Celebrate Solutions: Engaging Men in Family Planning Decision-Making

In June’s ‘Celebrate Solutions’ columns, Women Deliver is highlighting Jacaranda Health’s efforts to change the way family planning decision-making happens in the postpartum period among low-income women in Kenya.  As a maternity health care organization, Jacaranda Health works to make pregnancy and childbirth safer for women and newborns by building a new model of maternity care in East Africa; one that is respectful, high-quality and patient-centered.

By: Shalmali Radha Karnad and Claire Watt Rothschild, Jacaranda Health

On any given morning, the seats in the reception at Jacaranda Health’s Kahawa West maternity hospital are full – young mothers nursing newborns, pregnant women thumbing through antenatal care brochures, toddlers clambering over benches as they await their immunisations, and men – husbands, partners, fathers – all attending the maternity to support and care for their wives and children.

There is a growing volume of literature on the role of men in reproductive, maternal, newborn and child healthcare (RMNCH) decision-making and the efforts to harness their involvement to improve RMNCH outcomes, both in Kenya and across the globe. Men are viewed as gatekeepers, decision-makers, and financial leads within their family so when measures are taken to ensure their involvement in maternal healthcare, research consistently points to improved clinical indicators – be it accessing antenatal and postnatal care, skilled birth attendance, or early breastfeeding. In fact, a WHO recommendation specifically addresses “male involvement interventions for maternal and newborn health.”

As mentioned in the first two posts of this series, to ensure healthy birth spacing, it is critical to address the reasons why women do not start using contraception postpartum, or why they discontinue using it within the first year. Despite the high unmet need for contraception and high reported desire to postpone or stop childbearing, there are still relatively small numbers of women using family planning consistently. With the increasing interest in the role men play in family planning decision-making, there has been a shift in the perception of male involvement. Moving away from simply increased use of condoms or vasectomies, efforts now include men supporting and encouraging their partners and peers to use family planning methods. Several studies implicate male family members as a major reason for why women, who would otherwise consider using contraception, do not.

That’s why Jacaranda Health encourages husbands and partners of clients to be involved across the continuum of maternal and newborn healthcare decision-making, including family planning. They aim to shift the view of family planning as predominantly in the woman’s domain, with men at the periphery, to a focus on the couple, with men involved in a way that “respects, promotes and facilitates women’s choices and their autonomy in decision-making” and makes family planning and healthy birth spacing a shared responsibility.

Our approach to male involvement in family planning uses three key methods to reach men through our facilities and in the community:

1. Using human-centered design to improve male-centered services

Over the past two years, Jacaranda has conducted a series of human-centered design exercises to improve the experience of their services for men who accompany their wives and partners to their facilities. The outcome of these exercises was the development of father-specific educational materials, including a Father Antenatal Care Brochure, Father Delivery Discharge Letter, and Spousal Communication Tool for Family Planning. These tools were piloted with Jacaranda fathers, and are available at the facilities.

2. Using “group-care models” in facilities to increase male engagement

Group-based models for antenatal care delivery or pregnancy support are limited in Nairobi, with existing programs prohibitively expensive for the low- and middle-income population that Jacaranda serves. Jacaranda is currently piloting a group-based program that draws from best-practice models in the U.S and Europe that are just now being adapted for low-resource settings. The pilot provides women with a mix of individual and group-based care, including three antenatal and one postnatal group sessions. Group family planning counseling is a key component of the program incorporated throughout the sessions. One key goal of the program is to start engaging male partners as early as the 2nd trimester of pregnancy. A curriculum is being tested that engages partners through practical exercises (such as assisting their partners with breathing techniques for pain management), activities including facility tours, and educational counselling sessions aimed to engage a mixed gender audience and couples. Male engagement in the program is aimed at clarifying the ways in which men can be involved in the pregnancy, delivery, and postpartum periods as well as facilitating the crucial discussion between couples regarding contraceptive decision-making.

3. Community-based SMS messaging targeted at male partners

Jacaranda is also developing and testing community-based innovations with greater potential for scale, such as targeted messages for male partners. They are currently pre-testing health and counselling messages (an example is in the image on the right) for male partners during the postpartum period. These messages reframe key counselling messages around the health and financial benefits of healthy birth spacing to promote healthy spacing of pregnancies.

Jacaranda Health loves seeing male partners at their maternity hospitals to support the health of their partners, newborns, and small children. Given the importance of improving women’s health before, during, and after pregnancy, in this part of the world, Jacaranda Health is excited by the promise that involving male partners in maternity care decision-making may hold.

To read the rest of the Celebrate Solutions series on Jarcaranda Health please click here.

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