Revisiting Trials of Improved Practices Methodology_J.Jennings_5.10.11

Gender responsive programming

Changing men’s support to women during pregnancy, delivery, and post-partum.

Use of a modified TIPS methodology

Elena McEwan, MDSenior Technical AdviserCatholic Relief Services

Core Spring meeting, May 2011

What is a key problem in seeking care?

0

10

20

30

40

50

men together women

Who makes the decision

Pregnancy

Birth

For newborn

Step 1: Gather information on: •existing knowledge and decision-making, •Motivation and perceived benefits of recommended practices•Possible barriers to recommended practices

Step 1

Focus Group Discussion

14 FGD:•80 men with pregnant wives•16 men with postpartum wives.•16 postpartum women•36 men with children age 40 days to 2 yr

Home visits with individual interviews, husband and wife

32 interviews in 16 homes with children age 0 to 40 days

Step 2:

a) Debrief and analyze information

b) Develop community “counseling” strategies

Step 2

We can take care of our newborn during the day and the night

Motivation for recommended practices

Child will grow up to have more love for the father than is typical.

Newborn will be healthy and the family will save money not treating sickness.

Infant will grow easily and be happy.

After work, I find time to share quality time with my family

Potential barriers to male supportive care practices

Potential barriers:

3. Don’t know how to do it4. Lack of communication with

wife regarding pregnancy5. Lack of motivation due to

feeling left out by the health staff during care

6. They feel embarrassed to be seen by other women when taking care of the newborns

Developing community counseling strategies

During pregnancy:

3.Collect firewood and water.4.Support wife with household work5.Go with wife during at least 3 ANC visits and 6.Ask questions during care.

During childbirth and delivery:

3.Find someone to take care of the house while he goes with wife to HU for delivery.

4.Assist wife to go to maternity house 2 weeks before delivery.

5.Go with wife to HU and stay in room during labor and delivery.

6.Agree with wife to stay at the maternity waiting home seven days post partum.During post-partum period:

3.Alternating take care of newborn during the day and the night.4.After work, feed other children (one snack and dinner).

Step 3:

Negotiate “trial” practices (3 men per each practice)

Note: Negotiation done at group level

Step 3

Step 4:

Follow up home visits to gather information on experience with trial practice: results, response, reactions

Step 4: Results, response, reactions

Step 4: Gather results

During pregnancy:

3.Collect firewood and water.• 76% (practiced at least 4 times)

4.Support wife with household work. • 100% (practiced at least 4 times)

5.Go with wife during ANC visits and ask questions.• 66% (practiced at least during 3 ANC visits)

Step 4: Gather results (continued)

During childbirth and delivery:

3.Find someone to take care of the house while he goes with wife to HU for delivery.

• 80% practiced

4.Assist wife to go to maternity house 2 weeks before delivery.• 50% practiced

5.Go with wife to HU and stay in room during labor and delivery.• 40% practiced

6.Agree with wife to stay at the maternity waiting home seven days post partum.

• 75% practiced

During post-partum period:

3.Alternating with wife taking care of the newborn during the day and the night.

• 71% practiced at least 4 times

4.After work, feed other children (one snack and dinner).

• 98% practiced at least 4 times

Step 4: Gather results (continued)

Step 5: Recommendations for the program

3.Changes in recommended practices are feasible.

5.It will be possible to overcome resistance encountered.

7.It is critical to involve the Ministry of Health personnel in support of recommended practices that involve Health Units / Hospitals.

Step 5

Thank you!