Niger has the highest fertility rate in the world and one of the highest maternal mortality rates (648 maternal deaths/100,000 living births in 2006; 545/100,000 in 2011). A decision-making space has been created where husbands can encourage others to promote womens access to reproductive health. According to a situational analysis of this phenomenon, the authority exercised by husbands is a significant barrier to the use of reproductive health services by their wives.
Towards a Solution
In 2007, United Nations Population Fund (UNFPA), in collaboration with the Government of Niger (Ministries of Health and Women’s Promotion and Child Protection), developed a strategy to address the sociocultural barriers in the use of reproductive health services, i.e. the establishment of the Ecole des Maris (EDM, Husbands’ School). EDMs aim to:
- involve men in the promotion of reproductive health; and
- facilitate positive behavioural change at the community level by the husbands who as such, become agents of change and promote dialogue in their couple about family decisions.
EDM is a network of model husbands who were selected by health centres and trained to become leaders. These schools are formed of groups of 12 husband volunteers. They are structured and follow certain methods of operation but have no hierarchy. All members are equal and are peers.
Each school is attached to a health centre in the most vulnerable areas where reproductive health (RH) indicators are weak. Model husbands meet regularly to discuss and offer solutions for achieving better access to health services for women and children. They also conduct advocacy and sensitization activities with the men in their community and develop partnerships with all stakeholders in the health sectors and local structures. Since the Zinder region has some of the lowest RH indicators in Niger, UNFPA Niger, in collaboration with the Ministry of Health (MoH), decided to implement the strategy in this region first.
In 2008, a workshop was held bringing together all involved stakeholders’ regional administrative and health authorities, health agents, national non-governmental organizations (NGOs) and husband volunteers – to define the concept and the principles of EDM. This participatory approach is fundamental to the strategy in order to ensure alignment with local cultural and religious values and is also used in the implementation phase. UNFPA Niger has set up a support system in which two local NGOs, SONGES and ANBEF, supervise the schools.
These NGOs specialize in capacity-building and community work and are in charge of the ‘coach’. The coach supervises the capacities of each school and assists in implementing their activities. The coach assists each time the school meets (in general, twice a month). On average, a coach is responsible for 10-12 schools. The coach does not make decisions for the school, but helps the group resolve problems, find appropriate solutions and visualize their ideas. The coach also assists the group in terms of developing its action plan and monitors progress. To facilitate this work, UNFPA Niger and its partners have developed a Cahier de Suivi (a monitoring journal).
SONGES offers technical support by providing counselling and information on RH services (including prenatal care and contraceptive methods) to ensure that husbands access knowledge. Furthermore, ‘moderators’ often assist the schools. A moderator can be a local health agent, midwife, or religious leader, for example, who will assist in a meeting to bring specific information to a question that needs clarification. This close collaboration with local health agents and other entities, such as administrative and traditional authorities, is essential so as to ensure that the strategy is sustainable.
The strategy being developed nationwide is based on lessons learned, assessment of the challenges and upscaling of the keys to success in the Zinder and Maradi regions. It will apply the 10 key principles identified by a capitalization study conducted in February 2012 as factors in these schools’ success:
- Targeting men to reach women;
- Setting a good example as a driver for social change;
- Not having a hierarchy in EDM structures;
- Not paying the model husbands;
- Establishing diverse partnerships at the local, regional and national levels;
- Improving the national health system;
- Transferring knowledge through decentralization;
- Changing the participants from being passive beneficiaries to informed consumers of public services, and empowered citizens; and,
- Professionalism of all involved parties.
As of 2014, the initiative had achieved the following results:
- Husbands as role models;
- EDM members developed positive behaviours;
- Other husbands admired the model husbands, leading them to became sensitive to gender issues; and
- Positive changes were achieved in terms of the use of reproductive health services.
Reproductive health advocacy towards community leaders:
- EDM members advocated continuously with traditional leaders; and
- Sensitization sessions held with husbands in neighbouring areas and villages on the issues to be addressed.
Positive behaviour changes among men and women:
- Dialogue was created within couples;
- Men gained a better understanding of women’s health issues;
- EDMs and religious and traditional leaders developed harmonious relationships; and
- The decision was made to prohibit home births.
EDMs are based on a participatory approach and can be easily adapted to the values and needs of each community. By following these basic principles, the strategy can be replicated and implemented in many other settings. After starting in Niger, the strategy was replicated by international NGOs such as Save the Children, CONCERN, HKI and PSI. UNFPA Niger and the Government of Niger then mobilized bilateral partners such as Denmark, Spain, and the European Union, to obtain funding. Finally, many West and Central African countries with similar sociocultural realities to Niger replicated the strategy. For example, knowledge is being shared in Burkina Faso, Cameroon, Côte d’Ivoire, Guinea, Mali, Mauritania, Senegal, Sierra Leone, and Togo on how to set up a husbands’ school and on its success factors and lessons learned. All of these countries sent delegations from the government, civil society, and technical and financial partners to visit Niger.