Promoting Social Behavioral Change through Male Engagement and Inter-generational Dialogue between Women and Girls. 1

INTRODUCTION

PRETERM BIRTH IS THE LEADING CAUSE OF DEATH AMONG CHILDREN UNDER FIVE AROUND THE WORLD, AND A LEADING CAUSE OF DISABILITY AND ILL HEALTH LATER IN LIFE.

n , 604,000 babies are born too BOT in Bangladesh works with 55 Union Health soon each year and 23,600 children under & Family Welfare Centres (UH&FWCs), three five die (Every Preemie Scale) due to direct Community Clinic (CCs), two Union Sub Centres pretermI complications. The Born on Time (BOT) (USCs), one Health Complex (UHC) and one project aims to prevent preterm births by targeting Maternal and Child Welfare Centre (MCWC) under six risk factors related to unhealthy lifestyles, maternal rural (sub-district) of . infections, inadequate nutrition, and limited access to contraception that BOT also supports can lead to babies the empowerment being born too soon. In Bangladesh, 604,000 babies of women and are born too soon each year and adolescent girls BOT is the first by investing in 23,600 children under five die due public-private their increased partnership to direct preterm complications. knowledge, decision- dedicated to the making capacity prevention of preterm — Every Preemie Scale, 2019 and promoting their birth in targeted leadership. The communities of Project systematically Bangladesh, Ethiopia and Mali, bringing together engages men and boys in gender equality training the collective expertise of World Vision, Plan that promotes positive masculinities aimed at International, Save the Children, the Government redistribution of household chores and childcare of Canada and Johnson & Johnson. This project responsibilities, prevention of gender-based violence supports women and adolescent girls before, during and intimate partner violence, and male support and after pregnancies by strengthening health around the continuum of maternal newborn health/ systems to provide quality, gender-responsive, sexual reproductive health (MNH/SRH) care. adolescent-friendly, maternal, newborn and reproductive healthcare. BOT uses a combination Moreover, the project also engages other key of approaches that include health system influencers like community leaders, household strengthening, demand generation via Social and decision makers, including mother-in laws to Behavior Change Communication (SBCC) and transform harmful gender norms and address strengthening data collection and utilization. gender-based discrimination and barriers that Method • Desk review: The BOT Team members were involved in facilitating the lesson learned exercise and preparing this report. The desk review looked at several project planning and design documents and reports. This included the findings of the Baseline Study, Formative Research, Midterm Study, SBCC Strategy, GE Strategy and GE Assessment Report, Project Implementation Plan, Performance Measurement Framework (PMF), Annual Work Plans (AWP), testimony collected from different stakeholders during monitoring visits, Annual Reports, and Quarterly Management Reports. • Virtual Meeting: The project held two half- have negative long-lasting impacts on maternal This report presents two best practices of BOT in day virtual meetings on 27 and 29 April 2020. and newborn health, as well as the realization of Bangladesh and the lessons learned according In these meetings, the key implementers and women’s and adolescent girls’ rights. to key project personnel. Project staff working at technical project staff (Annex i & ii) reflected the field level as well as those operating at the on what worked well and what did not; the For this, BOT uses a wide variety of SBCC management, policy and planning levels, were enablers and the challenges, and what could interventions to bring behavioral change at the brought together for the exercise that took place have been done better. The discussions covered individual level and to promote positive social norms virtually via the MS Teams platform due to the BOT’s activities and achievements up to March both at the family and at the community levels that Covid-19 pandemic. 2020. The participants, who are involved with support collective health objectives and challenge implementation directly, were quite passionate harmful practices, by engaging individuals, families about the achievement/outcome of all the major and communities, to commit to better health and Objective interventions. Finally, two BOT best practices social outcomes. The objectives of this lessons learned exercise and have been documented, considering their Born on Time has been the first of its kind working the report are to: outcome/impact is ‘visible’ either via the Midterm with the targeted communities towards preterm Assessment and/or internal monitoring, and birth (PTB) prevention in Bangladesh. BOT applied • Identify best practices and lessons learned supported the project to achieve targets. a combination of approaches and strategies from BOT. to achieve project goals. The project uses a • Identify key enablers, barriers and challenges to comprehensive approach which includes demand implementing these interventions; and generation; improving the availability and quality • Discuss the learnings for potential scale up and of MNH/SRH services; and data and knowledge sustainability following the momentum already generation and utilization. Along with these, Gender created towards PTB prevention. Equality (GE), Knowledge Management (KM) and capacity building have been mainstreamed to achieve the project goals. 5

THEME 1

Male Engagement: Engaging men and boys as proactive partners of change to prevent preterm birth

IMPLEMENTATION

Challenges he GE Assessment observed that one of fetching those from far away, fixing mud houses, the key gender inequalities contributing and washing clothes. Such types of heavy physical to preterm birth and poor MNH/SRH labour can increase the risk of preterm birth. The outcomesT is women’s and girls’ limited autonomy baseline data indicated that 70.9 percent of women and decision-making power, particularly with continued to do household chores and activities regards to pregnancy and accessing essential MNH/ during their pregnancy. SRH services during and after their pregnancies, birth spacing, and child rearing. Women’s limited The Formative Research and GE Assessment mobility and agency often restrict their access also revealed that often pregnant women are to information or accessing MNH/SRH services not getting adequate nutrition due to a number independently of their husbands or in-laws. The of factors. This includes lack of knowledge about Baseline Study and Formative research also found the importance of adequate nutrition during that women’s lack of knowledge about MNH/SRH pregnancy, misconceptions around food during issues and PTB risk factors, low or lack of financial pregnancy, poverty, and that the husband or a independence to allocate resources for MNH/SRH male member of the family buys food but he is services, coupled with husbands’ lack of awareness not aware about the specific nutritional needs about the importance of accessing MNH/SRH of a pregnant woman. The study also observed services before, during and after pregnancy at the that while men’s influence on maternal matters health facility, contribute to lower utilization of MNH is decisive in most instances, men’s involvement services by women and adolescent girls. and support throughout the continuum of care is very low. Husbands/male members of the family Traditionally, women are responsible for all are less aware and/or involved in antenatal care household chores and caring for their children. In (ANC), delivery, post-natal care (PNC) and seeking Rangpur, women engage in physically laborious other health care services including treatment for activities like pumping hand-pumps and fetching infections during pregnancy. Moreover, husbands water, paddy boiling in large pots, cutting soil, are reluctant to use contraceptive methods. 6

Rationale for the intervention n Bangladesh, men typically hold significant Later, SBCC formative research also found that All these above learnings were applied to inform the decision-making power on whether and how community leaders such as teachers, religious BOT project design and implementation process, their family, including women and adolescent leaders, elected male and female local government and along with these older members, adolescent The baseline data girls,I access health care. Men also play a significant representatives, and mothers-in-law influence boys were also mobilized, and adolescent boys’ peer role in how women and girls are treated in their women’s health seeking behavior; and identified education groups were established to foster positive indicated that 70.9 % of society, especially relating to harmful traditional them as important community networks to promote masculinities premised on gender equality and girls’ women continued to do practices such as Child Early and Forced Marriage social and behavioral change. The root cause rights. A total of 186 adolescent boys’ groups were household chores and (CEFM), and Intimate Partner Violence (IPV), both of analysis presented the importance of creating formed and targeted, and group-wise customized which directly contribute to preterm birth. During the awareness at the individual, family and community SBCC activities were conducted to educate men and activities during their GE Assessment, some married women aged 20-49 level about preterm birth risks and gender equality boys with explicit messaging on gender equitable pregnancy. mentioned that bringing change required husbands’ in one hand; on the other, to facilitate male behaviours and relationships and the importance taking on what they referred to as “women’s work.” engagement by sensitizing the husband/male about of their participation in the MNH/SRH continuum of Both the GE Assessment and Formative Research their role in safe pregnancy and motherhood. care. Gradually, Father’s Clubs and Young Married recommended systematic engagement of men and Couples Groups were also formed. a broader awareness-raising campaign to promote positive masculinities in changing attitudes towards a more flexible division of labour, reduction in CEFM and IPV, and male engagement in the MNH/SRH continuum of care. 8 9

Overall male engagement interventions

I. ENGAGING COMMUNITY LEADERS II. ENGAGING HOUSEHOLD INFLUENCERS Drawing on the positive learnings mainly from Plan Bangladesh’s previous two projects, the ‘Human Similar to the Change makers group, 186 and PNC and getting treatment for infections Resource for Health (HRH) Project’ and the ‘Women Household Decision Makers Groups were formed during pregnancy, utilization of contraceptives and and Their Children Health (WATCH) Project, the Born with the decision-makers/influencers within a joint decision making. on Time (BOT) project designed interventions to family, including the mothers-in-laws. An informal pre-design community consultation was also mobilize the entire community and educate them As part of its male engagement strategies, BOT conducted to inform the project design and on the importance of gender equality (GE) and male organized the male members (aged 22 to 35) into accordingly mother-in-laws were also engaged engagement in the MNH/SRH continuum of care. 1,240 Fathers Clubs with each having membership in the Household Decision Makers Groups, as Accordingly, BOT organized the community level of 15 fathers, thus reaching a total male population they were found to be influential regarding their influencers and/or leaders and created 62 Change- of 18,600. All men voluntarily self-selected to receive daughters-in-laws’ reproductive health related Makers Groups comprising of 20 members per Fathers Clubs sessions. The 20 Fathers Club weekly issues, as well as male engagement. group. At least seven of them are women leaders. sessions were staggered over a period of time to be completed at the venue and time convenient to the target men. III. FATHERS CLUBS

For an effective male engagement strategy that The weekly training sessions deployed an contributes to preterm birth prevention, BOT entertainment-education approach combined with established Fathers Clubs to help men understand interactive and reflective methods using matching the preterm risk factors and reasons for maternal games, pictorial cards and videos containing short and neonatal death and morbidity. The Fathers Club dramas based on real life issues, to cater to the idea was borrowed from another Plan International head and heart of the participants and help recall project, ‘Strengthening Health Outcomes of Women messages. The training methodology, for example, and Children (SHOW)’, also being implemented included interactive, emotional role-play sessions in Bangladesh. Under the SHOW project, Plan with specific examples of a husband’s role for his International, in partnership with ‘Promundo-US’, wife’s safe pregnancy and motherhood delivery. developed an approach and curriculum for the Compelling discussions and role-play left a lasting orientation of the husbands of target women impression on the minds of the participants. beneficiaries by asking them to voluntarily join the The Fathers Clubs became an important strategy Fathers Club. as this activity directly engages men as proactive BOT adopted the Fathers Clubs curriculum partners of gender transformative change. The consisting of 16 training sessions and improvised objective is to sensitize men about their roles and the training content with illustrations, organization responsibilities towards jointly sharing household of the modules, and methodology not only to chores and childcare responsibilities with their ensure its suitability to BOT’s PTB prevention wives; importance of GE and equitable relationships; objective, but also to further emphasize the male and to break the existing gender stereotypes partner’s role towards his wife and children. around nurturing and child caring responsibilities, Training also included content around the need for preventing gender based violence (GBV) and IPV, men to understand adequate nutritional needs of promote joint decision-making, and encourage their pregnant partners, the importance of ANC modeling positive and non-violent masculinities. 11

RESULTS

BASED ON ROUTINE PROJECT MONITORING THE FORMATION OF COMMUNITY GROUPS (CHANGE MAKERS AND HOUSEHOLD DECISION MAKERS GROUPS) AND THE SUBSEQUENT SENSITIZATION PROGRAMS HAVE CONTRIBUTED TO INCREASING KNOWLEDGE AND AWARENESS ABOUT GENDER EQUALITY AND ITS RELATIONSHIP WITH PRETERM BIRTH.

he community leaders and mothers-in- report equitable decision-making power within law have become advocates for reducing the household in relation to seeking health care harmful social norms such as the information and services (family planning, ANC, perceptionsT that since pregnancy is a normal part facility-based delivery, MNH services) for WRA or of life, pregnant women do not need any medical their newborns compared to baseline. checkups or that it is okay for a pregnant woman to continue to do The Fathers Clubs the majority of the have also contributed household chores. “As a man, I wouldn’t consider to raising awareness within its members Rather, they now household chores as my on the importance promote male responsibility. In 2018, after of GE, including engagement to becoming a member of Fathers sharing everyday prevent and care household chores. As Clubs, I for the first time realized for preterm births. Abdur Rauf, a Fathers They encourage that homemaking is men’s Clubs member from husbands to take responsibility, too!” Gangachara upazila their wives for stated: ‘As a man, — Abdur Rauf, a Fathers Clubs member check-ups and I wouldn’t consider share household household chores as IV. YOUNG MARRIED COUPLE GROUP chores; and have my responsibility. In Another effective strategy towards male engagement has been to form, ‘Young Married Couple (YMC) become advocates 2018, after becoming a Groups.’ Through this group, BOT reached out not only the most energetic and vibrant males, but also the for preventing violence against women within their member of Fathers Clubs, I for the first time realized most vulnerable adolescents 15-19 years of age – the married adolescents and adolescent mothers who are family and community. While direct comparisons that homemaking is men’s responsibility, too!’ under pressure to prove their fertility right after getting married, but lack negotiating power and skills. To between baseline and midterm are subject to reduce such traditional vulnerabilities of married adolescent girls and young women, BOT formed 310 YMC limited interpretation due to varying methodologies They have also learned about a husband’s groups comprised of 718 married adolescent girls and 177 boys. The YMCs are the only groups where both and inclusion criteria, results of the Midterm Study responsibilities towards his wife’s safe pregnancy the spouses participate and learn together about using contraception, ways of preventing infection, benefits suggest improvements in the percentage of women and motherhood. Many of them, breaking the usual of good understanding, mutual respect and joint decision-making between a husband and wife. of reproductive age (WRA) (adolescents 11%; adult norm, take care of their pregnant wives, ensure women 56%) and their male partners (42%) who adequate nutrition, keep them safe from smoke, and 12 13 also accompany their wives during ANC, PNC visits The Midterm Study report stated that men’s active and also delivery. Another Fathers Clubs member participation in safe motherhood has resulted Raju Miah echoed the importance of men’s role in in reducing preterm risk factors as they are now safe pregnancy and said the following, “I learned aware, of how to avoid many pregnancy related about how much responsibility I have towards my complications that lead to preterm birth. Now, they pregnant wife. During her pregnancy, I took her not only practice positive lifestyles, but also promote to health center for regular checkups, ensure that to others. They participate in the BOT project’s she eats nutritious food and rest adequately. As I activities to disseminate some GE messages among learned in the sessions, I had kept a rickshaw van the other men in the community. Even the adolescent ready, I had some dry clothes ready. We had also boys raise their voices against child marriage and saved some money. When her labor pain started, take part in activities that are geared to promote I immediately took her to the health center. By the prevention of IPV and GBV. grace of Allah, at health center, my wife gave birth to a baby boy safely.” According to Md. Masud Rana, a member of YMC group from : “During group Similarly, the YMCs learning together about MNH sessions, I learnt about gender issues, IPV, domestic and sexual reproductive health and rights (SRHR) violence and how this could destroy the relationship and male engagement, helps to break the inertia between a husband and wife. My old perceptions and foster mutual dialogue and subsequent better changed. Now, we support each other in our daily understanding between them. As Iren Begum “My husband and I life. And we also spread messages of IPV and GBV (18 years) from Gopinathpur, Pirganj said: “I was became a member and prevention among our neighbors.” married to Md. Jenerul Islam just two months ago. At that time, I was very nervous about our learn lots of things Similarly, another member Most. Fensi Begum from married life. I was worried about what kind of about family planning, YMC group in said, “I was person my would-be-husband would be. After menstrual hygiene, married only at 17. My husband was a careless man. marriage, I realized my husband was like all other I was scared of him. But after participating in YMC traditional husbands and ignorant even about domestic violence and on Group sessions and learning about partner violence, family planning issues. In the meantime, we learn many other issues that joint decision making, gender equality, my husband about YMC Group from a health worker of BOT. My make us feel good.” has changed. We now jointly take decisions and he husband and I became a member and learn lots of always helps me in domestic work, cares about me things about family planning, menstrual hygiene, as well as supports me. Moreover, he advises others domestic violence and on many other issues that to do the same”. make us feel good. I am happy that I do not have to worry about anything as my husband discusses everything with me.” 14 15

interventions instead of keeping it a separate activity limited only to, for example, Fathers Clubs. LESSONS LEARNED Apart from the community group-based approach, BOT kept delivering male engagement and GE messages consistently and repeatedly through other project activities, for example, the Theater for Development (TfD), Boushashuri mela, various trainings of health professionals, even via the content and illustrations/images used in SBCC materials and training/ orientation modules.

and preterm birth prevention; The interventions like Fathers What could have and mother in laws promote Clubs have many different been done to achieve LINC factors2 , anecdotal nuances, for example these better results? evidence suggests that it would groups consist of members BOT provided GE training to stimulate male engagement coming from different all the project staff, including within the community. occupations and professions. field level providers, Training of Some of them are teachers and/ Trainers (ToT) on Fathers Clubs For example, a Father’s Group or Imams (Muslim religious manual and other trainings. member or YMC group member leaders), who in a Bangladeshi It would have been better to learns about GE/importance community, are by default have more opportunities for the of male engagement in their ‘leaders.’ When they model community facilitators to learn respective groups, and then positive behavior, it creates a from each other’s experiences sees a teacher and/or religious ripple effect in the community, during the Fathers Clubs and leader (community leader) as it encourages other men in other community group roll out; What went well promoting the same issue. When the community to be inspired and to identify champion father/ he application of socio-ecological and women’s attitude and behavior towards male he comes home, his mother, who and adopt positive masculine husband and engage them as model1 allowed BOT to understand the engagement. is a Household Decision-maker behavior. In this way, this group advocates. range of factors (barriers) limiting male Group member, asks him to wash helped reach a critical mass of engagement, and therefore prioritized interventions The involvement of the community leaders and the clothes as doing such things men performing roles they did not T Having such learning sharing across all levels to address those underlying causes. family level decision-makers supported the is harmful for his pregnant wife. perform before. platforms at the local level This multi-pronged approach where different age development of an enabling environment, as well Such social persuasion coupled would have supported applying and role-specific groups were mobilized through as secure community trust to support and promote with his newly gained knowledge One important element of BOT’s lessons learned from one customized modules and targeted SBCC materials men breaking the gender barriers and displaying is thought to develop his self- male engagement strategy is union and/or upazila for the proved to be effective. It helped develop personal positive and non-violent masculinities. When efficacy and change in behavior. that consistent messages were betterment of the other. and collective efficacy to positively change men community leaders advocate for gender equality also shared through other project

1 The Socio-ecological model of communication considers the complex interplay between individual, family, community, and societal and cultural factors 2 LINC factors means issues related to Lifestyle, Infection, Nutrition & Contraception such as preventing child marriage; delayed pregnancy; saving that influences people’s behavior. pregnant women from heavy work and support to rest enough ie two hours during the day and two hours more at night; provide her nutritious food; men sharing household chores; regular and at least 4 ANC checkups; birth preparedness, and so on. 16

CONCLUSION

CONSIDERING THE IMPORTANCE OF JOINT RESPONSIBILITIES AND MALE PARTICIPATION IN ACHIEVING GENDER EQUALITY WHILE ALSO IMPROVING MATERNAL HEALTHCARE TO REDUCE PRETERM BIRTH, AND THE POSSIBLE CHALLENGES OF DOING THIS IN A PATRIARCHAL SETTING, BOT APPLIED A RESEARCH-BASED, DATA DRIVEN AND PROCESS- ORIENTED COMMUNICATION APPROACH.

his helped BOT identify the complex programs supported men to come out of such social and cultural barriers to stereotypical beliefs and practices and undertake male engagement, understand the more proactive roles in ensuring the health and environmentT and identify interpersonal influences wellbeing of their life partners, not only when (such as peers) as well as the individual hegemony they were pregnant, but also in general for equal that restricts male engagement. BOT’ s multi-layered relationships in the future. campaign design was informed by all these insights, which involved community leaders/opinion leaders A science-based approach coupled with the art of as advocates and mother-in-laws to create an culturally compatible and consistent multi-channel enabling environment within the family. messaging also via entertainment education platforms supported BOT to promote positive and Simultaneously, tailored programs for young and non-violent masculinity breaking the stereotypical adult men helped them realize the harmfulness of perceptions and barriers to male engagement, at treating everyday household chores as ‘women’s least to some extent. However, there remains a long work,’ and that as heads of the family and controller way to go to realize the goals for men’s voluntary of resources, men’s only responsibility is to serve active participation in reproductive care, which is as the final authority on where and when pregnant crucial for preterm birth prevention across the country women should seek medical care. The focused and in achieving gender equality more broadly. 19

THEME 2

Boushashuri Mela (Mothers-in-Law & Daughters-in-Law Fair)

IMPLEMENTATION

Challenges E Assessment and SBCC Formative Sometimes, the daughter-in-law wants to go to a Research both identified mother-in- health center, but the mother-in-law prevents this laws as the influential figure in the due to her lack of knowledge about the importance householdG and daughter-in-laws have to depend of a skilled birth attendant, which consequently on mother-in-laws for decisions about FP use, ANC/ could lead to a serious pregnancy related PNC check-ups, etc. However, mother-in-laws often complication. Such situations often cause conflict. create barriers to health seeking behavior, as they Cases of domestic violence and IPV are a direct lack knowledge and awareness about risk factors of result of gender inequality and power imbalance preterm birth and gender equality. The situation was within the household and communities. Attitudes worse for adolescent girls as the Baseline observed and norms around gender roles of ‘obeying’ or doing that after marriage, they are under pressure to certain tasks (or not) may result in higher instances conceive to prove their fertility, but their decision- of IPV. Due to these power imbalances, adolescent making power within the household in relation to married girls often experience higher rates of such seeking health care information and services is poor violence. The GE assessment report shows that the (8.2%) compared to adult women, which is slightly rate of adolescent IPV is higher (16.2%) than the higher at 13.9%. adult women (11.4%). 21

how difficult it is and how much skill is required to roll and flatten a soft and slightly sticky wheat flour ball of about 2” in diameter and to make a roti of about 6-8” in diameter. The challenge is to make it perfectly round-shaped, not too thin or too thick, and to do it fast. Another challenge the men participated in was the sari (11-12-yard-long attire worn by women) folding competition.

The male participants enthusiastically take part in this competition and a huge amount of fun and excitement is created around these games. At the same time the game contributes to men’s self- realization that they should not undermine women’s domestic work, be sensitive to the work burden and time-poverty constraint they experience, and more importantly, share the household chores and Intervention Details childcare responsibilities. ela or fairs are popular in rural Bangladesh and are a big source Similarly, quiz competitions on issues related to of entertainment for the village GE, IPV, PTB, MNH, male engagement, services people.M Harnessing this strength, BOT organized of UH&FWC, etc. are held. Mainly mothers-in-law, ‘Boushashuri Mela’ or ‘Mother-in-law and daughters-in-law, and also adolescent girls and Daughters-in-Law Fair’ at the community level in boys take part and the “Best Mother-in-law” award six Upazilas of Rangpur where BOT works. This is declared and presented. Per union, three mothers- concept was borrowed from the ‘Human Resource in-law receive this award every year. The members for Health (HRH) Project’ implemented by Plan of Change Maker Group and Household Decision International Bangladesh in . Maker Group with support from BOT field workers Rationale for the Intervention Based on the project focus, BOT added several nominate these mothers-in-law from among those other elements like participation of men, “Best who participated in the Boushashuri mela last o raise awareness about the gender The expectation was that the Boushashuri mela Mother-in-law” award, etc. From the third year of the year, and after that, she not only practices those related social norms and practices that would provide a unique opportunity for sharing the project, 185 fairs were organized engaging the local learnings in her own family but also promotes to cause preterm birth; and to promote project’s educative messages through entertaining government institutions, health and family planning others. Different government and non-government congenial relationships between the mothers-in-law events to both men and women of different ages. T departments and community support groups. The organizations organize booths displaying their and daughters-in-laws, BOT utilized the strength The women, both adult and adolescent, and also BOT team decorated the entire area with colourful related services and awareness materials/messages. of this popular cultural forum called, ‘Mela’ or fair. men take part in various games and events held festoons, banners and buntings with project-focused Traditionally, the relationship between mother- in the fair, which help amplify women’s decision- messages to give it a festive look. Boushashuri Mela is an activity that uses many in-laws and daughter-in-laws are critical in terms making capacity at family level, break existing different communication strategies embedded in of upholding their respective dominance, which gender stereotypes, roles and attitudes, and bring This daylong program is comprised of interesting one event. Men, women, adolescents all take part often affects their health and wellbeing. The main positive changes among influencers, especially games, competitions, skits/short drama, songs, etc with a huge interest and enthusiasm. Approximately objective of these fairs is to carry out local outreach mother-in-laws, regarding MNH/SRHR and to with a prize distribution ceremony for the winners at 1120 people joined each of these fairs. and awareness on issues like healthy pregnancy encourage men’s engagement in equitable share the end. Games like pillow passing between mother- and safe motherhood, myths and misconceptions of household work. Moreover, this intervention also in-laws and daughter-in-laws help break the ice, related to pregnancy and PTB, gender equality, fosters inter-generational conversation regarding which is then following by project themed games. prevention of child, early and forced marriage, male MNH/SRHR issues. For example, roti (round flat unleavened bread) engagement and IPV. making competition for men helps men to realize 22 23

RESULTS

idterm review results found these Messages subtly disseminated through games Boushashuri Mela as a common help the participants better understand it. As Md. source of information for adult Jahid Mia (28), a participant from Roti-making “Earlier I would believe that it (roti making) womenM and adolescent girls and boys. This fair competition in Gopalpur Union, Mithapukur upazila was a simple task. But I was wrong. Now I turned out to be an effective tool to foster positive said: “Earlier I would believe that it (roti making) will not underestimate my wife’s household relationships and spread messages on preterm birth was a simple task. But I was wrong. Now I will not chores and I’ll support her in daily life. I prevention and gender equality. underestimate my wife’s household chores and I’ll support her in daily life. I think, like me, so many think, like me, so many other people are also These events are also used as a social platform to other people are also sensitized on this issue after sensitized on this issue after they enjoyed share the project’s gender transformative messages they enjoyed the game.” the game.” on the harms of CEFM, the importance of male engagement, gender equality, nutrition, healthy — Md. Jahid Mia (28), a participant behaviours, preventing preterm birth, and preterm from Roti-making competition taboos and harmful practices. 24 25

LESSONS LEARNED

What went well ccording to field staff including Field Coordinators and Community Health Workers (CHWs), Boushashuri MelaA became an effective tool to foster positive relationships and spread messages on preterm birth prevention and gender equality, as it uses many different communication strategies in one event. The well-planned entertaining events delivered the project’s educative messages on preterm prevention, the harms of CEFM, the importance of male engagement, gender equality, nutrition, healthy behaviours, and preterm taboos and harmful practices, in a subtle manner, that it easily touches men, women and adolescents and promotes gender equality and health messages around pre-term birth and MNH.

Boushashuri Mela successfully created an added mothers in law awardee’s from Morneya Union, Gangachara said: interest among the community people as the events ‘when my daughter in law was pregnant, I took care of her and ensured engaged the entire community, and contributed 4 times ANC, nutritious food and rest. I never put any mental pressure to raising awareness about gender related social on her. I learnt all these in last year’s Boushashuri Mela. I promote norms and practices and its contribution in pre- these learnings among others, too.’ term birth prevention; awareness on the importance of male engagement, GE, SRHR and preterm birth The event also contributed to high-level government policy buy-in risk factors. This platform creates opportunities for as well. For example, after visiting a Boushashuri Mela in 2018, the mother-in-laws and daughter-in-laws to learn MNH/ Honorable Member of Parliament from Rangpur Md. Tipu Munshi SRHR issues including the LINC factors together and said, “The name of the event is so different that I voluntarily joined understand their importance. and found it as a great event where male, female and adolescents join, participate in different events, and get aware of health and MNH As a result, this helped mother-in-laws and messages that will improve health status of this community.” daughter- in-laws become closer and foster better understanding and eased the traditional tensions Such open-platform events and discussions on GE, MNH/SRHR issues among themselves; and motivated mother-in-laws helped people discuss SRHR issues among their family members more to support improved care for pregnant mothers comfortably than before. However, achieving all of these objectives and adolescent girls. Sobijon Banu, one of the best depends on successful accomplishment of the following elements: 27

CONCLUSION

• Effective involvement of the government • These fairs are organized in UH&FWC compound agencies, members of Change Maker Group, so that the participants not familiar with this Decision Maker group and the members of health facility can get familiar. UH&FWC-MC from the planning stage to the • Appropriately briefing the government high-level implementation of the events. policymakers who join the Mela is helpful as they can • To ensure that women and adolescent girls then effectively communicate with the participants, can freely participate, securing buy-in from the especially with women and adolescents. community leaders and family-level decision makers is important. What could have been done to • Ensure the event is entertaining enough to the achieve better results? participants so that they do not consider it as an extended session by the CHWs and sparks interest. This fair has been a powerful channel to disseminate project messages. Starting the fairs in the second • This is the only platform where mothers- year, instead of third, would have allowed the project in-law, daughters-in-law and husbands he Born on Time Project with its gender Approximately 1120 people join each of these fairs to spread messages of GE and MNH/SRHR among participate and learn about MNCH/SRHR, GE, transformative approach coupled with a every year. Boushashuri mela portrays positive a wider audience. Secondly, from the very beginning male engagement related issues. Therefore, multi-channel SBCC strategy presented behaviors in an entertaining way and through of the project, BOT should have brought the local everything (games, competitions, etc) is a Tunique opportunity for the project staff to apply demonstrations and modelling, helped people government agency in the lead role in organizing organized in such a manner that no one feels innovative approaches to address the barriers and remember the issues, and contributes to the diffusion the fair, to avoid several hassles such as securing embarrassed. It is important to make the event challenges. Boushashuri Mela is one of those. of ideas and behaviors promoted by the event. permission to organize the fair from different enjoyable to the participants by making it government authorities, including local law and compatible to local cultural and social norms. As mentioned earlier, this is an activity that uses Respondents to the Midterm Study also commonly order agency. Moreover, involving local and national many different communication strategies embedded identified Boushashuri mela as a source of • Apart from the planning and organizing role, the media ahead of time would also have helped to in one event and engages and involves almost information. This is a feasible and effective strategy members of Change Maker Group and Decision spread the word about the event. the entire community as either organizers and/or for use in community-based interventions aimed at Maker group and the members of UH&FWC-MC participants. Men, women, adolescents and elders all influencing behaviors, particularly those that are also function as the judge of different games and take part with huge interest and enthusiasm. complex or involve interactions with other people. competitions. Therefore, full community ownership is developed. Born on Time is the first public-private partnership dedicated to the prevention of preterm birth, bringing together the collective expertise of World Vision Canada, Plan International Canada, Save the Children Canada, the Government of Canada and Johnson & Johnson.

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