Building the Evidence Base for Male Involvement in Malawi Targeting Men in Cross-Generational Relationships: Results from the Malawi Male Motivator Study October 4, 2011: Interagency Gender Working Group Brad Kerner, Adolescent Reproductive Health, Sr. Specialist Increasing Family Planning Utilization by Youth Access Quality Community Based Distribution by Youth Improved Supervision Expanding LAM use through TBAs Family Planning Logistics Workshops Demand Enabling Environment Teen Mother Clubs Initiation Counselors Male Motivators National FP meetings Male Motivator Operations Research Design 40 Male motivators trained Randomized Controlled Trial with 400 couples Pre/Post quantitative assessment Qualitative interviews 14 ♂ 30 ♀ The Intervention Visit 1 • INFORMATION: Socio Economic benefits of birth spacing, Family Planning 101 Visit 2 • MOTIVATION: Norms and perceptions of men who use family planning; disclosure of educators own experiences Visits 3, 4 & 5 • BEHAVIOR CHANGE: Skills development and role plays to encourage couples communication 5 visits over 8 months Quantitative Results Outcome Measurement 1: Increased uptake of modern family planning methods 100 80 60 Treatment 40 Control • Both arms increased significantly (p < .01) 20 0 Baseline Post Increase in Treatment arm significantly greater than Control (p < .01) Quantitative Results Outcome Measurement 2: Increased Family Planning Knowledge 58 56 54 Treatment 52 Control 50 48 Baseline Post Values represent the average percentage correct for each group. • Both groups showed significant increases in their family planning knowledge (p < .05) • No statistical differences in group scores over time Outcome 3 : Improved Attitudes toward Family Planning & Gender Equity Outcome 4: Improved Family Planning self-efficacy 4.5 • FP self-efficacy scale, Gender Equitable Male scale, FP attitudes scale. 4.25 • Both groups showed significant increases in each of the variables (p < .05) 4 3.75 Baseline Post Strongly Disagree (1) – Strongly Agree (5) Likert Scale • No statistical differences in group scores over time Quantitative Results Outcome 5a: General Communication about family planning 4.5 • Treat CG 4.25 Cont CG Communication General Scale – Assesses whether participants’ discussed family planning with wives, extended family, friends • • Both groups significantly increased scores on variable (p < .01) No statistical differences between groups at baseline or post intervention 4 Baseline Post 5 point Likert-scale Strongly Disagree EASE OF COMMUNICATION WITH WIFE was found moderately significant (OR =1.57, p=.08) “ It is easy to discuss family planning with your wife?” Quantitative Results Outcome 5b: Communication Frequency about family planning • Communication Frequency Scale – Assesses how often participants’ discussed family planning with wives, extended family, friends • 3 2.75 Treat CF Both groups significantly increased scores on variable (p < .01) 2.5 Cont CF 2.25 2 Significant change over time was identified between the two groups with communication with wives (p < .05) “How often do you discuss family planning with your wife?” Baseline Post Qualitative Results Pathways to FP Use Improved Ease in Communication Results: Qualitative Qualitative Results Pathways to FP Use Improved Frequency of Communication Wife states… “We never discussed matters, but since his participation in the study we talk about sex, family planning, and how to enjoy marriage.” Qualitative Results Communication Patterns Theme # of male (n=14) # of female (n=30) Man initiates conversation 10 18 Man communicates support of FP 2 15 Woman initiates conversation 2 9 Woman previously initiated conversation 0 9 “There has been an improvement in the way we discuss FP issues because I have been telling my husband about FP but he never believed me until the coming of the Male Motivator.” Qualitative Results Family Planning Decision Making Decision to use Family Planning Joint Decision MaleDominated Female Dominated # of male 7 8 0 # of female 9 18 4 “I have seen my husband consulting me in some issues, a thing I think he has learned from the study initiative. This attitude gives me the impression that I am considered worthy and trustworthy friend in the family” Thank you! Changes in Couples’ Communication as a Result of a Male Involvement Family Planning Intervention; Miriam Hartmann, Kate Gilles, Dominick Shattuck, Brad Kerner, Greg Guest, Journal of Health Communication, accepted Feb 2011 (Forthcoming) Motivating Men to Communicate about Family Planning and its Effect on Contraceptive Uptake: The Malawi Male Motivator Project, Dominick Shattuck; Brad Kerner; Katherine Gilles; Miriam Hartmann; Thokozani Ng'ombe; Greg Guest; American Journal of Public Health April14th, 2011