Historically, women in West Africa have not had a voice. Men decide if their wife or wives can use birth control or have access to money; fathers decide if their daughters stay home from school, marry young, or undergo female genital mutilation. Typically, the outcomes of these decisions tend not to benefit the women.
But some of that is changing now, thanks to an initiative called Husband School. In 2007, the United Nations Population Fund (UNFPA) launched its École Des Maris (literally, the school for husbands) program in Niger as a means of educating men on all things gender equality. A Husband School is formed when UNFPA representatives and community leaders convene with village chiefs to identify eight to 10 “model husbands” — respected men within the village who have the willingness, drive, and progressive point of view required to learn about modern-day practices like family planning, birth spacing, and discontinuation of domestic abuse. After participating in an initial three-day training program, where they learn about reproductive and maternal health, gender equality, genital mutilation and cutting, and other issues that adversely affect women and girls, the model husbands gather weekly, with each session led by a coach and devoted to a different topic. They then return to their community, where they spread the word in an effort to bring other men on board and, ideally, spearhead real change in the arenas of maternal, infant, and women’s health.
There are now more than 1200 Husband Schools in session across West Africa, with most villages seeing promising results. For instance, after the Maiki School for Husbands was established in Niger in 2011, the number of women receiving prenatal consultations (an important marker of women's health) jumped 95% in less than a year; model husbands also secured housing for a local midwife.
In Côte d’Ivoire, which has an extremely high rate of maternal mortality (645 women out of 100,000 live births will die in or as a result of childbirth — that’s one woman dying every two hours) and infant mortality (67 out of 1000 live births), maternal death rates in the rural village of Toumodi have reportedly dropped since its Husband School opened: Record-keeping and reporting methods in rural areas like Toumodi can be unreliable, but one local health official estimates that in the first half of 2016, two women in Toumodi died during or as a result of childbirth, compared with nine who perished within the same time frame last year. “We’ve even seen model husbands escorting women [who are not even related to them] to clinics,” says Doris Bartel, Senior Director of Gender Empowerment for CARE, a global nonprofit dedicated to fighting poverty through gender equality, which routinely partners with UNFPA on global-health initiatives. “So women and men throughout the community, regardless of who they are married to, all benefit from the engagement of men and boys becoming champions for women’s health.”
In May, the members of Toumodi’s Husband School invited me to visit and participate in a session. Read on for a few of their encouraging stories.
Donald Kouame, 36, Coach
Father of two children, ages three and 12 years old
After volunteering as a model husband for three years, Donald — the son of the village chief — is now a “coach,” responsible for training other model husbands so they can spread awareness about gender equality and maternal and child health to men throughout the community. Since joining École Des Maris, Donald says he and his wife, Amoin Chimène, 28, have been able to successfully time and space her pregnancies with the help of contraception. Perhaps as a result, “our relationship is much stronger than before. We communicate more effectively, I help take care of household work and the children equally now. Husband School has helped my wife and I to create a partnership.”
Photographed by Josh Estey.
Kouame Akissi N’da, Wife Of The Village Chief
Mother of seven children, ages 28 to 41 years old
“In the village here, people don’t have money and they make a lot of children. As a result, we have a lot of children wandering the village, suffering. Before [Husband] School, women used to take glass bottles, reduce them to powder form, and drink it with water [as birth control]. When they did it, they’d still get pregnant and after a few months, most of them would [experience complications and] die, or else they could no longer have children. We lost many women in childbirth. Sometimes when the baby is being breastfed, and the women gets pregnant again, the baby can die because they mother doesn’t have enough [milk] to give. When women go to work, they have to travel with babies on their back, and they [may also be] pregnant, and it causes a lot of health problems. Now, they treat their wives better than before. Before they used to fight a lot in the home; now there is peace in the home. Families are able to plan, and therefore they have enough money to take care of their children.”
In addition to its high rates of maternal and infant mortality, Côte d’Ivoire has one of the highest rates of fertility — an average of five living children per family — in the world. Less than 3% of women use a modern method of contraception, such as oral or injectable contraceptives. As recently as last year, women in the village of Toumodi, Côte d’Ivoire have relied on a beaded rope, called a Bâ Oulê Djranlê Gnaman (literally, child stop pregnancy rope) tied around their waist, or a drinkable concoction of palm leaves steeped in well water, as a means of avoiding pregnancy.
Photographed by Josh Estey.
Donald Kouame, Coach
Donald uses UNFPA-prepared materials to educate male community members about birth control and the safe timing and spacing of pregnancy. (Women who do not wait 18 months between pregnancies are more likely to have a premature baby; short intervals between births also increase the risk of bleeding and maternal death.) His use of frank language, softened by an easygoing personality, makes him an ideal teacher. Donald has successfully guided village members and their wives in using birth-control pills, contraceptive injections, diaphragms (which he describes as “a kind of plastic that looks like a hat that the woman puts in her vagina”) and condoms.
Photographed by Josh Estey.
Kouadio Kouame Pierre, 42, Model Husband
Father of eight children, ages 4 to 18 years old
“I want my village to modernize. Before this school, men refused to go to the hospital with their wives, and pregnancies were too close to each other. I wanted this to stop. There was no family planning at all. We realized we are not able to take care of the many children we have in our village. Now people are able to plan so they are able to take care of the children. Women are taking medicine [birth-control pills], people are using condoms. I want to stop having children, and the school is helping me to do that. When I bring information back [to my community members], they do listen to me.”
Despite recent economic progress, women in the West African country of Côte d’Ivoire, which recently emerged from a decade-long civil war, remain marginalized with little access to even the most basic health care services. “In Côte d’Ivoire, men make the decisions about family and about money” explains CARE’s Bartel. “When men hold all the purse strings, women end up having to ask for an allowance for transportation to get to a clinic, or permission to spend household income on birth control.” It is rare for women to be granted this permission, considering that many men in West Africa believe that birth-control pills and injectables may make their wives sterile, ill, or unfaithful.
Photographed by Josh Estey.
N’guessan Kouakou, Model Husband
Father of 10 children, ages 1.5 to 26 years old
“The village is changing. Now, if our wife is suffering from a disease, we send her to the hospital. We [now know that we] need at least two years between pregnancies so the wife can recover from the first pregnancy. We have some methods we can use so women don’t get pregnant quickly.”
On domestic abuse: “We talk to the men…and we tell them not to fight with their wives, not to beat them. Women already suffer a lot; they don’t need to beat them. Also, we tell them to help the women. If a woman is carrying something, like a baby and [a bucket of] water, you should help them carry the baby. The reason why we accepted the Husband School program is we realized that if we listened carefully and followed instructions, we could change.”
Kouakou’s, wife, Oka Ahou Monique, has started using oral contraceptives and is pleased with the results. She’s also enjoying the newfound help of her husband during day-to-day activities: “My husband helps me to work. When I go to the farm and I have things to carry, he helps me carry them.”
Photographed by Josh Estey.
N’guessan Kouassi Heaman, 34, Model Husband
Father of three boys, ages 2 to 7 years old
Village members weren’t immediately receptive to the information emerging from the Husband School, says model husband Kouassi Heaman. “But we insisted and with time, people started accepting it.” Personally, Kouassi Heaman says he and his wife, Angora Amenan, have enjoyed the ability to take time between each pregnancy, as well as the sense of increased safety they felt as a result of her delivering their last child at a local hospital.
Photographed by Josh Estey.
Sinan Bamba, 33, Model Husband
Father of two children
When Sinan’s wife went into labor with their first child, she asked him for permission to go to the hospital. Even though home deliveries are the norm in Côte d’Ivoire (often with tragic consequences), Sinan agreed, but he did not join her, and she delivered alone. École Des Maris had a significant impact on his outlook on gender and has changed the way he treats his wife. “Now, if she is sick and I don’t have money, I look for it to buy medicine. [For her last pregnancy, I paid for an ultrasound] exam. We went together to the hospital for the delivery.”
Outcomes like this dovetail nicely with recently introduced bipartisan legislation called the Reach Every Mother and Child Act, designed to help create solutions to save the lives of 15 million children and 600,000 women by 2020 and end preventable maternal and child deaths by 2035. A major impediment to safe delivery in Côte d’Ivoire is that women often have to ask their husbands for permission to visit or deliver in a health facility.
Photographed by Josh Estey.
Local Children
“After the advent of Husband School, I [began taking contraceptive] injections,” says Kouakou Rosine, a mother of three children. “I’ve been taking them for three years, ever since my last child was born, and I noticed nothing happened to me. I felt good, I could continue my activities.” When asked if she wants more children, she responds, “it depends on if my husband wants more.”
Bartel says she is not surprised to hear women who have benefited from Husband School still deferring to their spouses on decisions about children and birth spacing, “especially in a context like West Africa where women’s status, economic security, and relationship with extended family are all based on her role as mother. Access to a good contraceptive is not a panacea for other deep-rooted gender discrimination issues — although it’s a great start. There is a lot more to be done, especially when it comes to changing deep-rooted beliefs and social norms.”
Photographed by Josh Estey.
Local Teenage Boys
“We speak to those who are married and not; we even talk to young boys so they can grow well before they start going into sex, so they [understand proper birth control and] hygiene,” says N’guessan Kouakou, a model husband.
Photographed by Josh Estey.
Translated: “Male involvement in reproductive health.”
In order to be a model husband, a man must fulfill certain UNFPA criteria. These criteria include: “Be a husband who allows his wife to participate in group organizations” and “Be someone who nurtures harmony within his household.” He must also be willing to allow his wife/wives to use reproductive health services — no easy feat in a country where there is so much stigma surrounding contraception that “couples tend to not talk about it or even hide their use of it,” says Bartel. Because some men have more than one wife, a model husband’s potential impact may be doubled or tripled, as multiple wives are affected.
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