Reproductive Health: From Women’s Issue to Community Affair

[Originally posted by the Georgetown Global Health Initiative here.]

Reproductive health is often viewed as a women’s issue, leaving the broader community—and men, specifically—excluded from the conversation. Members of Georgetown’s Institute for Reproductive Health (IRH) are working to change that.

“So much of what we do here at IRH revolves around the underlying social factors related to reproductive health. It’s about understanding the community, context, and factors such as social norms and cultural beliefs that drive behavior,” said Dr. Rebecka Inga Lundgren, research director at IRH and a research instructor in the Department of Obstetrics and Gynecology at the Medical Center.

Strategic Interventions

Lundgren’s current work through IRH is a USAID-funded project called Passages. Passages expands efforts to ensure quality, accessible reproductive health services and also to address the root of chronic sexual and reproductive health challenges such as gender-based violence, child marriage, and unintended pregnancy. The project addresses a program gap by developing and testing scalable interventions to foster supportive normative environments. It capitalizes on life-course transitions—children entering puberty, women and men entering marriage, and adults becoming new parents—three critical stages when social norms and roles are formed and transformed.

Passages is currently conducting implementation science research in the Democratic Republic of the Congo (DRC), Senegal, Mali, and Niger, and Lundgren has already seen a measurable impact. In Mali, for example, Passages is supporting expansion of Tékponon Jikuagou, a program recently proven effective by a pilot study IRH conducted in Benin in collaboration with Plan International and CARE.

Lundgren explains, “Working with existing groups and informal leaders, Tékponon Jikuagou fostered reflective dialogue and spread new ideas through social networks, reducing taboos about discussing family planning and challenging inequitable gender norms, and ultimately creating a social environment that helped women achieve their fertility goals.”

Lundgren is also involved in two studies that address the urban poor in Kinshasa, DRC: Growing Up GREAT! and Transforming Masculinities. The latter program works with Protestant faith leaders and congregations to identify, create, and embrace new, positive masculine identities and gender equitable beliefs. It ultimately aims to decrease intimate partner violence and increase behaviors such as family spacing.

Broadening the Conversation

Other IRH colleagues are also involved in engaging men on the issue of reproductive health. Dr. Dominick Shattuck, who works as a senior research officer with IRH, has spent much of his career focused on bringing men into the conversation.

“Men play an important role in determining social norms, and involving them in the conversation allows communities and individual households to reduce the stigma often associated with reproductive health. This encourages women and men to more openly discuss reproductive health and access the public health resources available,” Shattuck explained.

“Particularly in rural villages, Shattuck continued, “increased access [to family planning methods] will potentially lead to increased use, but you can get the use faster…if you complement the work with some kind of interpersonal and social behavior change activities around [couples] or, even more specifically…[by] working with the man as a supportive partner or potential user of family planning.”

Challenging Social Norms

Currently, Dr. Shattuck and a team of IRH colleagues are working on such change-oriented activities through the USAID-funded Fertility Awareness for Community Transformation (FACT) project, which is a large cooperative agreement being implemented in several countries. The project, which is led by IRH Director Dr. Victoria Jennings, is designed to provide information on reproductive health and family planning methods to women in communities with a high risk of pregnancy or childbirth-related mortalities and high rates of unintended pregnancies.

As a part of FACT’s work in Nepal, Dr. Shattuck is working to develop a game-based approach to engage communities in reproductive health conversations and education in an initiative titled Pragati. So far, Pragati involves nine interactive games led by community healthcare providers. The games address negative social norms like gender norms, family preferences for sons, pressure for immediate conception after marriage, and stigma around family planning.

Shattuck stressed the importance of working with community members and, in a sense, letting them guide the initiatives in order to foster effective engagement. “Our work depends on strong trusting relationships at various community levels. For example, in Nepal, we engage community stakeholders with research results and procedures that facilitated their guidance on the creation of the games. This engagement enriches the intervention and helps us to learn more about how our work impacts lives.”

Always More to Learn

The work of Drs. Shattuck and Lundgren and their IRH colleagues is rewarding beyond the immediate impact it has on people’s lives. Shattuck says that his over 20 years of work with communities and individuals has led to his always learning more, not just about global health issues, but about people and society.

One of the most important things Shattuck has learned over the years is to “find a way to balance the things that need all of my attention at the moment with those few things that I’m really interested in because in this work there’s always something that’s interesting, whether it’s a culture or a disease or a behavior change program or an opportunity to meet somebody. It’s very enriching work.”

Lundgren expressed similar sentiments about the personal enrichment her work has provided: “My tenure at IRH over the last twenty plus years has been a journey of exploration and growth. Each new initiative has offered exciting opportunities to better understand connections between individuals, organizations, sectors, and disciplines. Although I started my journey with a focus on women’s health, I found that I needed to go beyond the clinic walls to engage with women’s partners, families and communities. As a result I have had incredible opportunities to develop professional relationships and expertise across disciplines and around the globe.”