by Charlotte Feldman-Jacobs

(March 2009) Six years ago, the Mali Mission and its local partners faced a discouraging reality:

• Too many mothers were dying (estimates ranged between 600 and 1,300 maternal deaths per 100,000 live births).
• Women were having too many children (a fertility rate of about 7 children per woman).
• Too few women were using contraception (only 8 percent of married women ages 15-49 used any contraceptive method and even fewer used modern methods).

Clearly this would not be a situation with a quick fix, and it would require very fundamental shifts in the country.

Fortunately, reproductive health staff members at the Mission knew that part of the fix would have to involve changing gender barriers that contributed to the reproductive health situation in Mali. So, in October of 2003, Christine Sow, a reproductive health advisor at the Mission, placed a call to the Interagency Gender Working Group (IGWG) in Washington, DC. Her objective? To integrate gender into reproductive health programs in Mali to begin changing some of the realities on the ground.

"Women's health and status are big issues here. And women are the gatekeepers of health for families and children," Sow said recently from her new post with UNICEF in Mali. "But there are lots of barriers to their role as gatekeepers.

"Women in Mali still need to ask their men for money and there are lots of taboos around talking about reproductive health issues." Sow, who remained on the Mali Mission reproductive health staff until 2008, the last three as team leader, believed that the Mission would need to improve communications between couples in addition to beginning a discussion on "what it means to be a good husband and a good father." Thus, the 2003 call to IGWG, requesting a gender training for the Mali Mission and its local partners.

It isn't the only time that the IGWG gender training has been requested by Missions and partners in developing countries, but it is among the most successful examples of what such a partnership can achieve.

In response to Sow's request for IGWG training, the Health Policy Initiative (HPI) Task Order 1, a USAID-funded project implemented by Futures Group, began by holding an introductory gender training (Gender 101) in Mali. Once that was completed, the Mission and its local partners wanted more. A second training team went back to Mali to do a more in-depth, hands-on three-day gender integration training with a focus on constructive men's engagement (CME), which aims to involve men in reproductive health in three overlapping roles:

• As clients of RH services.
• As supportive partners to women.
• As agents of change in the family and community.¹

Over the course of the last six years, multiple organizations and stakeholders have come together on this effort, including trainers from the National Technical Assistance Project (ATN), Futures Group, HPI/Mali, IntraHealth, and private consultants, drawing on each others’ expertise and skills. Through numerous phone calls, visits, assessments, training sessions, pilot interventions, and identification of local stakeholders, this rewarding partnership has yielded results, as outlined in a new publication, “Men Matter: Scaling Up Approaches to Promote Constructive Men’s Engagement in Reproductive Health and Gender Equity.”²

Asked what made this such a model partnership, Mary Kincaid, head of HPI's gender training portfolio, said, "This was the perfect storm. Here we had sustained interest over a period of years from a Mission that was already "convinced" about the importance of gender; we had several CAs willing to collaborate; and it was about men's engagement-one of the IGWG's main priorities."

And, she added, the conditions of gender inequity in Mali-the low literacy rate of women (17 percent of women compared to 37 percent of men) and the gender norms that continuously deny women a role as decisionmakers in education and health care-made it all the more important.

Despite the fact that the IGWG conducts these trainings without a fee to Missions, it takes a coordinated effort by the Mission, NGOs, donors, and policy decisionmakers to make it work as well as a willingness by the Missions to cover local expenses such as venue costs and co-funding for some of the training consultants. “The partners on the ground were really committed,” Kincaid said, “and at the end of the trainings, the CAs that attended felt empowered to move forward.”

Kincaid said that one other critical factor made this a success story: a champion in the form of Christine Sow. "Without Christine none of this would have happened," Kincaid said, referring to Sow's great interest in gender, reproductive health and male involvement, and also the fact that she remained at the Mali Mission for five years.

Outcomes

This Mission/IGWG Partnership has paved the way to real results in Mali. First, national CME guidelines have been adopted by the Malian Ministry of Health. Second, CME has been established as a formal strategy within USAID/Mali's FP/RH portfolio. Third, it has improved multisectoral collaboration in country.

And finally, evaluation of the project indicates that change is visible and sustainable. Through a pilot project with a local Cooperating Agency (CA), community peer educators are being trained to counsel couples on communicating more openly on reproductive health and joint decisionmaking. A preliminary evaluation showed that the work of these peer educators has already impacted men's roles in Mali and improved their use of family planning services. Health service providers report that men are visiting health centers, accompanying their wives there, and sharing information with their wives. Service providers also report an increase in the demand for contraceptive products at distribution centers.

"These preliminary results mirror the sentiment expressed … that Malian men truly want the best for their families and that, if equipped with information about how they can help improve the health of their families, men can be key actors in increasing gender equity and improving reproductive health," according to the report on this successful partnership.³

Asked if she would recommend that other USAID Missions should consider taking advantage of such an IGWG country partnership, Sow answered emphatically, "First of all, USAID is supposed to address gender, and we all want to do it well. IGWG made it painless and allowed us to have a high quality product.

"And in the end," she added, "the Ministry of Health was very pleased."

For more information on the IGWG/Mission Partnership, contact Michal Avni at mavni@usaid.gov.

Charlotte Feldman-Jacobs is program director for gender at the Population Reference Bureau (PRB) and co-chair of the IGWG's Task Force on Gender-Based Violence.

References

1. Margaret E. Greene, SysteMALEtizing: Resources for Engaging Men in Sexual and Reproductive Health (Washington, DC: PRB for the IGWG, 2006).
2. Elizabeth Doggett and Britt Herstad, Men Matter: Scaling Up Approaches to Promote Constructive Men's Engagements in Reproductive Health and Gender Equity (Washington, DC: HPI, Task Order 1, Futures Group).
3. HPI, Men Matter.