The World Health Organisation has declared the involvement of men in maternal and newborn health (MNH) as a priority.

It is one of 8 “strong recommendations” in a list of 12 in its just-published WHO recommendations on health promotion interventions for maternal and newborn health. It recommends further research into a family approach, looking also at other key family relationships around the mother and baby.

The recommendation

“Interventions to promote the involvement of men during pregnancy, childbirth and after birth are recommended to facilitate and support improved self-care of women, improved home care practices for women and newborns, improved use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns, and increase the timely use of facility care for obstetric and newborn complications.”

To date, different programmes for engaging men have had different aims, including these.

• Improving prompt access by women to MNH services (men can be gatekeepers and decision-makers)
• Addressing gender inequalities
• Supporting men’s positive involvement as partners and fathers.

Methods have included mass media campaigns, community and workplace engagement (men only as well as jointly with women), home visits and counselling services.

The report recommends a combination of individual engagement with fathers to transfer knowledge and programmes to shift social norms in the community.

In relation to shifting social norms, it recommends a focus on young men and women.

“The importance of male involvement as a support to women making their decisions should be introduced with young men and women to build social changes and consciousness towards gender equality in younger generations.”

The research base

The research review, conducted at the Burnet Institute in Australia, examined 13 studies from Bangladesh, Eritrea, India, Indonesia, Nepal, Pakistan, South Africa, Tanzania and Turkey. [At the time of writing this post, the published WHO report contains an error and the research review for this section is missing.]

Risks

The recommendations highlight the concerns about engaging with men, for example the possibility of their undermining women’s autonomy, rights and decision-making. The panel that produced the WHO report debated this at some length and decided that the benefits and risks balance each other. The key is to ensure that implementation is high-quality and addresses gender equality and egalitarian decision-making between couples. The report sets out a number of key principles underlying good implementation.

10 recommendations for implementation

1. Don’t reduce women’s autonomy.
2. Focus on positive roles that men can plan as partners and fathers in a gender egalitarian way.
3. Ensure women’s safety and confidentiality in view of the fact that intimate partner violence might be present.
4. Train health providers and staff to promote egalitarian decision-making in families and to promote respects for the rights and autonomy of women.
5. Design services in relation to the values and preferences of local women – do reseach and discuss with women.
6. Obtain women’s autonomous consent to the inclusion of men in antenatal care, childbirth and after the birth before the men are invited to attend.
7. Recognise family diversity – the father of the baby may not be present.
8. Make health facilities male friendly and able to engage with men. Make is possible for men to accompany those women who want him there.
9. Monitor implementation carefully, involving women in the process.
10. Link approach to wider programmes to promote gender equality and women’s autonomy to make decisions about their own health.

Further research

The quality of research on which the recommendation is based is classified in the report as “very low”, with major variability.

The report recommends filling research gaps.

• Measure the effect of including men and women together in MNH, and also other key decision-makers in the home (not just fathers).
• Examine the values and preferences of women and men relating to changes in men’s roles.
• Examine the impact of male involvement on family relationships, including those involving grandparents.
• Measure the cost of providing male-friendly health facilities.
• Examine the impact of male involvement on how communities set priorities and allocate resources.
• Integrate lessons from other sectors, such as work with men and boys on gender equality and sexual and reproductive health support.

Next steps

WHO is setting up a steering committee to develop a new guideline, Caring for the newborn and child in the community. They will develop a complementary publication to the existing Essential interventions, commodities and guidelines for reproductive, maternal, newborn and child health, which currently does not include any reference to family inclusive care.