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From father to father: Why men must get involved in maternal and child health


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In cultures where men are not usually involved in matters pregnancy and childbirth, maternal and child health indicators are usually the most negative.

Tuesday June 19 2018

Keshi Leodip is a father of seven. He’d have had his eighth child by now, but he lost his seven-month pregnant wife and the unborn child.

“I was at a cultural party in February when I received a call just before midnight that my heavily pregnant wife was unconscious,” he recalls.

“I rushed back only to find my wife – Jemimmah – bleeding profusely. Traditional midwives were administering medicinal herbs to her and due to tradition and a poor healthcare system, she was kept at home for over an hour without any emergency care. She breathed her last at exactly midnight.”

Jemimmah had not gone for antenatal care and there were no arrangements for her to give birth in hospital. All their seven children were born at home. They tried calling for an ambulance but due to poor cellular network, they could not reach the hospital.

“Men have never been involved in matters pregnancy. It was a path that women walked as lone soldiers. My wife’s death changed my thinking,” the 50-year-old who lives in Marti Village in Samburu County.

“Cultural practices tend to override science and modern medicine and as a result woman in dire need of basic health services rarely seek them,” Mr Leodip told the Healthy Nation in an interview.

But things are changing in Samburu. Through Amref Health Africa Uzazi Salama initiative, men and fathers in pastoralist communities are being trained on the importance of skilled delivery and being encouraged on male involvement in maternal and child health. This is to make fathers realise their family obligations through shifts in attitudes, behaviour and culture.

“I thought there was nothing hospitals could offer that was better than our herbs. And of course hospitals would give my wife family planning and that’s against our culture. But my wife’s death brought me back to reality.

“I sought a second opinion on what could have led to her untimely death and to avoid the same in future my area chief introduced me to Marti, a father-to-father support group.”

MADE ARRANGEMENTS

“Thanks to the group I have made arrangements on how my second wife would give birth in a health facility,” he added.

Fredrick Majiwa, the project officer for Samburu County, says that inclusion of men in maternal and child health has helped reduce child and mother deaths.

“Fathers are the final decision-makers in this patriarchal society, so they have to be on board to boost maternal and child health,” he added, calling upon the county to adopt the project which ends in September. There are 10 such groups in the county comprising 23 elders each.

Men do not believe in hospitals, so they do not allow their wives to seek much-needed healthcare, such as attending the recommended antenatal clinics. Most of them end up dying at home, but things are changing,” said acting county executive member for health Dr Dorcas Lekisanyar, noting that women have to seek permission from their husbands, and if the man is not bothered, they don’t go to hospital.

For Mr Leodip getting involved in “feminine” matters is now not strange at all. He is also persuading his second wife to embrace contraceptives, while accompanying her regularly for her antenatal check-ups, as well as discussing the health of their babies.

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Keshi Leodip at his home. PHOTO| ANGELA OKETCH

They are taught – during their support group meetings – of the importance of antenatal check-ups, family planning options, like the use a condom, immunisation, skilled delivery, how to check on the danger signs during pregnancy, hygiene and how to practise natural methods of birth control.

MONTHLY MEETINGS

“We meet every month at Marti Dispensary to discuss and learn about maternal and child health,” he said, adding that plans are underway for his family to move closer to a health facility when his new wife is about to give birth.

Marti chief George Ewokon leads the men in family planning discussions. During barazas, he takes them through different types of family planning methods, their effects and even how to use the methods. The methods which were available when Healthy Nation visited them on the baraza day included, condoms, pills, injectables and implants.

“I am happy that elders can now sit and listen to the teachings. Before, they would chase away health care workers, they would tear and throw away their teaching aids,” said Mr Ewokon.

Not far from Mr Leodip’s homestead is another man whose wife is five months pregnant. Petro Echuka, 44, says after his first three children were born at home, he decided to have the rest at a health facility. His last three children were born in hospital and this is going to be the same case for the pregnancy his wife is now carrying – thanks to the Marti father-to-father support group.

Mr Echuka says the difference between his six children is noticeable.

“The ones who were born at home were never immunised. They get sick a lot,” he said. “But now I love how cheap giving birth has become. My wife no longer gets sick when she is pregnant, since she gets drugs at the facility and even goes for checkups.”

WALKING TOGETHER

He added: “When my wife is pregnant, we walk together.”

Mr Echuka, just like his mate Mr Leodip, has been accompanying his wife to the antenatal clinic and his children are now all immunised and healthy. Besides the clinic visits, he can now cook and wash clothes for his wife, since they were taught at the forum that a woman faces certain risks if she overworks and walks long distances. Since the men got involved, the number of successful deliveries in a health facility with a qualified health worker has also increased.

Dr Lekisanyar says had they started the initiative of engaging men earlier, they would have reduced the deaths. She says maternal health has been a great improvement with only five mothers dying in 2017, compared to nine in 2016, according to data from the county.

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Fathers learn about natural family planning (bead method)during a support group in Marti Village in Samburu County. PHOTO| ANGELA OKETCH

There were 49 neonatal deaths in 2016, compared to 28 in 2017. In 2017, 4,000 mothers had skilled deliveries as compared to 2,000 in 2016. About 5,000 children were immunised in 2017, a situation that was largely affected by the long health workers strike. The numbers have increased in 2018 to 6,000, due to outreach services from the counties.

The Kenya Demographic and Health Survey (KDHS) 2014 shows that skilled birth attendance in Samburu County was 32 per cent. Reports from the Ministry of Health last year indicate that only 30 per cent of the county’s 850,000 people have access to the most basic maternal health services, and due to other factors such as deplorable road networks, culture and ignorance, only 17 per cent use these services.

The World Health Organisation (WHO) declared 2016 the year of involving men in maternal and newborn health as a priority. It published recommendations on health promotion interventions for maternal and newborn health.

WHO recommends further research into a family approach, with a focus on key family relationships around the mother and baby, therefore fathers cannot be left behind.

MEN'S INVOLVEMENT

“Interventions to promote the involvement of men during pregnancy, childbirth and after birth are recommended to facilitate and support improved self-care of women, improved home care practices for women and newborns, improved use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns, and increase the timely use of facility care for obstetric and newborn complications,” WHO said.

The KDHS 2014 shows that only six counties have less than 90 per cent coverage of antenatal clinic attendance. They are Mandera, Wajir, Samburu, Marsabit, West Pokot and Garissa.

The percentage of women attending four or more antenatal clinic visits ranges from 18 per cent in West Pokot to 73 per cent in Nairobi, while in 12 counties (Garissa, Wajir, Mandera, Meru, Bomet, Marsabit, Turkana, West Pokot, Trans-Nzoia, Elgeyo Marakwet, Narok, Bomet, and Kakamega), less than 50 per cent of women make the recommended number of visits.

In six counties, (Tana River, Wajir, Marsabit, Turkana, West Pokot, and Samburu) less than one-third of live births in the past five years were attended by a skilled provider or were delivered in a health facility.

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WHO recommends further research into a family approach, with a focus on key family relationships around the mother and baby, therefore fathers cannot be left behind. PHOTO| FILE| NATION MEDIA GROUP

The survey indicated that national fertility stood at 3.9 births per woman, with rural women having about 1.4 children more on average than urban women.

Counties with the highest fertility rate include Wajir at 7.8, West Pokot (7.2), Turkana (6.9), Samburu (6.3), Garissa (6.1) and Narok at 6.

According to KDHS 2014, contraceptive use among married women is lowest in the North Eastern region at 3 per cent. Counties with the lowest contraceptive prevalence rates are predominantly from northern Kenya, and include Mandera and Wajir (2 per cent each), Garissa (6 per cent), Turkana (10 per cent) and Marsabit (12 per cent). Some 18 per cent of currently married women have an unmet need for family planning: Nine per cent to space births and eight per cent to limit the number of children.

Prof Omar Egesa, a lecturer at Moi University’s Department of Anthropology, acknowledged the involvement of men in maternal health saying that it is “the most effective method” more so in resource-limited areas.

“It is the best decision since most women depend on their husbands for advice. Men can’t be ignored in this journey,” said Prof Egesa.

 

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Dad loss means cell stress

The absence of a father due to imprisonment, death, separation or divorce, could affect the health of children by decreasing telomere length.

Telomeres, the protective end caps of chromosomes, reflect cell ageing and overall health. Telomeres shorten each time a cell divides, and when they are too short, cell replication stops. Short telomeres are associated with cardiovascular disease and cancer.

Researchers measured telomere length and analysed data collected from the Fragile Families and Child Wellbeing Study, which has a cohort of 5,000 children.

They found that the stress of losing a father led to shorter telomeres. The effect was greatest for father loss between birth and nine years (14 per cent shorter telomeres) and the effect was greatest for children whose fathers died (16 per cent shorter). Boys, especially those under age 5 were the most affected.

 

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Dads matter in obesity war

Fathers play an important role in their children’s eating and physical activity habits, even though they are not included in family-based interventions to prevent childhood obesity.

Researchers reviewed scientific studies on childhood obesity prevention interventions from around the world and found fathers nearly absent, even though they have a strong influence on what their children eat. Some studies show that a child is 10 times more likely to be overweight is his or her father is overweight, than if only the mother is overweight.

“Fathers have a unique influence on kids and their dietary habits. If they are missing from childhood obesity interventions, we are compromising our ability to improve children’s weight outcomes,” said the researchers. They analysed 85 family-based interventions for childhood obesity prevention conducted around the world since 2008. Fathers represented only six per cent of all parent participants.

They were rarely included in interventions targeting families with infants. Only one per cent of interventions were geared toward fathers only.

The researchers said that where children live with both parents, both should be included in teaching kids healthy habits because they both play a role in children’s food and activity.

The findings were published in Preventive Medicine.