• Basil Safi

    K4Health, CCP | Director of Field Programs
    © 2013 Valerie Caldas, Courtesy of Photoshare

    A Suaahara field supervisor plays with an infant in the Terai region of Nepal during a household visit in his community. © 2013 Valerie Caldas, Courtesy of Photoshare

    With so many women having already posted their advice and experience on male engagement this month, I’d like to add my own recommendations on this important topic. My experiences working with the Nepal HC3 Project—a four-year, $5 million project that focuses on youth, adolescents, migrants, and marginalized and disadvantaged groups— have brought to light a key male engagement issue that needs attention before designing any new family planning or other public health program: migration.

    Countries with high male migration rates often have low contraceptive prevalence rates (CPR). In the case of Nepal, one can look at the 2011 Demographic Health Survey (DHS) and clearly see that national level statistics who CPRs that hover around 43.3% (modern methods) and 6.5% (traditional methods). Upon closer inspection, however, roughly 50% of married women surveyed in the 2011 DHS reported their husbands were “currently away” at the time of data collection.

  • K4Health Highlights

    Naheed Ahmed

    CCP | Monitoring & Evaluation Program Officer

    POPLINE: Putting Research in the Right Hands

    Last year, K4Health launched the Idea Lab, a forum for users to directly share their feedback on our products and services with us. We’ve held several Idea Lab evaluation sessions since then and received great suggestions from users on how we can enhance our products and services to better meet their information needs.

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    Lisa Mwaikambo

    CCP | Program Officer II

    Akuba Dolphyne

    Grameen Foundation | Project Manager
    CHN Image

    Through Concern Worldwide’s Innovations Care Community Hub (CCH) for MNCH Project, Grameen Foundation/Ghana and K4Health are collaborating to make eLearning courses more accessible to rural Community Health Nurses (CHNs) in Ghana. CHNs are the frontline health workers of the Ghana Health Service (GHS) and play a vital role in extending maternal and child health care to rural communities. However, as the lowest credentialed nurses, they are at the bottom of the GHS hierarchy, have limited opportunities for career advancement, and report challenges with isolation and lack of resources. 

    To address the issue of lack of opportunities for career advancement as well as a desire for improving their health knowledge, Grameen Foundation/Ghana and K4Health selected a sample of family planning (FP) and maternal, newborn, child health (MNCH) courses from the Global Health eLearning Center (GHeL) that contain provider-specific content to adapt and transfer onto CCH’s mobile app – “CHN on the go.” With support from Concern Worldwide, Grameen Foundation/Ghana developed “CHN on the go” to support CHNs through tools for continuous learning, diagnostic decision making, and improved nurse-supervisor interactions. It is an open source hybrid application, leveraging the open source elearning platforms Moodle and Oppia Learning, and was developed in Ghana by Grameen’s team of local software developers.

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    Rebecka Lundgren, PhD

    Director of Research | Institute for Reproductive Health at Georgetown University

     

    Family planning user in the DRC

    A family planning user in the Democratic Republic of Congo explains the standard days method (SDM) using cycle beads. © 2004 Daren Trudeau, Courtesy of Photoshare

    Engaging men in family planning is a personal issue. Some of us are passionately on board, and others find it uncomfortable, risky or inequitable. In 1994, I reported to work in Honduras for my first real job in family planning the same week as the landmark International Conference on Population and Development (ICPD). The call to action from ICPD recommended programs and policies to enable men to play a more active role in reproductive decisions, including contraceptive method choice and use.  This reverberated globally, reaching even tiny Honduras, the only country that did not sign the agreement.

    Not long afterwards, I found myself in a dim rural school room, crowded with farmers dressed in boots and cowboy hats, discussing how to address sexual and reproductive issues in their agroforestry program. When I mentioned to my supervisor how uncomfortable I felt in a room full of men discussing family planning, he responded, “I kind of like it.” That day marked the beginning of a journey that taught me two things: (1) sometimes the professional is personal, and vice versa, and (2) ongoing reflection on the role of gender in our lives and our work, accompanied by rigorous research to inform our programs, is important. 

    Since then, I’ve been privileged to participate in the development and introduction of the fertility awareness-based Standard Days Method ® (SDM).  Because SDM requires the cooperation of men, its introduction in 2001 created an opportunity: test strategies for engaging men in family planning service delivery, while promoting male participation in contraceptive use. Over the course of this research, I’ve developed a list of things I know for sure about engaging men in family planning:

  • Shawn Malarcher

    USAID | Senior Advisor on Utilization of Best Practices
    © 2013 Valerie Caldas/ Johns Hopkins University Center for Communication Programs, Courtesy of Photoshare

    A Suaahara field supervisor with his family in District of Dolakha, Nepal. © 2013 Valerie Caldas/ Johns Hopkins University Center for Communication Programs, Courtesy of Photoshare

    The older I get, the more I understand the deep truth behind this cliché. Despite piles of evidence and loads of rhetoric about their importance, men remain nearly absent from family planning programming worldwide. Rather than return to the tired old question about, “What works in male engagement?” I propose we ask ourselves, “Why do we continue to leave men out of family planning programming?”

    I believe one significant reason for leaving men out of the picture is the type of programming we typically propose and support. Male engagement tends to be compartmentalized, such as male support groups or separate services for men—activities completely separate from female-focused activities. While such approaches may be effective on a small scale, they face serious challenges in large-scale implementation. The complexity of the activities and dependence on highly charismatic individuals make large scale implementation difficult. In addition, ownership or responsibility for implementing activities often falls between the mandates of government entities.

    And when policy makers are faced with decisions of how to allocate scarce resources, male to male interpersonal communication often loses out to the need to reach women with information, clinical training, support for commodities, and other priorities.

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    Lisa Mwaikambo

    CCP | Program Officer II
    © 2004 Ahsanul Kabir, Courtesy of Photoshare

    A health worker administers a Somazet injection for family planning at a community health clinic in Islampur union, Rajbari district, Bangladesh. © 2004 Ahsanul Kabir, Courtesy of Photoshare

    Hormonal contraceptives are very effective in preventing pregnancy when used correctly and are an important part of a program's contraceptive method mix. There are many exciting developments in terms of new contraceptive technologies, as well as evidence that the renewed focus on long-acting reversible contraceptives (LARCs), specifically implants, has been quite successful in some countries. The following three come to mind:

    1.)    Injectable contraceptives continue to be one of the world’s most popular methods for preventing pregnancy, offering women safe and effective protection, convenience, and privacy. Until now, however, they have not been widely available outside clinic settings. The introduction of Sayana® Press, a lower-dose formulation and presentation of Depo-Provera®, offers the potential to improve contraceptive access for women worldwide.

    Sayana Press is a three-month, progestin-only injectable contraceptive product packaged in the Uniject™ injection system and administered via subcutaneous injection. It is small, light, easy to use, and requires minimal training, making it especially suitable for community-based distribution. PATH and partners are supporting country-led pilot introduction of Sayana Press in Bangladesh, Burkina Faso, Niger, Senegal, and Uganda, which will continue through 2016. 

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    Kate Gilles

    PRB | Senior Policy Analyst
    © 2007 Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare

    A father who supports and believes in the benefits of family planning holds his infant at a rural health facility in Momostenango, Totonicapán, Guatemala. © 2007 Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare

    Gender equality is fundamental to the achievement of other development goals. Simultaneously, organizations are recognizing that advancing gender equality requires working with men as well as women.

    These two trends are reflected in the increased attention to male engagement in reproductive health programs and services, including family planning, as a way to improve outcomes for both men and women, and for their families and communities. As more programs seek to involve men, it is critical to consider the impact on women and to ensure that women’s rights and agency are not limited by the inclusion of men.

    Programs that bring men into traditionally female spaces without considering the impact on women can actually do more harm than good. For example, if a program begins to include male partners in family planning counseling, and contraceptive rates subsequently increase, but men are making unilateral decisions about family planning use, then the program may actually have reduced women’s agency. 

    “Constructive male engagement” is a programmatic approach through which men are engaged as clients, partners, and agents of change to promote gender equality, transform gender norms, and improve health or other outcomes. The word “constructive” is key, because it describes a thoughtful, gender-sensitive approach to male engagement that places gender equality and women’s empowerment on equal footing with other outcomes. 

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    Elizabeth Futrell

    CCP | Content Development Lead/Program Officer II
     © 2013 Tanwe Shende/ GlobeMed at UCLA, Courtesy of Photoshare

    Women that are part of the Village Loan and Saving Program created by the Nwoya Youth Center, located in Anaka, Uganda, gather before their weekly meeting to look through photo albums at the center. © 2013 Tanwe Shende/ GlobeMed at UCLA, Courtesy of Photoshare

    The global development community has understood for years that investing in women yields powerful outcomes. So why does the gender gap persist? This was the big question posed to panelists at a recent Chicago Council on Global Affairs talk titled, “Investing in Women: Understanding the Gender Gap.”

    As CEO of Opportunity International, one of the largest global microfinance networks, panelist Vicki Escarra knows that women are a sound investment—they are more likely than men to repay loans and invest in their communities. In low- and middle-income countries, an average of 90 cents of every dollar a woman earns goes right back into her family and community, compared to 30 cents of every dollar a man earns. Education, job creation, and ongoing capacity strengthening are critical to changing the lives of not only women, but also their families and communities. Escarra cited Uganda, where research found that when girls graduate from school, their earning potential increases from US$600 to US$9,000 a year. That kind of difference can completely change the trajectory of a person’s life.

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    Elizabeth Goslin Doggett

    FHI 360 | Technical Officer, Research Utilization
    © 2014 Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare

    In Cobán, Alta Verapaz, Guatemala, trainers show health providers from the Ministry of Health how to use different tools and exchange experiences on engaging men in gender and reproductive health. © 2014 Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare

    Men’s engagement has been part of the family planning agenda for over a decade, at least since the 1994 International Conference on Population and Development, yet the field is still learning what truly constructive engagement of men in family planning looks like and how health programs can foster that engagement.

    We do know that the “add men and stir” approach is not the way to improve reproductive health and increase women’s agency over their bodies. In fact, involving men without confronting gender inequality runs the risk of giving men even more power and control over their partners. That risk should not scare program designers away from working with men, however.

    We have an expanding body of literature showing that engaging men can lead to significant changes in harmful gender attitudes and behaviors: better relationships between women and men; improved communication and shared decision making about sexuality, family size, and contraceptive methods; and higher uptake of family planning. We know that these results come from an investment in challenging men (and sometimes women) to think critically about gender inequality and health.   

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    Jarret Cassaniti

    CCP | Program Officer
    EAC’s Open Health Initiative RMNCH indicator scorecard, signed by Conference delegates.

    EAC’s Open Health Initiative RMNCH indicator scorecard, signed by Conference delegates.

    I recently traveled from Arusha, Tanzania, home of the East Africa Community (EAC) Secretariat, to Uganda, the site of the EAC’s 5th Annual Health and Scientific Conference. On the way, I heard a couple delegates discuss which African countries were leading the way in health. “Who is #1?” they asked each other. Was it Botswana? Who could be last? Maybe Guinea?

    The conversation reflected the friendly competition that helps to motivate EAC’s five member states: Kenya, Tanzania, Uganda, Rwanda, and Burundi. During the Conference’s opening plenary, Professor Gerald Yonga from the Aga Khan University of East Africa compared regional statistics relating to non-communicable diseases, including alcohol and tobacco use as well as poor diet. Similarly, during the Symposium on Reproductive Maternal Newborn and Child Health (RMNCH), EAC Deputy Secretary General Hon. Jesca Eriyo and Hon. Dr. Chris Maryomunsi launched a scorecard that tracks key indicators and highlights trends among member states. 

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