Changing times? Gender roles and relationships in maternal, newborn and child health in Malawi

Abstract

BackgroundFor years, Malawi remained at the bottom of league tables on maternal, neonatal and child health. Although maternal mortality ratios have reduced and significant progress has been made in reducing neonatal morality, many challenges in achieving universal access to maternal, newborn and child health care still exist in Malawi. In Malawi, there is still minimal, though increasing, male involvement in ANC/PMTCT/MNCH services, but little understanding of why this is the case. The aim of this paper is to explore the role and involvement of men in MNCH services, as part of the broader understanding of those community system factors.MethodsThis paper draws on the qualitative data collected in two districts in Malawi to explore the role and involvement of men across the MNCH continuum of care, with a focus on understanding the community systems barriers and enablers to male involvement. A total of 85 IDIs and 20 FGDs were conducted from August 2014 to January 2015. Semi-structure interview guides were used to guide the discussion and a thematic analysis approach was used for data analysis.ResultsPolicy changes and community and health care provider initiatives stimulated men to get involved in the health of their female partners and children. The informal bylaws, the health care provider strategies and NGO initiatives created an enabling environment to support ANC and delivery service utilisation in Malawi. However, traditional gender roles in the home and the male ‘unfriendly’ health facility environments still present challenges to male involvement.ConclusionTraditional notions of men as decision makers and socio-cultural views on maternal health present challenges to male involvement in MNCH programs. Health care provider initiatives need to be sensitive and mindful of gender roles and relations by, for example, creating gender inclusive programs and spaces that aim at reducing perceptions of barriers to male involvement in MNCH services so that programs and spaces that are aimed at involving men are designed to welcome men as full partners in the overall goals for improving maternal, neonatal and child health outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1523-1) contains supplementary material, which is available to authorized users.

‘Unless you come with your partner you will be sent back home’: strategies used to promote male involvement in antenatal care in Southern Tanzania

“…A similar strategy was reported in Malawi and Kenya. For example, in Malawi, women who attended ANC clinics together with their husbands were given priority in receiving health services [33,37]. In Kenya, health service providers promoted male involvement in ANC through fast-tracking men attending with their partners and giving a free shawl for their child [38].…”

Developing a Contextually Appropriate Integrated Hygiene Intervention to Achieve Sustained Reductions in Diarrheal Diseases

“…These findings have been integrated into an intervention plan, which builds upon successes of previous studies in food hygiene promotion [35][36][37][38], but is also cognizant of the cultural setting of rural Malawi. This is particularly relevant to the methods that were used for intervention delivery [43,49,50].…”

“…These activities were then developed with an in-house design team to produce specific and complementary modules, which could be delivered through community-based volunteers with support from community health workers (Table 4). The basis of delivery was derived from both the formative work and experience from previous community-based studies in Malawi [43,49,50]. These studies have highlighted the effective use of women's cluster groups, contextualized dramas, and songs in the delivery of health promotion through the leveraging of social capital and collective efficacy.…”

Questões de gênero na consulta pré-natal de enfermagem: percepções das enfermeiras residentes

“…4,12 Assim, apesar dos avanços percebidos pelas enfermeiras residentes acerca da postura participativa de alguns homens, e embora as políticas de saúde estimulem o envolvimento paterno no pré-natal, verifica-se que, nos países em desenvolvimento, ainda há baixa participação masculina na gravidez e parto devido às normas sociais e do sistema de saúde. [9][10] Ademais, as unidades de saúde tendem a ter ambientes estruturados e destinados ao público feminino, a exemplo das maternidades, o que pode fazer com que os homens se sintam desconfortáveis nesses locais. Nota-se, diante desses fatores, que as normas de gênero influem na participação masculina e na manutenção dos padrões tradicionais de feminilidade e masculinidade no âmbito da saúde e da sociedade.…”