For every 22 babies born in Pakistan, one will die. Pakistan has the worst infant mortality rate in the world according to UNICEF — the equivalent figure in Denmark was four out of every 1000 babies. But a group of researchers found an ally to help reverse the deadly trend: Pakistani fathers.

An increasing amount of research suggests that programs which support women’s independence while promoting men’s involvement in pregnancy and birth result in healthier mothers and babies.

The Super Abbu hotline service, launched in Punjab, Pakistan’s most populous province, sought to put this theory into practice. It went live in January 2018, and lets men ask licensed Pakistani doctors questions about pregnancy and infant child care. Within the first two months, the service garnered over 39,000 calls, 96% of them from men.

Engaging both parents

Pakistan consistently ranks at the bottom of global gender parity lists for inequality and labor force participation for women.

This conservative approach to gender often results in men being the sole earners, leading to them having greater control over budgets and the responsibility for household decision-making, especially for healthcare choices.

While health care decisions are largely determined by men, their involvement in maternal care usually doesn’t extend past providing financial support and transportation, which means crucial information about birth and delivery may not reach fathers.

The Super Abbu project  — which translates as “super dad” — was founded by Mustafa Naseem, Agha Ali Raza and Sacha Ahmad, academic researchers from the United States.

The idea for the program came after researchers discovered that men didn’t have access to public health resources, such as information from community health workers, which are often aimed at women.

Men usually miss out because they are at work, said Naseem, a Clinical Assistant Professor of Information at the University of Michigan. He added that men also have to wait outside women’s doctors’ appointments and are not allowed to be present during delivery.

“Research shows that engaging male partners in pregnancy and childcare helps improve health outcomes for both mother and child, so our goal was to try to engage this audience that otherwise that doesn't get engaged in this life-changing experience,” said Naseem.

Reaching Pakistani men

The consensus among health officials is that men are not interested in learning about maternal health care because it is a taboo topic, but Naseem said that this is not the case. A government-sanctioned study also showed that men’s attitudes towards education on maternal health care are shifting and they are increasingly showing interest.

But men without a formal education may lack knowledge of what care is required for pregnant women, and they may not have the literacy skills to learn from available resources.

For example, men may not know that women need to attend doctors’ appointments prior to birth and that infants need to attend follow up appointments.

Through an expansive marketing campaign using radio, television and social media advertisements word reached men around Punjab that this service was available.

They could then call and leave a message on a question related to nutrition, general health, costs and advice for preparing for childbirth.

“We wanted to do the program in a way that could be done in the comfort of their [expectant fathers’] home without having sophisticated technology access or technology literacy in their own language, and at an extremely low cost,” said Naseem.

Moderators screen the calls and pass along relevant questions to licensed health care professionals. Example calls included: “What kind of precautions should women be taking to increase the odds of a normal pregnancy?” or “How much longer should we breastfeed our son compared to our daughter?”

The researchers were awarded a $100,000 grant from UNICEF Innovation Ventures to get the project off the ground.

When men engage in maternal and infant health care, women are more proactive about attending scheduled doctors’ appointments, better practices at home such as healthy eating are more likely, and parents collaborate more about decisions for healthier options, according to a 2018 World Health Organisation study.

The study cited a male education intervention program in Pakistan, which helped increase routine postnatal care visits as one positive outcome. While family and community engagement projects in Pakistan as well as Tanzania, Nepal, Indonesia, helped parents prepare better for delivery.

Now Naseem has received a $250,000 grant from the National Institute of Health in the US to investigate whether the service has improved outcomes and changed attitudes towards maternal health.

He is also hoping to extend Super Abbu through a collaboration with the health department within the government of Punjab to offer Super Abbu as a 24-hour service where callers can receive answers in real-time.

The government has made improvements to the general health care system in the last 20 years, but Naseem said that more needs to be done to reverse the infant mortality rate, which he described with one word: “dire”. — Amelia Axelsen

(Picture credit: Flickr/UNHCR)