Fathers can play a lifesaving role in the prevention of mother-to-child transmission of HIV treatment by supporting their partners and attending counselling and testing programmes with the mothers-to-be.
Studies from South Africa, Kenya and Nigeria show HIV-positive mothers-to-be are more likely to maintain their treatment plans and save their baby’s lives if their partners are supportive and attend testing and counselling sessions with them.
The findings of the State of the World’s Fathers report echo this. The report is the first of its kind, and joins the State of the World’s Mothers and State of the World’s Children reports. It compiles data about men’s contribution to care-giving across the world.
At this stage, the report is mostly a narrative compilation of data since there is not enough comparable data worldwide on this topic yet. One of the report’s research areas was the valuable role that men can play in maternal, infant and child health.
Sexual and reproductive health related risks are the biggest threat to women and girls’ health worldwide. Yet involving men in the conversation on reducing these risks remains a complex challenge.
Fathers can help, but they can also hinder
In Africa the picture of men’s involvement in sexual and reproductive health and maternal, infant and child health is a mixed collage of promising steps as well as challenging circumstances.
Research in South Africa shows that when fathers-to-be join their pregnant partners for HIV testing and counselling, HIV positive mothers-to-be are more likely to return to the clinic for a follow up visit, successfully take their anti-retroviral medication and adhere to infant feeding recommendations.
In Kenya, the fathers’ involvement resulted in a decrease in the prevention of mother-to-child transmission. There was also a decrease in the risk of the baby being infected with HIV and in infant mortality.
A Nigerian study also showed that good adherence was achievable during pregnancy when women came with their treatment partners.
But the report also shows that men can prevent women from receiving care, directly or indirectly.
A study in Ethiopia, found that 33% of men said they were the sole decision-makers in their families when it came to childbearing.
Research from Nigeria found that women said their unco-operative male partners was one of the reasons they did not attend pre-natal care.
In some contexts, men tend to dominate the decision-making around when and how many children to have when contraceptives are available. Data from the Demographic and Health Surveys in Ethiopia, Nigeria, Mozambique and Uganda also showed that 74% of couples do not use any form of contraception.
Polygamy and having multiple sexual partners also complicates decisions to plan, prevent or time a pregnancy. In Malawi, people in polygamous marriages use contraceptives less than those in monogamous ones.
Women’s choice around abortions is also a challenging issue. In some countries like Uganda, Burkina Faso and Zimbabwe, women need permission from their husbands or parents to have a safe abortion. But requesting this permission may be risky. Research shows that in these countries some men view an abortion as a sign of illicit sexual activity and may respond violently to such a request
The MenCare+ programme is an integrated package of interventions to improve men’s engagement in maternal and child health, implemented in South Africa, Rwanda, Indonesia and Brazil. Formative research in preparation for the MenCare+ programme in South Africa and Rwanda found that few men got involved in maternal infant and child health because they viewed pregnancy and child-rearing as women’s issues.
The research also found that men are often reluctant to visit health care services, as these are “female” spaces. They regard seeking help as a sign of weakness.
What it takes to get successful engagement
In low-income countries, experience from programmes like MenCare+ show that peer education, community meetings, distributing educational materials, one-on-one counselling sessions, workplace-based initiatives and mass media campaigns can potentially effectively engage men in contributing to maternal and child health.
One such programme is the Program P intervention – a group-based programme which helps fathers better understand their roles beyond financial providers as caregivers. This matches what children expressed through participatory research as the ideal father, a man who can be a caregiver and a communicator. Program P and the State of the World’s Fathers report are both produced as resources for the MenCare global fatherhood campaign.
Fathers who participated in the programme reported that they learnt how to negotiate better with their partners and partners’ families. Mothers said that their partners supported them by providing money for transport to the clinic or by taking care of another child when the mother had a prenatal check-up.
There is a recognised need to expand such programmes to include men and women who are not normally reached. These include adolescent and first-time fathers, mothers, minority groups, and immigrants. Programmes need to be tailored to their specific needs.
Improving men’s use of health services, and HIV services in particular, has benefits beyond improving the health of mothers and children. It also improves their own health.