Back in November, we started a program called Men Are Partners (MAP). At the first round of meetings in 4 different villages with over 100 men, we held discussions on the role of Gambian men in the health of their wives and children. Most men believe their only role is to give money for food and for clinic fees (usually amounting to $1 a day – 25 Dalasis for clinic fees if they go and 25 dalasis for fish). The nine indicators of the MAP project are:
1. Men who accompany their wives to the clinic for early ANC booking in the first trimester of pregnancy
2. Men who accompany their wives for delivery
3. Men who accompany their wives for post-natal check ups after delivery
4. Men who complete household chores so their wife has time to exclusively breastfeed their child for the first 6 months
5. Men who take their children to the monthly Reproductive and Child Health clinics
6. Men who prepare nutritious complementary foods while their child weans off of exclusive breastfeeding
7. Men who construct handwashing stations in their compounds and insist upon its use
8. Men who hang bed nets on every bed in their compound and insist upon their use
9. Men who accompany their wives for family planning consultations
I’ve found this a perfect place where my health education and cultural exchange overlap – I often reference the fact that my Dad would do all of these things without any pressure and more. Still, most men laugh at me when I tell them that I want them to cook lunch one day or sweep their compound.
In our second round of MAP meetings, we focused on Men’s Health. I opened the meetings by reminding them about the 9 things I want them to do – some men will tell me:
“Ali! Dama dee bale suma ker por suma jabar.” – Ali! Every day I usually sweep my compound for my wife.
“Newna noorse bu passe, Ali!” – I came to last month’s RCH clinic, Ali!
But some will say:
“Ali, lolu nekut suun ada. Lolu ligeey jigeen.” – Ali, that’s not our culture. That’s women’s work.
We’re working on it.
After we review, we go over a few issues that men don’t usually want to talk about: heart health, family planning, and STIs. We explained the causes of hypertension and that we need to reduce salt intake and exercise more. Then each man got his blood pressure taken and was advised accordingly. I told them that they don’t know how much salt is in their food because they refuse to help with the cooking – tying it back to the indicators.
We then explained the different forms of contraception in The Gambia. Mostly here, women will wait until night time and then sneak to the clinic and ask to join family planning. When the woman doesn’t get pregnant, the husband is angry and confused. I told them that if they would sit down and discuss these things with their wives, they could all understand what’s going on. Family planning consultations should be between the doctor, husband and wife. We also discussed how family planning is not just the responsibility of the woman, that there are measures you can also take as men.
This transitioned into STIs: signs, symptoms, and treatment. Pregnant women are tested for STIs, but they usually don’t inform their husbands of the disease. We discussed how STIs are transmitted and how if you have multiple wives, all of you could have the disease and keep reinfecting each other. Again this looped back to family planning and having open conversations with your wives as partners.
One of the best moments was when the Imam in my village, the religious leader, moved from the back of the group to the front row to get a better look at the family planning poster I brought. It has all of the different types of contraceptions, and he was blown away by what he didn’t know about family planning. He said:
“Leegi dama maget, so nekut suma affar, waay dama wax ak suma xadiitli ak xaleii.” – Now I’m old, so it’s not really my problem, but I’m going to talk to the younger men about this.
After Ramadan and farming season, we’ll have another formal meeting in which I hope to discuss all of these issues and give them a cue-to-action to bridge between the education and actual behavior change.