Analysis done with data from 1999-2004. Using matched couples and pooled data. Results clearly indicate that agreement between couples/women and men on fertility-related issues leads to overall reduction in fertility intentions, which leads to increased use of modern FP. But to get to agreement, communication is critical. Policy implications: “Joint goals can be reached when both partners are able to discuss their reproductive desires and goals and how to achieve them. Toward this end, efforts are needed to expand FP outreach education that focuses on men and their role in fertility decisions”Fertility preferences: “would you like to have another child or would you prefer not to have any/more children? If both agree to have more /to not have any more children” – this is spousal agreementIdeal number of children – joint agreement occurs when both give same answer to ‘if you could choose exactly the number of children to have in your whole life, how many would that be?’Analysed many different ways. If no partner agreement, saw that men ideal no of children goals were generally higher than those of their wives. When both spouses agreed on the ideal no of children, the mean number no of children desired was smaller than the ideal number of children desired by either spouse separately.How to achieve joint goals? When partners are able to discuss their reproductive desires and goals and how to achieve them.
In September 2003, program implementers, researchers, evaluators, and donors came together in a four-day conference in the Washington, D.C., area to learn about men and reproductive health programs around the world that had challenged gender norms. Participants in the conference were particularly interested in those programs that could show through evaluations that gender-related attitudes and behaviors had changed in a direction likely to reduce health risks, specifically, those associated with violence and unsafe sex. Analysis of 14 programs recognized as state of the art / very innovative programmatically.Without proper consideration of gender as a determinant of health, initiatives can have haphazard or unintended effects on gender norms. For example, between 1993 and 1994 in Zimbabwe, the Male Motivation and Family Planning Campaign affected many Zimbabwean men. The plannersintegrated language from competitive sports and images of local soccer heroes into some of the campaign’s materials. As intended, the messages appealed to the male target audience and contraceptive use increased. The action-oriented and assertive imagery and messages reinforced gender stereotypes, however. According to surveys, not only did men become more interested and involved in selecting a family planning method, men tended to dominate and even assume full responsibility for this decision. Rather than endorsing shared decision-making between both partners in a couple, the mass media campaign had the effect of sanctioning and encouraging male-dominant behavior.Kim, Young Mi, Caroline Marangwanda, and Adrienne Kols. 1996.Involving Men in Family Planning. The Zimbabwe Male Motivation and Family Planning Method Expansion Project, 1993–1994. Available at the following Web address: www.africa2000.com/PNDX%5CJHU-zimbabwe.html. Accessed October 9, 2003.
Info from slide of a presentation made by Gary Barker, then of Promundo, at the Rio conferenceWhat does mean to you when you think about communications? Media / IPC /
Examples from IRH work with men reflect on SBCC changesCross sectional surveys before and after intervention with control groups.CPR rose from 45 to 58%Comparison area showed similar increased in CPR, authors concluded that it was messages passing between men via social networks Addressing normative and individual changeMen as partners, caring, and more complex gender role dynamics
Broader SRH focus in El Salvador. Encouraged public debate and dialogue among men (communication for social change approaches) using simple materialsChild spacing messages focused on health benefitsSignificant increase in FP uptake
Research shows couple involvement in FP –related decisions leads to better FP continuation rates. So it is an approach with relative value.
Focus on intimacy – card with white bead days. Card showing gender violence. What are possible communication approaches?
Info from slide of a presentation made by Gary Barker, then of Promundo, at the Rio conference
Important question – our research on SDM users shows important changes within most couples.Lots of questions on women’s empowerment – will men dominate if they become involved in FP decision-making? Our data show quite consistently that there are positive shifts in women’s empowerment within a couples using the SDM.
Three main types of communication channels and communications strategies and messages for each sub group (women, men, couples) will make SBCC more effectiveWhich seem most relevant/appropriate for couples approaches? For informing and raising awareness among men? For challenging gender roles of women and of men, including intimate decision-making / FP decision-making?
Using Communication to Address Gender Norms – Focus on Couple Communication and Male Involvement
Using Communication to Address Gender Norms – Focus on Couple Communication and Male Involvement<br />Susan Igras, MPH<br />Institute for Reproductive Health/Georgetown University<br />AfriComNet Practicum<br />International Family Planning Conference, Kampala, 19 November 2009<br />
Session ObjectivesParticipants will leave with:<br />Selected research findings on couples communication and male involvement in FP-related discussions and outcomes, including normative gender shifts;<br />Updated information on changing program frameworks for improving interventions for couples and male involvement; <br />New ideas, lessons, and challenges of communications strategies to improve couple and male involvement, which can lead to increased use of modern family planning methods.<br />
Partner Communication Matters: Findings From an Analysis of 14 DHS Having Female and Male Data(Source: Gebreselassie, T, Spousal Agreement on Reproductive Preferences in Sub-Saharan Africa, Macro International, 2008)<br />
Joint goals can be reached when both partners are able to discuss their reproductive desires and goals and how to achieve them. Toward this end, efforts are needed to expand FP outreach education that focuses on men and their role in fertility decisions.<br />
Engaging Men Constructively in FP Matters: Findings of Meta-analysis of RH Projects Involving Men (Source: White V, et al, Men and Reproductive Health Programs: Influencing Gender Norms, Synergy Project, 2004?)<br />Initiatives must expose their audiences to the interconnected messages of behaviors driven by socially accepted norms…<br />Programs that harness men’s desire to change,... optimize indigenous infrastructure, collaborate with opinion leaders,suffuse the media with positive images, and draw upon local culture to craft appropriate messages are the best-suited to creating social environments to enable positive and healthful behaviors and beliefs.<br />
Careless<br />Potential for caring<br />As individuals<br />Subjects of their own needs<br />Means to an end<br />Gender role dynamics & intimate decision making<br />Partners<br />CHANGING VIEWS OF MEN INFLUENCE BEHAVIOR COMMUNICATION CHANGE STRATEGIES<br />Complex subjects<br />Simple power analysis<br />Obstacles<br />
Example: Engaging Men via Community-based Water-Sanitation Program in El Salvador (Source: Lundgren et al, Cultivating Men’s Interest in FP in Rural El Salvador, Studies in FP 2005)<br />Messages: Reflected cultural context, values, and conservation analogy to appeal to men <br />Work with leaders: <br />Water and sanitation <br />committees reached men <br />with FP info and referrals<br />Results after 18 mon<br /><ul><li>Significant increases in KAB
Demonstrated power of social </li></ul> networks<br />
Reaching men through <br />extension programs <br />in rural El Salvador<br />(Source: Gribble, J et al. Being Strategic About Contraceptive Introduction: <br />The Experience of the Standard Days Method, Contraception, 2008)<br />Agricultural agents and community <br />volunteers reached farmers with <br />SRH info<br />Messages challenging behaviors/normsusing lowliteracymaterials<br />stressingchildhealthbenefits of <br />birthspacing (plus violence, intimacy, etc): <br />Family planning use increased 37 – 55%<br />
Couple Counseling Results in Better Continuation Rates<br />
How Can We Engage Couples More?<br />Couples-based services<br />Programming is directed towards couple<br />Couples-focused services<br />Do not involve both partners but address issues related to the relationship or male partner<br />Begins with an individual female client and may expand to include partner<br />
Couple-Focused Approach<br />Discuss with clients the role of their partners in birth control<br />Offer women the choice of including their partners in counseling<br />Give clients take-home materials for their partners<br />Include SDM in method choices<br />Other (referrals, welcoming men)<br />
General education messages<br />Counsel couple together<br />Train in gender & cultural sensitivity<br />Train providers in couple counseling<br />Explicitly discussing sexuality<br />Reach people separately - if desired<br />EVOLUTION OF COUPLES’ APPROACHES<br />Tailored msgs for woman, man, couple<br />Avoiding sexuality discussions<br />
Do Couple-Oriented Methods Influence Gender Roles of Partners? Case of SDM<br />Effect of SDM on the couple relationship (India)<br />92% of rural users reported that SDM use had a positive influence on their relationship citing…<br />Increased partner communication<br />Improved ability to negotiate sex<br />Increased affection/understanding<br />Improved sexual relations due to confidence in fertile days<br />8% cited a negative effect<br />Husband angry or uncomfortable<br />SDM use positively influenced female partner’s empowerment (GEI shifts in Guatemala pre/post SDM use)<br />
Concerns About Male Engagement Approaches<br />Reinforce gender inequalities<br />Communicate false sense of symmetry<br />Increase violence against women<br />Erosion of women’s reproductive rights and autonomy<br />Evaluate on the same old basis (CPR)<br />
Concerns About Couples Approaches<br />Term ‘couples’ might be stigmatizing to clients who are not in traditional relationships<br />Decrease safety for women clients<br />Discord within couples<br />Less open communication due to concerns about confidentiality and emphasis on partner<br />Staff discomfort or uncertainty may reduce quality<br />
Evolving Communications Frameworks – Social and Behavior Change Communication<br />SBCC is an interactive, researched and planned process aimed at changing social conditions and individual behaviors. <br />SBCC uses advocacy, social mobilization and behavior change communication to achieve its desired goals: to provide an enabling environment in which to achieve positive changes in behaviors and society overall.<br />
Implications for Communication Strategies -Men, Couples, Gender and Other Social Norms<br />
Exercise (30 minutes table discussion + 20 minutes of plenary to share)<br />What approaches have you used/observed for couples approach? For male involvement?<br />Which communication strategies have worked well? Which communication strategies have not worked well?<br /> What lessons have you learned? What would you do differently in the future?<br />
Final Thoughts on Communications<br />Engaging men and couples in discussions on fertility and FP-related themes can help address unmet need and can lead to normative change. But it needs to be done with open eyes.<br />Behavior change communication should be complemented by social change communication to address more explicitly gender and social norms at ‘enabling environment’ level.<br />Need more (rigorous) program evaluation and research to measure gender and social normative shifts.<br />And need much better description of communication and other processes to develop better practices.<br />
Sexual and reproductive programs can address not only the behaviors of the women, men, and youth audiences, but more importantly, the normative beliefs that govern behavior.<br />