Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions

Background: Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes. Objective: To determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships. Methods: Using a comprehensive, highly sensitive mapping of maternal health intervention studies conducted in low- and middle-income countries between 2000 and 2012, we identified interventions that have engaged men to improve maternal and newborn health. Primary outcomes were care-seeking for essential services, mortality and morbidity, and home care practices. Secondary outcomes relating to couple relationships were extracted from included studies. Results: Thirteen studies from nine countries were included. Interventions to engage men were associated with improved antenatal care attendance, skilled birth attendance, facility birth, postpartum care, birth and complications preparedness and maternal nutrition. The impact of interventions on mortality, morbidity and breastfeeding was less clear. Included interventions improved male partner support for women and increased couple communication and joint decision-making, with ambiguous effects on women\u27s autonomy. Conclusion: Interventions to engage men in maternal and newborn health can increase care-seeking, improve home care practices, and support more equitable couple communication and decision-making for maternal and newborn health. These findings support engaging men as a health promotion strategy, although evidence gaps remain around effects on mortality and morbidity. Findings also indicate that interventions to increase male involvement should be carefully designed and implemented to mitigate potential harmful effects on couple relationship dynamics

Challenging gender inequity through male involvement in maternal and newborn health: critical assessment of an emerging evidence base

Men\u27s involvement in the health of women and children is considered an important avenue for addressing gender influences on maternal and newborn health. The impact of male involvement around the time of childbirth on maternal and newborn health outcomes was examined as one part of a systematic review of maternal health intervention studies published between 2000 and 2012. Of 33,888 articles screened, 13 eligible studies relating to male involvement were identified. The interventions documented in these studies comprise an emerging evidence base for male involvement in maternal and newborn health. We conducted a secondary qualitative analysis of the 13 studies, reviewing content that had been systematically extracted. A critical assessment of this extracted content finds important gaps in the evidence base, which are likely to limit how ‘male involvement’ is understood and implemented in maternal and newborn health policy, programmes and research. Collectively, the studies point to the need for an evidence base that includes studies that clearly articulate and document the gender-transformative potential of involving men. This broader evidence base could support the use of male involvement as a strategy to improve both health and gender equity outcomes

Expectant fathers’ participation in antenatal care services in Papua New Guinea: a qualitative inquiry

Background: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG. Methods: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across four provinces of PNG. Fourteen key informant interviews were also conducted with health workers. Qualitative data generated were analysed thematically. Results: While some men accompany their pregnant partners to the antenatal clinic and wait outside, very few men participate in antenatal consultations. Factors supporting fathers’ participation in antenatal consultations included feelings of shared responsibility for the unborn child, concern for the mother’s or baby’s health, the child being a first child, friendly health workers, and male health workers. Sociocultural norms and taboos were the most significant barrier to fathers’ participation in antenatal care, contributing to men feeling ashamed or embarrassed to attend clinic with their partner. Other barriers to men’s participation included fear of HIV or sexually transmitted infection testing, lack of separate waiting spaces for men, rude treatment by health workers, and being in a polygamous relationship. Building community awareness of the benefits of fathers participating in maternal and child health service, inviting fathers to attend antenatal care if their pregnant partner would like them to, and ensuring clinic spaces and staff are welcoming to men were strategies suggested for increasing fathers’ participation in antenatal care. Conclusion: This study identified significant sociocultural and health service barriers to expectant fathers’ participation in antenatal care in PNG. Our findings highlight the need to address these barriers – through health staff training and support, changes to health facility layout and community awareness raising – so that couples in PNG can access the benefits of men’s participation in antenatal care

Male involvement interventions and improved couples’ emotional relationships in Tanzania and Zimbabwe: ‘When we are walking together, I feel happy’

Male involvement in maternal and child health is recognised as a valuable strategy to improve care-seeking and uptake of optimal home care practices for women and children in low- and middle-income settings. However, the specific mechanisms by which involving men can lead to observed behaviour change are not well substantiated. A qualitative study conducted to explore men’s and women’s experiences of male involvement interventions in Tanzania and Zimbabwe found that, for some women and men, the interventions had fostered more loving partner relationships. Both male and female participants identified these changes as profoundly meaningful and highly valued. Our findings illustrate key pathways by which male involvement interventions were able to improve couples’ emotional relationships. Findings also indicate that these positive impacts on couple relationships can motivate and support men’s behaviour change, to improve care-seeking and home care practices. Men’s and women’s subjective experiences of partner relationships following male involvement interventions have not been well documented to date. Findings highlight the importance of increased love, happiness and emotional intimacy in couple relationships – both as a wellbeing outcome valued by men and women, and as a contributor to the effectiveness of male involvement interventions

Engaging women and men in the gender-synchronised, community-based Mbereko+Men intervention to improve maternal mental health and perinatal care-seeking in Manicaland, Zimbabwe: A cluster-randomised controlled pragmatic trial

Background Maternal mental morbidity and low perinatal health service utilisation in resource-constrained settings contribute substantially to the global burden of poor maternal, newborn, and child health. The community-based Mbereko+Men program in rural Zimbabwe engaged women and men in complementary activities to improve men’s support for women and babies, coparents’ equitable, informed health decision-making, and ultimately, maternal mental health and care-seeking for maternal and newborn health services. The study aimed to test the effectiveness of the Mbereko+Men program on maternal mental health at 0-6 months after childbirth. Methods We conducted a cluster-randomised controlled pragmatic trial using a two-arm parallel design with four clusters per arm. Data was data collected through cross-sectional surveys before and after the implementation of the intervention or standard care. Rural health facility catchments in Mutasa District, Zimbabwe, were randomised using a true random number sequence. Survey participants were women who had given birth within 0-6 months and their male coparents. The primary outcome was women’s mean Edinburgh Postnatal Depression Scale (EPDS) score. Secondary outcomes captured care-seeking, men’s supportive behaviours, and gender dynamics in coparent relationships. Masking was not used. All clusters were included in the analysis. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001014943) in October 2020. Results Between April 13 and May 20, 2016, 457 women and 242 men participated in the pre-intervention survey; between October 19 and November 30, 2017, 433 women and 273 men participated in the post-intervention survey. Women’s mean EPDS scores declined in both arms. The decline was 34% greater in the intervention arm (adjusted risk ratio = 0.66; 95% confidence interval = 0.48, 0.90, P = 0.008). Improvements in care-seeking, men’s support, and coparents’ relationships were detected. Conclusions A low-intensity gender-synchronised intervention engaged women and men to improve maternal mental health and care-seeking in a setting characterised by gender inequality and demand-side barriers to care

Addressing Child Undernutrition: Evidence Review

This evidence review provides an overview of current evidence-based approaches to addressing child undernutrition and how they may apply to the Australian aid program. Part I provides an up-to-date overview of the evidence for the ‘proximal’ (direct) and ‘distal’ (indirect) risk factors for child undernutrition, and the effectiveness of tested ‘nutrition-specific’ (direct) and ‘nutrition-sensitive’ (indirect) interventions to reduce child undernutrition. Evidence on the cost-effectiveness of these interventions is also included. These terms are explained in the ‘Explanation of technical terms’ and further elaborated later in this report. Part II provides an overview of contemporary policy thinking and approaches to addressing childhood undernutrition by development partners, including multilateral organisations, global frameworks and alliances, bilateral donors, and developing country governments. Reference is also made to contemporary nutrition research and programming work by non-government organisations. Part III summarises data on child nutrition indicators in countries relevant to the Australian aid program. Indicators have been selected to capture type I and type II undernutrition, low birthweight, and the proximal and distal risk factors for child undernutrition. Data for countries most relevant to the Australian aid program are interpreted in supplementary text. Data on overweight and obesity in children are not readily available for most countries of interest to the Australian aid program; however, a global and regional overview is provided

A Window of Opportunity: Australian Aid and Child Undernutrition

Undernutrition in young children is a key development challenge. In low- and middle-income countries, undernutrition is associated with between one third and half of child deaths. The Australian Government’s 2014 development policy identifies early childhood nutrition as ‘a critical driver of better development outcomes’. International evidence shows that investments to reduce child undernutrition are cost-effective and protect other investments in health, education and private sector development. Providing the right nutritional support to children aged less than 5 years, and particularly those aged less than 2 years, is pivotal for a healthy life. This includes ensuring adequate protein and energy for growth, and micronutrients to prevent conditions such as anaemia. Children can suffer acute and/or chronic undernutrition. Wasting (thinness), often seen during famines, reflects acute undernutrition and significantly increases a child’s risk of death. Stunting (shortness) reflects chronic undernutrition and is associated with reduced capacity to resist disease, suboptimal cognitive development and poor school performance. Childhood stunting is associated with lower earnings and poor health in adulthood. The first 1000 days of a child’s life between conception and the age of 2 years is considered to be a ‘window of opportunity’, as stunting prior to the age of 2 years is largely irreversible. Maternal undernutrition, leading to poor growth in utero, may initiate stunting. In 2013, a quarter of children aged less than 5 years worldwide were stunted. Half of these children were in Asia and over one third in Africa. Undernutrition is also a significant development problem in priority regions for Australian aid. In Pacific countries with small populations, the number of stunted children is low compared to other regions, but the proportion of stunted children is amongst the highest in the world and there has been little improvement since the 1990s. In Southeast Asia, the proportion of children stunted is also high, especially in Cambodia, Laos and Timor-Leste. Undernutrition is caused by factors operating at the level of the individual (immediate causes), household (underlying causes) and society (basic causes). Nutrition-specific interventions, such as micronutrient supplementation and emergency food assistance, address the immediate causes of undernutrition, such as inadequate food intake and disease. Nutrition-sensitive interventions, such as crop breeding, health professional training, girls’ education and sanitation behaviour change, address the underlying causes of undernutrition, such as food insecurity, inadequate care, low status of women and intestinal worms. Nutrition-governance interventions, such as laws, policies and the promotion of economic growth, operate at the societal level to address the basic causes of undernutrition, such as weak governance and poverty. The evaluation aimed to answer three questions: 1. How does Australian aid policy and programming address child undernutrition? 2. To what extent does this approach align with the principles of good practice? 3. What opportunities exist to improve how Australian aid addresses child undernutrition? Four analyses were used for the evaluation: (1) a review of the international literature on undernutrition prevalence, the effectiveness of interventions and donor policies; (2) a financial analysis of Australia’s nutrition expenditure; (3) a document review to assess a sample of initiatives against the principles of best practice; and (4) a series of case studies to examine four initiatives in Pakistan and Timor-Leste in greater depth

PRISMA flow diagram.

<p>PRISMA flow diagram.</p