In the past two decades, Ethiopia has experienced significant improvements in its health system and the health status of its population. Despite these advancements, the population still has limited access to quality reproductive, maternal, and child health services through the primary health care system. Only 41 percent of women in Ethiopia use a family planning method, and one in five married women still have an unmet need for family planning services. Only 43 percent of women completed the recommended four antenatal care (ANC) visits during pregnancy, and the pregnancy-related mortality ratio remains high—almost twice the global average at 412 deaths per 100,000 pregnancies (EPHI and ICF, 2021).
Gender-based violence (GBV), specifically intimate-partner violence, has been linked to lower utilization of maternal health services and, subsequently, poorer health outcomes for mothers and children throughout pregnancy and early childhood (Leight and Wilson, 2021; Hill, McCleary Sills, and Garcia-Moreno, 2016; Sarkar, 2008). Furthermore, in 2017–2018, the Transform: Primary Health Care Activity carried out a comprehensive gender analysis that identified the need to improve and enhance male engagement in family planning and maternal healthcare to address barriers to care. The report revealed widespread opposition among men to their partners’ use of family planning methods and that men influence women’s decisions and autonomy on their healthcare in a variety of ways, even when collaboration occurs around seeking health services for themselves or for their children.
To address the above, the activity identified a community-based male engagement intervention to adapt to the Ethiopian context, Program P. Promundo and its partners developed the program for MenCare specifically to address men’s involvement as partners and fathers through critical reflection and peer group discussions around responsible fatherhood, healthy relationships, men’s roles throughout pregnancy and early childhood, exploration of gender identity and roles, and prevention of GBV. An adaptation of Program P in Rwanda, Bandebereho, demonstrated through a randomized-controlled trial the ability to not only increase overall ANC attendance and modern contraceptive use but also to reduce the incidence of intimate-partner violence (Doyle et al., 2018).
Transform: Primary Health Care carried out its own research to identify specific cultural and contextual barriers and opportunities for men’s engagement in the targeted communities to inform the adaptation of Program P to the Ethiopian context. The study found that community members emphasized education and awareness-raising around family planning, gender, and GBV as important topics to improve men’s engagement and women’s access to family planning and ANC. Interviews and focus group discussions also revealed rigid gender roles affecting both men’s and women’s relationships, healthcare decision-making, and capacity to fully participate in ANC and family planning services.
The activity edited and adapted the Program P sessions to include a stronger emphasis on GBV, gender norms, and household division of labor. It also strengthened the curriculum’s gender-transformational approach, involving both men and their partners in certain sessions and using participatory and experiential learning activities to explore issues of manhood, fatherhood, power, and violence. In the final adapted curriculum, Fathers: Responsible, Involved, Healthy, four of the eleven sessions talk about violence and violence prevention: identifying types of power, violence in our own lives, GBV, and resolving conflict.
The activity was unfortunately unable to complete the pilot intervention due to the outbreak of COVID-19, but Ethiopia’s Federal Ministry of Health is currently exploring opportunities to pilot and scale the intervention through future programming.
You can learn more about our work on Transform and find other resources and tools on our website. EnCompass’ approach to gender and inclusive development integrates the standards and principles of human rights—participation, non-discrimination, and accountability—and spans a range of program sectors (e.g., agriculture, conflict, democracy, rights, and governance, economic growth, education, energy and infrastructure, health, HIV; and rule of law) and geographies (including Africa, Asia, Eastern Europe and Eurasia, Latin America, and the Middle East).
References:
Doyle, K., R.G. Levtov, G. Barker, G.G. Bastian, J.B. Bingenheimer, S. Kazimbaya, et al. 2018. “Gender transformative Bandebereho couples’ intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial.” PLoS ONE 13(4): e0192756. https://doi.org/10.1371/journal.pone.0192756.
Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. 2021. Ethiopia Mini Demographic and Health Survey 2019: Final Report. Rockville, Maryland, USA: EPHI and ICF
Hill A, Pallitto C, McCleary-Sills J, Garcia-Moreno C. A systematic review and meta-analysis of intimate partner violence during pregnancy and selected birth outcomes. Int J Gynecol Obstetrics. 2016;133:269–76.
Leight, J., Wilson, N. Intimate partner violence and maternal health services utilization: evidence from 36 National Household Surveys. BMC Public Health 21, 405 (2021). https://doi.org/10.1186/s12889-021-10447-y
Sarkar NN. The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. J Obstet Gynaecol (Lahore). 2008;28(3):266–71.