NOTE 26: Involving men in nutrition

Introduction

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Men often have priority when it comes to food: they may eat before everyone else and enjoy the most nutritious food. Women and children can be left with smaller portions and less nutritious meals. This exposes women and girls to a range of harmful physical and emotional health outcomes. Malnutrition has intergenerational consequences because undernourished women give birth to low birth-weight babies. Such children can face cognitive and other limitations all their lives, making it difficult to escape from poverty. When women face food discrimination on a national scale, the human capital of the nation is put at risk.

Integrating men in nutrition initiatives helps turn this situation around. By virtue of their power and privilege, men are in a prime position to tackle malnutrition in their own homes and in the broader community. In many households and communities, men make key decisions about what to grow and which animals to raise. They often decide what to sell, how much to store, and what foods to buy. However, many initiatives target women and girls, and ignore men. Women may learn a lot from courses on good nutrition, but excluding men means that women may not be able to act on their improved knowledge. Men may feel angry because their own nutritional needs are ignored.

In this note we discuss lessons elicited through discussions with staff from Men for Gender Equality Now (MEGEN) in Kenya; the Zambia National Men’s Network (ZNMN); the National Association of Farmers in Malawi (NASFAM); CARE in Benin; GIZ and BRAC in Bangladesh; and USAID in Guatemala, Zimbabwe, and Kyrgyzstan. All boxed case studies are drawn from these discussions.

Philosophy and principles

Make good nutrition everyone’s responsibility Encourage men to talk about healthy food choices with their wives and children. Work with men together with women to plan how the farm can produce healthy food for the family. Stimulate discussions on how to purchase good, healthy food with the proceeds from cash crops and off-farm work.

Be inclusive Encourage men to think about the benefits to the whole family of eating nutritious food together with women and children rather than separately. Discuss the special needs of women during pregnancy, childbirth, and breastfeeding. Emphasise the importance of good nutrition to children’s development.

Build trust Engage with men and boys about nutrition, taking time to win their trust and develop their confidence. This is the basis for changing behaviour and men’s attitudes for the good of their families and communities. Be patient – change doesn’t happen overnight. Work towards slow but sure change.

BOX 1: Men's perception of their roles

Bangladesh: "Men consider themselves responsible for food production and marketing. They believe good health and nutrition are essential to being strong and productive on the farm. They consider they play an important role in supporting their children’s education and development. However, men are rarely interested in food preparation or the intricacies of food distribution, and they view these activities as a woman’s domain. Yet decisions about spending on food fall predominantly to men, since they buy the food. Research shows men are interested in being able to make informed purchasing decisions."

Zambia: "It is the man’s responsibility to have food in the home, but it is not a man’s role to distribute the food. In my community a man must ensure that there is enough food in the house at all costs because if there is not enough food for the family, a man is considered weak by his peers. He becomes a laughing stock."

Implementation

The best initiatives:

have a bold vision but work to change norms from within by building on men’s existing responsibilities
work with agricultural, health, and behavioural change specialists
work across individual, community, and institutional levels making sure to engage key indirect stakeholders and decision formers within the family and in the community
use innovative methodologies – conduct thorough research, develop a strategy, pilot, revise, pilot again, and use lots of different methods to say the same thing.

Culturally relevant data should be obtained alongside standard nutritional data such as the household dietary diversity score (HDDS) and individual dietary diversity score (IDDS) (1, 2)

Move from personal to political
It is important to move beyond interventions that focus on individual responsibility for securing nutritious food because men and boys are embedded in wider structures that condition their behaviour. They must be supported as they begin to confront and question the cultures at home, in the community, at work, and presented by the media, which shape their psychological and social identities. Activities might include:

developing men-only groups to help men support each other in changing their behaviour and challenge concepts and practices related to traditional ways of being a man
strengthening men’s personal commitment to gender equality and equipping them with the nutritional and agricultural knowledge and skills to put that commitment into practice in their own lives
relating messages to men as fathers.

BOX 2: Peer pressure

MEGEN Kenya: "We can’t go on thinking and believing that we are superior to women. However, we have a lot of pressure as men from our families, friends, and workmates expecting us not to change. We conform because we are afraid to be laughed at or be stigmatised or be called ‘weaklings’. These fears make it difficult for us to put into practice the discoveries that we’re making in this workshop."

Get everyone on board
The promotion of community-wide change in attitudes and practices is vital. In some places, reforming traditional councils and local decision-making bodies is a cornerstone of securing support for cultural changes regarding rights to nutritious and sufficient food for all. Actions include:

developing community-based awareness campaigns aimed at mobilising policy makers, media, and other opinion formers
involving communities in nutrition assessments, defining health and nutrition priorities, planning interventions, and monitoring and evaluation.

Create multidisciplinary teams
Some approaches to team building are outlined below.

Training clinic staff, community nutritionists, and extension workers on the gender dimensions of health and nutrition ensures they understand men’s roles and responsibilities and ways to get men on board.
Training rural advisory services (livestock, fish, crops) and input providers on how to include nutrition advice in their work helps farmers create a farm capable of providing healthy and sufficient food. Data obtained from the IDDS and HDDS can help guide this work.
Involve behavioural change specialists where possible.

BOX 3: Committements and trust

CARE Benin: "At the end of each meeting, members make small commitments to try a new behaviour or speak to someone about what they learned. Reviewing these small commitments at each meeting facilitates peer learning, helps reinforce new behaviours, and supports group members."

GIZ Bangladesh: "First we conduct gender training with influential community leaders. We then work with men, including training on improved agricultural inputs, developing their understanding, and showing this is about the betterment of themselves and their families. Trust is won once they see the impact of the changes they are making and they become open to bigger ideas. We build on traditional behaviours, make sure our messages are simple, and use many methods including cooking demonstrations, games, entertainment, educational materials, and role-plays."

Be innovative
Seek out new partners and methodologies. Repeat the message in many different ways in different groups, and tailor the message to the target group. Keep the message simple, do-able, and fun. Some projects work through village savings and loans associations because men are often interested in making money. Some value-chain projects include farm planning for good nutrition.

Share knowledge
Right from the start, share lessons with people and organisations from community, to national, to global level. This builds critical mass for change and ensures the best methods are taken to scale quickly.

For men and other primary target groups: produce learning aids, talking books, education modules, and handouts. Develop visual tools as well as materials written in local languages.
For external stakeholders (partners, research institutions, and donors) and internal stakeholders (programme staff): participate in workshops and conferences; share evaluation reports; prepare ‘how to’ notes; post blogs, etc.

BOX 4: Lessons from Kyrgyzstan and Bangladesh

USAID Kyrgyzstan: "We contract with agriculture service providers to provide training to farmers (many of whom are male) on water, sanitation, and hygiene (WASH); agricultural WASH; and diet diversity. We have a home budgeting training day for spouses to learn together about ensuring equitable spending decisions. A diet diversity session during the training day delivers nutrition messages."

GIZ Bangladesh: "Men, as key rice farmers, receive training on application of zinc foliar fertilisers to increase the zinc content of rice grains. The training includes messages on crop and human nutrition, and overall understanding of zinc’s dietary function."

Capacities required

All partners must have a good knowledge of the target areas (agroecological, sociocultural, political) and they should be able to identify, and work positively with, local knowledge. We recommend building on the methodologies and lessons learned developed by the men’s movements for gender equality in various countries. As the project progresses, the skills of the ever-increasing presence of gender-sensitive men in the community should be built upon.

Facilitators need experience in enabling participatory, bottom-up development processes. They need to be enthusiastic and believe in men’s ability to change. They should be committed to open dialogue and learning based on respect and understanding for members of the community. Facilitators, particularly male facilitators, must be able to ‘walk the talk’ and reject the benefits conferred upon them by virtue of their gender.

Costs

The cost of engaging men varies according to the size of the target group, location, and type of activities planned. These may include a baseline survey, implementation, and final evaluation. Specific costs include salaries, overhead costs of implementing partners, costs associated with training and mentoring, and possibly exposure visits. Other costs include developing training and advocacy materials, and operational costs.

BOX 6: Lessons from Benin

CARE Benin: "All local partner facilitators are based in target communities. They are very familiar with the sociocultural context in which the programme is implemented. Community health workers work closely with facilitators to promote growth, monitoring, and promotional and community health activities, such as Child Days. Community health workers are highly involved in community mobilisation surrounding local health and nutrition events."

Strengths and weaknesses

Working with men in nutrition initiatives is very new. More needs to be learned about men who have changed in order to understand their recipe for success. Resources are required to train extension workers on how to integrate nutrition in their work and train them in effective strategies for engaging men. Data on nutritional gaps and sociocultural norms – including the nutritional needs of men – must be secured in most communities.

BOX 5: Lessons from Malawi and Guatemala

NASFAM Malawi: "We train farmer members of Gender, HIV and Aids nutrition subcommittees in every NASFAM farmer club to train other farmers. They invite men and women to bring foodstuffs from their homes and ask them to categorise them into six food groups. We show that all six food groups can be procured from their homes and that they can have a balanced diet. The belief is widespread that this is not possible because they are so poor! The trainers give tips on minimising nutrient loss through cooking, and demonstrate how one meal can have items from all food groups. Everyone – men and women – then cooks together and shares their food. The trainees are provided with simple planning tools such as a food availability calendar to help them plan for difficult times by preserving and storing key foods."

USAID/Anacafé Rural Value Chains Project Guatemala: "We provide men with delicious, varied dishes with a high nutritional value based on the crops they grow at home. This motivates them to bring their spouses to the workshops so they can learn how to prepare the same dishes for the family."

Best-fit considerations

Fit to national plans
Ensure the programme’s design and implementation strategy fits well within a country’s national development vision and has the potential to generate high levels of support in relevant ministries. Where possible, sit in interministerial and interagency working groups responsible for food and nutrition security.

Be context-specific
In some communities it can be more effective to target men alone, as in the case of Zambia through the Men’s Campfire Conferences. In other cases joint activities and awareness-raising activities are appropriate, as in Kenya where MEGEN uses intergender and strategic dialogues to reach out to men and women. The most appropriate approach should be contextualised and should include participation and a thorough community assessment.

BOX 7: Considering the costs

USAID/Anacafé Rural Value Chains Project Guatemala: "We want to replicate this project in other communities but this will be expensive. We need partners. The total cost of the project was approximately US$5 million for five years."

NASFAM Malawi: "Costs are minimal because the structures exist already. NASFAM works through existing committee members who are all volunteers. Costs include committee members using a bicycle taxi to get from their homes to the training venue, and the costs of cooking oil and salt."

CARE Benin: "US$300,000 per year for a five-year complex programme to reach 70,000 men, women, and children by year four."

Go to where men are
Find men where they socialise rather than expect them to come to you. Enter and build positively upon male spaces while at the same time tapping into like-minded men who are already persuaded by your ideas. Encourage such men to become role models for others. Involving boys in peer-group learning is important and helps in cultivating positive attitudes that are carried on into adulthood.

Governance

Walk the talk
Work on nutrition is more effective when backed up with changes throughout partner institutions. This is not just about securing technical changes to health status but – critically – about demonstrating through everyday interactions that partners take gender equality seriously.

Evidence of impacts, sustainability, and scalability

If the project is to succeed, the benefits of change must be recognised immediately by men during implementation. Several projects have developed behavioural change indicators alongside more conventional indicators focusing on improvements in key aspects of nutrition. BRAC measures the support of fathers in early initiation of breast feeding, exclusive breast feeding, meal frequency of children, and childcare. Table 1 shows the changes demonstrated by the GIZ-led Affordable Nutritious Foods for Women (ANF4W) project (3)

, which also produced gender-disaggregated data on dietary diversity, etc.

Advocacy is essential. Be innovative in spreading the message and get men and boys involved as role models and agents of change. Make smart use of social media, posters, music, and drama. Attract a wide public through digital stories and radio/TV interviews.