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Constructive Male Engagement inFamily Planning in Madagascar
Ashley Jackson, Technical AdvisorPopulation Services International (PSI)
Laura Hurley, Senior Program ManagerIntraHealth International
Global Health Mini-UMarch 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
