The Dilemma of Men’s Participation in Reproductive and Family Health

This is taken from the Centre of Gender Equity and Health blog

Holly Shakya and Beniamino Cislaghi

Everywhere in the world, life is more difficult for women than men. The difference between men’s and women’s lives in low and mid-income countries (LMIC) is a source of concern for those working to achieve global justice. Women in LMIC often have limited abilities to make decisions regarding their jobs, their health (particularly their reproductive health), and their participation in public life. Why is it that?

Part of the answer can be found using social norms theory. Social norms are the informal rules of behavior that dictate what is acceptable within a given social context. Gender-related social norms are often deeply engrained within the cultural framework of a society and embedded in its institutions. They are taught, modeled and reinforced since children are very young. In strongly patriarchal societies, gender norms for women might include expectations of submissiveness, duty to family above duty to self, strong expectations of motherhood, strictly monitored sexual fidelity, limited mobility, and modesty in physical appearance and behavior. These expectations can also limit women’s access to resources and services. The result is often a disproportionate distribution of power, with men (some deliberately while others possibly unconsciously) enjoying greater decision making over personal and family life.

Given this unequal distribution of power, many practitioners wonder whether men should be part of international development programs that aim to improve women’s lives. So far, the trend has been, in general, towards working only with women partly because programmatic theories of behavior change often consider women as independent behavioral agents. Interventions to promote contraceptive use, for instance, often work only with women to help them overcome local structural and social barriers that limit their access to services and resources. Some of these interventions, however, resulted in generating more harm than help for women. That is because on some occasions, women were empowered to resist existing social expectations, but there no efforts made to change those expectations at the level of the social context in which those women lived. As a result, women would stand up for their rights, but the people around them, including husbands and in-laws, would not understand their arguments or would see them as a threat to their authority, responding with increased control and dominance. As awareness of this problem has increased, programmatic efforts have experimented with including men particularly in the discussions around family health.

This problem, however, leaves us with what seems to be an unsolvable dilemma. Do programs that target men in attempts to help women end up reinforcing or challenging the unequal status quo?  Do these programs, in other words, end up helping men and women live together more equitably, or do they increase the unequal distribution of power by including men? In some contexts, despite unequal gender norms, women still manage to make some decisions about their own bodies and their own health, as those decisions can be considered “women’s business”. Offering men more resources or decision making power might disempower women who were autonomously making decisions until their husbands were drawn into the process. On the other hand, recent empirical research has shown that when men are positively engaged in the process of pregnancy and childbirth, the women and babies are likely to have better health overall. Men who are present at birth and actively interact with newborns have elevated oxytocin levels, and lower levels of testosterone, which can help men forge stronger bonds with their children. Men’s engagement has also been found to be linked to their increased participation in childcare later on, an important factor to increase both women’s agency and men’s healthy relationships with their children and families.

To achieve positive men’s participation, however, takes more than talking to men to convince them of the need to be there for their wives. A man’s role in the family is not only shaped by what the man wants to do. He also needs to think about what his wife, family, friends, and neighbors expect from him. That is, for men to be actively engaged in women’s and children’s reproductive health, social expectations around men’s role in their context must also change. Encouraging men to help their pregnant wives with heavy housework is a worthy goal, but unlikely to succeed if the men who attempt those behaviors are ridiculed by other men in their social surroundings.  Similarly, men who may want to do more child care work in the family might be strongly chastised by friends or family members, their own mothers for example, who might insist that it is women’s job to take care of children, not men’s. Without changing deeper gender specific social norms, efforts at change along the surface might eventually fail.

Holly adds this anecdote: When traveling through rural Honduras to understand decision making around childbirth, our team visited an indigenous village. The woman who was our guide warned us as we entered the village that it was considered a “problem village” because the people there didn’t follow the health recommendations of the health promoters, including the fact that most births took place at home. We discovered, as we talked to people in this village, that most of the births took place at home with the assistance of one local midwife. Intrigued by this, we sought out this woman and spent some time talking to her. One of the most interesting things that she told us was how she had a policy, a very strict policy, of requiring the participation of the father at the birth. This she believed, was his responsibility, and the men in the village, understanding that expectation, complied accordingly. Later when we talked to one of those men, he relayed his experiences. He and his wife had 7 children, and he had been present and assisted at every birth. The most compelling thing about his story was the confidence he had around the process of childbirth, the care of infants and of young children, and his belief about the positive role of fathers in the process. The men in other villages, where births took place at a maternal health clinic which did not allow men in the birthing room, were disengaged from the process and considered it something in which they did not expect to participate.

Ben had a similar experience: I lived for an extended period of time in a village in rural West Africa, where I studied social norms regulating appropriate behaviors for men and women. One day, as I was talking with a young man, this man’s wife called to ask whether she could go to the clinic. He said she needed to wait for him to return home and they would go together. This man explained to me that, in his opinion, frankly there was no real problem in his wife going alone: she could walk to the clinic, the road was safe, and she would have been back in time to take care of the children. “Why did you tell her to wait?” I asked. Well, said this man, it’s ok with me, but if others see my wife walking alone they might think I am being cheated on: “around here people think that when women leave the household they are looking for troubles”. This man, in other words, was open to the possibility of his wife leaving the household, but was worried about the deeper set of beliefs that structured social life in his village. A change in behavior required effective collective renegotiation of those beliefs with other men and women in the village, not just convincing people individually of the advantages of having women visit the clinics autonomously whenever they needed.

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Five ways to find open access research

You find a citation for an article in a little-known journal that is just right for your dissertation. Unfortunately, the library doesn’t subscribe and you haven’t time to wait for an interlibrary loan.  You are looking for grey literature (such as conference reports and dissertations) but Google Scholar catches far too much or too little. You’re interested in clinical trials on a particular medicine, but those where the results have not been published in medical journals.https://scholar.google.co.uk/

The good news is that there is a veritable bookshelf full of website and projects will help you locate just these kind of research outputs, from raw data to peer-reviewed articles, and what’s more they are freely and legally available as open access.

So here are five to get you started:

 1. Pressing buttons

aaOABOpen Access Button can be added to your browser to take you to legally uploaded articles, generally the accepted manuscript (Green Open Access) or PDFs made open access on the publisher’s website (Gold Open Access). It is also is available as a search engine. You can search using the article URL, DOI, PubMed ID, PubMed Central ID, title or citation.

2. Trial issues

Open Trials is collaborative and open linked database for all available structured data and documents on all clinical trials, threaded together by individual trial. It is designed to host and match registry entries; links, abstracts, or texts of academic journal papers; portions of regulatory documents describing individual trials; structured data on methods and results extracted by systematic reviewers or other researchers; clinical Study Reports; and additional documents such as blank consent forms, blank case report forms, and protocols.

3. Is there a doctoral thesis in the house?

aaethos

No longer are PhD and other doctoral theses only to be found buried in the dusty basements of libraries. EThOS: e-theses online service is a national aggregated record of all doctoral theses awarded by UK Higher Education institutions maintained by the British Library. There are approximately 450,000 records relating to theses awarded by over 120 institutions. Around 160,000 of these also provide access to the full text thesis, either via download from the EThOS database or via links to the institution’s own repository. DART-Europe E-theses Portal is a searchable index providing access to over 700,000 open access research theses from 606 Universities in 28 European countries.

4. Opening the door to research

Directory of Open Access Journals is a community-curated list of open access journals, which is a starting point for all information searches for quality, peer reviewed open access material.  DOAJ aims to be comprehensive and cover all open access scientific and scholarly journals that use a quality control system to guarantee the content.

5. It’s not uncommon

aaDCNThe Digital Commons Network brings together free, full-text scholarly articles from hundreds of universities and colleges worldwide. Curated by university librarians and their supporting institutions, the Network includes a growing searchable collection of peer-reviewed journal articles, book chapters, dissertations, working papers, conference proceedings, and other original scholarly work.

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Obviously, being indexed and available through one of these sites does not guarantee the quality of research articles and data. Critical assessment and having an overview including other published studies is essential.

But the good news is that the quantity and findability of research outputs published open access is growing all the time.

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Upcoming Seminar: Disability, Health & Human Development

ICED Seminar Series: Summer 2017

Disability, Health & Human Development 

Speaker: Dr Sophie Mitra, Fordham University, New York, USA

Monday 3 July 2017, 12.30 – 2.00 PM

Venue: LG 7, LSHTM. Keppel Street, London

ALL WELCOME

 Event Registration is Not Required

 

This talk will cover the main messages from Dr Mitra’s forthcoming book. It will describe the current understanding of the links between disability and wellbeing. It will introduce the human development model to define disability and map its links with health and wellbeing. This model is based on Sen’s capability approach. The talk will also describe the use of panel survey data with internationally comparable questions on disability for Ethiopia, Malawi, Tanzania and Uganda. It will present evidence on the prevalence of disability and its strong and consistent association with multidimensional poverty, mortality, economic insecurity and deprivations in education, morbidity and employment. 

This evidence shows that disability needs to be considered from multiple angles including aging, gender, health and poverty. The talk will conclude that disability policies are unlikely to be conducive to human development for all if they exclusively use an oppressed minority group approach and focus on barrier removal. It will make a call for inclusion and prevention interventions as solutions to the deprivations associated with impairments and health conditions. 

Dr Sophie Mitra

Sophie Mitra is Professor of Economics at Fordham University. She is co-editor of the Palgrave Studies in Disability and International Development, a fellow of the Human Development and Capability Association and a senior research associate at the Center for International Policy Studies at Fordham.

Publication Reference: Disability, Health and Human Development.

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Alumni Report: Working with gangs in London – a public health approach

LSHTM Uganda 3MSc Public Health alumna Dorcas Gwata is a Mental Health Specialist who works in the Integrated Gangs Unit in London. Dorcas is also a Trustee for Zimbabwe Health Training Support Diaspora Charity, and Co-Director of the Global Health Café. In addition to studying an MSc at LSHTM, Dorcas also studied a short course in Researching Gender Violence in 2014. Her studies developed her skills and practice in the area of gender violence. In this alumni report, Dorcas talks about her work in the Integrated Gangs Unit and how that led her to set up the Global Health Café – a platform for Global Health enthusiasts.

The Integrated Gangs Unit is a unique multi-agency unit that addresses youth violence and sexual exploitation, and its impact on community safety for young people aged 12 to 21. The goal of the Unit is to reduce youth violence and improve community safety using public health approaches. “On measurement, their experiences are well beyond the scope of other youth who are not involved in gang culture”. Some do not expect to live beyond the age of 25, some have been victims of violence or lost friends due to violence, and most have been exploited or bullied. These young people are struggling with issues of identity, masculinity and some have poor literacy skills. Young girls are particularly vulnerable to sexual exploitation.

Dorcas was asked to take a lead role at the Unit after working as a Mental Health Adviser for AFRUCA Charity, a charity formed on the backdrop of the Victoria Climbe case. Dorcas’s work at the Unit explores the impact of traumatic events on the mental health of young people at the Unit. “I work within a brilliant multi-agency setting. The strength of our work is based on our ability to work across disciplines and innovation”.

The Integrated Gangs Unit is currently working on developing community-based clinics across Westminster, which will increase access to mental health services for young people that have experienced youth violence and exploitation. “I am bringing in evidence based approaches from the Friendship Bench project in Zimbabwe, which uses problem solving tools to address trauma and common mental health conditions. In doing so I am contributing to the emerging body of evidence on how health care systems in high income countries can learn from low income countries whilst validating the tremendous work going on in low income countries despite the challenges

“In response to the depth of enquiries that we receive on the work we do at the Unit, we have set up the Global Health Cafe, a platform for “Global Health enthusiasts” who meet regularly to discuss global health issues with a view to inform innovation, health policy, evaluation and practice”. Dorcas jointly set up the Global Health Cafe with Global Policy Expert, Ade Adeyemi and with support from their mentors Dr Titilola Banjoko and Professor Aliko Ahmed. “Over time we will be looking to develop these discussions on bigger think tank platforms, seeking funding to grow our influence in Global Health. The timing could not be more right with the new appointment of Dr Tedros Ghebreyesus as WHO Director General, the first African to hold to this post”.

For more information about the Intergrated Gangs Unit and the Global Health Café, please see visit www.tribalsands.com and www.zhts.org.uk. You can also follow Dorcas and the Global Health Café on twitter @zambezi40 and @TheGHCafe.

 

12 – 19 June 2017

Sally Bloomfield provides comment to The Guardian on the potential contamination of children’s soft play areas: “[Ball pits] will become contaminated in the same way as any environment where there is a large number of children will become contaminated” adding that places with ‘millions of germs’ are often just harmless bacteria.

James Logan explains what Lyme Disease is and how it is spread via ticks for Channel 4’s How to Stay Well.

Forbes reference Harry Rutter’s presentation at the recent European Congress on Obesity which analysed studies showing the scale of the global obesity epidemic.

An Irish Times article on organic food refers to School research which found eating organic food makes no significant difference to consumer health.

Wired Italia investigate the results of the Vaccine Confidence Project which revealed Italy as particularly sceptical of vaccines. The article also includes interactive infographics and maps based on the results.

Martin McKee discusses the impact of a hypothetical ‘no deal’ Brexit on the pharmaceutical industry with the Daily Telegraph (£): “A disorderly Brexit poses serious risks to public health.” Martin also writes for the BMJ blogs summarising the key implications for health following the result of the recent UK general election.

There is further coverage in The Science Times and Asia One of a School study that found male farmers are at a higher risk of contracting ‘monkey malaria’ in Malaysia than other people in their communities.

Workshop: Adolescents and Young People Living with a Disability – Register Now!

The International Centre for Evidence in Disability (ICED) and the Centre for Maternal, Adolescent, Reproductive, and Child Health (MARCH) are pleased to host the following workshop:

 

‘Adolescents and young people living with a disability or chronic conditions … sharing research experiences’

Tuesday 27 June 2017 from 13:00 – 16:45

Venue: LG24 Keppel Street

 

This half-day event will look at methodological approaches as well as thematic issues, sharing good practice, networking and learning from past mistakes! A light lunch and refreshments will be served. For further information please contact Maria Zuurmond, ICED Research Fellow.

Places are limited, so …

If you would like to participate in this free workshop please Register Here

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2017 Alumni Visits and Career Talks

We are pleased to have received a number of visits from our alumni in April, May and June. We welcomed Bobbi Pritt, Vanessa Kerry, Elizabeth Pisani, Georgios Chatzimanolis, and Nita Chaudhuri to the School.

Image 5MSc in Health Policy Planning & Financing (HPPF) alumna (2005), Vanessa Kerry was invited to the School in April to give a career talk to current students. Vanessa Kerry is the CEO of Seed Global Health, a non-profit organisation that aims to strengthen education of healthcare professionals in low- and middle-income countries. Vanessa gave a talk to current students on her transition from a practising physician to leading an organisation of her own in order to help solve the shortage of trained healthcare staff in sub-Saharan Africa. See here for more information on Vanessa’s visit.

Image 1MSc in Medical Demography (1994) and PhD in Infectious Disease Epidemiology alumna (2006), Elizabeth Pisani was invited to the School in May to also give a career talk to current students. Elizabeth is a Public Health consultant and author who recently featured on the alumni blog talking about how she accidentally became an epidemiologist. During Elizabeth’s visit she spoke to current students about her career in epidemiology. See here for more information on Elizabeth Pisani.

George 2In May we had two other alumni visits. We welcomed Georgios (George) Chatzimanolis and Nita Chaudhuri to the School. George who is an MSc in Medical Microbiology alumnus (1999) and a consultant, was visiting the School from Greece. George came to discuss the possibility of starting an alumni chapter in Athens; he will be hosting an inaugural event for Athens alumni on Saturday 24 June. Please see our events page for more information.

Nita 3Nita Chaudhuri who studied an MSc in Public Health at the School through distance learning, graduating in 2016, was visiting us from France. This was her first time being at the School, so it was our pleasure to give her a tour of the Keppel Street building. Nita also met with LSHTM researcher Mark Petticrew at our Tavistock Square site to learn more about Social and Environmental Health research at the School.

Image 6 In June, MSc in Medical Parasitology, Bobbi Pritt visited the School to give a career talk on her role as a Medical Director of the Parasitology Unit atMayo Clinic. Bobbi took current students through real life case studies and tested their knowledge of parasites. She also gave them advice on how to build their reputation in their field using blogs and social media, and outlined the pathway to becoming a Medical Director.

 

 

We enjoy having alumni come to visit us at the School, so if you are in London and would like to stop by, drop us an email at alumni@lshtm.ac.uk to let us know you are coming.

Also, if you would like to give a career talk to current students, please get in touch.

We look forward to seeing you!

Library & Archives Service BookSwap

Fancy reading something non-academic this summer? Looking to refresh your own collection at home? Why not try the Library & Archives Service BookSwap scheme. Running for several years now, BookSwap continues to be extremely popular among LAS users.
Located just inside the foyer, our growing selection accommodates all sorts of literature tastes: popular and classic fiction; biography and autobiography; we even have one or two travel guides!
So feel free to have a browse, choose something to take home, and if there’s any books you’d like to donate in return, we’d be really grateful. Please ask a member of staff at the enquiries desk if you want to find out more.

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5 – 11 June 2017

Heidi Larson provides comment to CNN on the vaccination challenges in Europe: “I think the main point is that while there is overall good vaccine acceptance in Europe, there are clear trends reflecting more questioning about vaccines.” The article generates coverage in over 50 regional papers across the US.

AFP report on a study published in the new Lancet Series on Health in Humanitarian Crises, led by the School, which shows WhatsApp is being successfully used to monitor attacks on healthcare workers in Syria. The article generates coverage in the Daily Mail, Yahoo and France24.

News Deeply compile a list of 11 experts to watch on refugee health, including Karl Blanchet and Francesco Checchi.

Chris Drakeley is quoted by The Star (Malaysia) about a study led by the School that found male farmers are at higher risk of contracting ‘monkey malaria’ in Malaysia: “Conventional approaches used to tackle malaria such as drugs or bed nets cannot be used to combat P. knowlesi as monkeys are the host and the risk is associated with outdoor work. Our study offers important insight into where social interventions are likely to have the biggest impact.” The study is also reported in Free Malaysia Today, Business Standard (India) and The Week (India).

Julian Eaton is interviewed by BBC World TV’s Focus on Africa programme, discussing mental health in areas that have suffered long-term conflict and violence.

BBC Radio Gloucester (from 1h44m10s) interview Ailie Robinson and Will Stone at the Cheltenham Science Festival about their event ‘The Story of the Mosquito’. Will said [Mosquitoes] are a tremendous challenge. Close to a million deaths every year are caused by mosquito-borne diseases and we are here in honour of Ronald Ross’ discovery that malaria is transmitted by mosquitoes. Malaria alone causes about two-thirds of those deaths every year.”

Joy Lawn provides comment to The Observer on studies that investigate why women live longer than men: “When we were there on the neonatal unit and a boy came out, you were taught that, statistically, the boy is more likely to die.”

“Let’s Face It” – 2017 Alumni Photo Competition Results

The 2017 Alumni Photo Competition with the theme “Let’s Face It” closed at the end of May. We received over 40 entries that highlighted the variety of experiences our alumni encounter on a daily basis. The quality of entries was excellent and we are pleased to announce that this year’s winner is Diploma in Tropical Medicine & Hygiene (DTMH) alumnus (2016), Dr Alexander Kumar with his striking image “Love in the time of Zika”.

UntitledAlexander said: “Love in the time of Zika – where there is love, there is hope. I took this image while on a research visit to a neurological rehabilitation centre in North East Brazil. Loving mother Anacarla cradles her baby boy Jose-davi affected by Zika-microcephaly. The true burden of the cognitive impairment associated with Zika-microcephaly is still yet unknown and will challenge Brazil’s public health system requiring a multidisciplinary effort to overcome these challenges. A colouring book with Peter Pan on its cover sits in the foreground.”

 

IMG_4991 MSc in Control of Infectious Diseases alumna (2016), Katina Zeligman-Sommers is our first runner up with her photo entitled “Facing Trachoma”. Katina said: “This young girl takes part in the daily washing routine, common before leaving the compound, in rural Ethiopia. In this region of Oromia trachoma prevalence rates are upwards of 40% in children aged 1-9 years”.

 

 

Version 2DTMH alumnus (2006), Dr Dan Wiklund is our second runner up for one of his images entered in a series entitled “Faces of NGO Medical Work”. Dan said “[we’ve worked] in 150 countries since 1985 and [we] just finished our 20th medical outreach in Cameroon where over those years we have seen in this single country over 100,000 patients; pulled nearly 15,000 decayed, painful teeth; dispensed over 16,000 glasses; performed some 500 surgeries; and, hopefully saved from death hundreds of children from Malaria, Onchocerciasis, Leishmaniasis, Typhoid and innumerable other infectious diseases. No research yet has evaluated the benefit of non-governmental organizations impact on global health. Every year thousands of NGO’s are doing work in hundreds of countries”.

Thank you to everyone who entered this year’s photo competition. The winning entry will feature on the front cover of this year’s alumni magazine. We will also be using other entries in School publications and other materials to showcase the inspiring work of our alumni community.