BackgroundRigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women’s decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples’ intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations.MethodsWe conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women’s experience of physical and sexual IPV, women’s attendance and men’s accompaniment at ANC, modern contraceptive use, and partner support during pregnancy. At 21-months post-baseline, 1123 men and 1162 partners were included in intention to treat analysis. Generalized estimating equations with robust standard errors were used to fit the models.FindingsThe Bandebereho intervention led to substantial improvements in multiple reported outcomes. Compared to the control group, women in the intervention group reported: less past-year physical (OR 0.37, p<0.001) and sexual IPV (OR 0.34, p<0.001); and greater attendance (IRR 1.09, p<0.001) and male accompaniment at antenatal care (IRR 1.50, p<0.001); and women and men in the intervention group reported: less child physical punishment (women: OR 0.56, p = 0.001; men: OR 0.66, p = 0.005); greater modern contraceptive use (women: OR 1.53, p = 0.004; men: OR 1.65, p = 0.001); higher levels of men’s participation in childcare and household tasks (women: beta 0.39, p<0.001; men: beta 0.33, p<0.001); and less dominance of men in decision-making.ConclusionsOur study strengthens the existing evidence on male engagement approaches; together with earlier studies our findings suggest that culturally adapted gender-transformative interventions with men and couples can be effective at changing deeply entrenched gender inequalities and a range of health-related behavioral outcomes.Trial registrationClinicalTrials.gov NCT02694627

This article draws on Promundo and RWAMREC's programmatic experiences in Rwanda of implementing MenCare+, a gender transformative approach to engaging young and adult men (ages 15-35) in caregiving, maternal, newborn, and child health, and sexual and reproductive health and rights. We present initial results from fathers' groups with more than 600 men, including the impact of participation in these groups on men's participation in care work. The results confirm the importance for practitioners' planning strategies to engage fathers to think beyond men's token participation in care work, to use father participation as an entry point to truly transform gender dynamics within the home. The article provides practical lessons learnt to guide other organisations interested in working with men to transform norms around fatherhood and care work.Cet article se base sur les expériences programmatiques de Promundo et de RWAMREC au Rwanda concernant la mise en aeuvre de MenCare+, une approche transformative sur le plan du genre consistant à faire participer les hommes jeunes et adultes (de 15 à 35 ans) à la prestation de soins, à la santé maternelle, néonatale et infantile, et à des projets de santé et de droits sexuels et génésiques. Nous présentons les résultats initiaux de groupes de pères englobant plus de 600 hommes, y compris l'impact de la participation à ces groupes sur la participation des hommes à la prestation de soins. Les résultats confirment l'importance pour les praticiens qui planifient des stratégies visant à faire intervenir les pères de ne pas limiter leur réflexion à la participation symbolique des pères aux soins et d'utiliser la participation des pères comme un point d'entrée permettant de vraiment transformer la dynamique de genre au sein du foyer. Cet article fournit des enseignements concrets visant à orienter d'autres organisations désireuses de travailler avec des hommes pour transformer les normes relatives à la paternité et aux soins.El presente artículo se basa en las experiencias programáticas desarrolladas en Ruanda por Promundo y RWAMREC. Las mismas se vinculan a la implementación de 515 MenCare+, un enfoque de género transformador, cuyo objetivo apunta a lograr la participación de hombres jóvenes y adultos (cuyas edades oscilan entre los 15 y 35 años), como cuidadores y como actores en las áreas de salud materna, neonata e infantil, de salud sexual y reproductiva, y de derechos. Los autores presentan los resultados iniciales surgidos de grupos de padres a los que asistieron más de 600 hombres, así como los impactos que la participación en dichos grupos tuvo en el desempeño de los hombres en el trabajo de cuidado. Si el objetivo consiste en analizar el rol de los hombres en este trabajo más allá de lo simbólico, los resultados confirman la importancia de que las estrategias de planeación de los operadores involucren a los padres, y que aprovechen su participación como una manera de transformar efectivamente las dinámicas de género en el hogar. Asimismo, el artículo presenta aprendizajes práct...

Background Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth. Methods This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically. Results Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care. Conclusions Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics.

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