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Male involvement strategies are intended to encourage
men to accompany their spouses during ANC visits. Unfortunately the
interpretation of these policies has been left to health providers and
non-governmental organizations, who seek to demonstrate desirable outputs for
targets such as couples testing for HIV. It almost seems as if the
responsibility to “catch” the men who have long eluded the health
system and HIV screening has been unfairly transferred to the pregnant
spouse. Even prior to the launch of this strategy, some facilities all over
Uganda made it mandatory for a woman to bring her spouse if she wanted
access to ANC services. .(Suzanne Kiwanuka, 2015)

Men play a key role in decisions integral
to maternal and newborn health. For example, family planning, including
delaying first pregnancy, adequate birth spacing, reducing unplanned
pregnancies and limiting the total number of pregnancies, positively impacts
maternal health and reduces maternal deaths. Men are often responsible for
decision-making about family planning and use of contraceptives and program experience
suggests that male involvement can be a more effective strategy than including
women alone.
Men also play a
key role in determining women’s access to critical health services, including
antenatal and intrapartum care, through such mechanisms as determining the
availability of transport for women to reach a clinic and decisions that affect
whether a woman can be successfully referred to a higher-level facility if
But in order to
make informed decisions, men need to know why ANC and skilled birth attendance
are important, the risks associated with pregnancy and childbirth, how to
prepare for childbirth and how to recognise signs of complications. Involving
men in clinical services may be one way to ensure men receive this information.
Pregnancy and the birth of a child are significant events for men and women and
are likely to be times when a man is open to new information about his role as
father and husband.
studies tend to suggest that men who participate in antenatal education provide
information or other support to their pregnant wives and demand facility-based
childbirth.( Jessica Davis, Stanley Luchters, Wesley Holmes  2013)

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During pregnancy and the breastfeeding
period, there is also a particular need to involve both men and women in
efforts to prevent STIs and HIV. Physiological changes during pregnancy and the
postpartum period mean that women are more susceptible to HIV and other
infections.4Traditional beliefs,
concerns about whether sex is safe during pregnancy, and health workers
conveying incorrect information, can result in long periods of marital sexual
abstinence during pregnancy and postpartum. During this time, men may be more likely
to seek sex from other partners and may not use a condom.3 If an expectant father
acquires an STI such as syphilis during this time, he is in danger of passing
an STI to his pregnant or breastfeeding partner, which can seriously affect the
health of both mother and baby.In the first weeks after infection with HIV,
viral load in the blood is very high. If a man aquires HIV during extramarital
sex, he will be highly infectious to his pregnant or breastfeeding partner. A new HIV infection
during pregnancy or breastfeeding will further result in a high maternal viral
load, which greatly increases the risk of mother to child transmission of HIV. To protect pregnant and
breastfeeding women and their babies from HIV infection it is therefore
imperative that men have adequate knowledge and skills. .( Jessica
Davis, Stanley Luchters, Wesley Holmes  2013)


Men also play a role in decisions relating
to breastfeeding. There is strong evidence that exclusive or predominant
breastfeeding for the first six months of life significantly improves child
survival  Studies in high-income countries
have revealed that partner support is an important factor in successful

( Jessica Davis, Stanley Luchters,
Wesley Holmes  2013)

 Although most breastfeeding promotion efforts
in low-income countries are aimed at women, many women do not make choices
about infant feeding in isolation and experience significant influences and
pressures from family members, including male partners, parents, and
parents-in-law. Yet, many men have not been exposed to breastfeeding messages
and have insufficient knowledge to positively influence infant feeding
decisions. .( Jessica
Davis, Stanley Luchters, Wesley Holmes  2013)


Engaging men may also have benefits
for maternal mental health. A recent review found that perinatal mental
disorders are common in low and lower middle-income countries. These disorders
affect maternal wellbeing and the health and development of the baby. The
authors note that, when other factors were controlled for, higher rates of
common perinatal mental disorders were observed among women who experienced
difficulties in the intimate partner relationship, including having a partner who
was unsupportive and uninvolved.
.( Jessica Davis, Stanley Luchters, Wesley Holmes  2013)


Including men in maternal and child
health services may have further benefits for men’s own health. For women,
contact with health centres during pregnancy and childrearing provides an
opportunity to connect with a range of services, including treatment for
malaria, anaemia and HIV infection. In many settings, however, men have very
little contact with the formal health system, and even less engagement with
preventive health services. Men more often seek curative services, and often
attend a traditional healer or a pharmacy over a health centre.  For men, as for women, pregnancy provides an
opportunity to link men to the health system, to detect and treat conditions
such as STIs and other infections, and to provide relevant health messages. .( Jessica Davis,
Stanley Luchters, Wesley Holmes  2013)


Finally, research indicates that many
men and women would like to see greater male involvement in maternal and child
health services. In a qualitative study of the sexual practices of expectant
fathers in Laos, focus group discussions with pregnant women reveal that
although many men, particularly those from urban areas, accompany their
pregnant partner to the clinic and women would like their husbands to be
included in the consultation, they are rarely included. One expectant father in
a men-only focus group discussion noted that ‘Some men would like to go in with
their wife but instead end up asking them “what did the doctor say…oh yes, you
should do that. Similarly,. Men wanted to know how much work their pregnant
wife can do, at what stage in the pregnancy she should stop working, how to
keep her healthy, when she should go to the clinic and whether it is safe to
have sex. They also asked how to know when the baby would be born, why some
babies are born early or are stillborn, and how to feed and care for the baby.
Several studies have reported men’s interest in learning more about how to
support the health of their family and their frustration regarding lack of
information. It is also clear that many men care deeply about the welfare of
their families and respond positively to attempts to engage with them. .( Jessica Davis,
Stanley Luchters, Wesley Holmes  2013)


This report explores the potential
health benefits for women, newborns and families associated with involving men
more in maternal and child health. We also examine potential harms and
challenges associated with involving men more, and describe strategies for male
involvement that have been evaluated. The findings could inform and prompt
policy makers and health professionals to give greater priority to reaching and
involving men, and to develop effective policies and programs to overcome the
challenges and take up the opportunity of men’s interest. .( Jessica Davis, Stanley Luchters,
Wesley Holmes  2013)



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