Saving the lives of mothers and children by getting husbands ...

Miguel Gonz?lez D?vila?s wife, Yadira Cantillana, had already given birth to a daughter before the Child Survival Project began in Nicaragua. The family did not know that a maternity house was within traveling distance, so Yadira had little choice but to deliver her daughter at home with a midwife.

Like Yadira, many women in rural areas of Latin America give birth at home without a doctor, prenatal checkups, postnatal care, or education programs. Poor communities are often far away from the nearest health facility. Many men expect women to continue taking care of their kids, cooking meals, washing clothes, carrying water long distances and otherwise keeping the house in order throughout the pregnancy. Likewise, the responsibility of caring for newborns often falls squarely on the women?s shoulders.

But when Yadira became pregnant a second time, Miguel?s stepfather, F?lix Obreg?n, had some important information to share. F?lix was working as a program promoter with the Child Survival Project, a CRS- and USAID-supported project that helps improve the health of women and children in remote areas of northern Nicaragua by involving men in their family?s health care. He had been selected by the project partly because he is respected by the community and partly because he is a man. Health workers in Latin America and elsewhere have found that men are more likely to listen to other men, especially about socially awkward topics like women?s health. Through the Child Survival Project, F?lix learned how to communicate important health messages. Then he went door to door in order to reach couples who were expecting a child.

Together, Yadira and Miguel learned about their health care options. Program promoters insist that husbands and wives agree on a birth plan before the actual delivery. If the nearest health facility is too far away, the promoters encourage women to stay at the Ministry of Health?s maternity houses near the end of the pregnancy.

Each time the couple and the program interact, the couple learns more about how to deliver a healthy baby and how to care for it once it arrives. As Miguel understood more about his family?s needs, he realized that caring for the family?s health is not just women?s work?it?s also men?s work. ?[Miguel] has changed,? Yadira told us. ?Now he helps me a lot with the baby. If the baby is wet and I am busy, he changes the diaper, he picks him up when he is crying. When I go to the river to wash, he stays with them. . . . If I don?t have water, then he goes to get water. He helps me a lot.?

As husbands become more involved in family life, their households become more supportive environments in which to raise children. Other families are more likely to follow their neighbors? example.

Health workers in Nicaragua say that getting men involved in maternal health has been the key to the program?s success. Since 2008, the number of women delivering their babies in hospitals, rather than at home, has increased 60 percent in the project area. The number of prenatal visits increased from 40 percent to more than 70 percent in some of the most remote communities. Now, 95 percent of families have birth plans in place before delivery. Attendance at maternity waiting homes increased by 285 percent from 2006 to 2010.

Health facilities have asked CRS and its partners to expand the program to reach more people like Yadira and Miguel. In the next stage, CRS plans to use inexpensive mobile phones to help families go to appointments, share information and receive better care.

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