By Duncan Fisher, The Family Initiative, following a visit to Eritrea in June 2018
Last year the Health Ministry of Eritrea drew up a “Strategic plan for the implementation of reproductive, maternal, newborn, child, adolescent health, nutrition and healthy aging programs in Eritrea, 2017-2021.”
It presents the most systematic and comprehensive approach to engaging with men in maternal and child health that I have ever seen in any policy. What Eritrea is planning is way ahead of the global game.
The plan includes a full set of actions for male engagement, including, most unusually, measurement, so that success and failure can be detected.
- A full assessment of all opportunities to increase male engagement.
- A national policy framework.
- Guidelines and tools for practice.
- Advocacy programmes.
- Service directly supporting male engagement.
- Information for households on the role of men.
- Full monitoring and evaluation of male engagement.
- Partnerships with all stakeholders, including men in communities
To achieve a male engagement programme as ambitious as that proposed by Eritrea will require the country forging a path that no other government yet has. Other governments and international programmes have shown great interest in male engagement, but the art of going beyond pilots to mainstream the approach, including monitoring and measurement, has not been achieved.
The problem internationally is that, whilst everyone agrees that engaging men is a ‘good thing’, the barriers to implementation have not yet been analysed or tackled. The finger is often pointed at local cultures and the behaviour of men themselves. But those who have worked over the years with fathers know very well: if a service cannot engage fathers, the problem is the service. Blaming the ‘customer’ achieves nothing.
There are two key barriers internationally. The first is the “dyadic perspective” on child health and development. This is a belief that all that really matters is the mother and baby. As far as most maternal health and child development services are concerned, men are icing on the cake, and in most countries in the world, there are not enough resources to allow for any icing on any cake. Meanwhile, patriarchal societies strongly emphasise a division of roles, allocating caring to women only, the flip side of allocating the power to men. Men who get too involved in caring for children are often ridiculed in patriarchal societies, by both men and women.
The dyadic perspective is at odds with many years of research showing that what really matters for the health and wellbeing of children is the “community of care” around the child – otherwise known as the “village”. When this community of care is engaged with effectively, then health and wellbeing outcomes improve markedly. Men are not the icing on the cake; they are an essential ingredient of the cake.
The second global barrier is the “deficit perspective”. This is a belief that, when it comes to family responsibilities, men are a problem to be fixed. This leads to the idea that only expensive professionally led expert “interventions” can possibly turn these men round. But these interventions never turn out to be financially viable, even if proven to be effective at pilot phase. Also, this perspective overlooks the most important agent of change in any country: the men who already actively care for their children, often in the face of considerable cultural resistance. The global rise of active fatherhood did not come about because of government backed interventions. It came about through men and women taking a lead by themselves and sharing with each other their experiences and aspirations about caring for their children. These fathers are present in every country in the world and are the key to change. I have not seen a single piece of research in developing countries that examines this resource.
To make progress, therefore, Eritrea will need to rely on its own ability to forge a new path.
Eritrea is uniquely placed to do just this, having developed a powerful philosophy of “self-reliance”. The Eritreans are the masters of the do-it-yourself approach, forged through half a century of history that have shown them that self-reliance is the only option when it proves impossible to rely on anyone. A succession of governments and international governmental organisations that have engaged in Eritrea in that period have betrayed it, with the most terrible loss of life and livelihoods for the Eritrean people.
The Italian colonial period culminated with a fascist regime of extreme racism, apartheid and abuse. This was swept away by the British during the Second World War, desperately in need of assets left behind by the Italians for its war effort. The British did establish secondary education and political institutions, but then the international community imposed a lop-sided federal structure on Ethiopia and Eritrea, guaranteeing that if it were undermined in any way, the UN would act to protect it. When this was systematically and brutally undermined by the Ethiopians, with US backing and later backing from the Soviets and other foreign powers, the UN did nothing. A war of liberation with Ethiopia was the only option, which, after decades, Eritrea won, against all the odds. The most recent international UN backed agreement was reached in 2002, defining an internationally agreed border between Eritrea and Ethiopia, but history repeated itself. The Ethiopians refused to accept the deal, having given assurances they would, and the world stood by and did nothing.
All this has just this year entered a new chapter as a result of a unilateral change of heart on the part of the Ethiopians. Accepting the 2002 international agreement unconditionally, despite no international pressure on them to do so, peace has at last come, and with it, incredible hopes for Eritrea’s future.
I believe Eritrea could be a perfect place to do something that no other nation has achieved: to mainstream male engagement in family services, to go beyond talking and beyond pilot projects. The Ministry of Health has already made a bold first step, with an exceptionally articulated strategy, and so is already leading the way.
It is true that traditional cultures in Eritrea restrict the role of men in caring, severely dividing roles between women and men. But this is not an insuperable challenge. During the wars of liberation, Eritrean women fought alongside men as equals. This has challenged the status quo fundamentally. When I was last in Eritrea earlier this year, discussing this agenda with women at the Ministry of Health, there was a depth of passion about gender equality that shone through. They know that this means a change in the role of men in families.
In pursuing a radical male engagement strategy, Eritrea can access state-of-the-art expertise from non-governmental organisations that have pioneered working with men and fathers around the world. There is a wealth of experience, understanding, commitment and inspiration outside the traditional international development networks for Eritrea to connect with if it decides to take a lead.
I await with great anticipation to see what the next move of the Eritrean Ministry of Health is, as it stands at the start of a new chapter in the country’s history.
Photo 1: Author’s own.
Photo 2: Andrea Moroni. Creative Commons.