do we need to do?• Need to re-frame greater engagement of men in Tibet, Photo by L Renkin MCH as an essential, rights based, strategic and integrated approach rather than as a vertical intervention• Need to convey that different models or strategies will be appropriate in different settings• Need to convey that adaptations to services and systems to enable inclusion of men should not wait until services and systems are perfect
    26. 26. References• Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr. 2011; 56(1): 76-82• Becker S, Mlay R, Schwandt HM, Lyamuya E. Comparing couples and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: a randomized trial. AIDS Behav. 2010; 14(3): 558-66.• Kunune B, Beksinska M, Zondi S, Mthembu M, Mullick S, Ottolenghi E, et al. Involving men in maternity care. South Africa. Durban: University of Witswatersrand 2004.• Mullany BC, Becker S, Hindin MJ. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health education research. 2007 Apr;22(2):166-76.• Shattuck D, Kerner B, Gilles K, Hartmann M, Ngombe T, Guest G. Encouraging Contraceptive Uptake by Motivating Men to Communicate About Family Planning: The Malawi Male Motivator Project. American Journal of Public Health. 2011; 101(6): 1089.• Shefner-Rogers CL, Sood S. Involving husbands in safe motherhood: effects of the SUAMI SIAGA campaign in Indonesia. J Health Commun. 2004 May-Jun;9(3):233-58.• Sinha D. Empowering communities to make pregnancy safer: an intervention in rural Andhra Pradesh. New Delhi: Population Council 2008.• Varkey LC, Mishra A, Das A, Ottolenghi E, Huntington D, Adamchak S, et al. Involving men in maternity care in India. New Delhi: Population Council; 2004.

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