A multi-sectoral approach to male A multi-sectoral approach to male involvement in family planning and involvement in family planning and

reproductive health focusing on optimal reproductive health focusing on optimal birth spacingbirth spacing

American Public Health Association 133rd Annual MeetingPhiladelphia, Pennsylvania 2005

Manal Eid, B.A., M.A.

Session Objectives:Session Objectives:

Present TAHSEEN’s approaches for Present TAHSEEN’s approaches for engaging men in FP/RH issues, with engaging men in FP/RH issues, with specific emphasis on OBSIspecific emphasis on OBSI

Share results of the interventions Share results of the interventions promoting male involvement in FP/RHpromoting male involvement in FP/RH

TAHSEEN Integrated ModelTAHSEEN Integrated Model

Improving quality of care

Community mobilizationContributing to

long-term sustainability

TAHSEEN’s Rationale for TAHSEEN’s Rationale for Involving Men in FP/RHInvolving Men in FP/RH

Decision makers and opinion leadersDecision makers and opinion leaders Working with men: Working with men:

Impacts not only men themselves, but Impacts not only men themselves, but also the entire family, and communityalso the entire family, and community

Changes deeply-rooted beliefs and normsChanges deeply-rooted beliefs and norms Peer-to-peer effectPeer-to-peer effect

How does TAHSEEN Involve How does TAHSEEN Involve Men in FP/RHMen in FP/RH

AdvocacyAdvocacy for male involvement in for male involvement in FP/RH issuesFP/RH issues

TrainingTraining on gender and rights, on gender and rights, medical aspects of FP/RH issues, medical aspects of FP/RH issues, couple communicationcouple communication

Community MobilizationCommunity Mobilization through through outreach programs, plays, puppet outreach programs, plays, puppet shows, seminars, IPC…etc.shows, seminars, IPC…etc.

What is OBSI?What is OBSI?

Optimal Birth Spacing Interval (OBSI) is the Optimal Birth Spacing Interval (OBSI) is the ideal time period between birthsideal time period between births

Evidence to date suggests that a 3-5 year Evidence to date suggests that a 3-5 year interval between consecutive births is being interval between consecutive births is being associated with the most favorable associated with the most favorable outcomes for pregnancies, infants, children outcomes for pregnancies, infants, children and mothers and mothers

((Rutstein 2003, Agudelo 2002, Population Report 2002)Rutstein 2003, Agudelo 2002, Population Report 2002)

TAHSEEN’s Male Involvement TAHSEEN’s Male Involvement ModelsModels

Religious leadersReligious leaders Literacy facilitatorsLiteracy facilitators Agricultural/irrigation Agricultural/irrigation

extension workersextension workers Peer educatorsPeer educators Community leadersCommunity leaders Mothakaf sokany (population outreach Mothakaf sokany (population outreach

workers)workers) Media professionalsMedia professionals Transportation workersTransportation workers

Involving Religious Leaders – Involving Religious Leaders – Why?Why?

Considered to be Considered to be “the soul of the “the soul of the village and trustworthy ”village and trustworthy ”

Reach a large proportion of the Reach a large proportion of the population through their weekly population through their weekly sermonssermons

Opinion and attitude shapers Opinion and attitude shapers

Improvement of Religious Leaders' OBSI Improvement of Religious Leaders' OBSI Knowledge Knowledge

Beni Suef, Fayoum and Minia GovernoratesBeni Suef, Fayoum and Minia Governorates

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Beni Suef Fayoum Minia

Pre

Post

Involving Literacy Facilitators – Involving Literacy Facilitators – Why?Why?

36.4% of Egyptian males are 36.4% of Egyptian males are illiterate*illiterate*

Egypt has a strong national literacy Egypt has a strong national literacy program program

Illiterate men have never been Illiterate men have never been reached with FP/RH messagesreached with FP/RH messages

*UNDP HDR *UNDP HDR 20032003

OBSI Knowledge for Literacy OBSI Knowledge for Literacy StudentsStudents

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

%

OBSI (3-5 years) OBSI is beneficial tomother's health

OBSI is beneficial tofetal health

OBSI knowledge improvement of literacy students

Before intervention

After intervention

Involving Agricultural Extension Involving Agricultural Extension Workers (AEW) –Workers (AEW) – Why? Why?

57.9% of Egypt’s population is rural*57.9% of Egypt’s population is rural* AEW reach approximately 40,000 AEW reach approximately 40,000

farmers/monthfarmers/month Existing strong and widespread Existing strong and widespread

outreach program for farmersoutreach program for farmers AEW have direct personal AEW have direct personal

communication linkages with farmers communication linkages with farmers *UNDP 2002 POSAR*UNDP 2002 POSAR

OBSI Knowledge of FarmersOBSI Knowledge of Farmers

27

96

0

20

40

60

80

100

OBSI

prepost

)N=1000(

1,991

2,759

0

500

1000

1500

2000

2500

3000

2004 Q1 2005 Q1

39% Increase

Source: Five Prototype Clinics in Mina Governorate

FP Method UsersFP Method Users

Impact on practice

0

20

40

60

80

100

All Women Young Women of Low Parity

before

after

Improved couple communicationImproved couple communication

Source: Household Survey in Minia, Fayoum and Beni Suef, July 2005

all women n=1000, low-parity women (n=pre 214 and post 266)

Women discussing FP with their husbands

Lessons LearnedLessons Learned

Government/policy support is crucial Government/policy support is crucial

Building on already existing strong networks Building on already existing strong networks within local communities increased the program’s within local communities increased the program’s successsuccess

Comprehensive integrated approach vs. single Comprehensive integrated approach vs. single interventionintervention

Skilled male facilitators are criticalSkilled male facilitators are critical

Focus on gender relations is crucialFocus on gender relations is crucial

ChallengesChallenges

SustainabilitySustainability

Developing partnership and trust with Developing partnership and trust with male championsmale champions

Developing a cadre of skilled Developing a cadre of skilled intermediariesintermediaries

ConclusionConclusion

Adopting a multi-sectoral approach to Adopting a multi-sectoral approach to involving men and providing them with involving men and providing them with the same messages builds the the same messages builds the supportive environment that is needed supportive environment that is needed to improve the RH knowledge and to improve the RH knowledge and practice of the community at large. practice of the community at large.

Thank youThank you