Constructive Men’s Engagement (CME) in Enhancing Reproductive Health in Makindu and Mutitu Sub-Counties of Kenya.

Reproductive health problems are the leading cause of women's ill health and death worldwide. Approximately 99% of all maternal deaths occur in developing countries, with Sub-Saharan Africa registering a maternal mortality ratio of 1,000/100,000 live births. Maternal mortality in Kenya has continued to rise since 2003, from a ratio of 414 deaths per 100,000 live births to 488 deaths per 100,000 live births in 2009. Over 56% of deliveries in Kenya are attended by unskilled people and outside health facilities. Only 28% of women receive skilled care within the first 4 critical hours following delivery. Men play cardinal and dominant roles in reproductive health. However, increasing their participation has not always been achieved. The main objective of this study was to establish individual, programmatic and healthcare provider related determinants of Constructive Men’s Engagement (CME) in reproductive health, and explore their potential for improving women’s health. An interventional quasi-experimental design was applied with interventions to promote CME-RH being implemented in Makindu Sub-county for 12 months following baseline while Mutitu Sub-county served as a control site. A total of 968 men and 32 nurses participated with 484 men respondents being interviewed at baseline and end-term in both sites. Furthermore, 8 men and 10 women FGDs, in addition to 18 KII were undertaken. A GEM Scale for CMERH was adapted and applied to establish CME-RH levels among respondents. Similarly, a Trainer of Trainers’ manual on CME-RH was also developed and used to facilitate fortnightly CME-RH sessions with groups of men in Makindu. SPSS Ver 19.1 was used for data management with Chi-square tests, correlation and regression statistics applied for analysis. At baseline, Makindu and Mutitu had 43.4% and 44.6% of men who had CME-RH respectively. However Makindu recorded 60.3%, while Mutitu had only 47.1% of men who were CME-RH compliant at post-test. On individual characteristics, education level OR= 2.095 (0.9024.839) p=0.004, age of respondent OR= 1.716 (1.328 -2.438) p<0.010, knowledge on the number of times a pregnant woman should attend ante-natal clinic OR =1.738 (1.239 2.925) p=0.008 and knowledge of conventional family planning methods OR= 0.733 (0.579 0.968) p=0.043 were identified as independent predictors of CME-RH. Spousal approval for use of family planning OR= 1.316 (0.06 2.296) p=0.002 as well as approval for access to FP services by young unmarried couples OR= 2.881 (1.783 5.271) p<0.001 were also significant. Programmatic independent predictors of CME-RH were identified as having male only RH meetings/trainings OR= 1.094 (0.766 1.703) p=0.015, lack of confidentiality among ANC/MCH staff OR=1.297 (0.793 2.237) p=0.016 and the perception that RH programs have done little to involve men OR=1.963 (1.289 2.19) p=0.003. The capacity of health care providers including their skills, competencies and attitude also greatly influenced CME-RH. This study recommends promotion of CME-RH to be prioritized while reproductive health programs should adopt a multi-sectoral approach in design and implementation. Trainings and health promotion meetings targeting men on RH matters should always be organized for men only. Ways must also be devised to ensure staff at ANC/MCH clinics observe confidentiality with regard to client information, while RH programs must engender men to play seminal roles as prevalent at household and community level. Research would be valuable to unravel cultural values and practices that could be harnessed to promote CME-RH in Kitui and Makueni Counties. 1 CHAPTER ONE: INTRODUCTION 1.1 Background of the Study Reproductive health problems are the leading cause of women's ill health and death worldwide (WHO, 2012). When both women and men are taken into account, reproductive health conditions are the second-highest cause of ill health globally, after communicable diseases (UNFPA, 2009). Though almost entirely preventable, reproductive health problems remain widespread in much of the developing world. They ruin lives, burden families, tax health systems and weaken countries (WHO, 2012). The costs range from the sorrow of a motherless child to the diminished energy and productivity of millions of women. They include maternal deaths, unintended pregnancies, high fertility, abandoned children, unsafe abortions and AIDS, as well as sexually transmitted infections and the cancers, infertility and new-born illnesses associated with them (UNICEF, 2012). Sexual and reproductive health (SRH) is a prerequisite of all millennium goals, particularly those related to gender and health (UNFPA, 2009). The most direct link is MDG 5 which seeks to improve maternal health. The goal sets to realize by 2015, universal access to reproductive health including contraceptive prevalence rate, adolescent birth rate, antenatal care coverage and unmet need for family planning. The many costs of unsafe abortions far outweigh the price of the contraceptives that could prevent such suffering. The risk of death of children aged below 5 years in Kenya triples upon the death of a mother. Improving maternal health is thus a prerequisite to improving new-born, child survival and health (MoPHS, 2010b). According to the Kenya National Reproductive Health Strategy, skilled care during pregnancy, delivery and postpartum period is one of the most fundamental health care services for averting maternal and newborn mortality (MoPHS, 2009b). Besides, contraception/family planning services avert