Male Involvement in Family Planning and Reproductive Health: Observations from Three Operations Research Studies
M.E.Khan PhD Population Council, Delhi
[email protected]
Three OR studies • Men in maternity care men as health care taker of partner
• Men in promoting post partum contraception Men in family planning
• Provision of RH services from women centric clinic Men as client , gender equity to services
Broad Questions Addressed • Feasibility Can it be done? • Operational details How to implement? • Sustainability Can it be integrated with exiting health system? • Affordability At what cost? • Creating condition for scaling up
Men in Maternity care • Project goal: To develop a cost-effective and sustainable maternity care program which incorporates male partners and aims to improve reproductive health and pregnancy outcomes • Coverage: Implemented in MCH clinics of Delhi managed by ESIC Initially in 6 clinics; scaled up in all 35 clinics in Delhi • Study Design: Quasi experimental- control with pre-post design
Men in Maternity care: Interventions • Couple counseling: birth plans, emergency obstetric care, breastfeeding, family planning • Same sex individual or group counseling on STIs, condom demonstration • Universal on-site syphilis screening • Syndromic management of male urethral discharge, male and female genital ulcers • Promoting utilization post partum services
Men in Maternity Care: Results • More men came with their wives (91% Vs 64%), received any counseling (52 %Vs 21%), joint counseling (26% Vs 2 %), more received information on BF, immunization • Increased knowledge of danger sine, pregnancy preparedness, STI, Dual protection of condom, … • Increased H-W communication • Increased use of FP ( 51%V41%) and condom (36V26 %)
Promoting Post partum Contraception A BCC Intervention • Project Goal: To develop a BCC campaign model to to promote PPC among zero and first parity women using • Coverage: 24 villages now scaled up to 48 villages. • Study Design: Quasi- experimental- control, pre-post design • 600 pregnant women were registered and followed up till 9 month post partum
Promoting Post partum Contraception: Interventions
Educational campaign by Community level workers(CHW) – ASHA, AWW, ANM Audience specific messages reinforcing their perceived needs for spacing. Husbands were focused target Alignment and reinforcement of messages through different channels CTU and reorientation of CHW for strengthening counseling skills and use of counseling aids Supportive supervision and regular review meetings Joint effort to implement intervention by two Ministries—optimum use of existing resources
Promoting Postpartum Contraception: Results • Significant increase in correct knowledge of all FP methods (LAM 74 Vs 1%) IUD (68 Vs 18) • 4-month follow up:22% against non were using LAM • 68 % LAM users switched over modern FP methods • H-W communication on FP / STI increase significantly • 9-month follow up: 63% against 32% were using any FP method
Integration of RH services for men in HFWC, Bangladesh • Project Goal: To test feasibility of integrating men RH services (STI , FP ) in Health and Family Welfare Centers(HFWC) – a women centered clinic . HFWC covers 30,000-50,000 population • Coverage: 12 HFWC – 8 experimental and 4 control . Scaled up in 40 HFWC . Third stage MOH recommended for scaling up in100 HFWC • Study design: Quasi-experimental –control design
Integration of RH services for men in HFWC: Intervention • Orientation of the staff in syndromic management of RTI and STI –theoretical as well as practical • Introduction of Systematic screening tool to identify unmet RH needs • Educational campaign using different channels of communication
Integration of RH services for men in HFWC: Results • Significant increase in knowledge of workers in Exp. group about signs and symptom of different STI. No change in Control group • Demonstrated correct knowledge of using flow graph for of the syndromic management of RTI • Large number of men started availing services from of HFWC – mostly for general heath problems • Number of women clients using HFWC also increased significantly • Utilization of HFWC increased by more than 60 percent
Conclusions • Younger generation is changing fast and men are willing to be involved in maternity care and supporting PPC • Lack knowledge and generally are neglected by health and FW workers • Men involvement leads to positive RH/FP/ MCH results • Men and women could be served from same clinic • With minor modification in existing health system, men involvement could be achieved • Most required changes are financially sustainable • Long term TA for HS capacity building is critical • In resource constrained country, partnering with other donors could make significant difference
