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PARTNERS IN PROGRESS Innovating to Improve and Increase Male Engagement in Family Planning

WHY ENGAGE MEN AND BOYS IN FAMILY PLANNING?

Research shows that significant socio-cultural and structural barriers to creating and meeting demand for family planning (FP) persist. In countries such as Burkina Faso and Côte d'Ivoire, social and gender norms value having many children and prevent many women from making decisions regarding their own health and fertility. Men are often seen as barriers to modern contraceptive use, improving birth spacing, and achieving healthier family size. Therefore, innovative approaches are needed to engage men and boys in ways that challenge harmful gender norms and support family planning and reproductive health (FP/RH) outcomes.

Promoting Health-Adjusting The Reproductive Environment (Transform/PHARE)

To promote male engagement (ME) in FP, the United States Agency for International Development (USAID)-funded Promoting Health-Adjusting the Reproductive Environment (Transform/PHARE) Transform/PHARE project has been working to develop and pilot innovative approaches, including a Human Centered Design (HCD) project in Côte d'Ivoire focusing on men in the informal employment sector and an innovation lab in Burkina Faso aimed at increasing ME in FP.

These activities were designed to explore and address men and boys as users of contraceptive methods, supportive partners of FP use, decision makers, social influencers, and agents of change. The project piloted ME in FP approaches in order to increase modern contraceptive use, promote shared decision making between couples, stimulate conversations about the negative impacts of rigid gender roles, and actively address gender inequalities.

Transform/PHARE is a five-year (2015-2020) initiative led by Population Services International (PSI). The project is designed to infuse innovative practices from a range of disciplines into Social and Behavior Change (SBC). It emphasizes creative thinking, exceptional design, and high-quality production and implementation. Interventions and approaches are tested and iterated and the results of those showing potential impact on behavioral outcomes are disseminated to be adopted, adapted, and possibly scaled up by other implementing agencies.

Using Human-Centered Design to Innovate

The two projects described below use Human Centered Design (HCD) to identify both problems and solutions. HCD is a specific set of processes that place the intended audience and other key stakeholders at the center of the research, design, and implementation process. It is an innovative approach to SBC because it applies a set of core design principles to areas which are not traditionally defined as needing "design". These principles emphasize a human-centered point of view, experimentation, iteration and redesign, and tangibility. Applied to SBC, the process helps to ensure that audience needs and expectations inform design decisions, leading to a higher likelihood of reaching desired behavioral outcomes.

Young Men in Côte d'Ivoire's Informal Employment Sector

Attitudes toward sexuality and relationships are formed in early adolescence. During this time, boys form masculine and sexual identities that will shape the direction of their sexual relationships and their adoption or rejection of societal gender norms. Engaging young men in issues related to gender norms and dynamics, FP/RH, and healthy relationships can propel them towards more supportive behaviors for themselves and their partners. Transform/PHARE's Didier program prototype seeks to do just that.

In 2017, Transform/PHARE used an HCD process, shown in the timeline below, with young men ages 15-24 who were earning an income through the informal economy in two neighborhoods of Abidjan, as well as with their partners, parents, bosses, community leaders, and other direct and indirect influencers, to explore ways to engage these young men in dialogue about reproductive behaviors and choices for themselves and their partners. The Project used a literature review and "inspiration research," that consisted of individual field interviews, small group interviews, and expert interviews.

Activity Timeline

HCD Glossary

  • Secondary Research: Existing research that is summarized, collated, and synthesized.
  • Sacrificial Concepts: Simple abstract ideas, designs, concepts, or scenarios that are intended to elicit a reaction or serve as conversation starters for eliciting insights from an end user.
  • Inspiration Research: A collection of tasks and activities focused on learning about and understanding the audience's needs from immersive experiences and direct interaction with the audience.
  • Ideation: Identify opportunities for design, brainstorming, and prototyping possible solutions.
  • Prototyping: The process of quickly making ideas tangible.

Inspiration Research Insights

Inspiration research is an approach that uses conversational interviewing techniques to spark discussion. Rather than following a strict interview guide, it focuses on using discussion to gather information and insights.

The secondary and inspiration research revealed that young men in the informal sector spend considerable resources on women. They focus a great deal on sex and like to brag about the number of partners they have. Many come from rural areas and are the first in their families to live in Abidjan. Unable to relate to their parents' traditions, their attitudes toward sex and relationships are being shaped by their bosses - older men who are also hustling in the informal economy. While they serve as role models, these bosses do not actually reflect what the young men truly aspire in adulthood - a traditional family, just like their parents. Specific insights can be found in the research and project reports below.

“I like to listen to the older boys in my neighborhood talk about girls. They have a lot of experience.” — YOUNG MAN, 16
“Boys have a lot of questions about girls. They want relationship advice— how to please their girlfriend, how to present their girlfriend to their parents.” — YOUTH LEADER

Archetypes: Types of Young Men in the Informal Employment Sector

Based on these insights, the Project identified distinct patterns in behaviors regarding relationships and contraceptive use and created four archetypes to represent young men in Côte d'Ivoire's informal sector.

Co-Creation Workshop

A small group of designers, adolescents, and health care providers convened to participate in a co-creation workshop - a hands-on, participatory workshop to brainstorm and prototype intervention ideas. The value of this type of workshop is that designers are able to gather ideas directly from the intended audience and their influencers.

THE DESIGN OPPORTUNITY

How might we use dating advice to encourage young men in supporting behaviors related to contraceptive use?

It was clear from the insights and archetypes that young men are oblivious to issues around gender equality and have few positive role models who can show them alternative ways of behaving. They are excited about women and relationships, but not really interested in sexual health or contraception. These realities present both a challenge, and an opportunity.

The insights, archetypes, and co-creation workshop informed the design of a prototype of an interactive story delivered through SMS messaging, a live show, and Facebook, intended to motivate discussions on sexuality, condom use, unplanned pregnancy, and contraception.

DIDIER: A new brand that engages youth in positive dialogue about sex and relationships.

Didier uses dating advice as an entry point to sensitize young men about the benefits of supporting their partners' needs and reproductive choices. It reaches its audience of young men working in the informal sector through three touch points: messaging, a live show, and FACEBOOK

The plot centers around Didier, a 17-year-old apprentice living in Abobo, Abidjan. He left his home town in Gbêkê two years ago looking for his father who came to the city and never returned. Didier's dream is to make a living in the big city. Didier respects his big brother Joel, who knew his father, is happily married, and recently started a family. However, Didier is influenced by his boss, Yves, a bus driver famous for his sexual conquests. The program uses dating advice as an entry point to sensitize young men about the benefits of supporting their partners' needs and reproductive choices.

SMS Messaging

A tantalizing piece of the story is delivered in 160 characters every day via WhatsApp or SMS. The messages create suspense and draw in readers. The story progresses as the audience votes on what happens next at crucial moments. Polling engages the audience and allows monitoring of changes in their attitudes toward relationships, gender equality, and FP/RH choices. The platform is also used to engage the audience on Facebook and in upcoming "Dude Zone" events nearby (see below).

Live Shows

Young men can meet Didier's characters and chat with positive role models about sex and relationships during live shows. The live shows consist of "Dude Zones", Didier interactive skits, and networking.

  • Dude Zones: The live show starts with informal chats between young men and a positive role model (e.g., Big Brother).
  • The Show: Didier characters then perform interactive skits.
  • Networking: At the end of the live show, young men can chat with male and female Didier characters, ask questions, and are invited to stay in touch through the Facebook page.

Facebook

Young men can follow the latest story episode, interact with Didier characters, participate in polls about relationships, sexual health, and gender equality, and be connected with health services. It serves as a fun space to chat, ask questions, and learn from positive role models through Didier-themed content.

The Takeaway: Positive Role Models Create Awareness

Based on the insights generated, providing young men with positive role models and dedicated spaces to have their questions and concerns addressed may help to shift young men toward greater awareness of gender equality and increased support for contraceptive use.

Burkina Faso's population is young and growing rapidly.

Using an Innovations Lab to Engage Men in FP in Burkina Faso

The past five years have shown a rising use of FP and improved RH outcomes for women in Burkina Faso. From 2012 to 2016, unintended pregnancies averted increased from 167,000 to 249,000 while maternal death averted increased from 400,000 to 600,000. Despite this progress, Burkina Faso is expected to miss its goal of 23 percent contraceptive prevalence rate (CPR) by 2020. Engaging men in FP offers an opportunity to address gender norms that prevent many women from making decisions regarding their own health and fertility and improve contraceptive uptake.

Through secondary research on men's role in FP, the Project found that men are implicated in many reasons for non-use of FP among women wanting to delay birth by two or more years. The review identified five dynamics that drive men's attitudes and behaviors toward FP:

RESEARCH INSIGHTS: DYNAMICS THAT DRIVE MEN'S ATTITUDES AND BEHAVIORS TOWARD FP

  • Perception of masculinity: The pressure men may feel to engage with women a certain way in order to show masculinity.
  • Social norms: Social pressures put on men and couples and norms around spacing and limiting births.
  • Couple dynamics: Power dynamics and quality of communication within the couple.
  • Knowledge and access: Men may receive conflicting information about FP from various sources and do not feel comfortable visiting health centers.
  • Economic considerations: Economic drivers change throughout the life course, impacting when a young man can start a family or have more children.
An "Innovations Lab" is a participatory workshop that uses HCD principles of inspiration and ideation to develop solutions.

INNOVATIONS LAB AND HEAT MAP

In order to turn these research insights into creative solutions, Transform/PHARE hosted a four-day "Innovations Lab" in Burkina Faso using the HCD principles of inspiration and ideation. The Innovations Lab engaged entrepreneurs, musicians, and comedians, working together in teams of five to create solutions that increase ME in FP.

During the Innovations Lab, participants mapped local ME in FP interventions to avoid redoing what has already been tested and to establish boundaries and guidelines for designing prototypes. The resultant "Heat Map" summarizes activities being implemented in the country targeting men to increase their engagement in FP, mapped by level of activity.

A heat map is a graphic that charts which intervention areas are most prevalent or absent. It helps identify where interventions are most needed.

PROTOTYPING

Three ideas were selected for the prototyping phase:

  • L'académie de 14 février (The February 14 Academy): Plans social activities for young couples and educates them on how to effectively discuss FP issues (Pathfinder/Alliance Technique d'Assistance au Développement)
  • L'homme Faiseur (The man-maker): Creates male ambassadors to talk about FP and its benefits to other men (Organisation Catholique pour le Développement et la Solidarité/Resilience and Economic Growth in the Sahel)
  • Père Burkinbila (Burkinbila Fathers): Teaches fathers to support the FP needs of their teenage children (Save the Children/IPC/Association Zood Nooma pour le Développement)

A jury consisting of representatives from USAID, PSI, YLabs, and Camber Collective evaluated the three prototypes based on the following criteria:

  1. Methodology and approach: Is the intervention well developed, innovative and feasible? (double weighted)
  2. Team experience: Does the implementation team have the skills required to carry out the intervention? (double weighted)
  3. Timetable: Is it realistic to think of drawing lessons and results in the period given?
  4. Budget: Is the budget clear and appropriate for the planned activities?

The Winner! Père Burkinbila

The jury selected Père Burkinbila to pilot for three months. The intervention responds to the need to strengthen the capacity of fathers to initiate and engage in parent-child communication on FP/RH. The intervention aimed to reduce the rate of unwanted pregnancies among girls and young women and make men more active agents of change. The pilot organized motivated fathers into three Father's Clubs composed of 12 members in each of the three villages. Parents and community members expressed appreciation for the activity and all men participating in the clubs received a certificate nominating them as "Pères Burkinbila". Activities consisted of:

  1. Educational sessions for Père Burkinbila;
  2. Discussions between fathers and sons using visual aids; and
  3. Home visits to support fathers.

Pilot Results and Lessons Learned

  • Frequency of communication about sexuality and FP between fathers and teens in households increased. Prior to the intervention, only two of the 36 fathers reported that they had discussions with their sons about pregnancy. Following the intervention, that number increased to 36 out of 36.
  • The overwhelming majority of fathers reported that they had discussions for the first time with their sons on responsible sexual behaviors and unwanted pregnancy. Sons disclosed surprising revelations to their fathers about their early sexual lives and discussions opened the debate on other topics such as education of girls and demand for contraception.
  • Strong community engagement was achieved through involvement of the administrative and customary authorities, commitment of village leaders, contributions from community radio, and community acceptance and appreciation for the intervention.

Challenges

The pilot encountered a number of challenges that can inform any future scale up or adaptation:

  • Facilitators found it difficult to supervise fathers during the discussions given the presence of the adolescent boys.
  • Educational guides and data collection support were not appropriate to the fathers' level of education.
  • The intervention is likely to create demand for FP/RH services, but services have not been established.

CONCLUSION

Gender inequality and the norms surrounding relationships between young men and women can impede FP/RH outcomes. In many settings, men are the primary decision makers in the household and they often play the dominant role in determining when to begin a family, family size, and use of contraception. Family planning programs can help challenge prevailing gender norms by engaging men and boys in ways that promote their roles as users of contraception, supportive partners, and agents of community and social change. This type of programming can help to expand women's reproductive agency and improve health outcomes for women and girls, men and boys.

When developing ME activities, it is important to remember that men and boys also have their own needs and preferences for accessing FP/RH information and services, needs that differ across life stages. Effective ME activities should address those needs and support men and boys in committing to personal health, healthy relationships, and healthy families. Involving men, and their influencers, in program design can help increase their interest and participation in FP.

CONTACT US

For more information on Transform/PHARE's Male Engagement work, please contact Luis Fernandez Martinez, Social and Behavior Change Communication Senior Technical Advisor, Transform/PHARE, lmartinez@psi.org

For more information on Breakthrough ACTION, please visit https://breakthroughactionandresearch.org

ADDITIONAL RESOURCES

This resource is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Breakthrough ACTION Cooperative Agreement #AID-OAA-17-00017. Breakthrough ACTION is based at Johns Hopkins Center for Communication Programs (CCP). The contents are the sole responsibility of Breakthrough ACTION and do not necessarily reflect the views of USAID, the United States Government, or Johns Hopkins University.

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