Issue 31 | JUNE 2011
Evaluating FP/RH programs that include men
C-Channel 31 presents six articles on evaluations of family planning/reproductive health (FP/RH) programs that involve men. The focus of the first two programs reviewed—one in Malawi and one in Nigeria—center on male involvement to promote increased contraceptive use. The third article provides a broad context for this topic, summarizing evaluations of many FP/RH programs that engage men and boys. The fourth article describes the accomplishments of an FP program in Afghanistan that involved community and Islamic leaders and couples. The fifth article addresses an RH program for youth in Uganda that was more successful with females than with males. The sixth outlines a program in India to promote birth spacing that developed separate messages for husbands, wives, and mothers-in-law, after researching barriers.
C-Change presented a poster on a research study in Tanzania that explores gender attitudes in relation to FP/RH at the annual meeting of the Population Association of America. The ongoing C-Change study is examining whether radio programming on gender norms supports increased uptake of FP services. A household survey of 200 couples scored their responses using four gender-attitude scales: gender equitable men (GEM), household decision-making, attitudes toward a wife refusing sex, and attitudes toward wife beating. These scales are further described in C-Change’s Compendium of Gender Scales, which is available on the website.
Evaluations of FP/RH programs that motivate and mobilize men and question gender norms
Evaluations of FP/RH programs that include men in Afghanistan, Uganda, and India
Authors: Shattuck D 1; Kerner B 2; Gilles K 1; Hartmann M 1; T Ng'ombe T 1; Guest G 3
OBJECTIVES: We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples' contraceptive uptake. We based the intervention design on the information-motivation-behavioral skills (IMB) model.
Authors: Exner T 1,2; Mantell J 1,2; Adeokun L 3; Udoh I 1,2; Ladipo O 3; Delano G 3; Faleye J 3; Akinpelu K 3
This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.
Authors: Barker G 1; Ricardo C 2; Nascimento M 2; Olukoya V 3; Santos C 4
This article describes a review of 58 evaluation studies of programmes with men and boys in sexual and reproductive health (including HIV prevention, treatment, care and support); father involvement; gender-based violence; maternal, newborn and child health; and gender socialisation more broadly. While few of the programmes go beyond the pilot stage, or a relatively short-term timeframe, they offer compelling evidence that well-designed programmes with men and boys can lead to positive changes in their behaviours and attitudes related to sexual and reproductive health; maternal, newborn and child health; their interaction with their children; their use of violence against women; their questioning of violence with other men; and their health-seeking behaviour. The evidence indicates that programmes that incorporate a gender-transformative approach and promote gender-equitable relationships between men and women are more effective in producing behaviour change than narrowly focused interventions, as are programmes which reach beyond the individual level to the social context.
Authors: Huber D 1; Saeedi N 2; Samadi A 3
PROBLEM: Afghan women have one of the world's highest lifetime risks of maternal death. Years of conflict have devastated the country's health infrastructure. Total fertility was one of the world's highest, contraceptive use was low and there were no Afghan models of success for family planning.
Authors: Karim A 1; Williams T 2; Patykewich L 2; Ali D 1; Colvin C 3; Posner J 4; Rutaremwa G 4
This study evaluates the impact of the African Youth Alliance (AYA) program on the sexual behavior of young people aged 17–22 in Uganda. Between 2000 and 2005, the comprehensive multicomponent AYA program implemented behavior-change communication and youth-friendly clinical services, and it coordinated policy and advocacy. The program provided institutional capacity building and established coordination mechanisms between agencies that implemented programs for young people. The analysis of findings from both a self-reported exposure design and a static group comparison design indicated that AYA had a positive impact on sexual behavior among young females but not among young males. AYA-exposed girls were at least 13 percentage points more likely to report having used a condom at last sex, at least 10 percentage points more likely to report that they had consistently used condoms with their current partner, at least 10 percentage points more likely to have used contraceptives at last sex, and 13 percentage points more likely to have had fewer sex partners during the past 12 months, compared with girls who were not exposed to the AYA program. Scaling up the AYA program in Uganda could, therefore, be expected to improve significantly the sexual and reproductive health of young women. Effective strategies for promoting safer sexual behaviors among boys and young men must be identified, however.
Authors: Sebastian MP 1; Khan ME 1; Roychowdhury S 2
OBJECTIVE: Birth spacing intervals are relatively short in India. Healthy spacing of 3-5 years between births is an effective way to prevent maternal and child mortality and morbidities. Socio-cultural and structural barriers, including limited awareness, socio-cultural norms, and misconceptions need to be addressed for behavior change. Hence the objective was to understand these barriers and accordingly develop separate messages for young women, her husband and her mother-in-law.