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Constructive Men's Engagement (Cme) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya

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Constructive Men's Engagement (Cme) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya CONSTRUCTIVE MEN’S ENGAGEMENT (CME) IN ENHANCING REPRODUCTIVE HEALTH IN MAKINDU AND MUTITU SUB-COUNTIES OF KENYA GEORGE KIMATHI (BSc, MPH) P97/14536/09 A THESIS SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY (PUBLIC HEALTH) IN THE SCHOOL OF PUBLIC HEALTH OF KENYATTA UNIVERSITY JUNE 2014 ii DECLARATION This thesis is my original work and has not been presented for a degree in any other University or any other award. Signature: ............................................ ............................................... George Kimathi Date Department of Community Health SUPERVISORS We confirm that the work reported in this thesis was carried out by the student under our supervision and has been submitted with our approval as University supervisors. Signature: ........................................ ........................................ Dr. John Paul Oyore, PhD Date Department of Community Health Signature: ....................................... ........................................ Dr. Isaac J. Mwanzo, PhD Date Department of Community Health iii DEDICATION To my family for their immortal love, encouragement and support during the entire period of the study iv ACKNOWLEDGEMENTS I would like to express my very sincere gratitude to several people for their invaluable role in enabling me undertake and accomplish this study. I extend my utmost appreciation and very special thanks to my University supervisors, Dr. John Paul Oyore and Dr. Isaac J. Mwanzo for their exceptional guidance, patience, support, availability and enthusiasm during the planning and execution of the study. I heartily thank the Makindu and Mutitu Sub-County Health Management Teams (SCHMTs) for facilitating this study in their respective Sub-counties and the various health facility in- charges for their unwavering assistance during the study. I am also very grateful to my study respondents, key informants and participants in focus group discussions for their priceless time and cooperation during data collection. My wife Doreen and our children Mwenda, Kendi and Mwendi assisted me immeasurably and provided unlevelled moral support during this study. I heartily appreciate their cheerful interest. Finally, I wish to thank the academic staff of Kenyatta University, School of Public Health for their insightful inputs and encouragement during the entire course of my doctoral studies. v TABLE OF CONTENTS TITLE PAGE…………………………………………………………………………………..i DECLARATION......................................................................................................................ii DEDICATION.........................................................................................................................iii ACKNOWLEDGEMENTS....................................................................................................iv TABLE OF CONTENTS.........................................................................................................v LIST OF TABLES...................................................................................................................xi LIST OF FIGURES..............................................................................................................xiv ABREVIATIONS AND ACRONYMS.................................................................................xv OPERATIONAL DEFINITIONS OF TERMS.................................................................xvii ABSTRACT...........................................................................................................................xix CHAPTER ONE: INTRODUCTION....................................................................................1 1.1 Background of the Study....................................................................1 1.2 Statement of the Problem..................................................................3 1.3 Research Questions............................................................................4 1.4 Hypotheses........................................................................................5 1.4.1 Null Hypothesis............................................................................5 1.5 Objectives of the Study .....................................................................5 1.5.1 Broad Objective............................................................................6 1.5.2 Specific Objectives.......................................................................6 1.6 Significance of the Study....................................................................6 1.7 Conceptual and Theoretical Framework.............................................7 CHAPTER TWO: LITERATURE REVIEW......................................................................11 2.0 Global Context .................................................................................11 2.1 African Context.................................................................................13 2.2 Status of Reproductive Health in Kenya...........................................14 2.3 Overview of Reproductive Health in Makindu and Mutitu Sub- counties..................................................................................................16 2.4 The Place of Men in Reproductive Health.........................................17 2.5 CME as an Approach and Emerging Perspectives ...........................19 2.6 Gender Dimensions in CME .............................................................21 2.7 The Concept of CME in Reproductive Health....................................23 2.8 Strategies for CME in Reproductive Health .....................................24 2.8.1 Men as Clients ...........................................................................24 2.8.2 Men as Partners ........................................................................25 vi 2.8.3 Men as Agents of Positive Change.............................................26 2.9 Existing Understanding of the Various Determinants.......................26 2.9.1 Individual Characteristic Determinants .....................................27 2.9.2 Programmatic Determinants of CME-RH....................................29 2.9.3 Determinants Related to Service Provider Technical Capacity..30 CHAPTER THREE: MATERIALS AND METHODS......................................................32 3.0 Study Design....................................................................................32 3.1 Variables..........................................................................................35 3.1.1 Dependent Variables..................................................................35 3.1.2 Independent Variables...............................................................35 3.2 Study Area........................................................................................35 3.2.1 Location of the Study.................................................................36 3.2.2 Justification of the Study Area....................................................36 3.3 Target Population.............................................................................37 3.4 Sampling Techniques and Sample Size............................................38 3.4.1 Sampling Techniques.................................................................38 3.4.2 Sample Size Determination........................................................40 3.4.3 Inclusion Criteria........................................................................41 3.4.4 Exclusion Criteria.......................................................................41 3.5 Construction of Research Instruments.............................................41 3.6 Reconnaissance Survey....................................................................42 3.7 Validity and Reliability......................................................................42 3.7.1 Validity.......................................................................................42 3.7.2 Reliability...................................................................................43 3.8 Data Collection Techniques..............................................................43 3.8.1 Household Surveys ...................................................................43 3.8.2 Focus Group Discussions (FGDs)................................................44 3.8.3 Key Informant Interviews (KII)....................................................45 3.8.4 Assessment of Health Care Providers........................................45 3.8.5 Gender Equitable Men (GEM) Scale for Reproductive Health.....45 vii 3.9 Data Management, Analysis and Presentation.................................46 3.9.1 Quantitative Data.......................................................................46 3.9.2 Qualitative Data.........................................................................47 3.10 Data Quality Control Measures.......................................................48 3.10.1 Quality Control at Data Collection Stage..................................48 3.10.2 Quality Control during Data Entry and Processing...................48 3.11 Logistical and Ethical Considerations.............................................49 CHAPTER FOUR: RESULTS..............................................................................................49 4.0 Socio-demographic Characteristics of Respondents........................49 4.1 Specific Objective 1: Level of CME-RH in Makindu and Mutitu.........51 4.1.1 CME-RH Levels Pre and Post Intervention..................................51
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