(Mis)measuring men’s involvement in global health: the case of expectant fathers in Dakar, Senegal

Abstract

Background In 2018, USAID published a report based on Demographic and Health Surveys data on the relationship between men’s involvement and women and children’s health outcomes. Using a flawed operationalization of “men’s involvement,” USAID’s analysis implies that Senegalese men are not involved in women and children’s health. Methods The findings of this study come from 12 months of ethnographic research in Dakar, Senegal that examined the roles and responsibilities of expectant fathers. Research participants included 32 pregnant women and 27 expectant partners recruited from three maternity wards. Research methods included long-term, immersive participant observation and semi-structured interviews. Results Pregnant women in Senegal are surrounded by a kin-based network of care providers called the entourage who share responsibilities for support. Expectant fathers, as members of the entourage, are expected to provide financial and emotional support, while other members of the entourage are expected to undertake the responsibilities which USAID have designated as “men’s involvement.” Men typically do not undertake additional forms of care and support because they are considered “women’s business,” meaning that women actively discourage men from doing those things, in order to preserve women’s autonomy. Conclusion This research demonstrates that expectant fathers are involved in antenatal care in ways that USAID does not track through DHS. Further, I argue that USAID’s heterosexist, monogamous, and nuclear operationalization of “men’s involvement” aligns with a long history of Eurocentrism in development discourse which may be potentially harmful and obstructive to improving maternal and child health when the problem that is targeted is not a problem at all. This study is yet another case that demonstrates an urgent need of public and global health engagement with local stakeholders and ethnographic researchers.

"We give our all": Mothers’ experience of participating in the care of their newborns in newborn care units in Eastern Uganda

“…This nding aligns with what Powis found in Senegal and refers to as a family "entourage" (40). As in the Senegal study, the roles of family members in this context were gendered, withfemales including sisters, mothers, and mothers-in-law supporting with day-to-day hospital chores while males are tasked with nding nancial assistance (40). In this study, we found that some men helped out with daily tasks, but mothers hardly ever acknowledged these contributions.…”

“…The study demonstrates a "whole" family support approach where mothers are supported by many family members doing various tasks. This nding aligns with what Powis found in Senegal and refers to as a family "entourage" (40). As in the Senegal study, the roles of family members in this context were gendered, withfemales including sisters, mothers, and mothers-in-law supporting with day-to-day hospital chores while males are tasked with nding nancial assistance (40).…”

Navigating relationship dynamics, pregnancy and fatherhood in the Bukhali trial: a qualitative study with men in Soweto, South Africa

“…"I used to also contribute at home while also maintaining my child; but now that I don't work, I have nothing you know so I have to hustle where I can and then be able to provide for both my children so they are taken care of so their mothers don't think I'm useless you understand, sure." (17) One participant shared in more detail about his mixed feelings, speci cally his initial shock and feelings of not being ready, considerations about terminating the pregnancy, and also contemplating his responsibility as the father of the baby.…”

“…(10) "I was short tempered with her at a point and then end up not picking up her phone calls cause I thought maybe she was making a fool out of me because she would make me leave the house like maybe at night and say her tummy is sore and that I must come rub it and then only to nd that when I get there she's ne and all she wants is to spend a bit of time with me at home." (17) Providing support during pregnancy…”

“…15,16 For example, research with expectant fathers in Senegal has also highlighted how Eurocentric notions of fathers' involvement do not adequately capture contextually speci c notions of involvement. 17 Healthy Life Trajectories Initiative: Bukhali trial The Healthy Life Trajectories Initiative (HeLTI) is an international consortium developed in partnership with the World Health Organization (WHO) in Canada, India, China, and South Africa. Drawing on interdisciplinary evidence from DOHaD, and adopting a life-course perspective, HeLTI hypothesises that an integrated complex intervention, comprising a continuum of care from preconception, through pregnancy, infancy and early childhood will promote young women's physical and mental health, in order to establish healthier trajectories for themselves and future offspring.…”