We present information on how the MTM Program has improved community members' attitudes about more equitable gender roles and fathers' involvement in caregiving. This includes; attitude changes, knowledge gained and parenting behavior change. We explored the type of attitudes and behaviors that existed before the program implementation (baseline) and point out any changes that may have occurred during the program implementation (midline) and after two years of the implementation period (endline).
Attitudes towards gender equality in parenting
At baseline, most respondents reported that childcare was the sole responsibility of mothers or the primary caregivers. Fathers were reported to be undertaking childcare responsibilities when mothers were unwell or not at home. Fathers and mothers narrated that the separation of parenting responsibilities stemmed from how they were brought up.
“They provide money to buy food for the children if you don’t have or as a mother you can buy for them some clothes so that they have a better life” FGD with primary caregivers, Zambia at baseline
“Children in the past, just like it was when we were growing up, weren’t free around their fathers. Fathers would chase the child asking the mother to get their child as though the mother was the only person responsible for birthing the child. Today’s children who were born into this program have no reason to fear their parents. Children and other parents from back in our time get surprised that fathers are taking care of children, playing with them. They say we have spoiled them.” FGD with Primary Caregivers, intervention, Zambia at endline
“In the past, the way we were raised, my father or my elder brother were like lions, whenever they entered a house, I would always look for a door in order to try and escape, but these days they teach is to be friendly with the children, these days’ children are not afraid of us, we also hug the children.” FGD with fathers, intervention, Zambia at endline
This notion changed at midline and further changes were noted at endline. At the endline, in both countries, Primary Caregivers mentioned in the qualitative interviews that fathers had embraced the notion that they could also provide caregiving. Primary Caregivers added that fathers were more involved than before; they had become close to their children, were involved in play with their children and supported their wives during pregnancy and with different household activities such as cleaning. Through fathers’ participation in the program activities, their parenting skills seemed to have improved.
“After sharing the knowledge we received through the MTM Program with our husbands, they are now involved in caring for their families. They feed their children, take them to the clinic, and support wives during pregnancy... Previously, fathers used to think that their responsibility was only to provide materially for their families. Nevertheless, after the training, they changed their attitude. They now play with children and care for pregnant mothers. For instance, he postpones other activities to care for pregnant mothers and provides a balanced diet too.” FGD with female Primary Caregivers, intervention arm, Kenya at endline
“Male caregivers are involved more in caring for their children. Some take time to stroll with their children as their wives care for other activities. Furthermore, fathers take their children to school both in the morning and evening besides making play items for them.” IDI with ECD Promoter, Kenya at endline
Notably, in the control arm, secondary caregivers also mentioned attitudinal changes towards caregiving. However, their sentiments were centered only on the provision of basic needs and psychological support to the mother during pregnancy. It was evident in the control arms that many caregivers still hold the opinion that caregiving was the sole responsibility of mothers for children below two years.
“The work of a mother in parenting children is to take full care of the children, cooking good food like porridge for babies, washing their clothes, taking the child to the nearest health post for under-five.” FGD with fathers, control, Zambia at endline
“The woman is the one who spends the most time with children, we men can have things like work, but if women spend too much time away from the child, then the child will not breastfeed well, and their health will go down. If the child is one year and six months old and is left with fellow children with no proper food, the children will not take care of that child the way the mother would. We men can be close to the child even from birth, but we only have a hand in the child’s life when they are old enough to be away from the mother when we can carry the child to the market or something of that sort.” FGD with fathers, control, Zambia at endline
Parenting behavior change toward gender equal roles
In both countries, before the implementation of the MTM Program, parenting responsibilities were delineated according to gender. Mothers were entirely responsible for their children. Activities such as bathing, feeding, dressing, healthcare, and spending time with children were the sole mandate of mothers. Fathers were expected to provide enabling means to mothers. However, both mothers and fathers provided information during qualitative interviews on how the MTM Program has influenced gender roles in not only parenting but at the household level in general.
The participants from the intervention arm mentioned that secondary caregivers were more involved in household chores. The respondents attributed these changes to the MTM Program activities. ECD Promoters also reported that through the mentorship they provided during household visits and Caregiver Group meetings, male caregivers had become more positive about participating in childcare and household chores.
“After the ECD training, both male and female caregivers participated in childcare and doing other domestic chores…. They are responding well. We can now see fathers cooking for their expectant wives besides going to the facility for clinics. Even this morning, I saw a father carrying a child… The fathers are helping their wives with some chores at home. When we are conducting our routine household visits, they warmly welcome us even in the absence of their wives.” IDI with Lead ECD Promoter, Kenya at endline
“In the past, I used to leave all the house chores in the hands of my wife. She was doing everything. Nowadays I help her with the chores in the house… I hold the baby, do the washing and cooking.” IDI with a secondary caregiver, intervention arm, Kenya at endline
“You’ll find that you’re tired from working in the field and so is your husband, but they will still want you to get home and do all the chores including taking care of the child. So, we have been taught that fathers are also supposed to take up a supportive role in the upbringing of children.” FGD with female Primary Caregivers, intervention, Zambia at endline
“I never used to play with my child or clean him when he poops, and when the child does something wrong, I was quick to get a whip to beat the child but I don’t do all these things.” FGD with fathers, intervention, Zambia at endline
“The program has taught us a lot, especially regarding gender. We never knew that men could also have a role in the upbringing of their children. Even if you went far and you come back, you will find your husband has cooked, fed the children, and even put water for you to bathe. We would in the old days do all these tasks, but that’s not the case today.” FGD with female Primary Caregivers, intervention, Zambia at endline
The MTM Program positively influenced sharing of household and parenting responsibilities among mothers and fathers. Fathers had become closer to, increased spending time with their children, and had taken up more responsibilities. Thus, fathers´ emotional relationship with their children has improved significantly, which in turn provides a more enabling environment for children to thrive. In addition to an improved relationship between fathers and children, the enhanced participation of fathers in daily household routines has also resulted in overall improved relationship quality between spouses.
“Through what we learnt I have seen that it is good for us to help each other, therefore, the only job that I know is strictly for the woman is giving birth, but the rest we can help each other. All of us can help, washing especially should be for men, for example, when the woman is pregnant and about to deliver... they may keep her for some days at the clinic. When she is away, I have to bathe my children. What am I going to lose by bathing my children? So everything we need to do is to help each other.” FGD with fathers, intervention, Zambia at endline
“Yes, there has been an improvement in my relationship with my wife. In the past, she was not happy, because she could not express herself properly to me. But now that I have learnt, she is more open to me, so there is an improvement in the way we relate, she has the freedom and can count on me for help.” FGD with fathers, intervention, Zambia at endline
“It is very true, I never had time to listen to a woman and her opinion, when she was giving me advice, I just thought she was wasting my time, but through the lessons, I have learnt to value her opinion, these days when she says something we sit together to discuss what she thinks.” FGD with fathers, intervention, Zambia at endline
Participation in the uptake of MCH services
In both countries, before the MTM Program, seeking healthcare for children was usually seen as the mothers´ responsibility. This meant that mothers had to walk long distances with their children tied on their backs to attend the monthly under-five clinic or seek healthcare when the child felt unwell. Most fathers did not participate in this task and many did not show interest in a child's health/physical development. At endline, the qualitative interviews revealed that the participants perceived that the MTM Program had improved male caregivers’ participation in the MCH services such as ANC services, nutrition and immunization, and preventive services including attending sessions on proper handwashing. They reported that more male caregivers accompanied their wives to the hospital.
“In the past, my husband never bothered with my antenatal visits. After the training, he now inquires about my clinical visits and even accompanies me to the hospital. At home, he discourages me from stressful duties and advises me. This makes my work easier… Previously, my husband believed that taking children to the hospital was the role of the mother. Recently, when I was sick, he took the child to the clinic when the child became ill.” FGD with female Primary Caregivers, intervention arm, Kenya at endline
“Fathers are now taking children to clinics and are involved in processing birth certificates.” IDI with Lead ECD Promoter, Kenya at endline
“The benefit I found is that long ago things were hard for women because here the health center is very far, but now the fathers help in taking care of the children even taking them to the clinic, but in the past, he would just leave everything to me to carry the child to the clinic.” FGD with female Primary Caregivers, intervention, Zambia at endline
“Me on my part, the benefits I have seen in my life are a lot, for example when my wife is going to the clinic for under five, I will get the child and put it on my back and then she will only get her handbag. I even see her get happy.” FGD with fathers, intervention, Zambia at endline
“There is change because of the teaching they give us. We see fathers carrying their children on the back and going to the clinics that never used to happen. They even bathe their children, even in our community we have seen the change. We see fathers feeding their children and doing things that they never used to do.” FGD with fathers, intervention, Zambia at endline
It is somewhat remarkable that fathers engaged in what is traditionally seen as the responsibility of a woman in the community despite resistance and mockery from other fathers in the community. Fathers narrated that men who helped their wives in chores that were perceived to be a woman´s responsibility were considered fools, weak, or bewitched.
“The other issue was escorting the wife to the clinic when our child was sick. Other men used to laugh at me, but these days I just consider them as fools and ignore them, even if they laugh, because I know the benefits of helping and taking care of my child. I just get my bicycle and take the child to the clinic, I don’t hesitate.” FGD with fathers, intervention, Zambia at endline
“Helping my wife carry firewood, if I help her carry the heavy ones, they will say she has finished me as a man, and I have just become a fool.” FGD with fathers, intervention, Zambia at endline
The community people used to laugh at me for example, when I carry my baby on my back, the moment I leave home people will start laughing at me, they will say I am a fool and my wife has given me charms.” FGD with fathers, intervention, Zambia at endline