Support parents as a team and pay specific attention to relationships and gender (Rwanda, Ghana)

Two new contributions to the debate about engaging fathers this month highlight the importance of addressing relationships. They back up earlier proposals flowing from research in Ghana.

The role of relationships in producing improved maternal and newborn health outcomes

A review of 13 studies, carried out by a team of researchers who work closely with the World Health Organisation, conclude that relationships are a key factor leading to improved health outcomes. (Tokhi et al, 2018) They propose a model showing the mediating role of relationships.

A positive couple relationship helps to improve support for the mother both within health services and at home, and this leads to improved care and better health outcomes.

fathers gender

The benefit of addressing gender issues specifically (Rwanda)

Another report this month on a 15-session programme in Rwanda proves the effectiveness of engaging with mother-father relationships and specifically including gender considerations. (Doyle et al, 2018) In a controlled trial of 1200 families – half in a control group and half experiencing the programme – radical improvements were seen in gender equal behaviour:

Control group  Programme group

Reports of physical violence by mothers       57%                   33%

Reports of sexual violence by mothers          60%                   35%

Hours/day in house work reported                 1.4 hours          2.25 hours

Contraceptive use reported                              61%                   70%

Man has final say in financial decisions         79%                   56%

Average number of prenatal visits                  3.1                     3.2

Also both mothers and fathers reported less use of physical force with their children.

The programme addresses couple communication and decision-making, gender issues, caregiving, child development, and fathers’ roles in reproductive and maternal health. Eight of the sessions were for fathers only, and the others were for couples.

Earlier research on relationships and gender (Ghana)

An earlier study from rural Ghana in 2014, quoted in Tokhi et al 2018, explores how gender shapes caring in families. (Dumbaugh et al, 2014) It comes to the same conclusion as the later studies discussed above.

The authors note that if and when women and men wish to change gender roles around caring, they face barriers: cultural norms and institutional practices in maternal and newborn health.

The barriers to paternal engagement include:

  • Lack of information for fathers so they remain uninformed about what they can do.
  • A cultural definition of different roles women and men: motherhood is natural, whilst fatherhood is a duty and social responsibility; decisions about caring made by women only, except when money is needed and then decision-making transfers to men; the exclusive role of men to work and provide; lack of engagement of fathers in maternal and newborn healthcare settings. These definitions of roles are widely backed by both women and men, by older generations of women in families and by health services.
  • The risk of ridicule from both women and men for fathers seen to be close to their babies.

The researchers advocate that gender norms should explicitly be addressed in the context of couple relationships: “encourage men and women to view each other as equal partners in health and relationships”. The authors talk of “mutual empowerment for mothers and fathers”. “Empowerment” for fathers in this context needs to be understand as the freedom to be a loving, competent and confident carer of a child, building a life-affirming and life-long relationship with the child.


Doyle K, Levtov RG, Barker G, Bastian GG, Bingenheimer JB, Kazimbaya S, Nzabonimpa A, Pulerwitz J. Sayinzoga F, Sharma V & Shattuck D (2018), Gender-transformative Bandebereho couples’ intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial, PLoS ONE

Dumbaugh M, Tawiah-Agyemang C, Manu A, ten Asbroek GHA, Kirkwood B & Hill Z (2014), Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis, BMC Pregnancy and Childbirth 14

Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M & Luchters S (2018), Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions, PLoS ONE 13.1

Photos: Adam Cohn. Creative Commons.