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Constructive Male Engagement in
Family Planning in Madagascar
Ashley Jackson, Technical Advisor
Population Services International (PSI)
Laura Hurley, Senior Program Manager
IntraHealth International
Global Health Mini-U
March 2, 2015
Overview
page 2
Madagascar
Context
– FP in Madagascar
– Top Réseau
– ISM Project
Gender assessment
Male engagement approach
Activity demonstration
Lessons learned
29% MCPR among
married women
– 23% among all WRA
19% unmet need among
married women
– 10% for spacing
– 9% for limiting
– 15% among all WRA
– 27% among age 15-19
Context: FP in Madagascar
page 3
23% of births are less than 2
years after a prior birth
33% of women (25-49) gave
birth before age 18
– 29% of 17-year-olds had given
birth or were pregnant
Context: FP in Madagascar
page 4
Nationwide network of 254 private health
clinics
– Started by PSI in 2000
– 67% urban
Services:
– RH, STI, FP
• Including LARC methods
– Child survival, fever
Top Réseau social franchise
page 5
USAID funded project from 2013-2017
– PSI, IntraHealth, and 4 other partners
Focus on social marketing and franchising for
FP/RH, Child survival, malaria, and nutrition
Demand creation by IPC agents, peer
educators, and CHW
Quality assurance is key project objective –
gender integration is one aspect of QA
Integrated Social Marketing (ISM) Project
page 6
Objective: Identify gender-based constraints and
opportunities that affect men’s and women’s health
risks and capacity to seek appropriate quality care
Methodology
– Literature review
– 26 key informant interviews (MOH, NGOs, donors)
– 12 focus group discussions with 93 people:
• Women and men (married & unmarried, younger & older)
• Providers and Community Health Workers
Gender assessment led by IntraHealth (2013)
page 7
Barriers to contraceptive use: Male opposition to
family planning was second only to side effects,
and was raised in every focus group
– Misconceptions about what methods are appropriate for
young people (only condoms and counting days)
– Myths that hormonal methods would lead to infertility,
reduced sex drive, and health problems
– Married men felt that there were no family planning
programs or information for them
Gender assessment findings
page 8
All focus groups brought up that
many women hide
contraceptive use from their
partners
Men’s motivations to support
contraceptive use:
– “Life is hard.” – Married rural
man
– “You can fulfill your dreams.”
– Unmarried urban man
Gender assessment findings
page 9
68% of women think their partner
supports modern FP use
– 50% of women think that their
husbands would accept their
partner using an IUD
The most significant determinants
associated with the use of FP
among youth (age 15-24) were
social support from friends and
from partner
page 10
Quantitative data from PSI/Madagascar
Gender synchronized
approach
– Target men and women
alike with messages and
services
Communication channels
– Radio serial drama
– Peer education
– Couples’ counseling
page 11
Program design to constructively engage men
Healthy Images of Manhood (HIM) approach
page 12
Demo: Act Like a Man/Act Like a Woman
page 13
“When the PSI peer
educators invited me to
attend the session, I
laughed because I told
him that I can’t get
pregnant. But after the
session I realized that
my future is also at stake
and that if I really care
about my partner I
should help her to realize
her dreams too.”
Meet Romelle, age 23
page 14
Increase in number of young male FP clients
page 15
Keys to success:
– Separate peer education sessions for girls/women
and boys/men
– Involvement of providers in communication activities
– Training follow-up and supervision
Lessons learned
PAGE 16
Evaluation planning
underway
Thank you
PAGE 17
