by Dr. Pankaj Varma and Dr Neha Sareen
The recently published 5th National Family Health Survey (NFHS-5, 2019-21) shows substantial improvement in indicators from NFHS-4 (2015-16), such as antenatal service attendance and iron-folic acid consumption among pregnant women. It also shows an uptick in early initiation of breastfeeding, exclusive breastfeeding and complementary feeding. However, despite improvement in indicators, malnutrition among women and children is still a massive public health concern in India. As per the NFHS-5, 52.2% pregnant women in India are anaemic. Whereas, among children under five years, 35.5% are stunted, 19.3% wasted, 32.1% underweight, and 67.1% are anaemic. This constitutes a substantial proportion of the total population. So, despite improvement in adoption of better practices, where are we going wrong?
The low participation of men in mother and child health and nutritional practices is one of key factors that limits the eradication of maternal and infant mortality. In India, nutrition interventions focus largely on women as an entry point to push for positive health outcomes. By default, men have been left out of the planning, designing, and implementation of health and nutrition programmes because women and child healthcare is traditionally considered a female domain.
There is evidence to show that to improve maternal and child nutrition indicators, health structures need to attend to and support men because they play a critical role in providing instrumental and emotional support to mothers and children. The World Health Organization has already recommended the same. However, this is yet to be implemented in the Indian context. Currently, men are only involved in family planning programmes. There is a need to involve men in mother and child health and nutrition programmes as well, with clear policy directives.
Factors affecting participation of men
Various factors discourage men from playing an active role in the reproductive, maternal, neonatal, child health and nutrition space. Sociocultural factors like stereotyping, competing priorities, and the feminization of reproductive health are some of the critical barriers threatening effective male involvement. These, coupled with stigma and peer pressure, may hinder even the most well-meaning programs targeting men. Men participating in maternal and child health and nutrition fear being viewed as ‘weak’ and it is uncommon for them to take their children to the hospital unless the mother is unwell. Most of them also do not accompany their partners to family planning, antenatal and postnatal consultations or even during labour or delivery.
In additions, the low educational status, inadequate knowledge, lack of interest, ignorance and feigned unavailability that make it difficult for women to be supported by their male partners. Furthermore, economic factors such as inadequate financial resources to meet healthcare needs and transportation costs to access facilities also affect male involvement. Other institutional factors at the community- and facility-level such as inadequate government initiative on raising community awareness on the importance of male participation in health and nutrition programmes, feminization of programmes and poor attitudes of healthcare providers also prove to be a roadblock.
Why do men need to get involved?
Interventions that involve men have shown a positive association with maternal and child health and nutrition outcomes, especially those related to the utilization of services, discouragement of unhealthy practices, and reducing workload during pregnancy, among others.
Studies have shown that the involvement of male members facilitates the engagement with health providers and, therefore, presents an opportunity to access health and nutrition services and counselling, including learning about the importance of maternal nutrition, initiation of breastfeeding and complementary feeding, and counselling about obstetric danger signs. Being familiar with this information enables men to make effective health decisions for their spouses and children.
Men’s involvement in parenting is also associated with healthy birth outcomes, decreasing maternal mortality and positive cognitive, developmental and socio-behavioral outcomes among children. Studies have also demonstrated that when men get involved as an active caregiver, it also improves their physical and mental health.
Involving men in health and nutrition programmes
To overcome these roadblocks, broader gender transformative programs are needed at the community level that integrate increased sensitization and promote gender equality by involving men. Integration and collaborative mechanisms are essential to enable relevant ministries, departments and stakeholders to work towards encouraging men in health and nutrition programmes. This, ultimately, could contribute to achieving the national health goals as well as the Sustainable Development Goals 3, targets 1 and 2.
Engaging men in health and nutrition programmes can be done through a variety of approaches that combine efforts at the individual, community, institutional, and policy levels. Such as, behavioural change and communication strategies tailored for men with low educational levels that touch upon changing their knowledge, attitude, and behavioural practices. This could be done through sensitization campaigns, community-based awareness programs, involving influential male leaders in the community such as religious heads, male champions and teachers, and social gatherings. This would help effectively address misconceptions, change perceptions, and eventually encourage men’s participation. There is also a need to promote higher education among men from socio-economically disadvantaged background and integrating gender equity topics in school curriculum to foster positive attitudes from a young age.
Furthermore, healthcare providers, including outreach workers, should be provided specialized training to support the additional involvement of men. Policy implementation could include salaried male community health volunteers promoting the importance of men’s engagement in maternal and child health and nutrition outcomes. Programmes could also experiment by giving men a small stipend for attending community meetings and antenatal and postnatal visits. This may motivate them to participate, and the stipend could be used for transport costs.
Such approaches could drastically improve health and nutrition outcomes for the entire family, greater cohesion within the household, and a visible challenge to gender stereotypes and norms in the community.
Dr. Pankaj Varma, Vice President and Dr Neha Sareen, Nutrition Scientist at Vitamin Angels India.
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person / organisation directly or indirectly.)