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Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced RMNCH in rural Kisii and Kilifi. Methods: The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions (FGDs) with 82 community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews (KIIs) with facility health managers, and sub-county and county officials who were aware of the AQCESS project. Results: Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning (FP), spousal/partner accompaniment to facility care, and defeminization of social and gender roles. Conclusion: This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children’s health as well as in improving spousal support for use of FP methods.
A qualitative study. The evaluation study was conducted in Kilifi (Kaloleni and Rabai sub-Counties) in southeast Kenya and Kisii (Bomachoge Borabu sub-County) in southwest Kenya where Aga Khan University conducted a RMNCH intervention since 2015. Both Kilifi and Kisii are patriarchal communities and geographically dissimilar rural counties in Kenya. Further details on social-cultural context of Kilifi can be found in our earlier research paper (19). Table 1 gives a summary of some of the interventions that were led by the AQCESS project team to promote male engagement. The interventions were implemented in these areas over a period of 4 years and were nearing completion when this study was conducted and a detailed description is provided by Lusambili et al. (27). The male engagement strategies were designed to change men’s behaviors and increase their support toward women during pregnancy, ANC, delivery, and PNC. The interventions also aimed to enable men to become change agents in addressing socio-cultural and gender inequalities in Kisii and Kilifi counties. The qualitative study assessment employed 10 FGDs with 82 participants and 11 KIIs across the two study sites. Key informants who were aware of the AQCESS project in the past 1 year were purposively sampled by AQCESS project managers for interviews. These included males and females at the county, sub-county, and health facility (HF) levels. Focus group discussions participants were recruited by AQCESS project field coordinators. Across the two sites, FGDs were conducted separately with female and male CHC members, male and female adult community members, and female and male adolescent community members. To qualify, participants had to have lived in the AQCESS target areas for at least 1 year and have awareness of AQCESS male engagement activities. While efforts were made to secure as great a representation as possible to ensure an unbiased and representative sample, this was balanced necessarily by the need to be familiar with or engaged in the AQCESS project. Adolescents were aged 15–19 and included those who had been involved in AQCESS gender forums. The qualitative evaluation explored the observed benefits of male engagement, the perceived effectiveness of male engagement strategies in promoting RMNCH, facilitators and barriers to male engagement, and the lessons learned for engaging men in RMNCH. For this paper, we will focus on the evaluation of the benefits of involving men in RMNCH activities. Data collection was led by the study Principal Investigator (PI), a qualified qualitative consultant, and a team of experienced research assistants. Actual data collection commenced after securing institutional approval from the Aga Khan University (AKU) Kenya and National Commission for Science Technology and Innovation (NACOSTI/P/19/2768) on December 3, 2019. The research also sought consent from all participants and was granted permission to carry out the research from local HF and CHCs. Data was collected from January to March 2020 in the local Swahili language. All the study participants were provided with full disclosure and information regarding the purpose of the study, including the benefits and risks. They were also given the opportunity to ask questions before, during, and after the KIIs and FGDs. Focus group discussions for “women adult community members,” “male adult community members,” “male adolescents,” and “female adolescents” were facilitated separately by a qualified facilitator and a note taker of the same gender. Research assistants were trained on the approved protocol requirements and participants consenting processes prior to performing data collection. Parental/guardian assent was sought for adolescents <18 years of age. All participants provided written consent prior to participating in the study. All KIIs and FGDs were conducted in community spaces deemed convenient and private for interviewees to converse. Focus group discussions consisted of 6–8 people. All audio recordings from the collected interview data were labeled and transferred to a secure laptop at AKU's Monitoring Evaluation and Learning Unit (MERL) and then subsequently deleted from the audio recorders. All reflective field notes and transcripts were stored on a password protected computer and accessibility was limited to the study team. Further, transcripts were anonymized by deleting any references to names and additional identifiers to safeguard participants' confidentiality. Translated and transcribed data was checked by the study PI and study consultant who are Swahili native speakers. To address reliability and validity, two qualitative researchers read all the transcripts, coded them separately into NVivo 12 Data Analysis Software (QSR International), and proceeded to identify codes, categories, and themes with attention to contradictions across the two sites and diversity of experiences, and to perceptions and attitudes across the different stakeholders. These codes, categories and themes were compared and harmonized. Additionally, the study PI randomly reviewed selected transcripts and compared the final codes, categories, and themes identified by the two preceding coders. Toward the end of March 2020 and early April 2020, the AQCESS research team held a workshop at both study sites to validate the findings. The workshop, attended by all field staff, local stakeholders, and the research team, confirmed the observed interventions as well as findings on the benefits of involving men in the RMNCH activities.
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