Posted by Maria Codina on June 20, 2018 at 9:31 am
Over a year ago, I went to Malawi to discover why, as literature told me, men are not as involved in planning a family as women. As you might know, family planning is essential to improve reproductive and maternal health through preventing unwanted pregnancies, reduction of unsafe abortion and the promotion of child spacing. However, planning a family carefully does not happen everywhere in the world. African countries stand out in this regard with a high number of unwanted pregnancies, unsafe abortions, high maternal mortality rates, low contraceptive prevalence rates and high unmet need for family planning. Malawi is among the countries with the highest maternal mortality ratio (MMR) and fertility rate (FR) in Africa. Although contraceptive prevalence rate (CPR) has risen in the past, the unmet need for family planning is still very high. Moreover, there is a tendency to think about family planning (FP), pregnancy and childbirth as a ‘woman’s domain’. This focus on has frequently led to men being excluded next to excluding themselves from family planning services. As male involvement still remains to be lower than wanted, there is a desire to increase this. Thus, my study aimed to explore influencing factors to male involvement and come up with ways to improve this.
Through interviewing 23 participants (14 men, 5 women, 4 HSAs) I tried to figure out which factors underlined the lack of male involvement in Ntchisi District. Ntchisi is a rural district in Central Malawi that is located 90 kilometres north of the capital city. Main income comes from agriculture, in particular tobacco farming. The main tribe inhabiting Ntchisi district is the Chewa tribe, which is the largest ethnic group in Malawi. Ntchisi has one main hospital: Ntchisi District Hospital. Within the hospital, there is the District Nursing Officer who is in charge of all the nurses in Ntchisi and the District Health Officer who is in charge of all the HSAs in Ntchisi. Many villages in Ntchisi also have a local Health Surveillance Assistant (HSA). HSAs have a central position within communities since they form a bridge between official health authorities and the people within the community (Perez, Ba, Dastagire, & Altmann, 2009; Rachlis et al., 2016). However, there is still a large number of villages without a local HSA.
My findings led to the conclusion that the personal motivation of men regarding involvement in family planning is mainly influenced by their negative attitude towards going to the clinic. The fact that often there are only women present at the clinic feels intimidating to the men. This is a vicious circle: because there are never men present, other men will not go as well and they will feel that the family planning clinic is a place only for women. If a ‘man-friendly’ environment could be created at the family planning clinics, their negative attitude towards going to the clinic might turn around which would increase their involvement in family planning. Next to this, family planning is often not discussed among friends, families or in school. The topic of family planning still is regarded as too sensitive and people believe it to be a private issue that is not to be talked about with others.
Gender roles also still play a big role in family planning in Ntchisi. Men are viewed by both themselves and women as head of the household and therefore as main decision-makers. However, often they are unable to make well-informed decisions as they do not have sufficient knowledge about family planning and never visit the family planning clinic. The latter might also be caused by gender roles, as reasons for not going to the clinic are often described as very masculine, for example: “working in the land” and “too busy resourcing money”. Family planning matters are still viewed as a female domain in which men do not have to participate, which contributes to the lack of male involvement in family planning, reinforced by both men and women.
To reduce men’s ignorance towards family planning, their level of knowledge on the importance of male involvement should be increased. This could be done through improving the information accessibility by involving stakeholders such as the village headmen and HSAs. HSAs are the link between the community and the (formal) health system and should therefore play an important part in demand creation on such issues as FP. They can facilitate community meetings. Other community networks, such as village committees might also be important. According to several respondents, the most influential person in a village is the village headman – community members will believe and accept what the village headmen tells them. With the help of the village headman, community mobilisation programmes could be set up to promote greater male involvement. The village headman could facilitate reproductive health education meetings in the village – if the male community members are invited by the village headmen to attend these meetings, they most likely will show up, according to several respondents. This could be done in the form of awareness meetings. These meetings are being organized throughout Malawi already, for example in the fields of nutrition and maternal health. However, in the field of family planning, these meetings are rare in Ntchisi. Village headmen would be able to facilitate these meetings by calling together all the (male) community members. Moreover, because of the fact that the village headman is such an influential person, he is in the position to speak out motivating messages about male engagement in FP, and maternal and reproductive health. HSAs should lead the meetings and provide the men with relevant information regarding FP methods, the importance for men to be involved and how this affects their own and their partner’s reproductive health. Amref could aid in this by organizing a meeting with village headmen and HSAs to tell them about the importance of such awareness meetings and to guide them in setting this up.
I truly believe that making the Ntchisi men aware of the importance of their involvement in family planning might assist in increasing their knowledge and their involvement in family planning. Men’s involvement in family planning issues in Ntchisi could eventually assist in reducing the shame about going to the FP clinic, in reducing the ignorance among men and in increasing their understanding of the importance of shared decision-making and shared responsibilities in the field of family planning and reproductive health.