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 Table of Contents  
OPENING CEREMONY
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 41-44

Key Note Lecture by Dr Eghe Abe, Health Specialist, UNICEF


Date of Web Publication30-Jun-2021

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How to cite this article:
. Key Note Lecture by Dr Eghe Abe, Health Specialist, UNICEF. J Med Womens Assoc Niger 2021;6:41-4

How to cite this URL:
. Key Note Lecture by Dr Eghe Abe, Health Specialist, UNICEF. J Med Womens Assoc Niger [serial online] 2021 [cited 2021 Sep 20];6:41-4. Available from: http://www.jmwan.org/text.asp?2021/6/1/41/319842

[TAG:2]Key Note Lecture by Dr Eghe Abe (MBBS, FWACS, FICS, MPH, MPA), Health Specialist, UNICEF on the Occasion of the Opening Ceremony of the 21st National Medical Women Association of Nigeria (MWAN) Biennial Conference & General Assembly at the Orchid Hotel, Asaba on Friday 13th September, 2019.[/TAG:2]


  Protocol Top



  Introduction Top


It is a great honour to be here to present this keynote lecture at this important gathering of Medical Women in Nigeria. I thank the organisers of this Biennial conference for inviting me.

l am convinced that improving maternal, and child health should be one of the highest priorities on the global development agenda. I am particularly delighted about the theme of this conference '' Male Involvement in Maternal and Child Health'' which I think is quite apt and very germane, because of my belief that special and serious consideration should always to be given to the role of men in achieving optimal maternal and child health. Achieving sustainable development goals (SDGs) requires alleviating gender-based inequalities as well as improving male partner participation in the maternal health care systems.

There has been increased recognition of the need to include men in MCH programmes since the mid-1990s, given the important role men play as partners/ husbands, fathers and community members and as a way of promoting egalitarian decisions about reproductive and maternal health.


  What is Male Involvement in MCH Top


According to the ICPD 1994, male involvement in maternal healthcare is a process of social and behavioral change that is needed for men to play more responsible roles in maternal health care with the purpose of ensuring the wellbeing of women and children.

It therefore implies that a man should discuss maternal health issues with his spouse and they should make joint decisions on seeking good maternal health care services.

It is generally acclaimed that the non-involvement of men in maternal health promotion, prevention and care programs by policy makers, program planers and implementers of maternal health services has had very serious impact on the health of women and the success of MCH programs.

In most African countries, maternal health issues particularly family planning, pregnancy and childbirth have been long regarded as a woman's affair only.

Evidence shows that men can prevent unintended pregnancies, reduce unmet need for family planning (FP), foster safe motherhood and practice responsible fatherhood. In the USA, partner involvement in pregnancy has increased antenatal care. In India, a maternity care model that encouraged husband's participation in their wives' antenatal and postnatal care found positive changes in knowledge, gender roles and decision-making. In addition, demographic and health surveys in five Latin American countries (Bolivia, Peru, Colombia, Haiti and Nicaragua) indicated that positive couple interaction is associated with improved health outcome for children. In Nigeria, though studies are scanty, it is not different from the above findings. It is generally known that in many parts of the country, decisions about women's health cannot be taken without the consent of the men/husbands both religious and traditional. This is also buttressed by personal experiences as doctor and obstetrician of many years standing.

Consequently, the value of direct male involvement in reducing maternal mortality cannot be over emphasised.

However, globally male involvement in maternal health care services remains a challenge to effective maternal health care accessibility and utilization

Situation of Women and Children

According to the recent global estimates by the World Health Organization (WHO), more than half a million women lose their lives from pregnancy-related complications worldwide every year, ninety-nine per cent (99%) of which occur in the less developed world. In Sub-Saharan Africa, one out of every thirteen women dies of pregnancy-related causes compared with one in 4,085 women in industrialized countries. For every maternal death, many more women suffer short-term injuries, infections, and disabilities during pregnancy or child birth each year.

In Nigeria, 40 million women of childbearing age (between 15 and 49 years of age) suffer a disproportionally high level of health issues surrounding birth. While the country represents 2.4 per cent of the world's population, it currently contributes 10 per cent of global deaths for pregnant mothers. Latest figures show a maternal mortality rate of 576 per 100,000 live births, the fourth highest on Earth. Each year approximately 262,000 babies die at birth, the world's second highest national total (38/1000 live births). Infant mortality currently stands at 67 per 1,000 live births while for under-fives it rises to 132 per 1,000 live births (NDHS 2018).

These statistics can be related to the tendency to view maternal health as a woman's issue and has contributed to a narrow focus of targeting mostly women, particularly mothers in intervention efforts. Most maternal and child health (MCH) programmes seek to address the health needs of women and children by engaging and educating pregnant women and mothers in care-seeking practices for themselves and their children. This has contributed to men being sidelined as far as reproductive health and MCH matters are concerned.

Factors Associated with Male Involvement in MCH

a) Sociodemographic factors - Partner's Education, Type of marriage, living arrangements and number of Children

Studies show that male involvement in antenatal care and delivery was significantly associated with partner's education, type of marriage, living arrangement, and number of children. In contrast, no significant association was found between any of the sociodemographic factors and male involvement in postnatal care. Male involvement in MHC was significantly higher among respondents whose partners had tertiary education than those with no education.

b) Prohibitive cultural norms, unfavourable health policies, and gender roles

The poor attitude of men towards maternal health especially in Africa has been greatly attributed to the practice of male dominance, often called “patriarchy”.

Studies have revealed that prohibitive cultural norms and gender roles play a role in male involvement in MHC. Men often see pregnancy and maternal health related issues as women's responsibility. For instance, Mullick et al. indicated that men hold on to their cultural beliefs that a man may lose “strength” if he is present during the birth of his baby and therefore men do not escort the women for maternal health services. Similar views have been reported in Kenya.

In relation to the “3 delays” causing maternal deaths, the first and second delays are dependent on whether the man will provide money for transport or even consent to enable the pregnant woman go to hospital to deliver.

c) Conceptual barriers at the policy level

It has been noted that most reproductive health programs designed to improve women reproductive health consider men as part of the problem and not part of the solution. Such health policies addressing maternal health issues focus primarily on women and children than men. This demoralizes the intention of men to accompany their partners to assess MHC. The failure to incorporate men in maternal health promotion, prevention, and care programs by policy makers, program planners, and implementers has had a serious impact on male involvement in the health of women including MHC

d) Health worker attitude

Studies have consistently shown that attitudes of health workers accounted for low male involvement in MNCH. Harsh and critical language directed at women from health workers remains a barrier to male participation. Thus, low male involvement in MHC could result from the fear of men being the subject of verbal, emotional, and sometimes physical abuse.

e) Health centre resource constraints

A large number and variety of heath systems constraints believed to militate against male involvement were revealed, including very under-resourced health services that do not have capacity to reach out to men.

Insuffcient numbers of male health workers and inadequate training and support for male and female staff to engage men were seen as barriers to male involvement in some settings.

Insuffcient training means that many health workers are not confident talking to couples together during clinic visits, particularly on sensitive topics relating to SRH.

Inflexible clinic opening hours and men's working time constraints were also identified as barriers.

Long waiting times in clinics are likely to deter men who need to return to work quickly. The physical layout of clinics is not male-friendly. Many clinics may also find it diffcult to accommodate men due to lack of physical space for private consultations thus making the presence of men problematic.

Delays in care seeking for obstetric emergencies are major determinants of maternal death in Nigeria. Birth preparedness has been found to be effective in reducing these delays. Male involvement is necessary for improving birth preparedness because of patriarchy which allows men to control women's access to and utilization of maternal health care

Strategies to improve male involvement in MCH

The 2015 World Health Organization (WHO) recommendation on maternal and newborn health promotion interventions included active involvement of men during pregnancy, child birth and post partum period as an effective intervention to improve maternal as well as newborn health outcomes.

•Culturally appropriate messaging

Use of messages that build on traditional cultural roles and values are more likely to be successful and spur changes in behaviour. Such messages could speak to men's traditional role as provider highlighting the economic benefits or health benefits associated with preventative care and male involvement in MCH.

Additionally, male involvement strategies should be linked to other efforts to implement gender transformative programming (e.g., programmes that promote egalitarian gender norms and women's empowerment) and should promote the positive roles that men can play as partners and fathers.

•Engaging boys and men throughout the life-cycle

There is an urgent need to involve men early in the life-cycle to support MNCH. Young men and women should be educated in SRH and MCH through school family life education programs. There should be a language of responsibility among young people and young men in particular should be made to understand their roles as responsible fathers.

•Engaging institutions

There is the need to engage with community structures, such as the church, community leaders, and schools so as to promote male involvement.

Also important is the engagement with politicians and local leaders to ensure they are informed and political will is mobilised.

•Father-friendly clinics

Clinics and Health centres should be made male friendly and MNCH program design should always have this in mind.

Health services could be made more 'male-friendly', including providing waiting spaces where men would feel comfortable, such as a separate room where men or couples can wait.

It is also emphasized that staff have the time to engage men and women

Need to promote routine couple antenatal visit if possible so that the men are around to hear things for themselves”, because presently men currently rarely or never attend an antenatal care consultation with their pregnant partner. It has been recognised that pregnancy is a time when expectant fathers are more receptive to information about MCH, when “their ears are open” especially the first booking visit.

Health facilities should be male-friendly and health systems should be oriented towards dealing with men as well as women during the time of pregnancy, childbirth and after birth. However, access to quality care for women and newborns must not be contingent on men's attendance or involvement.

Many health services are not set up for men to accompany their partners. Physical infrastructure and the capacity of health providers to work with men and couples through gender-sensitive approaches need to be addressed.


  UNICEF's Strategic Partnerships Top


Our Mandate

  • UNICEF works to promote the rights of children globally and in Nigeria
  • We are committed to realizing the rights of all children to help them build a strong foundation and have the best chance of fulfilling their potential.
  • UNICEF believes that ensuring a happy and healthy child begins before birth: from ensuring his/her mother has access to good neonatal care and delivering in a clean, safe environment to reaching adulthood as a responsible, healthy and informed parent to the next generation.
  • This journey relies on a child having access to shelter, good nutrition, clean water and sanitation, healthcare and education- requiring a multisectoral approach


Achievements

  • UNICEF is committed to provide technical support to develop Action Frameworks in states with the highest child mortality rates including the development of State Every Newborn Action Plans
  • Continue support for the improvement in routine immunization in the country and presently supporting the introduction of new vaccines into the RI schedule
  • Technical support will be provided to costing the action frameworks to determine what it takes to reduce newborn deaths in a state .
  • Efforts will be made to leverage resources from other sources/partners to complete and implement the AF
  • UNICEF will continue to support the functioning of Core Technical Committees at Federal and state levels.
  • Technical support will be provided to coordination for a at state level (NEMCHIC/SEMCHIC/SERICC etc that will support the coordination and implementation of the AF and RMNCH.
  • UNICEF is committed to provide support for the country's maternal and perinatal death review.
  • UNICEF is committed to provide support to the development of State AOPs as per guidelines.
  • UNICEF will support generation of evidence to support the development of the AF and state AOP.
  • Support to improve data collection and analysis systems including at community levels to allow better targeting of beneficiaries and decision making.
  • Strengthen mechanisms for monitoring key MNCH indicators and BHCPF performance (use of scorecards and dashboards) for real time monitoring and decision making (state, LGA, PHC levels)



  Recommendations and Conclusion Top


The low male involvement in maternal health care services warrants interventions to improve the situation. Public health interventions should focus on designing messages to diffuse existing sociocultural perceptions and health care provider attitudes which influence male involvement in maternal health care services.

I also wish to advocate for policies and strategies that can improve men's level of awareness and their engagement in the maternal care through health education and incentives. Community based awareness creation by utilizing mass media and campaigning is recommended.

I recommend that we all ''get it together'' so as to save our women and children.

I conclude by paraphrasing the words of the great sage - Mahatma Gandhi who said ''It is health that is real wealth and not pieces of gold and silver'' l enjoin all men and women alike to note that it is the women's and children's health that is the real wealth and not the pieces of gold and silver that are provided for them.

Thank you and God bless.


  References Top


  1. Trends in maternal mortality. 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization. p. 2015.
  2. McPherson RA, Khadka N, Moore JM, Sharma M. Are birth-preparedness programmes effective? Results from a field trial in Siraha district, Nepal. J Health Popul Nutr. 2006;24(4):479-88.
  3. Tura G, Afework MF, Yalew AW. The effect of birth preparedness and complication readiness on skilled care use: a prospective follow-up study in Southwest Ethiopia. Reprod Health. 2014;11:60.
  4. Alison McIntosh C, L. Finkle J. The Cairo Conference on Population and Development: A New Paradigm? 1995. 223 p.
  5. Amanual G M. Male involvement in maternal health care system: implication towards decreasing the high burden of maternal mortality. BMC Pregnancy and Childbirth 2018;18:493
  6. Ibrahim MS, Sufiyan MB, Idris SH, Asuke S, Yahaya SS, Olorukooba AA, Sabitu K. Effect of a behavioral intervention on male involvement in birth preparedness in a rural community in Northern Nigerian. Ann Nigerian Med 2014;8:20-7
  7. Davis J, Luchters S and Holmes W. Men and maternal and newborn health: benefits, harms, challenges and potential strategies for engaging men. Melbourne: Centre for International Health, Burnet Institute; 2012 (http://www.comminit.com/hiv-aids/content/men-and-maternal-and-newborn- health-benefits-harms-challenges-and-potential-strategies-e.
  8. Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions. PLoS One. 2018;13(1):e0191620.
  9. Story, et al. Husbands' involvement in delivery care utilization in rural Bangladesh: a qualitative study. BMC Pregnancy Child birth. 2012;12:28. https://doi.org/10.1186/1471-2393-12-28.
  10. Wassie L, Bekele A, Ismael A, Tariku N, Heran A, Getnet M, et al. Magnitude and factors that affect males' involvement in deciding partners' place of delivery in Tiyo District of Oromia region, Ethiopia. Ethiop J Heal Dev. 2014;28:1-43.
  11. August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Men's knowledge of obstetric danger signs, birth preparedness and complication readiness in rural Tanzania. PLoS One. 2015;10(5):e0125978.
  12. Dunn A, Haque S, Innes M. Rural Kenyan men's awareness of danger signs of obstetric complications. Pan Afr Med J. 2011;10:39.
  13. Sekoni O O, Owoaje ET. Male knowledge of danger signs of obstetric complications in an urban city in South west Nigeria. Annals of Ibadan postgraduate medicine. 2014;12(2):89-95.
  14. Kakaire O, Kaye DK, Osinde MO. Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda. Reprod Health. 2011;8(1):12.





 

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