Control, struggle, and emergent masculinities: a qualitative study of men’s care-seeking determinants for chronic cough and tuberculosis symptoms in Blantyre, Malawi

Abstract

BackgroundMen’s healthcare-seeking delay results in higher mortality while on HIV or tuberculosis (TB) treatment, and implies contribution to ongoing community-level TB transmission before initiating treatment. We investigated masculinity’s role in healthcare-seeking delay for men with TB-suggestive symptoms, with a view to developing potential interventions for men.MethodsData were collected during March 2011- March 2012 in three high-density suburbs in urban Blantyre. Ten focus group discussions were carried out of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers. Individual interviews were done with 20 TB patients (female =14) and 20 un-investigated chronic coughers (female = eight), and a three-day workshop was held with 27 health stakeholder representatives.ResultsAn expectation to provide for and lead their families, and to control various aspects of their lives while facing limited employment opportunities and small incomes leaves men feeling inadequate, devoid of control, and anxious about being marginalised as men. Men were fearful about being looked at as less than men, and about their wives engaging in extramarital sex without ability to detect or monitor them. Control was a key defining feature of adequate manhood, and efforts to achieve it also led men into side-lining their health. Articulate and consistent concepts of men’s bodily strength or appropriate illness responses were absent from the accounts.ConclusionsFacilitating men to seek care early is an urgent public health imperative, given the contexts of high HIV/AIDS prevalence but increasingly available treatment, and the role of care-seeking delay in TB transmission. Men’s struggles trying to achieve ideal images seem to influence their engagement with their health. Ambiguous views regarding some key masculinity representations and the embrace of less harmful masculinities raise questions about some common assumptions that guide work with men. Apparent ‘emergent masculinities’ might be a useful platform from which to support the transformation of harmful masculinity. Finally, the complex manifestations of masculinity indicate the need for interventions targeting men in health and TB control to assume supportive, multidimensional and long-term outlooks.

Integrated agriculture programs to address malnutrition in northern Malawi

“…A key aspect of the emergent masculinities is involving male leaders and integrating agriculture and food security concerns with nutrition. In doing so, men’s concern with respect is both adhered to and altered, which speaks to the hybrid, fractured and contingent masculinity at work in Malawi [20]. With the use of community-based participatory education on nutrition, health and gender, the study participants have seen improvements in many social factors that affect child care.…”

“…At the same time, the authors’ acknowledge that there can be cultural and racially-driven biases about gender difference, that there are a broad range of cultural ideas about gender, and that there are possibilities for multiple layers of inequalities – race, class, gender, position- to shape ideas about ‘improved’ gender relations - which must be taken into account [17–19]. In this paper we use theoretical approaches drawn from feminist theory and critical men’s studies on health [20, 21] to examine a program which integrated agriculture, nutrition and gender. In doing so, we try to open up the ‘black box’ of processes that can lead to improved gender relations – meaning one in which women and men have a more equal say, control over resources, workload and are free from violence and exploitation.…”

“…Hegemonic masculinities in this region emphasized men as heads of household, strong providers and heavy alcohol users [43]. Domestic spaces in this cultural milieu were decidedly feminine [20]. Recent scholarship on masculinities in southern and eastern Africa, however, show evidence that men living in poverty-striken regions with high levels of unemployment face severe challenges in maintaining hegemonic masculinities, leading to fractured, hybrid, contradictory and shifting masculinities, with an emphasis on male control, power and violence [20, 43–48].…”

“…Domestic spaces in this cultural milieu were decidedly feminine [20]. Recent scholarship on masculinities in southern and eastern Africa, however, show evidence that men living in poverty-striken regions with high levels of unemployment face severe challenges in maintaining hegemonic masculinities, leading to fractured, hybrid, contradictory and shifting masculinities, with an emphasis on male control, power and violence [20, 43–48]. It is in this context that the Soils, Food and Healthy Communities (SFHC) project has been working to change gender relations using participatory methods.…”

Racionality and Suffering: Men and Healthcare Practices

“…Muitos ainda destacam a relação entre valores tradicionais de masculinidade e prejuízos para a saúde do homem, entendendo que doenças e necessidade de cuidados são muitas vezes ignoradas ou minimizadas por colocarem em cheque características marcantes e hegemônicas do masculino (Banks & Baker, 2013;Chikovore, et al, 2014;Couto et al, 2010;Gomes, Nascimento & Araujo, 2007;Levorato, Mello, Silva & Nunes, 2014;Medrado & Granja, 2009). Embora alguns estudos rejeitem tal perspectiva (Douglas, Greener, van Teijlingen & Ludbrook, 2013;Jeffries & Grogan, 2011) e mereçam atenção ao indicar aspectos que mobilizem os homens a favor do cuidado da saúde, a prevalência de estudos que inter-relacionam concepções e práticas tradicionais de masculinidade à menor busca por serviços de atenção à saúde por homens é notável e merece também atenção.…”