Subsistence farmer Justine Ngbavungugbe, 39, and his wife, Flora Nakoo Raphael, 38, live with their four children in the small community of Nagoli in South Sudan. Justine had always followed strict religious norms and did not believe in using modern methods of voluntary family planning. He had also discouraged others from using family planning.
However, after participating in a male engagement activity through IMA World Health’s MOMENTUM Integrated Health Resilience, a project funded by the U.S. Agency for International Development (USAID), he now sees the benefits of family planning and spacing the birth of children.
“I learned from this game about family planning methods and benefits that helped clear my deeply held myths and misconceptions about family planning. This included not to discourage and stigmatize people who want to access family planning services for their own family planning needs and child spacing, based on religious backgrounds,” Justine explains. “In addition, I have learned new ways of communicating and engaging other men on family planning-related issues, how to reduce negative perceptions of family planning, and how to approach difficult men on these topics.”
The need for effective family planning in South Sudan is dire. Its infant mortality rate is among the highest in the world, with an average of just under 65 newborn deaths per 1,000 live births. South Sudan’s rate of modern contraceptive prevalence stands at just 2.7 percent. South Sudan also has one of the highest birth rates in the world, with each woman bearing four or five children in her lifetime, on average.
Although most education and outreach programs primarily target women, men also play an important role in decision-making about child spacing and contraceptive use. Men often have different priorities, assumptions and preferences than women about the available choices.
To address this, a game developed by USAID-funded Breakthrough ACTION, “Together We Decide,” was piloted in South Sudan in partnership with MOMENTUM Integrated Health Resilience. The game creates a safe space for men or couples to discuss child spacing with peers in a manner that resonates with them. The game lets players “experience” the consequences of choices about child spacing and contraceptive use, build familiarity with contraceptive methods, and envision conversations with their partners and health workers. The activity also provided accurate information to men to help debunk myths and misconceptions about family planning and reproductive health while also reviewing financial aspects of having children. The game in Yambio County, where Justine lives, was played with both couples and male pairs.
Since participating in the game, Justine has become more open with his family. He and Flora now conduct family meetings together.
Justine and Flora reported more love and respect for each other after the male engagement game. (Male Herbert for MOMENTUM Integrated Health Resilience)
“I heard about male engagement in reproductive health from the radio, but this was inadequate to engage me,” said Justine. When he happened to hear about the program from a friend, “I got excited and used this opportunity to learn about family planning. Men or couples gather and discuss family planning needs, ask questions, discuss issues together as couples and learn to make decisions together. This was an interesting game for fathers, and the first of its kind in Yambio.”
The collaboration with Breakthrough ACTION has encouraged wider community acceptance in the counties where MOMENTUM Integrated Health Resilience operates. Work is ongoing to apply lessons learned through the pilot to other counties and communities, perhaps even in other countries in the region. Success will be measured, among other markers, by increasing the number of men who participate, resulting in more couples who make decisions together about family planning.
Justine was particularly engaged with the financial implications of having fewer children. Following the activity, Justine and Flora made a joint decision to establish a small kiosk to increase their family’s income. The money generated by the kiosk will help to support family needs and build on the current family harmony.
Justine is now a role model in his community. He has already referred three families with family planning issues to health facilities to access information, counseling and services. He said he is also confident that he can now lead the male engagement game for many men in his community.
“I have helped to address the fear and shame that men experience while being seen together with their wives at reproductive health [clinics], and helped to break the social barriers in accessing health services among couples that are rooted in gender roles and decision-making powers,” Justine concludes.
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