Intervention Studies on Youth Reproductive Health in India: Findings about Men's Involvement

Collaborators tested various communication-based interventions in an effort to understand men's involvement in young women's RH - as well as men's own needs. The activities and strategies used interpersonal, face-to-face channels in an effort to stimulate dialogue between partners, motivate men and women to take active roles in their own and their partners' RH, and change RH-seeking behaviour for better overall health. The various roles that gender plays in RH - and strategies for cultivating a sensitivity to that role - figured prominently in this research. The approach involved finding ways to increase the participation of each of those actors who exercise influence over adolescent girls lives, such as male partners and fathers, so that they became supportive allies of the girls.

Among the research findings:

Fathers are compelling advocates for skills their daughters' need to ensure quality of life after marriage

• In Maharashtra, IHMP conducts an intensive one-year life skills course for unmarried, out-of-school adolescent girls (10-18 years of age) that is designed to improve their self-esteem and literacy, and to delay marriage. IHMP worked closely with their fathers and mothers in designing the course, conducting monthly meetings to discuss the girls' progress. IHMP found that both fathers and mothers welcomed the programme and participated fully. However, whereas mothers left the details of curriculum development to the "experts" among IHMP's staff, "[f]athers forcefully appealed for life skills modules they felt their daughters would need in married life, such as a working knowledge of child upbringing, home management, money management, and agriculture, as well as sexual and reproductive health..." Fathers supported the inclusion of a comprehensive sexuality module, but requested that it be reserved for older girls. Fathers also suggested acceptable venues for the course within the villages, the duration and timing of the course, as well as the profile of the teachers. Finally, 70 percent of fathers kept track of the progress of the course by asking daughters what they were learning from their life skills classes. It was apparent throughout the course that fathers held their daughters’ interests at heart, even though they would be leaving their parental homes for marital homes in the next few years.

Popular figures in the local community can generate interest among unmarried, adolescent boys

• To engage adolescent boys in the Naglamachi slum (Delhi), Swaasthya employed a popular male teacher from the community to conduct group information, education, and communication (IEC) sessions specifically for boys. This well-liked teacher drew the interest of the boys and the sessions were well attended. However, male participation in the programme proved hard to sustain when the teacher left the programme and could not be replaced. When Swaasthya sought outreach workers to lead the sessions, it found that boys were not comfortable with female outreach workers, and male outreach workers were rare due to low wages in such social-sector jobs.

Husbands are knowledgeable and feel responsible for their wives' maternal care, but they often do not participate in that care despite their interest

• Through interviews with 972 husbands in Ahmednagar district (Maharashtra), FRHS found that more than 75 percent are aware of their adolescent wives' need for antenatal care. Fewer knew about delivery and postnatal care, which is likely to be related to the local custom of the wife delivering away from the husband at her mother’s house, and staying at the natal home during the postnatal period. Although most husbands also feel responsible for, and indicate that they want to participate in, maternal care, only about half accompanied their wives for routine care. Sex and gender norms dissuading husbands from participating included: the belief that maternity is a 'woman's affair', decisions about maternal care were usually made by mothers-in-law or mothers, and the practice at health centres in which husbands are often made to wait outside while their wives receive care.

Community-level educators successfully engage men in RH when they adopt new approaches

• In an effort to reach young, married couples as couples in a rural part of Pune district (Maharashtra), KEM selected and trained 5 men and 6 women from the project villages to serve as volunteer community level educators (CLEs). CLEs worked as male-female pairs to lead RH education sessions, provide referrals to services, and conduct sexuality counseling sessions. In 3 cases, the CLE pairs were young, married couples themselves. This proved effective, as newly married husbands and wives felt more free to talk about sexual and RH concerns with someone they knew was in a similar situation. It was also more acceptable within the community for a married couple - the CLEs - to talk about RH matters. The study measured couple dialogue on RH issues by determining whether information was presumably passed on from a spouse who attended a session to the spouse who did not attend. It found that several topics yielded substantial increases in knowledge, including: limiting family size through vasectomies; medical advice an acceptable reason for an induced abortion; and female sex of the fetus not an acceptable reason for induced abortion. Wives’ knowledge also increased on: avoiding work during pregnancy; sexually transmitted diseases (STIs) detectable through signs and symptoms; and HIV and AIDS and other STIs avoidable with condoms. There was one important increase in husbands’ awareness: fewer men reported thinking that infertility problems emanated only from women. Another finding from the study was that men preferred a more didactic method of learning as compared to the dynamic, participatory methods (e.g., games and songs) found useful with women.

Embarrassment and shame prevent men from getting treatment for reproductive tract infections (RTIs).

• In Vellore district (Tamil Nadu), CMC is testing the effectiveness of two approaches to diagnose and treat RTIs among rural, young married women and their partners. Cure rates for women are compromised because male partners are not accessing treatment to the same degree, in spite of medications and referrals being made available to them. Six focus group discussions with 40 unmarried and married men aged 23-30 revealed that men know about and support prevention of and care for STIs and HIV/AIDS. However, they reported feeling shy, embarrassed, and ashamed to seek treatment for RTIs, which can be associated with having had extramarital sex or sex with a commercial sex worker. Qualitative data from the study suggest that husbands took a diagnosis more seriously and would be more willing to get treated if the woman’s infection was severe and if a medical professional directly encouraged him to do so. Also, though women were reluctant to give medicine for STIs to their husbands, most symptomatic women discussed their diagnosis with their partners and most reported that their husbands encouraged them to receive treatment.

Young men express concern about sexuality, while couples request information about fertility concerns

• In Ahmednagar (Maharashtra), FRHS formed male youth groups and community interactive health education sessions as social mobilisation components of its intervention to improve the RH of young married girls. The male youth groups, made up of males up to age 35, became active social mobilisers, voicing issues about their and their wives’ sexual and reproductive health. In health education sessions, youth groups chose topics by consensus, including HIV/AIDS transmission and prevention, STI signs and symptoms, sexual performance, infertility and family planning. Young men expressed anxiety about their sexuality and sexual performance, so sessions dealt at length with questions and misconceptions about erection, desire, impotence, size and shape of the penis, and effects of promiscuous sexual behaviour. Similar to male youth groups, in community health education sessions, 110 young couples requested more information on a concern of their own: infertility. In response, FRHS arranged for a sexuality counselor to talk with couples about their fertility concerns. Qualitative data from 79 couples suggests that women were most often blamed for a couples’ infertility and could suffer social consequences as a result, including: taunting; not being invited to important social occasions; not accepted into marital families and communities as a legitimate wife; disapproval in the form of extra work, denial of food and violence; and attempts at a second marriage by the husband. Men also indicated experiencing anxiety about infertility, even if the social consequences for them are less severe. Despite both partners’ concerns, the study did not indicate that couples were discussing their infertility.

Gender, Youth, Reproductive Health, Men's Participation, Women.