Engaging religious and traditional male leaders in Nigeria increases women and adolescent girls’ access to sexual and reproductive health services.
BACKGROUND
Sexual and reproductive health challenges such as early or unplanned pregnancies and sexually-transmitted illnesses (STIs) represent a third of the total disease burden for women and adolescent girls between 15 and 44 years old worldwide. In rural North Nigeria, women and adolescents between the ages of 15 and 24 often cannot make informed decisions about their sexual and reproductive health and rights, such as when to marry and when to plan and space their pregnancies.
A mother and her child smile after receiving a package of information about sexual and reproductive health.
Gender-based discrimination and inequalities, harmful gender norms, stereotypes of masculinity and femininity, and restrictive traditional and religious-based beliefs and practices contribute to poor sexual, reproductive, maternal, and newborn health outcomes for women and girls. Like in many countries globally, advocacy for women and girls’ sexual and reproductive health is mostly led by other women in Nigeria. However, many studies have shown that engaging men in adopting and promoting more gender-equitable sexual and reproductive health norms improve outcomes for women, men, girls, and boys. In Nigeria, particularly in the north, religious and traditional leaders are the trusted leaders of communities, and provide guidance on many aspects of life. As such, they can be change agents for promoting positive social norm change for more gender-equitable and healthier relationships within homes and communities.
APPROACH
In 2018, CHAI conducted a gender assessment in three program states (Kaduna, Kano, and Katsina) to understand community perceptions of gender roles, particularly regarding family life and health. The results were used for the development of an evidence-based strategy to engage men in advocacy for women and girls’ sexual and reproductive health and rights. We held sensitization workshops in 2019 for more than 2,000 predominantly male Christian and Muslim leaders (less than 1 percent female) across four program states – Kano, Kaduna, Katsina, and Rivers states. The purpose of the workshops was to train the leaders on gender justice, sexual, reproductive, maternal, and newborn health so that they could become gender justice champions in their families and communities. A few of the sessions were facilitated by widely respected religious and traditional leaders among the cohorts to ensure the workshops were culturally appropriate, respectful of religious beliefs, and encourage more men to join the initiative.
During the brainstorming sessions, participants unpacked the layers of gender socialization and questioned and addressed harmful patriarchal expectations which can negatively impact women’s and girls’ access to sexual and reproductive health information and services. Following the sessions, participants generally agreed that they had internalized certain stereotypical roles as men. These social expectations and power dynamics have had negative effects on their relationships with their wives and children.
The sensitization workshops included exercises to identify gender-related barriers to accessing sexual and reproductive health services. The participants developed action plans to address the challenges in themselves, their families, and communities. At the end of the training, they committed to a re-orientation program for community members on gender justice and sexual, reproductive, maternal, and newborn health.
An endline assessment[1] was conducted on a representative sample of 432 religious and traditional leaders nine months after the sensitization workshops to assess whether the workshops brought about any changes in knowledge, attitude and behavior toward gender norms and understanding of sexual, reproductive, maternal, and newborn health information and services[2]. The results showed an increase in knowledge of family planning methods by 23 percent above the baseline, an increase in positive attitudes to gender-responsive, adolescent-friendly sexual and reproductive health services by 19 percent, and an increase in favorable attitudes toward shared decision-making for child spacing by 12 percent.
CHAI-trained traditional leader Mallam Bello Usman in Kankara, Katsina State, Nigeria.
IMPACT
Mallam Bello Usman is the village head of Kankara ward in Kankara local government area of Katsina state in North-West Nigeria. He was among more than 500 religious and traditional leaders from the state who participated in the sensitization workshop in 2019. He noted that before the sensitization workshops, couples in his community practiced traditional methods for pregnancy care and delivery, leading to high maternal and newborn mortality rates from unsafe practices. After completing the workshop, Mallam Usman, together with other CHAI-trained leaders in his local government area, implemented a community outreach and action plan to sensitize community members during sermons, weddings, and naming ceremonies on the benefits of accessing necessary services from qualified healthcare providers. As a result of the initiative, combined with concerted efforts by other community change agents, we have observed an increase in the uptake of sexual and reproductive health services among women of reproductive age, as well as adolescent boys and girls in Katsina state. This led to a 58 per cent increase in Couple Year Protection[3] (CYP) from April 2019 to December 2020 in the program facilities.
Source: CHAI Nigeria Program Data
This collaborative approach is being applied across the program states as a network of male and female sexual and reproductive health champions has emerged with the main objective of promoting gender justice and positive sexual, reproductive, maternal, and newborn health. Religious and traditional leaders have demonstrated leadership by reinforcing positive behavior and healthy community relationships among community members. For example, many of these leaders are becoming advocates and educators on debunking myths that discourage healthy sexual, reproductive, maternal, and newborn health practices.
“There is an obvious imbalance in gender justice and access to sexual, reproductive, maternal, and newborn health among males and females in our society. For instance, pregnant women in some rural communities are restricted from eating certain nutritious food like eggs because it is believed that if they do, they are likely to give birth to children who will become thieves. There is another belief that if a pregnant woman eats proteinous foods, her unborn child may become overweight and vaginal delivery may be difficult. Furthermore, some husbands tend to discourage their wives from accessing healthcare services during pregnancy, leading to high maternal death rate from home deliveries that often result in pregnancy-related complications beyond traditional birth attendants’ capacity.
“After the training, I started creating awareness during the women’s international week of prayer and bible study in my church. I also created time and days to teach them on the dangers of giving birth at home because the woman who died last year before the program gave birth at home and not in the facility. I have also added this awareness as part of the church quarterly program to enlighten men and women members on gender justice. Male members also saw the benefits and therefore accepted the idea of child spacing and some of them have started sending their wives to access such services in the health facility even though there are still challenges as some men are yet to allow their wives to access child spacing services and antenatal care”.
– Fai Ward, Christian leader, Kaduna State
MOVING FORWARD
Patriarchal norms are deeply set in Nigeria. Changing the personal and social attitudes of religious and traditional leaders and the larger community requires a long-term commitment from program managers and policymakers.
The workshop model laid out here can be a useful tool to encourage discussions among community leaders, which leads to better uptake of sexual and reproductive health services in some areas. To ensure the continuity of their commitment to women and adolescent girls’ sexual and reproductive health and rights, CHAI helped establish community forums to facilitate the continued planning and implementation of community activities around women’s rights to reproductive health. CHAI continues to leverage these community forums in the program states to promote dialogue on women and adolescent girls’ sexual and reproductive health and rights and their access to relevant services.
[2] The evaluation tool was modified based on the Gender Module of the USAID Maternal and Child Survival Program Knowledge Practice and Coverage tool which assesses knowledge of healthy timing and spacing of pregnancy (HTSP), attitudes towards HTSP and women’s decision making, perceived risks of practicing/not practicing HTSP, as well as willingness to promote and personally practice HTSP.
[3] Estimated protection provided by family planning services over a period of one year based upon the volume of all contraceptives sold or distributed free of charge to clients during that period. Accessed on March 3, 2021.
