Mixed Success Involving Men in Maternal Care Worldwide
Total Page：16
File Type：pdf, Size：1020Kb
January 2005 Volume 11, Number 1 MATERNAL AND CHILD HEALTH Mixed Success Involving Men in Maternal Care Worldwide In most locales around the world, whether in mitted infections (STIs), correct condom use, group knew that condoms provide protection developing or developed countries, men are little and other topics. They also received antenatal from both STIs and pregnancy. Gender-based involved in their partners’ health care during testing and, if necessary, treatment for syphilis. disparities remained: twice as many men as pregnancy. Research has shown, however, that Couples were seen during the pregnancy and at women in the experimental group knew of the women would like their partners to be more six weeks postpartum. At control clinics, preg- dual protection provided by condoms (89 per- involved and that, in many cases, men are inter- nant women received standard care, which cent versus 48 percent). ested in being involved. Increased male partici- included very little counseling on pregnancy “Involving men in maternal care is some- pation could yield health benefits for men, danger signs, family planning, or other repro- thing that couples want, both women and women, and children. In recognition of this sit- ductive health issues. men,” says Council researcher Leila Caleb uation, the Population Council’s Frontiers in Varkey, who worked on the Indian intervention. Reproductive Health program conducted two “Involving men in “Men take more contraceptive responsibility if “Men in Maternity” studies in disparate set- they have adequate information and counseling tings—one in India and the other in South maternal care is feasi- about condoms. Our research shows that it’s Africa—to engage male partners in health serv- possible in crowded clinics to integrate services ices during the antenatal and postpartum peri- ble and acceptable.” for men and women. Both clients and providers ods. Although the intervention in India was appreciate the time spent in counseling.” more successful than the one in South Africa, According to ESIC, expenditures on the valuable lessons were learned in both countries. A total of 581 pregnant women at experi- reproductive health intervention were feasible mental clinics and 486 at control sites were and affordable, consisting mainly of purchases India interviewed when they came for their first of supplies and materials. No new staff mem- antenatal visit. Follow-up interviews were con- bers were required and changes in staff routines In India, women depend heavily on men for ducted in couples’ homes at six months post- were possible without increasing work hours. access to health care. Men are the key decision- partum: 327 women and their husbands from ESIC has expanded the program to ten makers regulating women’s access to health the intervention group and 302 women and clinics since the study ended and plans to care services even though they have limited their husbands from the control group were extend it to its 34 clinics and five hospitals in knowledge on this matter. Between 2000 and interviewed at this time. Delhi by 2005. The Frontiers in Reproductive 2003, the Population Council and the The postintervention survey showed that Health program is providing technical assis- Employees’ State Insurance Corporation couples in the experimental sites communicated tance to improve ESIC’s training and supervi- (ESIC) of India conducted the Men in significantly more about family planning (84 sory capacity and will monitor and evaluate Maternity study at six of ESIC’s Delhi clinics, percent versus 64 percent) and reported more the program’s progress for one year. assigning three to carry out the intervention joint decisionmaking on the issue (91 percent and three to act as controls. At the experimen- versus 71 percent) than did couples attending South Africa tal clinics, women and their husbands received the control clinics. Use of family planning by joint counseling on pregnancy care, family women and men six months postpartum was According to UNAIDS, HIV testing at antenatal planning, and infant care, and same-sex indi- also significantly higher in the intervention clinics has demonstrated a consistent and vidual or group counseling on sexually trans- sites. Significantly more men in the intervention sharp increase in infection among pregnant continued on page 6 DEMOGRAPHY Bengali Perceptions of Adult Mortality Trends Distorted Nostalgia for the “good old days,” a familiar ty, along with population growth and moral Finally, the moral decline often mentioned sentiment in the developed world, may be degeneration, as causes for this drop in by respondents suggests that apprehensions common in the developing world as well. longevity. about modern lifestyles may explain the per- Recent research in Bangladesh and the Indian The respondents stated that because of ceived increase in adult mortality. Children are state of West Bengal has revealed that, despite population growth, less food is available than too young to be held morally accountable. well-documented progress in health and an in the past. Food is also less healthful now Therefore, it is justifiable to appreciate the sur- acknowledged improvement in child mortality because it is produced for the market rather vival advantages that modernity has afforded rates, many rural Bengalis firmly believe that than for subsistence. Hence, it is grown with them. But the moral degeneration of adults can adult health and survival have declined in less care and with poisonous fertilizers and only be endured if it is accompanied by some recent years. Demographers Sajeda Amin, of kind of punishment, such as decreased survival. the Population Council, and Alaka Malwade Basu, of Cornell University, encountered this More important than Consequences of this outlook attitude while conducting interviews on women’s and men’s motivations for reproduc- the reasons for this More important than the reasons for this out- tion. They were intrigued and decided to fur- look, however, are its possible consequences, ther explore this surprising worldview. outlook are its possible says Amin. The perception of an uncertain The data analyzed in this study were future could have a variety of influences on drawn from a larger study of reproductive people’s behavior. Researchers need to investi- change. The researchers conducted 32 focus- consequences. gate these potential consequences more fully. group discussions, each with six to ten rural The contrasting perceptions of the prospects for respondents of the same sex and religion, in child and adult survival, for example, may nine rural districts (four in Bangladesh and pesticides. Furthermore, the lifestyle required have helped sustain fertility decline. “If more five in West Bengal). for producing marketable food leads to stress, children are expected to survive to maturity, which in turn leads to illness and such risky parents can afford to have fewer offspring,” behaviors as drug abuse, contended respon- explains Basu. “And if people do not expect to Contradictory perceptions dents. In the past, interviewees asserted, live as long as their forefathers did, they may Data from the World Health Organization people were more God-fearing and pious. also be less concerned about having children show that between 1901 and 2000 in The past was not just a time of abundant, to support them in their old age.” Bangladesh and West Bengal, death rates healthful food; it was also a time when people This worldview may also influence the declined and life expectancy increased for were “good.” way that women and children are treated in every age group. Respondents unanimously The researchers point to several possible society. “On the one hand, if people believe they agreed that child mortality had fallen dramati- explanations for this outlook. Memories of have little to lose, they may be more permissive cally in recent times. They pointed to several famines and disease epidemics could have with women and children and allow riskier reasons for improved child survival: immu- contributed to a general perception that sur- behavior,” says Amin. “On the other hand, if nization against childhood diseases, anti- vival is threatened. Or, the bare subsistence people think the world is more risky and ‘bad,’ tetanus vaccination for pregnant mothers, the experienced by many respondents could com- they may be more protective and less apt to give expansion of medical care facilities for women pare poorly with the lifestyle of abundance and women and children freedoms.” I and children, door-to-door service delivery by indulgence depicted in local folklore and health care workers, and a move to treat child- mythology. Improvements in skill with num- hood ailments with modern medicine rather bers and mathematics may account for some SOURCE than traditional healing practices. of the feeling that people are not living as long Amin, Sajeda and Alaka Malwade Basu. 2004. “Popular perceptions of emerging influences on In virtually every interview the as in the past. Today, if a recently deceased mortality and longevity in Bangladesh and West researchers conducted, however, they found man is known to have been 60 years old at his Bengal,” Population Studies 58(3): 357–363 that the respondents believed that adults today death, he will be thought to have died young (also published as Policy Research Division Working Paper no. 186. New York: Population Council, die earlier than they did in their fathers’ and in comparison to his forebears who are http://www.popcouncil.org/pdfs/wp/186.pdf).