Case study: ‘Husband schools’ in Niger
Écoles des Maris (‘Schools for Husbands’) in Niger is a UNFPA-funded project based on the theory that men‘s social power can act as a brake on rates of improvement in maternal and child health. Men‘s dominance in household and community decision-making in Niger, coupled with their lack of knowledge about the advantages of clinical care in childbirth, mean that many women are continuing to give birth at home, unattended. A mother dies in childbirth, and 6 newborn babies die, every two hours in Niger.
The project began with 11 pilot Écoles in 2008, and by 2011 there were 130 schools in the Zinder region. A further 45 are under development in the Maradi region. Expansion has been justified by the success of the Écoles in raising the rate of assisted births (for example in Bilmari district only 10 women per month gave birth in the clinic; since Écoles des Maris were established locally there are often 30-40 attended births in a month (UNFPA, 2011:5)). A total of 1600 men are now involved in the scheme. In one district (Guigidir) the work of the Écoles has seen the rate of attended childbirth rise from 15% to 74% of births (UNFPA, 2011:6).
The project aims to transform the attitudes and behaviour of whole communities by training maris modèles (model husbands‘) to spread the word about the benefits of using local health services. Each week the École convenes to discuss new reproductive health topics and how best to communicate knowledge to men. Health workers give ‘model husbands‘ the information they need to convey to other men about the risks of birth complications for women and babies who are unattended, or who only seek help late in labour. Meetings are also sometimes attended by local elected representatives or religious chiefs. These links ensure that health messages are reinforced throughout the community.
The job of the maris is to convince men and their wives that clinical assistance can be beneficial, even in relatively poorly-resourced clinics. Écoles have taken this further, by mobilising community fundraising to pay for the construction of new clinical facilities – and the men have also donated building labour. The health centres provide information about hygiene and healthy eating, and communities have come together to grow fruit and vegetables, and to work to combat malnutrition.
Whilst we do not have rigorous evaluation evidence of the effectiveness of Ecole des Maris, testimony from the men involved, and from pregnant women and new mothers, indicates that the scheme has transformed attitudes towards healthcare. Heads of clinics report that the Écoles des Maris are a powerful intermediary between the health services and the community. Through the men, they are often able to recapture women who have stopped coming to pre- or post-natal consultations. And the change in rates of attended labour are striking in a country where maternal and child death rates at birth remain high. Men and women respect the maris modèles and listen to their advice. Women are encouraged to attend all their pre- and post-natal appointments, and the Écoles are also working to boost take-up of childhood vaccinations. Involving men – most of whom are already fathers – has impacted positively on maternal and child health, and on community relations. The clinics provide a focus for positive community involvement in health and wider well-being.
For a fuller report (in French) see: Ecole des Maris NigerTags: child health, International, Maternity