Paternal Involvement in India
Today, Indian fathers only minimally participate in the health of the mothers and children in their lives. At the same time, healthy nutritional practices and interventions are key factors to eradicate maternal and infant mortality. In the article below, Drs. Pankaj Varma and Neha Sareen describe how engaging men in health and nutrition programs can play a positive role, employing a variety of approaches that combine efforts at the individual, community, institutional, and policy level.
There’s a mixed report on maternal health out of India. More Indian mothers are breastfeeding their babies either some of the time or exclusively, and many are also taking advantage of a range of services after their babies are born. Those are among the hopeful facts in the newly published National Family Health Survey, covering 2019–2021. The survey shows substantial improvement since the previous report was published in 2016.
Despite these improvements, malnutrition among women and children is still a massive public health concern across the country. More than half of pregnant women in India (52.2 percent) are anemic. Among children under five, more than a third (35.5 percent) are stunted; nearly a fifth (19.3 percent) are wasted (acutely malnourished); nearly a third (32.1 percent) are underweight; and more than two thirds (67.1 percent) are anemic. These statistics reflect a substantial proportion of the total population. Despite implementing better practices, where are we going wrong?
One factor is how few fathers are participating in mother and child health. And, nutritional practices are a significant factor making it difficult to eradicate maternal and infant mortality. In India, nutrition interventions focus largely on women as an entry point to encourage positive health outcomes. By default, men are left out of the planning, designing, and implementing of health and nutrition programs.
Women’s and children’s healthcare is traditionally considered a female domain. To improve maternal and child nutrition, evidence shows, health structures need to engage and support men. Why? Because men play a critical role in providing physical and emotional support to mothers and children, a belief the World Health Organization has long endorsed. Nevertheless, fully engaging men has yet to be implemented in India. Currently, men are only involved in family planning programs. There is now a pressing need to also involve them in mother and child health and nutrition programs.
The “feminization” of reproductive health
Various factors discourage men from playing an active role in mothers’ reproductive, maternal, neonatal, child health and nutrition. Sociocultural factors like stereotyping, competing priorities, and the “feminization of reproductive health” are among the barriers fathers and men face. These factors, coupled with stigma and peer pressure, may hinder even the most well-meaning programs aimed at engaging men. Many men who participate in maternal and child health and nutrition fear they will be viewed as “weak.” Additionally, it is uncommon for men to take their children to the hospital unless the mother is ill. Most men do not accompany their partners to family planning meetings and, antenatal and postnatal consultations or even during labor or delivery.
The reasons are both real and fake, including men’s low educational status, inadequate knowledge about pregnancy, birth, and child-raising, lack of interest, ignorance, and feigned unavailability. All make it more difficult for women to be supported by their male partners. Economic and other factors affect male involvement, including inadequate financial resources to provide for healthcare needs, and transportation costs to access facilities. Other institutional factors at the community and facility level also act as a roadblock, including: inadequate government initiatives to raise community awareness about the importance of male participation in health and nutrition programs, “feminizing” programs, and poor attitudes about healthcare providers.
Why do men need to get involved?
Involving men in maternal and child health and nutrition programs can have a positive effect, especially programs that utilize services that discourage unhealthy practices and reduce their workload during pregnancy.
Studies have shown that involving men facilitates their engagement with health providers and, therefore, presents an opportunity to access health and nutrition services and counseling, including learning about the importance of maternal nutrition, breastfeeding and complementary feeding, and counseling about obstetric danger signs. Being familiar with this information empowers men to make effective health decisions with their spouses and for their children.
Fathers’ involvement in parenting is also associated with healthy birth outcomes, decreased maternal mortality, and positive cognitive, developmental and sociobehavioral outcomes among children. Studies have also demonstrated that when men get involved as active caregivers, that involvement also improves their physical and mental health.
Involving men in health and nutrition programs
Essential to healthy maternal and child outcomes is engaging men in health and nutrition programs. They might include a variety of approaches that combine individual, community, institutional, and policy initiatives, as well as behavioral change and communication strategies tailored for men with only minimal education, adding to their knowledge base, and changing their attitudes and behaviors.
Reaching these goals could be achieved through sensitization campaigns, community-based awareness programs, involving influential male leaders in the community, i.e. religious heads, male champions and teachers, and at social gatherings. All would help to effectively address misconceptions, change perceptions, and eventually encourage men’s participation. There is also a need to promote higher education among men from socioeconomically disadvantaged backgrounds, and integrate gender equity into the school curriculum to foster positive attitudes among males, beginning at a young age.
Furthermore, healthcare providers—including outreach workers—should be specially trained to ensure more men become involved. To achieve that goal, male community health volunteers should be paid to promote men’s engagement in maternal and child health and nutrition. Programs could also experiment by giving men a small stipend to attend community meetings and antenatal and postnatal visits. This may motivate them to participate, and the stipend could be used to offset transportation costs. All of these approaches could drastically improve health and nutrition outcomes for the entire family, foster greater cohesion within the household, and serve as a visible challenge to gender stereotypes and norms in the community.
Dr. Pankaj Varma is vice president and Dr. Neha Sareen is a nutrition scientist at India’s Vitamin Angels, whose mission is to help at risk populations, especially those who are pregnant, new birth parents, and children under five.
A version of this article first appeared in ET HealthLine, a part of Economic Times. https://health.economictimes.indiatimes.com/news/industry/nutrition-equity-cannot-come-without-gender-equity-engaging-men-in-interventions/94165827