Masculinity and maternal, newborn, and child health

Men's engagement in maternal, newborn, and child health (MNCH) is associated with positive health outcomes for mothers and their newborns. However, most evidence supporting these claims is limited to industrialized countries, and studies from low- and middle-income countries, especially those from patriarchal societies, report mixed results. Furthermore, the current literature related to male engagement in MNCH has other limitations, including poor conceptualization of male engagement and lack of focus on masculinity, masculine capital, and relationship capital. Guided by the implicit gender role theory, this dissertation sought to understand the intersection of the socio-cultural construction of gender identity and male engagement in MNCH. Chapter 2 employs a meta-analytical approach to the study of male engagement in MNCH and included studies from Africa, Middle East, Asia, and Latin America (n=89). Gender-equitable male engagement approaches had a statistically significant positive association with the use of at least four antenatal (ANC) visits (adjusted odds ratio[aOR]=1.46, 95% confidence interval [95%CI]=1.22-1.70), having a skilled attendant at birth (aOR=1.74, 95%CI=1.32-2.17), use of postpartum care (aOR=1.31, 95%CI=1.18-1.44), use of postpartum modern family planning (aOR=1.52, 95%CI=1.27-1.77), adherence to antiretroviral treatment (aOR=2.37, 95%CI=1.37-3.38), and exclusive breastfeeding at least for six months (aOR=2.87, 95%CI=1.10-4.63). Gender-equitable engagement also had a statistically significant inverse association with the experience of pregnancy complication (aOR=0.50, 95%CI=0.30-0.69) and infant/neonatal mortality (aOR=0.35, 95%CI=0.17-0.53). Accompanying one's partner to the health facility and provision of support also had a significant association with some of the outcome variables. Chapter 3 used primary data collected among married men in Western Kenya who had a child in the last 12 months (n=280) to investigate whether there is an association between the perception of masculinity and male engagement in MNCH and whether masculine capital and relationship capital explain the association. Perception of masculinity had a statistically significant inverse association with male engagement in MNCH (aOR=0.80, 95%CI=0.71-0.91), and 34% of the association is explained by masculine capital. Chapter 4 used data from seven Focus Group Discussions (FGDs) conducted among married women (mothers and mothers-in-law) in Western Kenya (n=53) to examine women's perspectives on men's engagement in MNCH. Social pressure was reported as one of the factors that prevented gender-equitable male engagement in MNCH. The support for increased male engagement in MNCH varied between mothers and mothers-in-law, with mothers-in-law showing less support and more negative attitudes toward greater male engagement in MNCH. Mothers-in-law's resistance to male engagement in MNCH appeared to be framed by broad factors, including their view that women, by virtue of their gender, are designed to take care of children, the perception that MNCH is “women's business,”, their desire to avoid social pressure or negative stereotyping, and their desire to safeguard the space from men's control. Overall, the three empirical chapters demonstrate the importance and the need for greater integration of gender-transformative conceptual approaches into future male engagement interventions, with effective measures built into such interventions to develop the evidence base for their impact on a broad range of health and gender equity outcomes. It also showed the importance of incorporating women's views and voices in male engagement policies, research, and intervention designs. Thus, researchers, policymakers, funders, and practitioners in the field of MNCH may benefit from an increased focus on a gender-equitable male engagement that recognizes men as agents of positive change with the ability to transform underlying gendered constraints on MNCH and support men to challenge pre-existing roles and norms surrounding masculinity, intimate partner relationships, and parenting.