Hiperplasia intimal

A closer examination of the evidence supports the conclusion, drawn from existing reviews, that there is some, though inconclusive evidence on the effect of male involvement on ANC

attendance, SBA/facility delivery, and PNC attendance.

Three 3-arm RCTs found limited benefits of male involvement on these outcomes. A CRCT in Pakistan found no differential effect on any MNH outcomes in the arm providing additional educational materials to men, compared to the arm involving women’s education only (Midhet and Becker, 2010). In Nepal, an RCT by Mullany, involving hospital-based education for expectant couples, showed no effect on ANC or SBA, but a positive effect on attendance at a PNC consultation within 2 weeks postpartum (Mullany et al., 2007). Another RCT, in Turkey, involving hospital-based education for women or for couples, showed no effect on PNC attendance, although this may have been due to low uptake of the intervention (Turan et al., 2001).

Less rigorous studies found more promising results. Male participation in group educational meetings (with a parallel programme for women) had a positive impact on ANC attendance and facility delivery in a pre-post comparison in Eritrea, though it is unclear whether educating men or women had a stronger effect (Turan et al., 2011). Two community-based outreach

interventions in rural India (the First Time Parents Project) and in Palestine (using the Time and Targeted Counselling approach), involving home visits and neighbourhood meetings, also reported increased ANC and PNC attendance, although the evaluations had methodological limitations (Santhya et al., 2008, Salim Al Rabadi, 2015). Increases in SBA were reported based on service data from the areas of Niger where the Ecole des maris project was implemented, which involved male discussion groups on maternal health (UNFPA). Finally, a pre-post comparison of a multi-media campaign in Indonesia (SUAMI Siaga – “alert husband”) found higher ANC attendance among exposed women (Sood et al., 2004). However, a workplace- based educational intervention for expectant fathers in Turkey found no effect on PNC attendance (Sahip and Turan, 2007).

Positive effects on men and/or women’s knowledge of danger signs and other MNH issues were shown in several studies (Adeleye and Okonkwo, 2016) (August et al., 2016) (Shefner-Rogers and Sood, 2004) (Turan et al., 2011) (Varkey et al., 2004). In a subsequent publication based on the Nepal trial, Mullany reported that women had higher knowledge in couple education arm (Mullany et al., 2009).

For this Subchapter, further detail on studies by Turan 2011, UNFPA, Shefner-Rogers, Sood, Adeleye can be found in Table 6. Further detail on all other cited studies can be found in Table 5.

56 Table 6: Male involvement intervention studies reporting on MNH outcomes only

Study Methods Participants Intervention Findings Risk of bias

1) Adeleye and Okonkwo, 2016 Pre-post comparison, no control

Nigeria, 122 men Single group education session for men (4-30 participants), combined with information materials (flyers and posters). Facilitator was a male public health physician.

3 months after the session, men had higher knowledge of pregnancy and delivery danger signs. No change in willingness to participate in making the local hospital better for maternal health. 2) August et

al, 2016

Controlled pre- post

comparison

Tanzania, one control and one intervention district. 1426 men at baseline and 1311 at endline, not necessarily the same participants.

4 educational visits to each family during pregnancy by CHW to provide Home Based Life Saving Skills training.

Difference in difference analysis: increases in men’s knowledge of 3 or more danger signs during each maternity phase (pregnancy, birth and postpartum), and in male accompaniment of spouses to ANC and for birth. No difference in facility birth increase.

3) Comrie- Thomson 2015 Qualitative evaluation: FGDs, key informant and in-depth interviews Bangladesh, Tanzania and Zimbabwe

MNCH programmes with male engagement components run by Plan Canada, including peer education and outreach, home visits, edutainment, and facility-based activities.

Beneficiaries and key informants reported increases in male engagement and MNCH outcomes, improved couple

communication and relationships, reduced maternal workload, improved nutrition and rest for pregnant women.

4) Sinha, 2008 Pre-post comparison using repeat cross-sectional surveys. No control

One district in rural India. Postpartum women (319 at baseline and 501 at endline, 18 months later)

Home visits to mobilise husbands and mothers in law, and group meetings for husbands held at least every 2 months. Discussions focused on how husbands could support their wives by doing housework, ensuring food, and preparing for birth. They were also informed about services, transport plans, domestic violence and alcoholism.

Comparisons were between baseline and endline surveys for women with one child. For women with more than one, additional comparison drawn between most recent and previous birth. Increases seen in own attendance to services, and in husband’s accompaniment to ANC, participation in housework, and emotional support.

Less than half of husbands attended the groups

70-75% response rate in endline survey

57 5) Shefner- Rogers and Sood, 2004b 1999: Post- intervention cross-sectional survey of men 2001-2004: Pre-post comparison Indonesia. 1999: household survey of 1507 men and 606 women. 2001-2004: baseline survey (2269

postpartum women and 741 men) and endline survey (1782

postpartum women and 583 men) in 6 districts, including control villages

Suami SIAGA= alert husband programme ran 1999-2000. Multi-media campaign, targeting husbands with messages about birth preparedness. Included radio drama, TV miniseries, brochures, stickers, T-shirts, hats, etc. Also, training of midwives and community leaders on safe motherhood and interpersonal communication skills for talking to couples about birth

preparedness. Mini-=grants also given to villages to develop transport systems.

1999: Controlling for background characteristics, 50% of men were exposed. 44% of all men said the

campaign had brought new knowledge on birth preparedness and health in

pregnancy. 30% reported taking action e.g. helping a woman experiencing complications, participating in community activities, or encouraging peers.

2001-2004: Exposed women and those in intervention villages had higher

knowledge at endline. Exposed more likely to attend 4+ ANC and have SBA. No difference in knowledge of danger signs. 6) Turan et al, 2011 Non- equivalent group controlled pre- post comparison 2 rural communities in Eritrea, one as control. Cross-sectional surveys, distinct samples of postpartum women, 466 at baseline and 378 at endline

Participatory group antenatal programme on safe motherhood for women (especially pregnant, but open to all), and separate groups for men. Weekly meetings led by trained male and female

volunteers. Training on interpersonal skills for local nurses.

2 years after implementation, in the intervention area, higher women’s knowledge of birth danger signs, attendance at 4 or more ANC visits, and facility delivery. No change in the control area.

Adjustments made for differences in socio- demographic characteristics between areas Only 25% of husbands participated 7) UNFPA Interrupted time series with service data

Niger 11 “Husbands’ schools/Eccles des maris” for married men. They meet twice monthly to discuss cases of maternal health problems and look for solutions. They can bring in a skilled professional for more information.

Service data showed doubling of facility deliveries. Anecdotal reported

improvements in husbands’ caring for their family’s health and better dialogue within couples

Detail lacking [summary programme report only]

58