Identifying the Concerns and Obstacles to Increase a Greater Participation of Men in Improving Women’s Reproductive Health: Experience from Rural Uttar Pradesh, India

Sampurna Singh, National Council of Applied Economic Research, India

Introduction: Traditionally, reproductive health matters are perceived as a women’s domain. Often men do not have access to reproductive health information or services and cannot participate in responsible reproductive decision making even if they want to. Issues of women’s health are embedded in the family and cultural context. If men are brought into a wide range of reproductive health services as equal partners and responsible parents, as well as clients in their own right, better health conditions will be observed among women as well as among men. Objectives: An attempt has been made in this study to (a) Understand the men’s knowledge and attitude towards reproductive health problems of women in general and spouse in particular (b) Involvement in treatment seeking for spouse reproductive health problems (c) Understand men’s concerns and barriers in greater involvement in women’s reproductive health problems. (d) Propose few suitable policy implications. Methodology: The finding of this study is a part of a major reproductive health study conducted in 10 villages in Uttar Pradesh, the most populous and one of the least developed state in India. The broad aim of the study was to identify the barriers in improving the reproductive health status of rural women. A total number of 600 women in the age group of 15-49 and an equal number of their husbands were covered to collect the necessary information on reproductive health. Stakeholders at different levels in the community were also interviewed. Both quantitative and qualitative techniques of data collection were used for the study. In addition to background characteristics, beliefs and attitude regarding various gynaecological and obstetric problems, duration and severity of these problems, perceived causes, contraceptive use, decision making and treatment seeking behaviour. Women are also asked about involvement of husbands during treatment seeking and during pregnancy, delivery and after childbirth. From men, information on membership of social or cultural organisations legal age of marriage of the men, knowledge regarding the conception of women, complications at the time of delivery, perceive causes contraception use, and duration were collected Eight FGD’s with six to eight women in each group were conducted to explore women's perception of men's role in reproductive health and their expectations from men in improving their health. Ten FGD’s were also conducted with men to know their perceptions of health care delivery system, their role in women's health especially with respect to issues of treatment seeking and contraception. An attempt has been made to identify men's concerns and obstacles in their involvement in the issues relating to women's morbidity and treatment seeking. Apart from FGD’s ten in depth interviews were also conducted for which six men and four women were selected from the village after the completion of the survey. This was done to obtain a clear picture of the decision-making dynamics of women for treatment seeking at the household level. The same was explored with respect to men’s attitudes and concerns towards women’s reproductive health. With the aim to study the barriers at community level to improve involvement of men in reproductive health problems 10 in-depth interviews were conducted with village headman (pradhan) and physicians from the primary health care centres. Findings: It is found that about 68.4 percent of the men interviewed were Hindu and 31.6 percent were Muslim by religion. About 27 percent belong to socially lower caste. Half of the interviewed men were found to be illiterate. 18 percent of the male were the member of some social, cultural or political organization. Agriculture is explored to be the main occupation. Age distribution of the respondent’s shows that a large proportion of men belong to the younger age group. Mean age at marriage for the male was found to be 18.8 years. Only 21.7 percent of the husbands responded correctly that a woman is most likely to become pregnant two weeks after her menstrual cycle. Around 38.5 percent of the males responded that they did not have an idea of the fertile period. About 41 percent of the husbands reported that stoppage of menstrual cycle is an initial condition associated with conception. 93 percent of husbands agreed that the number of children should be controlled. While the same proportion of men agreed that if a couple is careful unwanted pregnancy could be avoided. About 90 percent of the men also agreed with the statement that luck plays a big part in determining the pregnancy of the women. Little more than 95 percent of the men agreed that a wife would find it difficult to discuss with her husband the use of a family planning method; only 37 percent of the males disagreed with the statements. This may be the reason for the low use of contraception and especially male methods in the study population It is found from the qualitative study that men’s knowledge regarding reproductive health problems of women are very poor. Some of the participants pointed out that the commonly reported problems were abnormal discharge some times associated with fever, weakness, itching around the vagina, irregular periods (heavy/light flow), burning sensation during urination and abdominal pain. The source of information was from the fellow workers followed by wives. About pregnancy usually the information about the first few pregnancies were first obtained from the mothers followed by wives. It is expected that in a culturally closed society women are expected to report firstly to the mother-in-law than the husbands. Men’s Role towards the Health Seeking Behaviour In the present study, husbands were asked about the expenditure on medical care incurred during the last one year. Men prefer to spend money on children first, followed by elders, themselves and women. Selection of practitioners for treatment seeking also differs, women are asked to go to government health centers where the treatment is free of charge and the quality of care is generally poor. Men accompanying women to the health centers for treatment is not socially acceptable. Although many men like to take their wives to health centers when they fall sick, the fear of social reaction stops them to do so. Above all, women need to get the approval of her husbands and other family members to seek treatment for any health problems. Obstacles Faced by the Men An attempt was also made to find out the obstacles faced by men especially when they were concerned with the problems or wanted to help their wives. Some of the major issues that had come out during the in-depth interviews are (a) the fear of the society and the traditions are still prevalent in the rural setup are the main hurdle “Kun nahin, agar nahi rakhaiga to aurat chaar din na rukegi, per agar aurat mei kami hai to aadmi sahan kar leta hai aur ilaaj ke liya lejayega aur socha lengye ki mayke ya ghar gayee hai.”. (b) Even if we accompany her to the nearby government health centers we are not allowed to go inside with her to doctor, the paramedics say it is women’s problem you should not go inside with her. Another man of 27 years reported that when his wife was delivering the first child, she was afraid of the delivery. On the day of delivery he stayed at home, though he wanted to be with her but he said, “In the village it is a custom that usually elderly women of the house or of the village stay with woman at the time of delivery. In this set up males are not allowed to enter in a room where the delivery takes place”. Regarding sexually transmitted infections, most of the men refused to share it with their respective wives, because men may loose their masculine image in front of their wives. Therefore not sharing emerged as the better option. Women’s Perception And Expectation From Their Husbands Information on women’s perception of men’s role and their expectation from men in improving women’s condition, especially in the context of health, was also collected with the help of focus group discussion and in depth interview. On the basis of FGDs it can be said that usually women perceive that the household responsibilities should be equally shared. Women also expect that men should not think that women are for sex objects and machines for producing children. Need a better inter spousal communication in initiating sex, caring and listening to their problems particularly on health. While discussing the health related problems with their husbands. The usual reply was that the husbands give money and ask them to go to doctor. They hardly accompanied them because they had to go for their work. Stakeholder Response The in-depth interviews of stakeholders reveal that the attitude of physicians and paramedics in the government centers are traditional and need to be educated in involving men in women’s reproductive health. . Although the government of India policy clearly defines involving men in reproductive and child health issues, men are not involved in discussing issues relate contraception, immunization and maternal health. Because female health workers feel comfortable in talking these issues with women. The village head man clearly agrees that men should be involved in women’s health in general and reproductive health in particular, they cite the reasons of ignorance, poverty, customs and traditions. Conclusion The result of the present study however shows that husbands in the sample population know very little about the reproductive health. Concern about male involvement in women’s reproductive health is growing but there is no deliberate attempt from the government of India to effectively enforce the existing policies into actions The low level of knowledge among husbands about serious conditions that can arises during pregnancy and childbirth means that many women are unlikely to receive treatment for these conditions until it is too late. The discussion also shows that women expect care and cooperation from their partner in all stages of life. As they are not educated and have very little hold on their own life, they have no say in their family. While discussions on the obstacles faced by men in the process of helping their wives, they reported that traditional norms and values existing in the society were the main hindrance, which prevented them from helping their wives. A cwell designed educational programme to improve the knowledge and remove the traditional barriers are immediately needed The particular study is crucial to bring the gap closer to involve men into a wide range of reproductive health programme. That would result in better health outcomes in terms of unwanted pregnancy, safe motherhood, child health and survival and prevention of sexual transmitted infections. By fostering a good understanding of reproductive health issues, communication between spouses and the health status of women is likely to be enhanced. There is a willingness to participate in any initiative to improve the involvement of men in the women’s health. The lack of clear programme initiative from the government is responsible for lack of involvement. The attitude of the health care providers needs to be changed by training them in the new policy framework.