Evaluating FP/RH programs that include men

C-Channel 31 presents six articles on evaluations of family planning/reproductive health (FP/RH) programs that involve men. The focus of the first two programs reviewed—one in Malawi and one in Nigeria—center on male involvement to promote increased contraceptive use. The third article provides a broad context for this topic, summarizing evaluations of many FP/RH programs that engage men and boys. The fourth article describes the accomplishments of an FP program in Afghanistan that involved community and Islamic leaders and couples. The fifth article addresses an RH program for youth in Uganda that was more successful with females than with males. The sixth outlines a program in India to promote birth spacing that developed separate messages for husbands, wives, and mothers-in-law, after researching barriers.

C-Change presented a poster on a research study in Tanzania that explores gender attitudes in relation to FP/RH at the annual meeting of the Population Association of America. The ongoing C-Change study is examining whether radio programming on gender norms supports increased uptake of FP services. A household survey of 200 couples scored their responses using four gender-attitude scales: gender equitable men (GEM), household decision-making, attitudes toward a wife refusing sex, and attitudes toward wife beating. These scales are further described in C-Change’s Compendium of Gender Scales, which is available on the website.

In this issue

Evaluations of FP/RH programs that motivate and mobilize men and question gender norms

1. Encouraging contraceptive uptake by motivating men in Malawi

2. Mobilizing men as partners in Nigeria
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3. Evaluations of programs that question gender norms

Evaluations of FP/RH programs that include men in Afghanistan, Uganda, and India

4.Achieving success in rural Afghanistan
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5. Impact of a RH program for youth in Uganda

6. Differential messages on birth spacing in India

1. Encouraging contraceptive uptake by motivating men to communicate about family planning: The Malawi Male Motivator Project

Authors: Shattuck D ¹; Kerner B ²; Gilles K ¹; Hartmann M ¹; T Ng'ombe T ¹; Guest G ³
Institutions: 1 Family Health International; 2 Save the Children; 3 CARE Malawi
Source: American Journal of Public Health, Jun 2011; doi: 10.2105/AJPH.2010.300091. [Epub ahead of print]

ABSTRACT

OBJECTIVES: We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples' contraceptive uptake. We based the intervention design on the information-motivation-behavioral skills (IMB) model.
METHODS: In 2008 we recruited 400 men from Malawi's Mangochi province who reported not using any method of contraception. We randomized them into an intervention arm and a control arm, and administered surveys on contraceptive use at baseline and after the intervention. We also conducted in-depth interviews with a subset of intervention participants.
RESULTS: After the intervention, contraceptive use increased significantly within both arms (P<.01), and this increase was significantly greater in the intervention arm than it was in the control arm (P<.01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P<.01).
CONCLUSIONS: Our findings indicate that men facilitated contraceptive use for their partners. Although the IMB model does not fully explain our findings, our results show that the intervention's content and its training in communication skills are essential mechanisms for successfully enabling men to help couples use contraceptives.

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2. Mobilizing men as partners: The results of an intervention to increase dual protection among Nigerian men

Authors: Exner T ^1,2; Mantell J ^1,2; Adeokun L ³; Udoh I ^1,2; Ladipo O ³; Delano G ³; Faleye J ³; Akinpelu K ³
Institutions: 1 HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, USA; 2 Columbia University, USA; 3 Association of Reproductive and Family Health, Nigeria
Source: Health Education and Research, Oct 2009; 24(5): 846-54.

ABSTRACT

This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.

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3. Questioning gender norms with men to improve health outcomes: Evidence of impact

Authors: Barker G ¹; Ricardo C ²; Nascimento M ²; Olukoya V ³; Santos C ⁴
Institutions: 1 International Center for Research on Women, USA; 2 Instituto Promundo, Brazil; 3 World Health Organization, Switzerland; 4 New York University, USA
Source: Global Public Health, 9 Jun 2009; doi: 10.1080/17441690902942464. [Epub ahead of print]

ABSTRACT

This article describes a review of 58 evaluation studies of programmes with men and boys in sexual and reproductive health (including HIV prevention, treatment, care and support); father involvement; gender-based violence; maternal, newborn and child health; and gender socialisation more broadly. While few of the programmes go beyond the pilot stage, or a relatively short-term timeframe, they offer compelling evidence that well-designed programmes with men and boys can lead to positive changes in their behaviours and attitudes related to sexual and reproductive health; maternal, newborn and child health; their interaction with their children; their use of violence against women; their questioning of violence with other men; and their health-seeking behaviour. The evidence indicates that programmes that incorporate a gender-transformative approach and promote gender-equitable relationships between men and women are more effective in producing behaviour change than narrowly focused interventions, as are programmes which reach beyond the individual level to the social context.

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4. Achieving success with family planning in rural Afghanistan

Authors: Huber D ¹; Saeedi N ²; Samadi A ³
Institutions: 1 Management Sciences for Health, USA; 2 United Nations Development Programme, Afghanistan; 3 STEP Health and Development Organization, Afghanistan
Source: Bulletin of the World Health Organization, Mar 2010; 88(3): 227-231. [PubMed Central]

ABSTRACT

PROBLEM: Afghan women have one of the world's highest lifetime risks of maternal death. Years of conflict have devastated the country's health infrastructure. Total fertility was one of the world's highest, contraceptive use was low and there were no Afghan models of success for family planning.
APPROACH: We worked closely with communities, providing information about the safety and non-harmful side-effects of contraceptives and improving access to injectable contraceptives, pills and condoms. Regular interaction with community leaders, mullahs (religious leaders), clinicians, community health workers and couples led to culturally acceptable innovations. A positive view of birth spacing was created by the messages that contraceptive use is 300 times safer than pregnancy in Afghanistan and that the Quran (the holy book of Islam) promotes two years of breastfeeding. Community health workers initiated the use of injectable contraceptives for the first time.
LOCAL SETTING: The non-for-profit organization, Management Sciences for Health, Afghan nongovernmental organizations and the Ministry of Public Health implemented the Accelerating Contraceptive Use project in three rural areas with different ethnic populations.
RELEVANT CHANGES: The contraceptive prevalence rate increased by 24-27% in 8 months in the project areas. Men supported modern contraceptives once they understood contraceptive safety, effectiveness and non-harmful side-effects. Injectable contraceptives contributed most to increases in contraceptive use.
LESSONS LEARNT: Community health workers can rapidly increase contraceptive use in rural areas when given responsibility and guidance. Project innovations were adopted as best practices for national scale-up.

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HEADING

5. The impact of the African Youth Alliance program on the sexual behavior of young people in Uganda

Authors: Karim A ¹; Williams T ²; Patykewich L ²; Ali D ¹; Colvin C ³; Posner J ⁴; Rutaremwa G ⁴
Institutions: 1 John Snow, Ethiopia, 2 John Snow, USA; 3 PATH, USA; 4 Makerere University, Uganda
Source: Studies in Family Planning, 8 Dec 2009; doi: 10.1111/j.1728-4465.2009.00212.x. [Epub ahead of print]

ABSTRACT

This study evaluates the impact of the African Youth Alliance (AYA) program on the sexual behavior of young people aged 17–22 in Uganda. Between 2000 and 2005, the comprehensive multicomponent AYA program implemented behavior-change communication and youth-friendly clinical services, and it coordinated policy and advocacy. The program provided institutional capacity building and established coordination mechanisms between agencies that implemented programs for young people. The analysis of findings from both a self-reported exposure design and a static group comparison design indicated that AYA had a positive impact on sexual behavior among young females but not among young males. AYA-exposed girls were at least 13 percentage points more likely to report having used a condom at last sex, at least 10 percentage points more likely to report that they had consistently used condoms with their current partner, at least 10 percentage points more likely to have used contraceptives at last sex, and 13 percentage points more likely to have had fewer sex partners during the past 12 months, compared with girls who were not exposed to the AYA program. Scaling up the AYA program in Uganda could, therefore, be expected to improve significantly the sexual and reproductive health of young women. Effective strategies for promoting safer sexual behaviors among boys and young men must be identified, however.

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6. Promoting healthy spacing between pregnancies in India: Need for differential education campaigns

Authors: Sebastian MP ¹; Khan ME ¹; Roychowdhury S ²
Institutions: 1 Population Council, India; 2 UNICEF State Office for West Bengal, India
Source: Patient Education and Counseling, Dec 2010; 81(3): 395-401. [Epub ahead of print]

ABSTRACT

OBJECTIVE: Birth spacing intervals are relatively short in India. Healthy spacing of 3-5 years between births is an effective way to prevent maternal and child mortality and morbidities. Socio-cultural and structural barriers, including limited awareness, socio-cultural norms, and misconceptions need to be addressed for behavior change. Hence the objective was to understand these barriers and accordingly develop separate messages for young women, her husband and her mother-in-law.
METHODS: Data were collected from young women, husbands and mothers-in-law using qualitative methods. Altogether 16 Focus Group Discussions and 30 in-depth interviews were conducted. Beliefs related to need of spacing, disadvantages of closely spaced pregnancies and messages considered suitable for different stakeholders were investigated. Messages were identified for women, husband and mother-in-law; communication aids prepared and community workers trained to appropriately communicate the messages to stakeholders. Quantitative data were collected to measure the effect of the intervention.
RESULTS: Educational campaign resulted in higher use of contraceptives for spacing among registered pregnant women from experimental area compared to control area.
CONCLUSION: Differential audience specific educational campaign is feasible and effective.
PRACTICE IMPLICATIONS: For an effective communication in the community, workers should know how exactly to convey the different health messages to different target population.

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