A Research paper on Male Involvement Strategy in Maternal, New-Born and Child Health-Turkana County

A Research Paper on Male Involvement Strategy in Maternal,
Newborn and Child Health --Turkana County
By: Stephen Olubulyera- A Public Health Officer at
Ministry of Health & Sanitation-Turkana County
Tackles: Strategies in engaging men in Maternal Newborn and Child Health program
Innovative approach in involving men in Maternal and New-born Health

Stephen Olubulyera-Public Health Officer at Ministry of Health-Turkana County
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Linkedin: https://ke.linkedin.com/in/stephenolubulyera
A RESEARCH PAPER ON MALE INVOLVEMENT STRATEGY IN MATERNAL, NEWBORN
AND CHILD HEALTH -- TURKANA COUNTY.
BBYY:: SSTTEEPPHHEENN OOLLUUBBUULLYYEERRAA
Turkana County is the second highest county with a high burden maternal mortality in Kenya, after
Mandera County, according to Kenya Demographic and Health Survey (KDHS) 2008-2009, Kenya
Service Provision Assessment (KSPA) 2010 survey and Kenya Malaria Indicator Survey (KMIS)
2010. The shocking news comes amid availability of intensive strategic policies by national
government as intervention to improve Maternal and New-born and Child Health (MNCH) in Kenya.
The study reveals that maternal, neonatal and child indicators remain unacceptably poorly
managed with less support and non-commitment to by policy makers. There is crucial need for
governments in the counties to accelerate improvements of maternal health to reduce maternal
morbidity and mortality. The report further discloses that more women are specifically dying from
pregnancy related causes that are easily preventable such as post-partum hemorrhage
complications, infections, high blood pressure and obstructed labour, malaria, anaemia, HIV and
tuberculosis that affect the health of pregnant women. However, there are other underlying major
factors that contribute to the high burden maternal, new-born and child mortality and morbidity
burden which include poverty and sociocultural issues such as gender norms that limit women’s
access to health care, especially in rural areas. In Turkana County has a strong socio-culture,
majority of men/male are household heads: they control household resources and are not expected
to be involved in seeking care for their wives and children, especially during pregnancy, childbirth,
and the postpartum period. Women often do not make decisions on their own, which limits their
ability to access household financial resources and to seek health care in a timely manner. Most
existing family- and community-level strategies to improve maternal, newborn, and child health
(MNCH), however, continue to target women. MNCH programs in Turkana County need to better
understand how to operationalize male involvement policies.
Pregnancy, childbirth and caring for newborns are viewed as ‘women’s business’ in many cultures
not only in Turkana County. Maternal, newborn and child health care services have focused on
providing information and services to women. Yet men’s behaviour and decisions affect the health
of their wives and babies. To support and protect the health and wellbeing of their family men need,
and have a right to information and health care services. Despite this international agreement on
the importance of including men in maternal and newborn health progress has been slow. I

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undertook a review to identify potential benefits, challenges and strategies for engaging men in
services that improve maternal and newborn health in low-income settings
BACKGROUND OF THE RESEARCH
Strategies to improve maternal, newborn and child health (MNCH) tend to focus on women. While
education and empowerment of women are critically important, there is a limit to the gains that can
be made when male partners are not considered.
In many societies, men are responsible for the decisions that directly impact their partners’ and
children’s health, such as the use of contraceptives, access to health services, food quality and
availability, and women’s workload.
Men may therefore play the role of ‘gatekeepers’ to health care , despite the fact that they often lack
relevant knowledge. Men who are poorly informed or disengaged from pregnancy and childbirth
may present serious barriers to women’s ability to act in their own and their children’s interests.
Despite their frequent position as primary decision maker, men tend to be excluded from health
services and spaces in which they could learn more about family planning, pregnancy and
childbirth. The exclusion can be sociocultural, in that pregnancy and childbirth is often considered
‘women’s business’, and there are economic drivers for men to work away from home. It can also be
programmatic; an exclusive focus on women in maternal health programs may result in health
services that are inaccessible to men. This exclusion may mean that men are less able to make
informed decisions about reproductive and maternal health, and less willing to engage in such
decision-making with their partners. For example, the omission of men from family planning
programs may have placed the burden of contraceptive decision-making onto women.
Men’s involvement has been tested in different contexts and found to be beneficial in a number of
domains, including safer birth practices, family planning, HIV prevention, maternal workload, birth
preparedness and emergency obstetric access, and partner communication and emotional support.
In addition to the benefits for women and children, male involvement has potential benefits for
men. These include improved quality of paternal and couple relationships, a more valued and
constructive role for men, and increased access to, and familiarity with the health system.
However, there are potential risks associated with male involvement programs if they are
implemented in a way that is not sensitive to existing gender norms. They may reinforce gender

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stereotypes and isolate single women from services, and may even result in decreased service
uptake by women, particularly in the case of HIV prevention.
To minimise these risks, it is important to ensure women have a central place in program design
and evaluation. In addition, interventions in which a positive model of masculinity is promoted and
men act as agents of change have been found to be particularly successful
DEFINING MALE INVOLVEMENT
Male involvement has been variously defined, with two broad theoretical approaches emerging
from the literature. The first considers male involvement to be a marker of gender equity as part of
a social determinants of health framework. Adopting more equitable gender roles such as joint
decision-making within couples and shared control of household tasks or parenting is posited to
lead to healthier behaviours and improved care-seeking. The second approach sees male
involvement as more instrumental; the direct assistance provided by men to improve their
partners’ and children’s health through the perinatal period. This approach is ‘gender-neutral’ or
‘genderblind’ in that it considers men’s actions independent of their gendered roles. In fact, there is
a risk that it may reinforce gender norms that disempower women .
These approaches are two ways of conceptualizing male involvement rather than categories of the
different ways in which men can be involved. Evidently, practical activities such as helping with
housework or attending childbirth may also challenge gender norms. The difference is that an
instrumental approach sees the behaviour (such as attending birth) as an end in itself, whereas a
gender equity approach examines its potential to combat gender inequities that contribute to poor
health.
It is difficult to measure male involvement in a way that captures both the practical assistance
provided by men to women, and the many ways that men can challenge prevailing gender norms.
There are no established indicators for measuring involvement in the literature, and few authors
are explicit about their own notions of involvement or their choice of indicators. Different
indicators have been used to represent different types of involvement, including inter-spousal
communication, attendance at antenatal care (ANC) and childbirth, and support provided during
pregnancy. Each indicator used on its own cannot be said to constitute involvement, and some
authors have combined multiple indicators into an index to capture a broader notion of
involvement.

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BENEFITS OF INCLUDING MEN IN MATERNAL AND CHILD HEALTH
Studies in many settings show that the support of their male partners influences women’s uptake of
services, their workload, nutrition and wellbeing during pregnancy, and the ways they care for and
feed their babies. Women are vulnerable to sexually transmitted infections and HIV infection during
and after pregnancy. So there are many potential benefits to reaching expectant fathers with
information and services. There have been few intervention studies that aim to engage men in
maternal and child health, but available evidence demonstrates:
a) Increased use of family planning and contraceptives in long-term couples;
b) Reduced workload for women during pregnancy;
c) Improved preparation for birth;
d) Improved couple communication and emotional support for women during pregnancy;
e) Increased uptake of interventions to prevent syphilis and HIV infection in children; and
f) Increased attendance at postnatal care.
STRATEGIES FOR ENGAGING MEN
Different strategies to reach men with information and services will be appropriate in different
contexts, as for Turkana County context:
Antenatal visits provide an opportunity to engage expectant fathers. Maternal nutrition, workload
and preparing for the birth can be discussed with both partners together. Much can be done to
make antenatal clinics more welcoming to expectant fathers. Maternal health care providers need
training, guidelines for a couple antenatal visit, and information materials for men. Clinic hours can
be adjusted to make it easier for expectant fathers to attend, for example, there might be an evening
clinic once a week. Separate waiting spaces and men’s health promotion posters will make men feel
more welcome. And including an indicator on the couple visit in Health Information Systems will
allow clinics to monitor male involvement. The presence of men in the clinic highlights the need to
improve arrangements for privacy and confidentiality. These are often neglected issues of great
importance to pregnant women too.
If the second antenatal visit becomes a routine couple visit, women have an opportunity to choose
whether to have their partner attend. It is important to try to avoid unintentionally discouraging
single or unaccompanied women from accessing services.

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While some topics can be discussed with a woman and her partner together, it is better to discuss
sensitive subjects such as the safety of sex during and after the pregnancy, the need to avoid
unprotected sex with someone else, and HIV and STI testing, in separate single-sex groups. This
could be undertaken by trained male staff at or near the clinic, or in separate meetings for
expectant fathers in a culturally appropriate community or workplace setting.
Community beliefs that discourage male involvement in maternal and newborn health can change.
Mass media strategies that appeal to men’s sense of responsibility for protecting their family should
be integrated with community outreach and peer education. These should aim to reach men,
women, traditional midwives, community and religious leaders. Boys and men can be reached at
different stages of life – at school, when preparing for marriage, expecting a baby, and as fathers
and grandfathers. Efforts to involve men are more likely to succeed if they focus on men’s concerns
about their own health as well as the health of their family.
A range of programmes and interventions, such as fathers’ clubs, peer education initiatives,
community mobilization campaigns and workplace-based initiatives, could be developed and
implemented around Turkana County with an intention to encourage active involvement of men
during the prenatal and postnatal periods as well as during the delivery. Studies demonstrate that
engaging future fathers during the antenatal period can improve birth preparedness, contribute to
better couple communication, increase assistance when complications arise during birth, facilitate
more equitable relationships and improve attendance at postnatal care.
To reduce risk of any possible negative consequences of involving men it is important to involve
women in the development of strategies to engage men. Encourage shared decision-making and
women’s autonomy.
CONCLUSION
The need for further research and evaluation of strategies to engage men in improving maternal
and child health should not delay action. Previous research provides a strong rationale for engaging
men, while studies examined in this review provide evidence of benefits of male involvement on
some maternal and newborn health indicators, and examples of effective strategies for including
men that can be implemented and evaluated in new settings. Men have a right to the information
and services they need to protect their own and their families' health. There is a significant need to
scale up men’s participation in maternal health and to provide them with the sufficient information
to help them make decisions, and support their partner’s decisions, concerning their family’s health.

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In addition to measures taken to encourage and motivate men to participate, special attention has
to be paid to the obstacles they face and complex approaches to overcome them. More rigorous
evaluations of male involvement initiatives, attention to vulnerable and disadvantaged families,
acknowledgement of heterogeneity of fathers’ groups, revision of policies and laws and closer
collaboration between different sectors are needed in order to strive for better maternal and
newborn health outcomes and well-being.
REFERENCES
1) Shattuck D, Kerner B, Gilles K, Hartmann M, Ng’ombe T, Guest G. Encouraging contraceptive
uptake by motivating men to communicate about family planning: the Malawi Male Motivator
project. Am J Public Heal. 2011;101:1089–95.
2) Exner TM, Mantell JE, Adeokun LA, Udoh IA, Ladipo OA, Delano GE, et al. Mobilizing men as
partners: the results of an intervention to increase dual protection among Nigerian men. Heal
Educ Res. 2009;24:846–54.
3) Byamugisha R, Tumwine JK, Semiyaga N, Tylleskar T. Determinants of male involvement in the
prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-
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4) Greene ME, Mehta M, Pulerwitz J, Wulf D, Bankole A, Singh S: Involving Men in Reproductive
Health: Contributions to Development. UN Millennium Project; 2004.
http://www.unmillenniumproject.org/documents/Greene_et_al-final.pdf
5) Adeleye OA, Aldoory L, Parakoyi DB. Using local culture and gender roles to improve male
involvement in maternal health in southern Nigeria. J Health Commun. 2011;16:1122–35.
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involvement in maternal and child health services in sub-Saharan Africa: a review. Reprod Heal.
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8) Kenya Demographic and Health Survey (KDHS) 2008-2009

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9) Kenya Service Provision Assessment (KSPA) 2010 survey
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11)WHO. Engaging men and boys in changing gender-based inequity in health: Evidence from
programme interventions. Geneva.World Health Organization. 2007.
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Experiences in the Department of Matagalpa, Nicaragua http://bit.ly/1l3J47L

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