1. Magnitude, Motivation and Barriers of Male Partner Involvement in Reproductive Health Services in Shinyanga District Alfred Chibwae Project Director Tuzungumze Project Voice Text for Health Project. Student Medical doctor (MD 5) Catholic University of Health and Allied Sciences-Bugando chibwae@tanzaniaruralhealth@org First UDOM’S International Global Health Conference

2. Preamble  Background  Justification  Research Question  Objectives  research methods  Results  discussion  Conclusion  Recommendation

3. Background  Male involvement in reproductive health (RH) in Africa has a direct significant effect on maternal and child health.  A number of barriers of male involvement has been previously reported  Following implementation of MDGs [20000- 2015] however the existing magnitude and motivation of their involvement remains not widely studied. Maja, T.M. et al 2013, Msuya, S., et al. 2008, Theuring, S., et al 2009, Greer, G., et al 2009. Walston, N., 2005

4. Justification  The household decision making in African setting as in Shinyanga remains to be under male partners.  However their involvement in decision making in RH have been not encouraging despite of poor maternal and under five mortalities in many red flagged regions like that of shinyanga.  Knowledge on magnitude and motivation of male involvement in RH will help the relevant programs to adjust their approaches especially at this point of 15 years post MDG The Lancet, 2009, Hollos, M. 2004, National HIV and AIDS Response Report 2012. 2013, TDHS 2010

5. Research Questions Are males in Shinyanga, Tanzania involved in sexual and reproductive health services and what determines their involvement or non- involvement?

6. Objectives  General To determine the magnitude, barriers and motivations factors for male involvement on the sexual and reproductive health services among married men

7.  Specific Objectives 1. To determine the proportion of males involved in sexual and reproductive health services. 2. To determine the practices of female partners to engage their husbands in reproductive health services. 3. To determine the factors hindering males seeking involvement in the sexual and reproductive health services. 4. To identify motivations that can improve male involvement on the locally available reproductive health services.

8. Methods Study design Cross-sectional study triangulated with qualitative approach [In-depth interview]. Study area; ShinyangaDC Study duration August to October 2015. Study Population and Sample Size 204 Married men

9. Method cont…. Swahili questionnaire was used to obtain social demographic information and their effects on the male involvement in different reproductive health services. quantitative data was processed and analysed using SPSS statistic version 20 software in-depth interviews were done and recorded using zoom H1 device to explore possible motivational factors, then data was analysed manually basing on the emerging themes.

10. Out of 204 married men participated in the study, 92.6 % (189/204) reported to attend at RH at least once while 72.1 % (147/204) attended at least twice. The attendance was highest in VCT services (75.5%) followed by 67% in ANC but STIs/STDs, PMTCT, reproductive and genital tract Cancer and adolescent reproductive health services were attended by less than 13% of all men interviewed. Results

11. Figure 1: Proportions of married men attendance and spouse invitation to various reproductive health services in three health centers of Shinyanga District, North western Tanzania

12. Socio-demographic Factors Associated with Male RH Involvement Age between 25-40 (χ 2 =9.347,df =2, p=0.009). number of children having up to two children (χ 2 =6.201, df=2, p=0.045) female partner invitation (χ 2 =29.901, df=1, p-< 0.001). Result cont……..

13. Barriers to Active Male Involvement Lack of information (71.6%), belief of services being for women only (52.9%), fear of HIV/AIDS results (8.8%) lack of specific services for men (15.2%) Fear of side effects and misconception of some of FP mehods

14. Qualitative Outcome Actually there are very few motivation factors for their attendance except for the need of the knowing their HIV/AIDS status possibly after their partners got their results after testing HIV/AIDS. below are some of the reasons for male attendance,

15.  Internal Motivation: Only 20% (4/20) “I wanted to know the condition of the baby in the womb and if my wife had any problem as there are many risks needed to be taken care of early”  External Motivations: “The community health workers have been talking to us in the village about voluntary counseling and testing together with our partners”. Another man said “My wife was pregnant and doctors denied her services until I went with her to the clinic”.

16. Other reasons Men participation as partners: About 20% of the participants. “I also wanted to know the condition of the baby in the womb and if my wife had any problem” Men attending as a requirement: About 65% (13/20). “When my wife was pregnant she went alone to the hospital, the doctor told her to come back home and take me with her to the clinic. So I had no other option except going with her to the clinic. Coincidental visits: About 15% (3/20).

17. DISCUSSION  unsatisfactory level of male participation being more to ANC and VCT services even though it’s better than the once previously reported in the region  majority of them attended with their partners only in VCT and ANC. Michael, E., 2012, Becker, S., et al., 2010, Byamugisha, R., et al. 2011, Msuya, S., et al.

18. Discussion cont…….  The maximum attendance was in age group of 25-40 years and Having 0-2 children in the family was also associated with male attendance in bivariate analysis.  Comprehensive communication delivered by female partners from health facilities to the husbands was also associated with attendance, similar finding has been observed in other settings Butto, D. 2015 Shahjahan, M., et al., 2013, Nantamu, D., 2011, Sarker, M., et al. 2007

19.  Lack of information was the major hindering factor.  cultural constraints, unfriendly health workers and lack of good quality specialized men friendly services.

20. Discussion cont…….  Majority (80%) of the interviewed attended reproductive health services simply because it was a requirement or just happened coincidentally BUT WERE NOT REALY MOTIVATED.  we need male partners who are motivated with the outcome of their participation to SRHC. This study found few motivators like men knowing HIV status and well described invitations associated progress updates from their female partners.

21. CONCLUSION. o Male involvement in RHC was higher than the previously reported but the frequency was not promising meanwhile STIs/STDs, PMTCT and reproductive and genital tract Cancer, were at all not known and not attended. o Despite the improved attendance there was lack of internal motivation among the RH male partners in attendance was high

22. Recommendation  Experimental studies on how best men can be internally motivated to attend RH  e- health and m-health on male RHC.  Male friendly reproductive health services

23. ACKNOWLEDGEMENT  SUPERVISORS: DR. ANTHONY KAPESA : DR. BASINDA NAMANYA  SCHOOL OF PUBLIC HEALTH CUHAS BUGANDO  TANZANIA RURAL HEALTH MOVEMENT  TOUCH Foundation and Bristol-Myers Squibb  Engender Health office-Shinyanga and Marie Stopes Kahama.  All men who participated in this study in Shy DC

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