Frontiers in Reproductive Health Program Population Council (FRONTIERS)

This 72-page report shares strategies and data gleaned from a research project called Men in Maternity (MiM) that investigated the feasibility, acceptability and cost of a model that encouraged husbands' participation in their wives' antenatal and postpartum care. Observing that, in India, men are often the primary decisionmakers regarding women's health care but are insufficiently informed about women's health, FRONTIERS, Taylor Nelson Sofres Mode Pvt. Ltd. (MODE), and the Employees' State Insurance Corporation (ESIC) collaborated to strengthen health practitioners' counselling skills as a strategy for fostering men's involvement with their partners' maternal care. This paper examines the impact of this strategy on health outcomes in 3 ESIC clinics in New Delhi, India. In brief, the intervention during prenatal consultations was found to improve knowledge about pregnancy and family planning, as well as to increase couples' discussion and use of contraception.

Specifically, the initiative began by providing face-to-face training to 12 auxiliary nurse-midwives (ANMs) and 12 doctors; skills in offering couple and individual counselling were strengthened. Then, at the 3 experimental clinics (3 additional clinics served as controls), a total of 2,836 consenting women and 1,897 of their husbands received couple, individual, or same-sex group counselling on pregnancy care and danger signs, family planning, postpartum infant care, breastfeeding and lactational amenorrhoea method (LAM), the symptoms and prevention of sexually transmitted infections (STIs), and correct condom use. They also received antenatal testing and, if necessary, treatment for syphilis. Couples were seen during the pregnancy and at 6 weeks postpartum. At control clinics, pregnant women received standard care but very little counselling.

The MiM study used a non-equivalent control group study design to examine the effects of the intervention. Interviews were conducted with pregnant women and their husbands, pre- and post-intervention. Selected findings include:

• Husbands were significantly more likely to attend the informational consultations at experimental clinics than at control clinics (28% versus 13%, respectively). "Attendance of men with their wives at antenatal and postpartum clinics increased dramatically as soon as the intervention encouraged husband's participation and syphilis screening of the majority of pregnant women became a routine activity."
• Couples in the experimental sites reported more communication on family planning than control couples (84% versus 64%, respectively) and more joint decision-making on the issue (91% versus 71%).
• Family planning use increased significantly at intervention sites compared to control sites. Use of family planning by women 6 months postpartum was 14 percentage points higher in the intervention sites as compared to the control sites. The corresponding figure for men was 17 percentage points greater. Condoms were the most frequently used method. The proportion of men and women who intended to use a method in the future was also higher in the experimental sites.
• Knowledge of STIs did not increase significantly after the intervention. In general more men than women knew about STIs (66% versus 32%).
• Significantly more men and women in the intervention group than the control group knew that condoms provide dual protection from STIs and pregnancy. Yet gender-based disparities continue: twice as many men than women knew of dual protection (89% versus 48%).
• Providers were satisfied with the strategy and expressed interest in its continuation. A fundamental change mentioned was the way they now approach clients and communicate with them. Providers reported that husbands were interested in participating in the new services. All the intervention group clients who received couple counselling reported that they were satisfied with the maternity care services.

The authors provide context for these findings by explaining that "Providers spent between five and 10 minutes per group in same-sex groups and also with individual couples, counseling them about the key messages of MiM. They were able to add this to their existing work routine without an appreciable increase in clinic time made possible through training and use of appropriate job aids and BCC [behaviour change communication] materials." However, they stress that "There were some interventions that were not so easily introduced and accepted within the existing services. One of these was the six-week postnatal checkup of mother and baby and couple counseling within the existing immunization clinics."

In conclusion, the authors note that "The high levels of acceptance of the importance of male involvement and men and women's almost universal interest in husband's involvement in antenatal and postnatal care suggest that with few exceptions the intervention can contribute to improvements in reproductive health and greater couple communication in other service delivery settings in India." Based on the demand for male involvement and the intervention's positive impact and reasonable cost, ESIC planned to expand the intervention to 10 clinics in 2003-04 and to its 34 clinics and 5 hospitals in Delhi by 2005. The authors note that "Efforts to implement and scale up interventions should build on existing infrastructure and elicit the participation and support of managers."