2. Using “Love Letters” to increase male involvement

3. What is Love Letter? It’s a strategy to increase male involvement in antenatal care, successfully piloted through the IMPACT program in Malawi

4. It’s a Love Letter! Official Individualized Written with love!

5. Love Letter Provided by ANC nurses to all pregnant women, to pass to their spouses to urge them to join them for their next appointment.

6. Goal of Love Letter Quality ANC Male Involve- ment MTCT

8. What do men learn at ANC? Pregnancy warning signs Their HIV status, as a couple HIV prevention ART adherence Benefits of practicing healthy birth spacing Nutritious foods to eat during pregnancy What to bring to the hospital for the delivery

9. Love Letter works!

10. How did we do it? 6. Position for scale-up5. Collect data4. Support implementation3. Prepare to implement2. Conduct baseline1. Lay groundwork

11. 1. Lay the groundwork Bring Ministry of Health on board at national and district levels Prepare to pilot: Select sites, create tools Sensitize traditional leaders and other key influencers Design and test your letter

12. Align pilot with health facility structures and practices -- consider patient flow, workload and record-keeping will affect implementation Identify your contact person at facility level Develop training materials that will suit the nurses’ learning needs Work with district health official to engage a strong MoH focal person

13. 2. Collect baseline information

14. Expect resistance and non- compliance 2. Collect baseline information

15. 3. Train ANC nurses Be consistent and sensitive; deliver encouraging messaging to couples Be welcoming with men, ensure adequate seating and space Encourage men to ask questions Accept alternative partners to support and acknowledge women without permanent partners

16. 4. Support implementation Provide regular supportive supervision and mentorship to nurses Conduct supportive supervisions with District focal person Think about secondary pilots / ORs to learn more about men’s engagement

17. 5. Collect implementation data

19. 6. Position for scale-up Present pilot findings to MOH at the most appropriate level for your context Institutionalize the Love Letter by embedding costs in the MOH budget – work with district officials as they develop annual budgets.

20. “I would recommend Love Letter to other facilities. If you verbally tell men, they won’t come. But with the letter, they come and realize it is valuable for them to be here.” Mervis Mkhalipi, ANC Nurse, Milonde Health Center, Mulanje district, Malawi