Why India needs more male health workers

Female health workers are the primary drivers of maternal health initiatives, but male health workers (MHWs) could complement their services significantly, according to a 2015 research study conducted in rural Odisha.

What can MHWs do in rural areas? Gender inequities in developing societies mean that men play a dominant, decision-making role in reproductive health. MHWs can make a difference by educating men about maternal health issues and guiding their decisions, said the study. They can also complement the efforts of female health workers in delivering health services in remote areas and at late hours.

However, this may prove to be difficult in India. There are no MHWs in 48 per cent of health sub-centres in Indian villages; and overall, there is a 65 per cent shortage of MHWs in public health centres, according to the Rural Health Statistics 2016.

It is clear India has to improve its maternal-health services. The government scheme to reduce maternal mortality rate, Janani Suraksha Yojana (JSY), has helped push up institutional deliveries by 15 per cent over the decade ending 2014, according to a 2016 report by think tank Brookings India. But as IndiaSpend reported in February 2017, JSY is often not delivering quality care to the country's poorest women.

This lack of access could explain why India accounted for close to a fifth of 3,03,000 maternal deaths and 26 per cent of the neonatal deaths globally, as IndiaSpend reported in September 2016. MHWs can help improve the coverage of maternal and newborn child health services delivered by the formal health care system, and improve home-based management of these services.

To research the role MHWs could play, the study recruited and trained men to complement the work of female health workers. An IndiaSpend analysis of the findings of the study and other data reveals three reasons why MHWs were effective in improving the quality of maternal and newborn child health services:

Female health workers struggle with mobility, security issues
Night deliveries: Female health workers (FHWs) are often unable to help pregnant women reach a hospital in case of night deliveries Communication gap with husbands is another reason. MHWs can convince men about the need for better maternal care…

Nearly 80 per cent of women in India said they had to seek permission from a family member to visit a health centre. Of these, 80 per cent said they needed permission from their husbands, 79.89 per cent from a senior male family member, and 79.94 per cent from a senior female family member, according to the 2012 Indian Human Development Survey (IHDS) survey, IndiaSpend reported in February 2017…

Given this social structure, MHWs can convince husbands – who have poor knowledge on the do's and don'ts during pregnancy, childbirth and the postpartum period – about the importance of providing antenatal care and health services during pregnancies.

India's RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent) health strategy – formulated in 2013 – recognised the central role of men in women's reproductive health and includes guidelines for training of health workers to provide husbands of pregnant women with the relevant information.

Coverage of maternal health services in west Odisha's Keonjhar district, where the study was focussed, improved due to increased MHW engagement. The male health workers arranged transport and accompanied pregnant women to distant health facilities in emergencies and also sometimes climbed hills to reach distressed households in different settlements.

At the time of deliveries, the gendered division of labour was apparent, researchers found. MHWs handled tasks outside of the delivery room, keeping track of the family's personal items, obtaining medicines, and in cases where a blood transfusion was necessary, obtaining donated blood.

Male health workers have made a difference in other developing nations
Health initiatives that are shouldered by both male and female health workers have worked well in other countries. There is a significant need to scale up men's participation in maternal health and provide them with the sufficient information to help them make decisions and support their partner's decisions concerning family health, wrote Olena Ivanova, a maternal health expert at the International Centre for Reproductive Health, Belgium, in a blogpost in February 2015…

Evidence from Rwanda, among the few countries to pair male and female health workers, indicates that the approach could work in settings where it is not safe or socially acceptable for women to travel alone. And, educating pregnant women and their male partners leads to better maternal health behaviour than educating women alone, according to a 2006 study in urban Nepal.

However, it is important to tread cautiously, said the study. To reinforce these successes, as the study showed, MHWs should operate in ways that do not contribute to widening gender inequalities in favour of men. (In arrangement with IndiaSpend.org)

By Devanik Saha