{"id":58648,"date":"2023-03-23T13:10:29","date_gmt":"2023-03-23T17:10:29","guid":{"rendered":"https:\/\/www.psi.org\/?p=58648"},"modified":"2024-07-22T11:13:13","modified_gmt":"2024-07-22T15:13:13","slug":"embracing-equity-understanding-gender-barriers-and-malaria-during-pregnancy-in-cameroon-and-kenya","status":"publish","type":"post","link":"https:\/\/www.psi.org\/fr\/2023\/03\/embracing-equity-understanding-gender-barriers-and-malaria-during-pregnancy-in-cameroon-and-kenya\/","title":{"rendered":"Embracing Equity: Understanding Gender Barriers and Malaria during Pregnancy in Cameroon and Kenya"},"content":{"rendered":"\t\t
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This piece originally ran on the Impact Malaria website.<\/em><\/a><\/p>\n

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Malaria in pregnancy is a major health threat to the lives of pregnant women, fetuses, and infants. Pregnant women are particularly at risk from malaria as their immunity against the disease declines during pregnancy, increasing the risk of anemia, severe illness, and death. For the unborn child, maternal malaria can cause premature delivery, low birth weight, and death. In areas that are malaria endemic or have moderate to high transmission of the malaria parasite, the World Health Organization (WHO) recommends a three-part package of interventions for preventing and controlling malaria and its effects during pregnancy. This includes the promotion and use of insecticide-treated bed nets, the administration of intermittent preventive treatment (IPTp), and prompt diagnosis and appropriate treatment of malaria.\u00a0<\/p>\n

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PMI Impact Malaria supports 11 partner countries to strengthen and expand malaria in pregnancy services by collaborating with the Ministries of Health, National Malaria Programs, reproductive programs, and maternal and child health programs. While evidence links gender and socio-cultural barriers to reduced uptake of reproductive and maternal health services in general, information is limited about their link to early entry into antenatal care and retention in care throughout pregnancy, as well as their link to the uptake.\u00a0In\u00a0Cameroon<\/a>\u00a0and\u00a0Kenya<\/a>, we collaborated with country partners to conduct assessments to understand gender-related barriers to accessing and adhering to malaria in pregnancy\u00a0services.\u00a0<\/p>\n

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Ahead of International Women\u2019s Day, we spoke with PMI Impact Malaria’s\u00a0senior technical advisor and resident expert on gender and malaria, Elizabeth Arlotti-Parish (right),\u00a0to learn more about the\u00a0assessments, why adopting a gender approach is a valuable component of malaria service delivery,\u00a0and\u00a0how\u00a0the\u00a0findings\u00a0are informing project activity (the interview has been edited for clarity<\/em>):\u00a0<\/p>\n

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What was the impetus for this assessment?\u00a0\u00a0<\/h5>\n

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Early in the project, the\u00a0PMI Impact Malaria\u00a0Kenya and Cameroon country teams noted that women were not using malaria in pregnancy services or sleeping under\u00a0insecticide-treated bed nets*, and the teams did not understand why\u00a0they were not adhering to these lifesaving, preventive measures. They thought that gender norms and power dynamics within the couple, family, and community,\u00a0might be a root cause\u00a0but they wanted to undertake an assessment to be certain. Knowing the root cause could then inform necessary changes to increase education of and access to these lifesaving tools.\u00a0In both countries, the teams\u00a0conducted\u00a0a gender analysis to explore\u00a0what issues\u00a0acted as barriers\u00a0to malaria in pregnancy services.\u00a0\u00a0<\/p>\n

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*Insecticide-treated bed nets are a lifesaving, preventive tool recommended by the World Health Organization to be used over beds. This prevents malaria-carrying mosquitoes from biting while the user is sleeping. These are one tool in the malaria prevention toolbox.<\/em><\/p>\n

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Why is it important to apply a gender approach to improve the quality of malaria service delivery?\u00a0\u00a0<\/h5>\n

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Research in other health areas has shown that the technical competency of health providers\u00a0is only one reason that motivates\u00a0clients to seek care. If a client\u00a0receives quality services but\u00a0is not treated kindly, or with empathy or compassion,\u00a0other assessments have shown that\u00a0she\u00a0is unlikely to\u00a0return and\u00a0may even tell her friends\u00a0of her experience and influence them\u00a0not to seek care. Oftentimes this mistreatment\u00a0she experiences\u00a0is due to gender biases on the part of the health care worker, or the gender of the\u00a0health worker\u00a0him or herself. We also know that\u00a0understanding\u00a0the\u00a0benefits of care is not the only motivation for\u00a0clients to seek care. A client may know the benefits of attending\u00a0antenatal care\u00a0or taking anti-malarial drugs, but she may face gender-related barriers in her family or her community that impede her from care-seeking. If we do not consider how gender influences care-seeking, or the provision of care, these barriers will\u00a0remain,\u00a0and\u00a0women will not get the care they need.\u00a0\u00a0<\/p>\n

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(Excerpt from PMI Impact Malaria Kenya assessment report)\u00a0<\/em><\/figcaption>\n<\/figure>\n

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What were the main findings from the qualitative assessment?<\/h5>\n

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We learned that in both\u00a0Cameroon and Kenya, male partners and mothers-in-laws\u00a0often\u00a0control women\u2019s decision-making about attending early\u00a0antenatal care, and in fact many of the factors that would often be cited to be the preferences of the woman were\u00a0instead\u00a0the preference of someone else\u00a0that influenced her decision. For example, we heard that many women preferred traditional medicine providers over health facility providers, but with some probing it came out that this was because the husbands and mothers-in-laws preferred this, and in some cases the mothers-in-law were traditional providers themselves.\u00a0\u00a0<\/p>\n

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We also learned that, even if a woman delayed seeking antenatal care, once she started going, she would continue (and the decision-makers in her household would support that),\u00a0if\u00a0she felt like she was treated respectfully by the nurse or other provider.\u00a0Not one woman or other respondent mentioned needing the provider to be clinically competent, but many\u00a0indicated that a woman would not return if she was not treated with respect.\u00a0\u00a0<\/p>\n

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Finally, when it came to\u00a0intermittent preventive\u00a0treatment\u00a0of malaria\u00a0during\u00a0pregnancy\u00a0(IPTp)*, we heard\u00a0form\u00a0many women that they did not like the medicine because it made them feel sick.\u00a0That experience was expected, but what was surprising is that we clearly heard\u00a0from the respondents is\u00a0that health providers did not take their\u00a0concerns seriously and thought that by continuing to explain the importance of the medicine and watching women take it, that the problem would be solved. Instead, women felt that being forced to sit in front of a provider to take the medicine was\u00a0coercive and made them not want to return to care.\u00a0\u00a0<\/p>\n

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* IPTp, a public health intervention aimed at preventing malaria in pregnant women, is a series of antimalarial medicine provided to women at routine visits to keep them safe from malaria infection during their pregnancy.\u00a0\u00a0\u00a0<\/em>\u00a0<\/p>\n

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What are the key messages from this assessment?\u00a0<\/h5>\n

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Engage male partners and mothers-in-law in meaningful ways. Invest in helping providers to communicate with respect and compassion (and help them to understand that this matters just as much if not more than clinical competency). Take women seriously when they voice their concerns. Even if we\u00a0can\u2019t\u00a0do anything about the side effects of IPTp pills, we can acknowledge women\u2019s discomfort and respond with empathy, which makes them more likely to take the advice that is given, and to return to care.\u00a0<\/p>\n

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(See\u00a0the infographic below for this summary)<\/em><\/p>\n

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What problems might these findings solve to help communities prevent and treat malaria?\u00a0\u00a0<\/h5>\n

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We can train providers, but if women do not seek care, malaria rates will continue to rise. Understanding the gender-related barriers that women face in seeking care, and understanding how health providers can effectively encourage continuation of care, will help us create effective interventions to help women get the care they need for malaria prevention and treatment.\u00a0<\/p>\n

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Though not a shift that resulted from these studies,\u00a0the best programmatic example we have of gender integration tied to results is in Mali, where\u00a0PMI Impact Malaria\u00a0invited the\u00a0National Malaria\u00a0Program (PNLP)\u00a0to the team gender training. That motivated the\u00a0PNLP\u00a0to request that\u00a0PMI Impact Malaria\u00a0develop a gender module for the national\u00a0malaria in pregnancy\u00a0training, which has now been used with hundreds of providers.\u00a0<\/p>\n

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Once a woman does begin care, decision-making power shifts [from social influencers] to the provider. A woman is likely to continue care, and practice other recommended behaviors such as IPTp use and sleeping under a long-lasting insecticidal net, if the provider treats her with respect, acknowledges and validates her concerns, and helps her to develop strategies to address them.<\/p><\/span>

(Excerpt from PMI Impact Malaria Kenya assessment report)<\/p><\/blockquote><\/div><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) and is led by\u00a0Population Services International (PSI)<\/a>\u00a0in partnership with\u00a0Jhpiego<\/a>,\u00a0MCD Global Health<\/a>, and the\u00a0Malaria Elimination Initiative (MEI)<\/a>\u00a0at the University of California, San Francisco.\u00a0 <\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Pregnant women are particularly at risk from malaria as their immunity against the disease declines during pregnancy, increasing the risk of anemia, severe illness, and death.<\/p>","protected":false},"author":89,"featured_media":58655,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"archive":[2538],"psi-blog-topic":[],"related_countries":[1510,1471],"corporate_partners":[],"related_projects":[1995],"class_list":["post-58648","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","archive-archived","related_countries-cameroon","related_countries-kenya","related_projects-pmi-impact-malaria"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/posts\/58648","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/users\/89"}],"replies":[{"embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/comments?post=58648"}],"version-history":[{"count":0,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/posts\/58648\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/media\/58655"}],"wp:attachment":[{"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/media?parent=58648"}],"wp:term":[{"taxonomy":"archive","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/archive?post=58648"},{"taxonomy":"psi-blog-topic","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/psi-blog-topic?post=58648"},{"taxonomy":"related_countries","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/related_countries?post=58648"},{"taxonomy":"corporate_partners","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/corporate_partners?post=58648"},{"taxonomy":"related_projects","embeddable":true,"href":"https:\/\/www.psi.org\/fr\/wp-json\/wp\/v2\/related_projects?post=58648"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}