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

1. Barriers to translating evidence into
policy and practice: male involvement
in maternal and child health
Dr Wendy Holmes, Jess Davis, Dr David Simon
Centre for International Health, Burnet Institute
4 April 2012

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. 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. 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 own
Mumbai, India, Photo by W Holmes
health

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 pregnancy4
1
Shattuck et al. 2011, Varkey et al. 2004
2
Becker et al. 2010, Aluisio et al. 2011
3
Shefner-Rogers et al. 2004, Mullany et al. 2007, Varkey et al. 2004
4
Sinha 2008

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 Lawson
1 Kunune et al. 2004
2
Aluisio et al. 2011

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. 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. Consultations with policy makers
• We consulted 17 senior MCH policy makers and planners
Regional

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. 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. 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. 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. 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 Sulaeman
barriers but culture unplanned/no prior over-stretched
dynamic contact with health services and staff
services

15. Perceived barriers
Cultural & social Pregnancies Under-resourced, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

16. Perceived barriers
Lack of male staff &
staff training on how
to include men
Cultural & social Pregnancies Under-resourced, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

20. Perceived barriers
Tendency to conceptualise
male involvement as
relevant 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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

21. Perceived barriers
Tendency to conceptualise Viewed as an ‘add-on’
male involvement as project requiring
relevant to family planning, additional funding or
or 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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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 that
relevant to family planning, additional funding or other things need to
or 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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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 hard
relevant to family planning, additional funding or other things need to
or 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, Inappropriate
barriers but culture unplanned/no prior over-stretched physical layout of
d
dynamic contact with health services and staff clinics
services

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. 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. 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, Ng'ombe 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.