Improving women’s health by addressing gender roles
Around the world, women are often the ones who bear the responsibility of childcare and household chores. This reality is often present in the communities where we work because of traditional gender roles and deep-rooted gender norms. Men and women in these communities do not consider it the husband’s responsibility to be informed about or take an active role in the health of their wife or children.
Explore this six-part multimedia series by scrolling through the content below to learn more about how this gender transformative* Gender transformative projects have an explicit rights-based intention to transform unequal gender power relations which are often at the heart of many disadvantages faced by women and girls; the focus goes beyond improving the condition of women and girls to improve their social position. Gender transformative projects address the root causes of gender inequality and promote the value of women and girls health project is helping entire communities champion women and adolescent girls’ health while moving the needle on gender equality.
We decide together
Plan International and its partners are improving health for vulnerable women, adolescent girls and children in five countries by tackling gender inequality, a root cause of maternal and child deaths.
When Saadya Hamdani travelled to eastern Ghana as SHOW was being developed, she met a 27-year old woman named Joyce, pregnant with her third child. Saadya, the Director of Gender Equality at Plan International Canada, asked Joyce about the nearest health facility, which was fairly new and in good repair. She’ll never forget her reply:
“Joyce told me you could build the best health facility in the world five minutes from my house, but if my husband won’t let me go, it won’t help me.”
Saadya uses this example to help explain the gender transformative approach embedded across SHOW that seeks to address gender power relationships and the root causes of gender inequality.
“A challenge is that the SHOW countries are strictly patriarchal,” says Ms Hamdani. “Men are the money-holders and the decision-makers. They tend to see anything regarding childbirth and child-rearing as women’s work.”
Women, especially in these poorer, vulnerable communities are confined in their gender role and responsibilities. They don’t have time, money, access to resources, or power over their own decisions and lives.
“before, My husband wouldn’t assist at all. He wouldn’t even pour a drink of water by himself,” a Bangladeshi woman told us in a group discussion.
Women reported working from dawn to night, sweeping and cleaning the house, preparing breakfast, washing clothes, grinding spices, caring for the children, preparing cooking fires, preparing more food, and cleaning again before bed - with no help from their husbands or sons.
“A man can wake up in the morning and not care about his children - whether they got up or not, if the child went to school or not - he was not concerned. Once he’d dropped money for food in the morning, whether it is enough or not, he doesn’t care he just goes out,” said Shafa’atu, a 25-year old woman from Sokoto State in Nigeria.
Yet evidence*, Swan, Doyle & Broers, IJBPE, vol 7, issue 1Promoting men’s engagement as equitable, non-violent fathers and caregivers in children’s early lives: Programmatic reflections and recommendations shows that when men are more engaged in family life including his partner’s pregnancy, pregnant women, mothers and children are healthier.
Engaging men in more equitable relationships is not an easy task. Men need to be motivated to change entrenched attitudes and behaviours.
We know that men can be active agents of change during the whole process From pregnancy, to birth, to helping with the children and work around the house.
Theodora Quaye
Plan International Ghana
We knew attitudes to gender roles could not change overnight. “These are gender norms that extend back for generations, and cannot be changed with a session or two of training,” says Saadya Hamdani.
She says the way men were traditionally “engaged” in health programming had to change.
Male Engagement:
the active participation of men in protecting and promoting the health and well-being of their partners and children and as active partners and beneficiaries of gender equality.
“By and large, the model has been to involve men by educating them with information on health and then telling them to do things - ‘take your wife for ante-natal care,’ ‘get your child vaccinated,’ or to ask religious leaders to ‘use your platform to spread messages,” says Ms Hamdani. “While important, this ‘help-out’ approach doesn’t create any long-term change in gender relations. The goal is for men to play a central, equal, caring role in family life.”
So, Plan Internationall and its partners, including Promundo, developed deeper ways for men to discuss traditional male roles. They invited husbands, partners, fathers and brothers to ask questions, to explore what it meant to be men, to get to the heart of why they would be interested in better health and gender equality in their families and communities.
“Men can think ‘well I’m not relevant here,’ or ‘I’m a bringer of harm,’ explains Gary Barker, the CEO of Promundo. “But we have seen from around the world men can very quickly change their attitudes and behaviours, once they are motivated and see the benefits of gender equality.”
The idea is to show that men can be partners and beneficiaries from pregnancy, through childbirth and fatherhood.
Fathers clubs
One major SHOW project activity was innovative “Fathers Clubs” – a place where men could gather regularly over several months and work through a set curriculum with a trained local facilitator.
There were challenges. Men took a risk by attending these groups. Some were chastised by their community – called the equivalent of ‘sissies’, or even questioned by their mothers & sisters who worried their community would think they were pushing them to do something they didn’t want to do.
“My wife is not from the village, and people thought that this woman from the outside was turning me into something else,” says Theophilus, a Ghanain father living in Volta.
What’s a Fathers Club?
“Fathers Clubs” had different names in SHOW countries, but the overall approach and principles are the same.
In Ghana, they’re called “Daddies Clubs.” Men who have children or expected to be fathers joined groups of about 15 others. The groups became ‘safe spaces’ where men could reflect, learn and share experiences and test out gender equitable behaviours.
A locally trained male leader walks the men through a reflective journey of change with twenty hour-long interactive sessions. They use role play, group discussions, and debates. Each week, the men had homework. Topics include gender roles and responsibilities - looking at the hours spent on care work in the home, how to support a pregnant partner, healthy relationships including joint decision-making, equitable sharing of resources in the family, gender-based violence and children’s futures.
The materials developed by SHOW for Fathers Clubs contain messages and pictorials so that people with all levels of literacy can benefit equally. The facilitation method is practical and interactive.
“Ecoles des Maris” or “School for Husbands” were an inspiration for Fathers Clubs. These began in Niger with support from UNFPA, with the aim of encouraging men to support their spouse's health needs during pregnancy and childbirth. The Schools are led by 'model' husbands, and they gather with other men and the local health worker to talk about ways to support and improve women's health. Based on Niger's success, Senegal had adopted two pilot “Ecoles des Maris.” The SHOW project helped to expand these to nine together with support from Promundo and ongoing support from UNFPA, and integrated the more reflective discussion style on positive masculinity into the training materials.
On the path to change
Our research* See links to reports in the 'learn more' section below pointed to change in male attitudes and perceptions, behaviours, and in the perceptions of how supportive behaviours impacted family life.
One way to measure change was in men’s knowledge of two or more strategies to address dangers signs at each stage of the continuum of care (during pregnancy, labour, delivery, and postnatally). In Nigeria, for example, only 4% of men could list two or more ways to address danger signs compared to 78% at endline. There was also promising results seen in Nigeria around men’s perceptions around women’s decision making in the household and community. 35% of men believed women should participate in decision making at household and community levels at the baseline survey, which increased to 59% at endline.
Support includes accompanying their partners to a health facility, arranging transport, providing opportunities for rest at home, helping with household chores, caring for the children and supporting breastfeeding. Support also includes talking with their partners and deciding together on issues like birth spacing and the number of children desired.
In Ghana, Haiti, Nigeria and Bangladesh, qualitative data gathered through focus groups and interviews with Fathers Club member and their families points to positive changes in members' support for their spouses.
One adolescent girl in Haiti told us that her father had become more helpful. “Before, my father spent all his time in the streets in domino games,” she says, “but since his participation in the Fathers Clubs, he started working in the garden to help mom meet our needs.”
In Nigeria, people surveyed told us that men had become more engaged with the family's health including with maternal health. One man in Dagawa in Sokoto says he now takes pride in caring for his wife. “Even going to hospital, if she is to see doctor I usually accompany her myself. I want people in the community to learn from me.”
At first, our men don't consult women in decision making, but now we are witnessing a tremendous change.
Community leader, Ghana
And even more than sharing chores, women and adolescents reported changes in the family itself.
In Five countries we trained a total of
1,098Men
As fathers club facilitators
They in turn formed
1,041Fathers clubs
Involving a total of
15,105Men
Formerly, I didn't support my wife in household chores like cooking, washing, sweeping, cleaning and bathing the children.
but with the help of SHOW, i know now that it is a collective responsibility and I support her.
Father in Adaklu, Ghana
Akhimoni, a teenage girl in Nilphamari district in Bangladesh, says her father was arranging a marriage for her when she was twelve. Around the same time, he started to participate in Fathers Club.
After discussing the links between domestic violence and child marriage, he called off the wedding. Akhimoni reports that their relationship has grown closer. Her father walks her to school, and encourages her to practice football with other girls in the village. Akhimoni says she sees a future as the first woman police officer in her community.
Men find that if they take it seriously, their relationships change. The man looks at their child in a new way. When the child lights up and smiles at the man, he becomes hooked. A relationship is formed. This becomes self-reinforcing within the family.
Gary Barker
CEO, Promundo
Women in different SHOW countries said that with more help from men at home, they felt “more relaxed,” “less worried” and “free and able to move around.”
Women also reported more inclusion in decisions. “Now we sit and discuss and agree on what to do collectively and the men are happy about that too because of the way we advise them,” one woman told us.
THERE WERE SIGNS OF A REDUCTION IN VIOLENCE, PARTICULARLY IN ARGUMENTS.
“My father has been changed a lot, he was a very ill-tempered before but now is patient and calm,” said one adolescent boy.
“I now show affection to my family,” one man from Leklebi Kame in Ghana told us.
Fathers said they felt better around the home – more appreciated and respected. Their adolescent children said they felt more supported – with fathers spending more time with them.
Now he has learned to be at home and spend time with his family.
a 42 year-old woman in Akrobortornu Afadzato South, Ghana
Saadya Hamdani says the positive feedback from women, men and adolescents underscores how improvements to gender equality can outlast the project. “This can be sustained because men, women and their children feel the benefits."
I feel proud for my husband. now he is very caring to me and our newborn. He gives me money to go to the health centre. My father-in-law also supports me to do household work.
Jesmin
Bangladesh
there is love in the family.
Changemakers
SHOW worked beyond the household and included community influencers – “changemakers” such as religious and traditional leaders.
For example, in Sokoto State in northern Nigeria, Islamic leaders play a critical role in people’s daily lives. They’re role models, gatekeepers of social values, community beliefs and behaviours – a vital and often conservative influence running through society.
If you don’t involve these respected leaders, you can’t possibly create any enduring change.
Dr. aaliya Bibi
Senior Health Advisor Plan International Canada
In Sokoto, SHOW partners worked with religious and traditional leaders to create “The Islamic Perspectives on MNCH.” It’s a manual that provides evidence on how SHOW’s messages about gender equality in women’s, children’s and reproductive health are compatible with Islam.
“We worked together with religious scholars to use passages from the holy Quran that emphasise gender equality between men and women and the need to support women through the continuum of care and child spacing,” says Dr. Bibi.
Religious and traditional leaders then met to endorse the manual – and together with senior government leaders, health leaders, partners and media, launched it – underscoring its legitimacy and authority. It was translated into Hausa, the local language, and distributed widely in the State.
Religious leaders now use the messages to talk about women and children’s health and gender equality with their community.
I use the manual to advise and convince my followers and other religious leaders on topics that are seemingly difficult to understand – such as child spacing and the importance of women delivering in hospital.
Religious Leader
Sokoto State, Nigeria
These messages are also used in sermons, local ceremonies and on radio and TV shows. As leaders told Plan International, linking these health messages with the Quran and Hadith showed that these messages were true.
My followers now know that it is a religious obligation to support women’s decision-making in the home and girls’ empowerment because the Quran says so.
Religious Leader
Sokoto State, Nigeria
recognition for the Work
In 2019, CanWACH recognized Dr. Aaliya Bibi for her efforts, together with the SHOW Nigeria team, “to demystify barriers to family planning in Nigeria.” This was for the work with religious leaders to develop explanations for maternal health and family planning based on Islamic teachings in the holy Quran that the community would accept and understand. Dr. Bibi received the Leadership award for demonstrating “exceptional leadership abilities that have motivated, inspired or resulted in action on a national or global scale.”
In addition, our efforts to strengthen integrated gender transformative programming was also recognized when Jenn Donville (then Senior Gender Equality Advisor at Plan International Canada) received the CanWACH Award for Canadian Excellence in Gender Equality.
“I’m so glad that our work, our passion, and our clarity in communication came through,” says Dr. Bibi. “We aimed for show messages to take inspiration from religious prescriptions to change practices.”
Read the NEXT story in this series about how the SHOW project engaged Canadians, and BACK to go to the full series!
Click the links below To read more about show’s experience with fathers clubs and engaging men for gender equality.
- State of the World's Fathers: Unlocking the Power of Men's Care (2019)
- Engaging Religious Leaders in Reducing Maternal and Child Mortality,
- Strengthening Health Outcomes for Women and Children (SHOW): Final Evaluation Report
- Engaging Missing Populations in Gender-Transformative Programs
- Role of Facilitation in Gender-Transformative Programs that Engage Men and Boys
- Recruitment and Retention of Male Participants in Gender-Transformative Programs
Reports from Fathers Club Study Findings “Engaging Men in the MNCH/SRHR Continuum of Care”
Join our mailing list to receive updates
By signing up you agree to receive our emails.