Power In Sexual Relationships | Page 9

client . . . those women
who cannot talk to their husbands, we try to help them
through a feeling of self-awareness and through showing them
“power to.”
My clients thought I was young, I felt shy, I could not talk
openly, but now (after the training) I speak with confidence and
they open up and tell me everything.

Integrating male partners into the
reproductive health equation:
An example from Kenya
(Esther Muia)
5
Esther Muia, of the Population
Council’s Nairobi office, discussed a
study examining the acceptability and
feasibility of integrating male partners
into reproductive health services in
Kenya. Despite men’s influence on
women’s ability to access services and
implement regimes of care, research
documented that male partners were
actually marginalized within the main-
stream of reproductive health care serv-
ices. Muia and her colleagues sought to
understand the actual and potential role
of men as supportive partners by iden-
tifying current participation; assessing
the attitudes of women, their partners,
and service providers toward the partic-
ipation of men; and identifying barriers
to male partners’ greater participation.
They carried out their study in
l998
in a provincial hospital in a largely rural
area of Kenya’s Western Province and in
a teaching hospital in urban Nairobi.
Qualitative and quantitative techniques
were used to collect information from
women receiving reproductive (in- and
outpatient) health services, men accom-
panying their partners, partners of
women who did notaccompany their
partners (who were followed up at
work, at home, or elsewhere in the com-
munity), and service providers. One-third of women at the urban site were
accompanied by their partners, com-
pared to one-sixth at the rural site.
A vast majority of the female and
male respondents indicated that men’s
participation was desired in antenatal,
postpartum, and family planning visits.
An overwhelming proportion (94%) of
the women said that they would like
their partners present during their con-
sultations, to assure their understanding
and support of the doctor’s advice. An
even greater proportion (98%) of men
said they would like to be present.
Despite the lack of cultural precedent
as well as strong provider opposition
(see below), 50% of women and 46%
of men said that it would be appropri-
ate to have the man present in the deliv-
ery room. The views of service providers
were for the most part similar to those
of their clients: they believed that part-
ners should be present during counsel-
ing and when discussing the client’s
condition; a much smaller proportion
(
l%–5%) wanted partners to be pres-
ent when examining the patient or in
the delivery room.
Muia identified the key constraints
hindering male participation to be:
•Financial (transport costs for two
people, time off from work, partners
working away from home);
•Social/cultural and peer pressure
(certain activities are not considered
“manly”);
16
5For a more in-depth discussion of this study, refer to Esther Muia et al. 2000. “Integrating men into
the reproductive health equation: Acceptability and feasibility in Kenya,” New York: Population
Council, or contact Esther Muia at emuia
@popcouncil.or.ke.

•Institutional (overcrowding, lack of
privacy, provider attitudes); and
•Poor communication (between the
couple, and between clients and
providers).
There are many important points to
be drawn from this study: that men,
women, and providers dosee a space for
greater partner participation in services;
that men are presently participating
despite barriers; that some reproductive
health services are seen as more appro-
priate and acceptable than others for
male participation; and that women,
men, and service providers do not
always agree on when male partners
should be included. Taking these les-
sons into account, an intervention has
been proposed for Western Kenya that
will work with female clients, their
partners, and providers at various levels
of service provision to ascertain appro-
priate and acceptable ways to increasemen’s involvement in selected reproduc-
tive health services. This could include
creating a space for accompanying part-
ners; including male partners in selec-
tive aspects of service delivery such as
counseling and consultations; deter-
mining appropriate ways and means of
sharing information on women’s repro-
ductive health needs and problems with
male partners; and developing verbal
protocols for opening discussion of
power in sexual relationships.
Discussion
Discussion centered around the idea of
male presence in reproductive health
services. One participant noted that men
are often excluded from the health care
of young children as well. He cited a sur-
vey in Zambia in which men suggested
having fathers’ days for under-5 check-
ups. The men hoped to take their chil-
17
Where respondents would like to see greater participation of
male partners in reproductive health services
Female respondents Male respondents Service provider
Service type (N=697)(N=284)respondents (N=l96)
Antenatal care
632(9l%)253(89%)ll8(60%)
Consultation
655 (94%)279(98%)98(50%)
Examination
468(67%)l83(64%)2(l%)
In the labor ward
438(63%)l76(62%)l0(5%)
During delivery
35l(50%)l32(46%)l0(5%)
Postpartum visits
644(92%)257(90%)88(45%)
FP clinic
622 (89%)246(87%)98(50%)
Pay for services
669 (96%)l82(64%)l76(90%)

dren to the clinics to gain access to some
of the information that was usually dis-
seminated to mothers within the mater-
nal and child health programs.
Other participants revisited an ethi-
cal question raised by Blanc: Is there a
risk that more involvement and infor-mation will perpetuate male control
over female decisions? Within the coun-
seling context, for example, there is the
danger that providers may begin talking
to the man instead of addressing
the woman or both members of the
couple.
18

19
The second group of field practition-
ers described larger-scale interventions
at the community level. The first pre-
senter depicted a multi-level interven-
tion designed to increase dialogue at
the community level and work directly
on social norms governing power in
relationships. The second described a
practical community-based and clinic-
based effort addressing men’s and
couples’ roles, communication strate-
gies, and power dynamics. And the
third explained how out of a women’s
reproductive health problem emerged
women’s wishes to work with