1. Constructive Male Engagement in Family Planning in Madagascar Ashley Jackson, Technical Advisor Population Services International (PSI) Laura Hurley, Senior Program Manager IntraHealth International Global Health Mini-U March 2, 2015

2. Overview page 2 Madagascar  Context –FP in Madagascar –Top Réseau –ISM Project  Gender assessment  Male engagement approach  Activity demonstration  Lessons learned

3.  29% MCPR among married women –23% among all WRA  19% unmet need among married women –10% for spacing –9% for limiting –15% among all WRA –27% among age 15-19 Context: FP in Madagascar page 3

4.  23% of births are less than 2 years after a prior birth  33% of women (25-49) gave birth before age 18 –29% of 17-year-olds had given birth or were pregnant Context: FP in Madagascar page 4

5.  Nationwide network of 254 private health clinics –Started by PSI in 2000 –67% urban  Services: –RH, STI, FP Including LARC methods –Child survival, fever Top Réseau social franchise page 5

6.  USAID funded project from 2013-2017 –PSI, IntraHealth, and 4 other partners  Focus on social marketing and franchising for FP/RH, Child survival, malaria, and nutrition  Demand creation by IPC agents, peer educators, and CHW  Quality assurance is key project objective – gender integration is one aspect of QA Integrated Social Marketing (ISM) Project page 6

7.  Objective: Identify gender-based constraints and opportunities that affect men’s and women’s health risks and capacity to seek appropriate quality care  Methodology –Literature review –26 key informant interviews (MOH, NGOs, donors) –12 focus group discussions with 93 people: Women and men (married & unmarried, younger & older) Providers and Community Health Workers Gender assessment led by IntraHealth (2013) page 7

8.  Barriers to contraceptive use: Male opposition to family planning was second only to side effects, and was raised in every focus group –Misconceptions about what methods are appropriate for young people (only condoms and counting days) –Myths that hormonal methods would lead to infertility, reduced sex drive, and health problems –Married men felt that there were no family planning programs or information for them Gender assessment findings page 8

9.  All focus groups brought up that many women hide contraceptive use from their partners  Men’s motivations to support contraceptive use: –“Life is hard.” – Married rural man –“You can fulfill your dreams.” – Unmarried urban man Gender assessment findings page 9

10.  68% of women think their partner supports modern FP use –50% of women think that their husbands would accept their partner using an IUD  The most significant determinants associated with the use of FP among youth (age 15-24) were social support from friends and from partner page 10 Quantitative data from PSI/Madagascar

11.  Gender synchronized approach –Target men and women alike with messages and services  Communication channels –Radio serial drama –Peer education –Couples’ counseling page 11 Program design to constructively engage men

12. Healthy Images of Manhood (HIM) approach page 12

13. Demo: Act Like a Man/Act Like a Woman page 13

14. “When the PSI peer educators invited me to attend the session, I laughed because I told him that I can’t get pregnant. But after the session I realized that my future is also at stake and that if I really care about my partner I should help her to realize her dreams too.” Meet Romelle, age 23 page 14

15. Increase in number of young male FP clients page 15

16.  Keys to success: –Separate peer education sessions for girls/women and boys/men –Involvement of providers in communication activities –Training follow-up and supervision Lessons learned PAGE 16  Evaluation planning underway

17. Thank you PAGE 17