Herman Lubwama stands in the corridors of Mulago Hospital’s Ward 5B, his gaze fixed at the door leading to the labour ward. He is eagerly waiting for a doctor to come out and announce the birth of his seventh child. Lubwama paces the corridors with thoughts going through his mind. He holds his head and looks at the door as it door swings open and closes again.
When Nalugo went into labour, Lubwama was still working so she went to a nearby health centre. But nurses referred her to Mulago as her case was complicated. By the time she reached Mulago, she had bled a lot. The doctors said it was an emergency. Lubwama wishes he had the answers to some of his questions. He wishes he had been involved in ensuring that she is healthy throughout the pregnancy. He can only wait.
Male involvement refers to the fulfilment of roles and responsibilities of men in sexual and reproductive health rights including HIV/AIDS prevention, care and support. The 2011-2016 National Strategy for Male Involvement in Child Health, Sexual and Reproductive Health and Rights Including HIV/AIDS states that boys and men will take responsible decisions to realise their full potential in their sexual and reproductive health and rights.
It also means men’s full enjoyment of their sexuality and realisation of their reproductive health goals and rights in a responsible manner. It means that males participate effectively in the health and well being as well as respecting rights of their partners and children. Male involvement is embedded in the 1994 Cairo International Conference on Population and Development Programme of Action which include male responsibilities and participation as a critical aspect of improving reproductive health (RH) outcomes, achieving gender equality, equity and empowering women. Male involvement is critical in reducing maternal and infant mortality and morbidity in Uganda.
“When we met as a team working in reproductive health, in HIV, in child health we believed that family planning is important to space and plan births. We are talking a lot of about sexuality, reproductive wellness and how fertility relates to our daily lives. It’s clear that we have to think about how a man and woman are socialised to think about who is responsible for fertility,” Dr Olive Sentumbwe-Mugisa the family health and population advisor at World Health Organisation says.
Dr Sentumbwe says that people know a man and woman make a child but for long communities have thought that the issues of who is responsible to plan for a pregnancy have been largely responsible for women in ordinary communities. Men like Lubwama are caught up with the reality of life when their wives die or walk out of the marriage leaving them with many children to care for and no experience to work with.
The doctor told Lubwama that his wife had died and only his son could be saved. His relatives pour in to comfort him as he prepares for a life of a single father of seven children with a new born on his hands to nurse, feed and care for all his demands and needs.
Before today, Nalugo was responsible for caring for the children, the home and cooking food.
She collected water from the well, nursed the children when they fell sick and tilled the garden. Lubwama spent the better part of his day working as a boda boda rider in Mawoto, Mukono district.
“What am I going to do? What am I going to tell my children? I didn’t know something was wrong with her, she didn’t tell me” Lubwama ponders as he stares at a life of a single father.
It is until today that he realises the burden he must now shoulder. A life of raising all his children singlehandedly and make sure they have food to eat, clothes to wear and school fees. His partner who has always has been shouldering many of these responsibilities is gone. Now Lubwama must learn to do them alone, he must get involved in the upbringing of his children.
Responsibility is for two
“You discover that actually bringing it within the context of family, many people appreciate it’s about two of them. So awareness needs to be created for communities to understand what exactly we are talking about male involvement,” Dr Ssentumbwe says
Since the beginning of time, leadership responsibility in family is rested in a male figure. When man and woman come together, it results in major responsibilities. A man is supposed to take charge of all costs involved and ensure she attends ANC, delivers in a hospital, requirements for new born are available and has money for the children to feed. So a man provides food, shelter, clothing education. A woman is then supposed to carry the pregnancy.
“We have not been looking at how a pregnancy affects a woman’s life. There should be a number where you say this is a good number which is four pregnancies for a woman. After that, continuing pregnancies affect the woman and they never leave her the same. They affect the brain, the heart and everything,” Dr Sentumbwe says.
Communities, people, women, men, young boys and girls must think about it as a physiological event that affects the body. The body has wear and tear issues related to pregnancy. It never leaves a woman the same. The woman’s womb stretches from five grammes to one kilogramme immediately after birth and shrinks to half a kilogramme after one week and continues to pre-pregnancy at around six-eight weeks.
As she goes back to her original size it does not completely regain original size and it heals with scars. Actually the whole body, the birth carnal never goes back to prepregnancy status and this affects many functions.
“We must understand that the more children you have you are more likely to get problems and that’s why it’s important to limit and plan for pregnancies,” Dr Sentumbwe says.
Information about the importance of male involvement in reproductive health should start reaching young boys and girls at their earliest age. Sexually active young men ought to have information about theirs and the girl’s body because any sexual encounter can result into a pregnancy. Yet when bringing up boys, communities continue to keep boys in the dark and don’t prepare them.
“What are norms for him to appreciate it early in life? That one of my responsibilities is there is new born in the home and I should also participate, wash nappies, help my wife cook, bring water, shower the baby. If man related with these responsibilities then it would help make decisions about how many children you can afford and have entire picture of what it means in regard to tasks described, carrying pregnancy, ensuring its safe and tall order of things you are responsible for,” Dr Sentumbwe says.
What is keeping men away?
Many of the family planning methods which we have are for women. Male methods include abstinence, condoms and vasectomy. Women have contraceptives, IUDs, injectable, implants, tuba ligation, gels, moon beads. So many methods and choices for a woman and little for a man.
This is because a woman’s fertility cycle can be interrupted with using artificial hormones without much interaction with her own body setup. It’s difficult for men because men constantly producing their sperms the whole day. So research has produced more options for women than men.
“Abstinence is encouraged for girls until they find a suitable partner. We should be communicating the same message for boys and girls. When nurturing boys too, we must talk about abstinence. Are their virgin boys? Does the word exist? The entire upbringing has an issue. It must be a value for both boys and girls because it’s one of the surest methods of family planning and birth spacing,” Dr Sentumbwe explains.
Secondly many times its women who visit health centres for routine checkups and this is where information and methods for family planning are passed on. The women then in turn pass on the information to men. Family planning service delivery should be ideal for couple counselling.
Partners should go together, know together, select a method together and help each other to use the method of choice. Those who don’t have partners but are sexually active should also seek FP services. It should start with couples discussing their sexuality. In some cultures it’s a taboo. It’s that knowledge of the menstrual cycle that leads to knowledge of fertility.
More time for couple
“Women find themselves with dangers of unplanned uncontrolled fertility. When the husband is not listening women go alone men say they are very busy. They even don’t offer support to their women. We want them to know the methods they are going to use as a couple. When women get side effects they are beaten by their men. Sometimes men have pulled out the IUDS,” Dr Sentumbwe says.
Men often do not realise why they should be involved in planning and caring for their families. Yet as a man, you cannot have children every year because you do not have resources to look after unintended pregnancies. Even if you say you have all the money, can you stand a new born crying baby in your bedroom every year?
Men need to think about their own health in relation to the many children at home. Family planning would release time to a couple. If children are spaced couples can have time for each other to go out. If the wife spaces her children her body has time to rebuild and regain its pre pregnancy shape. Then the aging process will work very slowly on the wife and be able to be more productive and outgoing and young.
“How do you feed so many children as the head of family? The affordability and work that comes with it is too much. People should stop premising large families on God’s help. God does not expect us to live in pain. He didn’t ask us to multiply irresponsibly,” Dr Sentumbwe says.
When it comes to grown up children sharing property creates wars often leading to murder over land. There has been land fragmentation and it is still going on. Land has stopped making economic sense hence the land pressure and issues. Population explosion due to uncontrolled fertility is getting us in many wars, fight for land, migration, destroying nature which we cannot put back. Dr Sentumbwe says that Uganda needs to strengthen information, education and communication targeting behaviour, traditional norms, and values.
“If we are going to encourage family planning use by men and women, if you take just commodities they will expire if you do not target values of men and women. Women think that when they have more children they have more value in the home. Even educated women have many children. Men believe they don’t enjoy sex if they don’t use condoms. Women believe they will become obese if they use contraceptives. We need to open community and talk. We need to engage in dialogue reach men and women at all levels,” Dr Sentumbwe acknowledges.
Health centres need more health workers to deal with family planning and inform people accurately, political advocacy also needs to be improved. Politicians must address their communities and review family planning benefits for men and women. Uganda needs to link benefits of family planning beyond health of people to real social, economic challenges.
“These constraints will be addressed through advocacy on male involvement and addressing health systems issues like staffing, skills development and customer care. Intensification of campaigns on public information and taking the services nearer to the people,” Dr Christine Ondoa said during an interview with The Observer.
Only 30% While it is true that 90% of people have knowledge about contraceptives, women continue to believe in the myths and misconceptions they hear from friends. But only 30% use contraceptives. Back in Mayuge, Rukia Nangobi has her own view about the money the government has committed towards family planning; she says it should go into helping women like her to provide for their children.
Yet if women like her knew and understood the burden of having an unmanageable family, they would not be crying out for help from the government. Dr Jennifer Wanyana, assistant commissioner for Reproductive Health in the ministry of Health, acknowledges inconsistencies in the information that people get.
“Sometimes people don’t have access to platforms on which messages are passed on, like radios,” Wanyana says, adding: “Sometimes they do not understand the language used. Of course their attitude also affects the message where information is provided but people do not take it, the information will not sink. We will do a lot of community sensitisation.”
The ministry also plans to strengthen the institutional capacity of public health facilities and community-based distributors to provide family planning services through staff recruitment, motivation and equipping of health centres.
“Our mandate is to ensure orders are placed, money is found and there is a system that ensures commodities reach the people. Everything must be done according to standards and policies in place,” Wanyana says.
The article can also be accessed at: http://www.observer.ug/index.php?option=com_content&view=article&id=21013%3Alets-integrate-men-in-family-planning&catid=57%3Afeature&Itemid=69