Abstract

In many settings worldwide, within families men tend to be responsible for important choices relating to the allocation of household resources and care-seeking behaviour that directly impact on the health of women and newborns. In addition, men’s behaviour influences the reproductive health of both men and women and the health of their children. Despite this, most maternal and child health programs focus strongly on engaging and educating women and mothers, to the exclusion of men. Although there has been increasing recognition of the need to include men in maternal and child health services since the mid-1990s actual progress towards engaging men in maternal and child health has been slow in most developing country contexts. We undertook a review of peer-reviewed and grey literature in order to identify potential benefits, harms, challenges and strategies related to engaging men in services that improve maternal and newborn health in low-income settings. We included studies published in English between January 2000 and April 2012 that examined the effect of engaging men in interventions to increase the use of family planning or improve maternal and newborn health. Such interventions include those focused on increasing the coverage of antenatal, intrapartum or postnatal care; breastfeeding; or immunisation for young babies. Studies that examined challenges or barriers to engaging men or evaluated strategies for increasing male involvement were also included. We included a broad range of study designs such as randomised controlled trials, community controlled trials, cohort studies, repeat cross-sectional, and qualitative studies that examined challenges to engaging men.

A total of 78 studies were included in this review. Of these, 12 intervention studies or systematic reviews reported outcomes related to potential benefits of greater male involvement for maternal and newborn health, nine articles examined potential harms associated with male involvement, 21 discussed challenges and barriers to the involvement of men in maternal and newborn health services and 57 considered strategies for working with men for maternal and newborn health.

This review concludes that including men in services relevant to maternal and newborn health can contribute to improvements in health behaviours and utilisation of maternal and newborn health services. The evidence suggests that engaging men can yield benefits relating to the use of family planning and contraceptives in long-term couples, maternal workload during pregnancy, birth preparedness, postnatal care attendance, couple communication and emotional support for women during pregnancy. However, while it is plausible that greater male involvement could increase antenatal care attendance, facility-based delivery, childhood immunisation, and improve infant feeding practices, studies included in this review do not demonstrate such impacts.

Available program experience described in this review provides examples of potential harms associated with increasing male involvement in maternal and newborn health that should be carefully considered and minimised in efforts to engage men. In particular, various studies underscore the importance of carefully considering sensitivities regarding STI and HIV testing and whether women feel comfortable discussing intimate and important details of health during pregnancy in front of their male partner. We also find that in clinical settings, efforts to encourage male involvement must avoid unintentionally discouraging single or unaccompanied women from accessing services. Involving women in the design of male involvement strategies and pilot testing key messages will be critical to minimising the potential harms associated with male involvement while maximising the benefits. Evaluations of pilot male involvement programs and qualitative research into the social, cultural and health system factors that impact on male involvement in maternal and newborn health provide a good overview of challenges that will be faced in efforts to engage men in protecting and promoting their family’s health. Such challenges include traditional gender norms that dissuade men from taking an active role in caring for the health of their wife and baby or from attending female dominated clinics. Further impediments to men’s engagement with maternal and newborn health include: negative community perceptions towards men playing an active role in caring for their family’s health, lack of knowledge regarding men’s role in maternal and newborn health, and health services that are not designed and implemented to facilitate male inclusion.

This review presents strategies that have proven effective in engaging men in maternal and newborn health in low-income settings. Community-based strategies for engaging men examined include peer education, community meetings, distribution of education materials, and one-on-one counselling sessions. This review also describes workplace-based initiatives, group education and mass media campaigns for involving men. We further describe a variety of initiatives that have proven effective in engaging men in clinical maternal and newborn health services, including written or verbal invitations from health workers encouraging men to attend with their pregnant partner, ensuring that clinic facilities and staff are welcoming to men and address men’s own health needs, and adjustments to the timing of clinics to enable working men to attend. Program evaluations suggest that including men for the benefit of maternal and child health can be simple, welcome, relatively inexpensive and implemented in a variety of settings. This review further suggests that male involvement interventions are more likely to be successful if they seek to address men’s own health concerns as well as maternal and newborn health and if they address gender-inequalities that lead to poor health outcomes.

Finally, while this review highlights the need for more rigorous research into the impact of strategies for including men in maternal and newborn health, the need for further research and evaluation should not preclude action. Previous research provides a strong rationale for engaging men, while studies examined in this review provide evidence of benefits of male involvement on some maternal and newborn health indicators, and examples of effective strategies for including men that can be implemented and evaluated in new settings. Men have a right to the information and services they need to protect their own and their families' health.