Men’s Response to Obulamu Campaign Messages about Male Involvement in Maternal Health: Mukono District,Uganda

ABSTRACT

Men’s involvement makes a difference in maternal health. Well-informed and supportive men may encourage their wives to get more complete and regular antenatal care. In much of sub-Saharan Africa, however, men’s involvement with their wives’ health during pregnancy is minimal. This study investigated men’s response to Obulamu: How’s Your Pregnancy radio campaign messages about attending antenatal care with their wives, delivering at a health facility, being tested for HIV, maintaining maternal nutrition, and using malaria prevention. We conducted eight focus group discussions ranging from six to ten participants each: two groups of men from a rural area, two groups of men from a peri-urban area, and two groups each of expectant or recent mothers from the same rural and peri-urban areas. We also conducted six key informant interviews of midwives and other healthcare providers. Findings revealed that participants were highly exposed to the Obulamu campaign and knowledgeable about campaign messages. Most men expressed positive attitudes toward behaviors promoted by the campaign and voiced an intention to change their behaviors. Key informant interviews confirmed that since the start of the campaign an increase in male involvement with maternity visits had taken place. However, a sizeable minority of men, mostly rural residents, resisted involvement in their wives’ antenatal visits because of poverty, gender and cultural stereotypes, fear of HIV testing, and incongruity between messages and the realities of antenatal clinical practice. An interaction between individual and institutional-level factors as posited by the social ecological model was clearly evident; there was an incongruity between encouraging Obulamu messages about men’s involvement and the discouraging realities of antenatal clinical practice.     

Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale,Uganda

Men’s limited understanding of family planning (FP) and harmful cultural gender norms pose obstacles to women’s FP use. Thirty-two model men called ‘Emanzis’ were recruited from the community in Kabale, Uganda to lead men from their peer group through a 10-session curriculum designed to transform gender norms and motivate men to engage in FP and HIV services. Cross-sectional surveys were conducted before (n?=?1251) and after (n?=?1122) implementation. The Gender Equitable Men (GEM) Scale was used to assess the effect on gender attitudes. The intervention achieved negligible changes in responses to GEM items. Improvements in some gender-influenced health-seeking behaviours and practices in men were noted, specifically in visiting health facilities, HIV testing, and condom use. For future application, the intervention should be adapted to require higher peer educator qualifications, longer intervention duration, and more frequent supervision. Practical guidance is needed on where to direct investments in gender-transformative approaches for maximum impact.     

‘Marriage means having children and forming your family,so what is the need of discussion?’ Communication and negotiation of childbearing preferences among Bangladeshi couples

This paper explores communication and negotiation regarding contraception and childbearing based on multiple semi‐structured interviews with 19 married couples in southwestern Bangladesh. The narratives of three couples are presented to describe how sociocultural context and gender‐based norms influence interactions between husbands and wives and their fertility decision‐making. Despite national‐level declines in fertility, the couples' stories illustrate the ongoing struggles to balance their desired number of male and female children with their financial and social well‐being. The stories also indicate that the nature of the interactions between spouses evolves throughout the course of their marital and reproductive lifespans, resulting in a shift in fertility decision‐making power. Both wives and husbands described the relative powerlessness of new wives in negotiating fertility with husbands and extended family; however, wives' preferences appeared to dominate as they became more established in their households. Many wives acted independently and often contrary to their husbands' desires, through their covert use or non‐use of contraception and pregnancy termination. These findings illustrate that, despite efforts to increase contraceptive availability within Bangladesh, without concurrent changes in the opportunities available for women beyond their reproductive capacities, the demand for children, and particularly for male children, is not likely to change.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

Female Migrant Sex Workers in Moscow: Gender and Power Factors and HIV Risk

This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies.     

Pathways to Modern Family Planning: A Longitudinal Study on Social Influence among Men and Women in Benin

Despite improvements in family planning (FP) knowledge and services in West Africa, unmet need for FP continues to grow. Many programs apply a demographically and biologically driven definition of unmet need, overlooking the complex social environment in which fertility and FP decisions are made. This longitudinal, qualitative cohort study captures the changing nature of FP need, attitudes and behaviors, taking into account life context to inform understanding of the complex behavior change process. Purposively sampled, 25 women and 25 men participated in three rounds of in‐depth interviews over 18 months. Analyses used a social network influence lens. Findings suggest alignment of six foundational building blocks operating at individual, couple, services, and social levels is essential to meet FP need. If one block is weak, a person may not achieve met need. Women and men commonly follow five pathways as they seek to fulfill their FP need. Some pathways achieve met need (determined users, quick converters), some do not (side effect avoiders), and some do not lead to consistent FP outcomes (male‐priority decision makers, gender–egalitarian decision makers). Findings clarify the role of social determinants of FP and offer insight into program approaches informed by user typologies and return on program investments.     

Male engagement in women's microbicide use in Kenya: Navigating gender norms

The success of women's microbicide use for HIV/AIDS prevention may hinge on health programs' ability to engage men to support it. In this qualitative study in Kenya, most women did not or would not tell their partners prior to initiating use, and/or would use despite their objections. Men generally did not agree with this, yet male partners of trial participants who discovered that their partners were using microbicides without their knowledge did not seem concerned. Findings suggest that efforts to engage men in microbicide use should avoid “awakening” patriarchal gender norms, and support women to use microbicides without involving their partners.     

Men's contribution to the food and nutritional situation in the Tanzanian household

More is presently known about women's than men's role in food production and nutrition in Africa. The present article is an attempt to remedy this shortcoming. A special focus is put on the influence men exert through their labour and decision‐making on the household food situation. Findings from a study in a subsistence agricultural community in Tanzania give a differentiated picture compared to current literature. Most men put a substantial amount of labour into food production, but not as much as their wives, while a minority did almost nothing. When men worked hard in the fields, their wives worked hard too. Both men's and women's labour input in the field was important for household food availability. However, no direct relationship was found between men's work and child nutrition. In decision‐making women had a subordinate position and men were apt to favour cash above food. However, women usually had their way with men to insure that family food needs were met. The potential for improving women's situation by increasing men's contribution is discussed.     

Why males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions

The article explores male perception, attitude, and knowledge on reproductive health issues and their opinions on how men's participation in reproductive health could be increased. Data were obtained from six focus groups' sessions organized among the men aged 18-59. The participants indicated that males are not motivated to be involved in reproductive health issues in Bangladesh. The participants feel that men also have unmet reproductive and sexual health needs. Their needs are not addressed and traditionally they are not encouraged to participate in reproductive health services. In Bangladesh poor interaction between husband and wife often makes it difficult to understand reproductive health problems of women. Because of prevailing culture and myth men do not visit health facilities with their wives; they do not feel comfortable to take their wives to the health facility because they do not like to discuss sexual reproductive health issues with the service providers. The analysis suggests that a complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them to take their wives to health clinics. In the focus group discussions men said that they do not feel comfortable in discussing sexually transmitted diseases with their wives. Generally women come to the health facility for the treatment of RTIs/STDs. Men do not bring their wives to the health facility because they feel shy to discuss such diseases with service providers. In order to increase male participation in reproductive health, males suggested introduction of male workers like the present female workers and visiting at the household level to counsel and mobilize them to participate in reproductive health. The analysis indicates that male involvement will be an important strategy to reach demographic goals in Bangladesh.     

‘Women now wear trousers’: men's perceptions of family planning in the context of changing gender relations in western Kenya

Gender inequity has been closely linked with unmet need for family planning among women in sub-Saharan Africa but the factors related to male family planning disapproval are not well-understood. This qualitative study explored men's perspectives of gender roles and cultural norms as they pertain to family planning. Twelve small group meetings were held with 106 married men in Nyanza Province, Kenya. Shifting gender relations made the definitions of manhood more tenuous than ever. Men's previous identities as sole breadwinners, which gave them significant control over decision-making, were being undermined by women's increasing labour force participation. While many men viewed family planning positively, fears that family planning would lead to more female sexual agency and promiscuity or that male roles would be further jeopardised were widespread and were major deterrents to male family planning approval. By addressing such fears, gender-sensitive programmes could help more men to accept family planning. Increased family planning education for men is needed to dispel misconceptions regarding family planning side-effects. Focusing on the advantages of family planning, namely financial benefits and reduced conflict among couples, could resonate with men. Community leaders, outreach workers and healthcare providers could help shift men's approval of joint decision-making around family size to other reproductive domains, such as family planning use.     

Men’s hopes,fears and challenges in engagement in perinatal health and the prevention of mother-to-child transmission of HIV in rural Kenya

Abstract

Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men’s perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy. However, thematic analysis revealed several obstacles that hindered participation. Poor couple relationship dynamics seemed negatively to influence male engagement. Some men were apprehensive that clinic staff might force them to test for HIV and disclose the results; if HIV-positive, men feared being labelled as ‘victimisers’ in situations of serodiscordancy, and described fears of abandonment by their wives. Some men avoided accompanying their wives, citing local culture as rationale for avoiding the ‘effeminate’ act of antenatal care attendance. Amidst these obstacles, some men chose to use their partners’ HIV status as proxy for their own. Findings suggest that improving male engagement in essential maternal and child health-related activities will require addressing both structural and interpersonal barriers.     

Role of men in promoting the uptake of HPV vaccinations: focus groups’ finding from a developing country

Objectives

Better outcomes of human papillomavirus (HPV) vaccination would be expected if men become full partners and advocates in vaccination initiative. Men involvement has important implication especially within the context that they are equally responsible for spreading the virus.

Methods

Twenty-seven men took part in four focus group discussions carried out to assess men’s attitudes toward the HPV vaccine between October and November 2007.

Results

The results revealed that men have low awareness about the newly release vaccine and minimal knowledge of HPV and its association with cervical cancer. When provided with information, most men were in favor of protecting their spouses, partners, or daughters from cervical cancer using the vaccine. They were aware of the effects of men’s risk behavioral patterns on women’s risk for acquiring HPV infections. Many needed assurance about the vaccine’s long-term safety and efficacy. They also expressed concern over the high cost of the vaccine. Men in this study played an influential role in the vaccination decision of their child and sexual partners. Many were in favor of male vaccination for cervical cancer prevention of their spouse or partner.

Conclusions

Vaccine advocacy should put special emphasis on men as sexual partners, husbands, and fathers from a gender equality and partnership perspective. The findings are useful in facilitating the development of strategies for effective immunization initiatives.     

Factors associated with gender differences in parent-adolescent relationships that delay first intercourse in Japan

Background: To determine the factors associated with gender differences in parent‐adolescent relationships that delay first intercourse in Japan. Methods: Japanese high school students aged 15‐18 years (female = 632 and male = 636) completed a questionnaire that evaluated the relationship with their parents. Logistic regression analyses were conducted to investigate the parent‐adolescent relationship (including the quality of parent‐adolescent communication, the frequency of parent‐adolescent sexual communication, parental disapproval of the adolescent’s sexual behavior, parental monitoring, parental psychological control/autonomy, and satisfaction with the parent‐adolescent relationship) and the adolescent’s sexual behavior. We explored student gender differences in each of the relationship patterns: mother‐female student, mother‐male student, father‐female student, and father‐male student. Results: Parental monitoring was statistically associated with delay of first intercourse in female students. While the same influences were present for male students, they also were influenced by parental disapproval of the adolescent’s sexual behavior. Furthermore, more parental communication about acquired immunodeficiency syndrome was related to delaying an adolescent’s first intercourse except for the relationship of father‐female student. Conclusions: This study suggests that gender differences in parent‐adolescent relationships delay first intercourse in Japan.     

Health help‐seeking by men in Brunei Darussalam: masculinities and ‘doing’ male identities across the life course

Using data collected through semi‐structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help‐seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help‐seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help‐seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of ‘hegemonic masculinity’ in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.     

Gender differences in informal caring

Men have hitherto largely been invisible in research on informal care. This paper examines gender differences in informal caring, focusing on gender differences according to the relationship between the carer and care-recipient and the location of caring. The paper uses secondary analysis of the 1990–91 General Household Survey, which identified over 2700 adults as informal carers. Four per cent of men and women provide care for someone living in the same household. More women than men, 13% compared with 10%, provide care for someone living in another household. Men carers are less involved in care provision than women, providing fewer hours of care each week, and are less likely to be the main carer. However, gender differences are most marked among married carers, apart from those caring for their spouse, and least among unmarried carers. Married men can often rely on their wives to perform caring roles rather than performing them personally. Women carers are more likely to provide personal care than men carers, but the gender difference is least among those caring for their spouse or for disabled children. Cross-sex personal care is performed within the marital relationship and by parents caring for disabled children, but seldom by adult children caring for their parents or in more distant caring relationships. Evidence of cross-sex taboos in giving personal care is largely restricted to care provided in another household. Since the majority of elderly people in need of care are women, such cultural taboos may reinforce the pressure on mid-life women to care for mothers and mothers-in-law.     

Traditional Gender Role Orientation and Dyadic Coping in Immigrant Latino Couples: Effects on Couple Functioning

The main goal of this study was to examine from a systemic‐transactional stress perspective (Bodenmann, 1997) whether a more traditional gender role orientation may affect psychological aggression and relationship satisfaction directly and indirectly by decreasing supportive (partner's efforts to help the other partner cope with stress) and common dyadic coping (partners' conjoint efforts to cope with stress) among first‐generation immigrant Latino couples. Structural equation modeling results from 104 couples indicate that the extent to which Latino men hold traditional gender role views and the extent to which those views differ from their female partners' may increase the risk for psychological aggression and relationship dissatisfaction directly, but also indirectly by reducing the couple's common dyadic coping and to some extent the male supportive coping. Latinas' traditional gender role views do not relate to either partner's psychological aggression or relationship satisfaction. The article discusses gender differences and research and clinical implications.     

Inter-population variations in concentrations, determinants of and correlations between 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE): a cross-sectional study of 3161 men and women from Inuit and European populations

Background

The study is part of a collaborative project (Inuendo), aiming to assess the impact of dietary persistent organochlorine pollutants (POPs) on human fertility. The aims with the present study are to analyze inter-population variations in serum concentrations of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE), to assess inter-population variations in biomarker correlations, and to evaluate the relative impact of different determinants for the inter-individual variations in POP-biomarkers.

Method

In study populations of 3161 adults, comprising Greenlandic Inuits, Swedish fishermen and their wives, and inhabitants from Warsaw, Poland and Kharkiv, Ukraine, serum concentrations of CB-153 and p,p'-DDE, were analysed by gas chromatography-mass spectrometry.

Results

The median serum concentrations of CB-153 were for male and female Inuits 200 and 110, for Swedish fishermen 190 and their wives 84, for Kharkiv men and women 44 and 27, and for Warsaw men and women 17 and 11 ng/g lipids, respectively. The median serum concentrations of p,p'-DDE were for Kharkiv men and women 930 and 650, for male and female Inuits 560 and 300, for Warsaw men and women 530 and 380, and for Swedish fishermen 240 and their wives 140 ng/g lipids, respectively. The correlation coefficients between CB-153 and p,p'-DDE varied between 0.19 and 0.92, with the highest correlation among Inuits and the lowest among men from Warsaw. Men had averagely higher serum concentrations of CB-153 and p,p'-DDE, and there were positive associations between age and the POP-biomarkers, whereas the associations with BMI and smoking were inconsistent. Dietary seafood was of importance only in the Inuit and Swedish populations.

Conclusion

CB-153 concentrations were much higher in Inuits and Swedish fishermen's populations than in the populations from Eastern Europe, whereas the pattern was different for p,p'-DDE showing highest concentrations in the Kharkiv population. The correlations between the POP-biomarkers varied considerably between the populations, underlining that exposure sources differ and that the choice of representative biomarkers of overall POP exposure has to be based on an analysis of the specific exposure situation for each population. Age and gender were consistent determinants of serum POPs; seafood was of importance only in the Inuit and Swedish populations.