Exploring the gender-specific impact of educational film on maternal and child health knowledge and behaviour: a qualitative study in Serenje district, Zambia

Summary:

Men's involvement in antenatal, childbirth and postnatal care is important for the health of mothers and new-borns. Yet many men do not consider they have a role to play, and evidence suggests they are discouraged by socio-cultural attitudes and lack of knowledge. In 2015 Medical Aid Films established a Bemba film screening project with the Zambian Ministry of Health to improve maternal and child health (MCH) knowledge amongst women in Serenje district. Unexpectedly the screenings attracted large numbers of men as well as women and subsequently, health workers perceived more women attending ANC, more facility deliveries and increased male involvement. Consequently Medical Aid Films conducted a qualitative study that explored the gender-specific impact of the film screenings. Both women and men reported increased knowledge of MCH topics and improved couple communication. Men reported changed attitudes and behaviours around male involvement. Health workers perceived that more men were accompanying women to ANC and facility delivery and traditional care-seeking and treatment practices had changed. Whilst men perceived male involvement in tangible and stereotypical ways, in contrast women expressed a desire for more and different types of male support. Recommendations highlighted the potential of film to improve knowledge of MCH, encourage changes in care-seeking and practices and to reach younger audiences, including young fathers. Further research and integration with other programmes is required to ensure that widespread project implementation maximises participation of men and women in MCH but does not undermine women's rights, autonomy or safety.

Background/Objectives:

Men's involvement in antenatal, childbirth and postnatal care is important for the health of mothers and new-borns. Yet many men do not consider they have a role to play, and evidence suggests they are discouraged by socio-cultural attitudes and lack of knowledge. In rural Zambia, Medical Aid Films and Serenje DHT run a health outreach project, screening maternal and child health films for women that also attracted male audiences. We conducted a qualitative study to understand gender-specific responses to film content and suitability of film for MCH education. Objectives explore effects on knowledge/behaviour and draw out recommendations for improved content/delivery.

Description of Intervention and/or Methods/Design:

Serenje district staff visit outreach posts every month to provide basic health care and deliver health education using eight MCH films in Bemba language. Around 4,350 individuals attended screenings each month. Subsequently, health workers perceived more women attending ANC, giving birth in facilities, seeking more timely care for child illness and an increase in men's involvement, attributing this to the high number of men watching the films (an unexpected outcome because the screenings were aimed at female audiences). We conducted in-depth interviews with women and male partners (n=8), six focus group discussions with men and women in catchment areas and key informant interviews with health workers (n= 3) in three purposefully selected health outposts with high numbers of film screenings. The research approach and thematic analysis were informed by communication-behaviour theory, which specifies inputs that may influence the extent of change after exposure to different communication media.

Results/Lessons Learned:

Both women and men reported increased knowledge and awareness of key maternal and child health topics, including nutrition and welfare of women during pregnancy, the need to seek skilled care during pregnancy and birth and the importance of male involvement in supporting the care of women and children. Men reported changed attitudes and behaviours such as recognising their responsibilities during pregnancy and after birth, increased accompaniment to ANC and facility delivery, practical care during pregnancy and a reduction in negative health beliefs. Couples reported improved communication and relationships as a result of watching the films. Health workers also perceived that more men were accompanying women to antenatal, outpatient and under 5 clinics and that traditional care-seeking and treatment practices had changed. Analysis highlights that whilst men perceive male involvement in tangible and stereotypical ways, in contrast women expressed a desire for more and different types of male support.

Discussion/Implications for the Field:

The study shows the potential of contextually relevant films in local language to improve to improve women's and men's knowledge of MCH topics and intention to act on this knowledge, especially the importance of male involvement in supporting the care of women and children. Film could be a useful tool to reach younger audiences, including young fathers. Further exploration of the needs, values and preferences of men and women and greater integration of screenings is required to ensure that widespread implementation maximises participation of men and women in MCH but does not undermine women's rights, autonomy or safety.

Abstract submitted by:

Helen Coombe

Oliver Mweemba

Helen Smith