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The Dilemma of Men’s Participation in Reproductive and Family Health

This is taken from the Centre of Gender Equity and Health blog

Holly Shakya and Beniamino Cislaghi

Everywhere in the world, life is more difficult for women than men. The difference between men’s and women’s lives in low and mid-income countries (LMIC) is a source of concern for those working to achieve global justice. Women in LMIC often have limited abilities to make decisions regarding their jobs, their health (particularly their reproductive health), and their participation in public life. Why is it that?

Part of the answer can be found using social norms theory. Social norms are the informal rules of behavior that dictate what is acceptable within a given social context. Gender-related social norms are often deeply engrained within the cultural framework of a society and embedded in its institutions. They are taught, modeled and reinforced since children are very young. In strongly patriarchal societies, gender norms for women might include expectations of submissiveness, duty to family above duty to self, strong expectations of motherhood, strictly monitored sexual fidelity, limited mobility, and modesty in physical appearance and behavior. These expectations can also limit women’s access to resources and services. The result is often a disproportionate distribution of power, with men (some deliberately while others possibly unconsciously) enjoying greater decision making over personal and family life.

Given this unequal distribution of power, many practitioners wonder whether men should be part of international development programs that aim to improve women’s lives. So far, the trend has been, in general, towards working only with women partly because programmatic theories of behavior change often consider women as independent behavioral agents. Interventions to promote contraceptive use, for instance, often work only with women to help them overcome local structural and social barriers that limit their access to services and resources. Some of these interventions, however, resulted in generating more harm than help for women. That is because on some occasions, women were empowered to resist existing social expectations, but there no efforts made to change those expectations at the level of the social context in which those women lived. As a result, women would stand up for their rights, but the people around them, including husbands and in-laws, would not understand their arguments or would see them as a threat to their authority, responding with increased control and dominance. As awareness of this problem has increased, programmatic efforts have experimented with including men particularly in the discussions around family health.

This problem, however, leaves us with what seems to be an unsolvable dilemma. Do programs that target men in attempts to help women end up reinforcing or challenging the unequal status quo?  Do these programs, in other words, end up helping men and women live together more equitably, or do they increase the unequal distribution of power by including men? In some contexts, despite unequal gender norms, women still manage to make some decisions about their own bodies and their own health, as those decisions can be considered “women’s business”. Offering men more resources or decision making power might disempower women who were autonomously making decisions until their husbands were drawn into the process. On the other hand, recent empirical research has shown that when men are positively engaged in the process of pregnancy and childbirth, the women and babies are likely to have better health overall. Men who are present at birth and actively interact with newborns have elevated oxytocin levels, and lower levels of testosterone, which can help men forge stronger bonds with their children. Men’s engagement has also been found to be linked to their increased participation in childcare later on, an important factor to increase both women’s agency and men’s healthy relationships with their children and families.

To achieve positive men’s participation, however, takes more than talking to men to convince them of the need to be there for their wives. A man’s role in the family is not only shaped by what the man wants to do. He also needs to think about what his wife, family, friends, and neighbors expect from him. That is, for men to be actively engaged in women’s and children’s reproductive health, social expectations around men’s role in their context must also change. Encouraging men to help their pregnant wives with heavy housework is a worthy goal, but unlikely to succeed if the men who attempt those behaviors are ridiculed by other men in their social surroundings.  Similarly, men who may want to do more child care work in the family might be strongly chastised by friends or family members, their own mothers for example, who might insist that it is women’s job to take care of children, not men’s. Without changing deeper gender specific social norms, efforts at change along the surface might eventually fail.

Holly adds this anecdote: When traveling through rural Honduras to understand decision making around childbirth, our team visited an indigenous village. The woman who was our guide warned us as we entered the village that it was considered a “problem village” because the people there didn’t follow the health recommendations of the health promoters, including the fact that most births took place at home. We discovered, as we talked to people in this village, that most of the births took place at home with the assistance of one local midwife. Intrigued by this, we sought out this woman and spent some time talking to her. One of the most interesting things that she told us was how she had a policy, a very strict policy, of requiring the participation of the father at the birth. This she believed, was his responsibility, and the men in the village, understanding that expectation, complied accordingly. Later when we talked to one of those men, he relayed his experiences. He and his wife had 7 children, and he had been present and assisted at every birth. The most compelling thing about his story was the confidence he had around the process of childbirth, the care of infants and of young children, and his belief about the positive role of fathers in the process. The men in other villages, where births took place at a maternal health clinic which did not allow men in the birthing room, were disengaged from the process and considered it something in which they did not expect to participate.

Ben had a similar experience: I lived for an extended period of time in a village in rural West Africa, where I studied social norms regulating appropriate behaviors for men and women. One day, as I was talking with a young man, this man’s wife called to ask whether she could go to the clinic. He said she needed to wait for him to return home and they would go together. This man explained to me that, in his opinion, frankly there was no real problem in his wife going alone: she could walk to the clinic, the road was safe, and she would have been back in time to take care of the children. “Why did you tell her to wait?” I asked. Well, said this man, it’s ok with me, but if others see my wife walking alone they might think I am being cheated on: “around here people think that when women leave the household they are looking for troubles”. This man, in other words, was open to the possibility of his wife leaving the household, but was worried about the deeper set of beliefs that structured social life in his village. A change in behavior required effective collective renegotiation of those beliefs with other men and women in the village, not just convincing people individually of the advantages of having women visit the clinics autonomously whenever they needed.

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