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A paper I authored with colleagues from the Canadian and Honduran Red Cross has recently been published in the Pan American Journal of Public Health.

The paper reports on an adequacy evaluation carried out on a Red Cross maternal health project in northern Honduras. A key result is that institutional births increased from 44 to 63% and this would drive a reduction in maternal mortality. One of the ways in which the project planned to improve birth outcomes was by engaging men in their wives’ health and pregnancy. However due to various project circumstances, the “engaging men” activities were not widely implemented and the level of engagement of men (as measured by the project) actually decreased. However, contrary to our expectations, this didn’t seem to matter, as institutional birth rates increased – and they increased the most in women with the least engaged husbands!

We concluded “Rather than the father’s involvement being key, changes in the mothers may have led to increased institutional births. The project may have empowered women through early identification of pregnancy and stronger social connections encouraged by home visits and pregnancy clubs. This would have enabled even the women with unsupportive fathers to make healthier choices and achieve higher rates of institutional births.

An alternative explanation could be that the true relationships were masked by how we measured father’s engagement. We used three questions: Did the father accompany the mother to prenatal checkups, was the father interested (as reported by the mother) in what happened at the checkups, and did the father accompany the mother to the birth. One point was scored for each “yes”, and the total points placed them into Highest (3 points), Moderate (2 points), or Lowest (0 or 1 points) groups. (Single moms grouped separately). These were the data that we had to work with, but do they really capture men’s involvement (or the more nebulous but more important “engagement”). A highly engaged man may do many things not reflected in the three questions (do the housework and let his wife rest, care for other children, or even work longer hours to earn more to provide more for the growing family and thus be unavailable to accompany his wife to checkups). We think that it is likely that a man who scores 3 points will also be engaged in other ways (so there will be few false positives), although a man who scores 0 or 1 points may well be engaged in ways not captured in those questions (there may be many false negatives. Perhaps more work is needed to develop a valid, globally applicable scale of men’s engagement. Something analogous to the “Women's Empowerment in Agriculture Index” would be useful.

As a footnote, this is the second paper I have published recently in this journal. While it isn’t the highest impact journal out there (eg H-Index of 38 versus, say, The Lancet, at 514) it has four very important things going for it. It is read by Spanish-speaking public health practitioners in the Americas, so it is reaching the right people. It is Open Access (meaning anybody can read any article without paying for it) and free to publish in (most Open Access journals charge the authors hundreds or thousands of dollars). And finally it allows colour graphics. I will continue to publish here. Although I just noticed now that the green line in Figure 2 was cut off. Its start should have extended to be directly above the word “Baseline”. Something to watch for next time.