It's a Family Affair Engaging Fathers and Grandmothers for Real and Lasting Change -- Kieffer

1. FAMILY ENGAGEMENT FOR SOCIAL
AND BEHAVIOR CHANGE
MARY PAT KIEFFER
SENIOR DIRECTOR, HEALTH
PROJECT CONCERN INTERNATIONAL,

2. WHY ENGAGE FAMILIES?
 Most maternal and
child health / nutrition
interventions have
targeted the
knowledge, attitudes,
and practices of
mothers alone
 Women don’t make
household decisions in
a vacuum: they live
within a wider
household unit,
extended family
networks, and the
broader community

3. WHY ENGAGE FAMILIES?
 A growing body of evidence
on impact of gender
inequality on child health
and nutrition outcomes
recognizes gender inequality
as an underlying or “basic”
determinant of child
undernutrition
Household food security and child
nutrition: the interaction of income
and gender of household head
Maternal
autonomy is
inversely related
to child stunting
in Andhra
Pradesh, India
Maternal Health Literacy Is
Associated with Early
Childhood Nutritional
Status in India
Are Improvements in Child Health
Due to Increasing Status of Women in
Developing Nations?
The influence of
father's child
feeding
knowledge and
practices on
children's dietary
diversity: a study
in urban and
rural districts of
Northern
Ethiopia, 2013.

4. WHY ENGAGE FATHERS AND GRANDMOTHERS?
 Men and women have shared desires for their household and their
children’s well-being
 Men want to and are willing to play a larger role in promoting MCHN in
their households and communities
 Men face unique barriers related to knowledge, attitudes, beliefs, and societal norms
and practices that can be addressed using gender-sensitive and transformative
interventions
 Fathers are receptive to IYCF messages, engaging men in SBC interventions leads to
positive behaviors and norms among men and families, and that father involvement leads
to an overall increase in the adoption of recommended practices among women.
 To improve inter-household communication on topics related to income
generation, household expenditures and chores, and health and nutrition
 Facilitating joint household decision making over the use of household
resources has a significant impact on household behaviors and outcomes regarding
food and nutrition.

5. PCI CARE GROUP TRIOS (TRIOS) IN BANGLADESH
 Platform for improving health and preventing malnutrition among mothers and children
 Based on the traditional mother Care Groups, with complementary groups for fathers
and mothers-in-law
 249 Trio groups reached nearly 75,000 adults over a four-year project
 Led to high levels of participant satisfaction and significant household health and
nutrition behavior change with marginal increased effort and resources
RESULTS
• Stunting reduced from 42% to 32% among
children 6-59 months
• Early initiation of breastfeeding within first
hour increased from 41% to 74%
• Household with access to water at hand-
washing facilities increased from 54% to 89%
• Qualitative findings: improved interpersonal
harmony at HH level and improved MCHN
decision-making among mothers

6. ENGAGING COUPLES FOR FAMILY PLANNING IN INDIA
 Intra-household communication to
engage men, MILs, and SILs, and
empower women to participate in
decision-making
 BCC to challenge social norms
and myths
 Leverage community institutions
 Early MIS data found that use of any
modern family planning method
increased from 13.3% to 26.2%
India/ JEEVIKATechnical Support Program (JTSP) – Engaging
Couples for Family Planning Pilot Study

7. NJIRA FATHER GROUPS IN MALAWI
 Fathers exposed to same CG
MCHN modules/messages,
tailored to fathers
Preliminary findings:
 Concrete benefits to men of
women’s empowerment, greater
participation in HH health and
nutrition, and joint decision-
making – women are less tired,
greater household harmony
 Men want to decide how to
leverage their skills/roles to engage
their communities for gender
equity and improved health and
nutrition

8. FAMILY-LED CARE MODEL IN MALAWI
 Integrates PTB/LBW newborn care into community
networks, referral systems, and health services.
 Uniquely designed to empower families as active
participants in the care of their newborns.
 This active participation builds family confidence to
care for vulnerable newborns at home.
IN THE FACILITY
Enhances provider
skills and quality of
care within KMC
units and empowers
families to directly
participate in the
care of their
PT/LBW newborn
INTHE HOME &
COMMUNITY
Builds family confidence
and skills to care for
their PT/LBW newborn
at home and links them
to the health care
system
LINKAGES:
2 way
referral
↑Follow-up
↓ Lost to
follow-up

9. SOCIAL AND BEHAVIOR CHANGE –
ESSENTIAL COMPONENTS
 Information and breaking misconceptions – important but not enough
 Target influencers at multiple levels – community, household, individual
 Community buy-in, address at various levels
 Use of SBC approaches that are gender transformative:
 Engaging couples for improved communication and joint decision-taking
 Concrete and consistent messages and outcomes, e.g.‘…excess childbearing
makes your wife age faster, too much work makes her tired’
 Valuing men’s perspectives, showing them dignity and respect, instead of the
finger-wagging
 Encourage and empower men to talk with other men about gender norms

10. THANKYOU!