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 Bangladesh, 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 Upazila 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 upazilas (sub-district) of Rangpur district. 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