Involving men in women's health care

18 World Health • 51 st Year, No. l, Jonuory-Februory 1998 Involving men in women's health care Veronica Kaune & Guillermo Seoane In Bolivia, MotherCare is helping husbands to make the right decisions for safe motherhood. suffered complications produced some interesting findings . On the basis of the study, MotherCare Bolivia developed an information, education, communication and counselling strategy which aims to promote the male role in women's access to health care. A rural family in the Department of La Paz. The MotherCare information programme an pregnancy complications is specifically aimed of husbands. Photo Panos Picfures/M. Clayton © MotherCare, a nongovernmen-tal organization funded by the United States Agency for International Development, has been involved in identifying aspects of men's involvement in promoting safe motherhood. In Bolivia, a study of the role of the husband when his wife The MotherCare strategy in- volves encouraging husbands and partners to be supportive and to take advantage of the health service delivery system should the need arise. At the same time, it aims to empower women and other family members by helping them to recog- nize danger signs during pregnancy and to take the right decisions about necessary health care. The approach is based on the assumption that husbands, members of the extended family and health providers should listen to mothers and mothers-to-be and recognize their needs as part of the process of providing appropriate health care. Study findings In our study in La Paz, we found that if a pregnant woman had informed her husband that something was "going wrong", the husband or partner would take the decision about what should be done. He would decide whether she should consult a traditional healer or go to the hospital or clinic. However, the husbands openly admitted that they did not always recognize signs of danger in pregnancy. Mothers, other family members and health workers were often better at recognizing whether the problem was serious, what to do and where to go. Usually, the mothers themselves took the decisions during pregnancy and the postpartum period, including the decisions about care of the new- born. However, during the crucial periods of delivery and the immedi- ate postpartum period, there were three decision-makers: the husband or partner, the mother-in-law and the traditional birth attendant. In comparing study participants who lived in "high health service utilization communities" with those living in "low health service utiliza- tion communities" , an interesting incongruity was found. Husbands who live in communities where little use is made of the services decide what should be done but do not accompany their wives in seeking World Health • Sls!Yeor, No. 1, Jonuory-Februory 1998 help. In communities where the health service utilization is high, on the other hand, husbands share the decision-making role with their wives and with the traditional health system, and accompany their wives throughout the process. We asked participants to say why husbands were so closely involved in making the decisions, and why they believed that husbands should decide. They gave four reasons: Tradition. The husband traditionally has responsibility for assessing the health situation and for taking care of his wife. "The husband always decides; that is the custom. It is his obligation to take care of his wife and do the best for her." (Husband, 29 years old, New Horizons, Low Health Service Utilization, La Paz.) Knowledge. The husband is per- ceived to know more; he is the link between the community and the external world. "The husband knows where to go. He knows and has to take care of his wife; it is for her benefit." (Mother, 60 years old, Anda Marca, Low Health Service Utilization, La Paz). Resources. The husband is the one who decides about "extra expenses" . "The husband is the one who decides how to spend money. He supports the family ; he will decide where to go according to the amount of re- sources he has." (Husband, 28 years old, Villa Alemania, High Health Service Utilization, La Paz.) Love and concern. The husband decides because he is concerned; he loves his wife. He is the closest person to her emotionally. He makes the decision out of love to ensure that his wife will receive the best possible care. "The husband loves his wife and gets worried about her; sometimes, when he sees her suffer- ing, he calls the physician." (Community Health Worker, 34 years old, Sacaba, Melga, High Health Service Utilization, Cochabamba.) The strategy The strategy now in use reflects the findings of this study. It aims to improve the community 's recogni- tion of problems and decision- making about seeking help and access to health services. It also targets health providers. They are encouraged to adapt their practices to important community customs, and to improve interpersonal com- munication and counselling skills in the health services. A group of experts analysed the study findings. They compared the actual behaviour of the husband and the community with ideal or possible behaviour. On this basis, they formu- lated a central message for the hus- bands: "As soon as your pregnant wife informs you that she is not feeling well, take her to the institu- tional health service." Family in Cochabamba. The study showed that most husbands felt responsible for their wives and could be instrumental in making motherhood safe. Photo Panos Pictures/S Sprague © 19 The experts also thought that husbands needed to know about and recognize at least four major dan- gers: haemorrhage, breech presenta- tion, puerperal sepsis, and newborn respiratory infections. This brought us to the communi- cations component. It comprises educational materials in print and on the radio for the community and the health providers. One of the 10 items of print material is the Access Plan. Its purpose is to help the couple plan how to get to a health facility once a complication has arisen. In particu- lar it helps them find a means of transport. The radio campaign involves two types of broadcast: a radio soap opera and radio spots aimed specifi- cally at husbands. The soap opera is about the role of both the pregnant woman and the husband. At the beginning of the story the husband behaves according to what was found in the study. Little by little this changes as he begins to listen to his wife 's complaints, understand her needs and accompany her to the antenatal care visits. He also starts to attend health talks and helps to work out an emergency plan for getting to a health facility if complications arise. Based on real-life testimonies, the radio spots dramatize the impor- tance of making decisions quickly. They reveal what can happen when a husband takes too long to decide after a problem has arisen during pregnancy. They also show the trouble and anxiety caused if he does not have an emergency plan for getting to a health facility. Unplanned and delayed actions are compared unfavourably with the competence of a husband who im- mediately accompanies his wife to the health facility by a planned route. • Ms Veronica Kaune is Coordinator of the information, education, communication and counselling strategy, and Dr Guillermo Seoane is Proiect Director of MotherCare - Bolivia, PO Box No. 9288, La Paz, Bolivia.