Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

Fathers and Global Maternal Health

Michelle Crotwell Kirtley


By Michelle Crotwell Kirtley

June 16, 2014 

Recent progress in improving global health has been partly driven by the recognition that maternal mortality, HIV/AIDS, and other health challenges are formidable barriers to economic development. In 2000, the United Nations (UN) established a series of Millennium Development Goals designed to focus international efforts on the ten most critical issues hindering development, including maternal mortality, a shortage of clean water, and a lack of education. Although most of these goals will not be fully met by the target date of 2015, laudable progress has been made in many countries, reinforcing the effectiveness of such a cooperative, international approach. 

But as the world, and especially the West, evaluates various public health interventions, it is important to take a step back and consider whether our well-meaning attempts to help are doing justice to the range of roles and responsibilities given to each person. Jim Skillen, founder of the Center for Public Justice, calls this idea “structural pluralism,” which he says, “refers to diverse social institutions and different types of human responsibility.”

In the realm of public health, for instance, this means that as we seek to improve maternal and child survival, we must remember that a pregnant mother is not merely an individual, with individual rights and responsibilities. She is (most likely) a wife; she is a daughter; she is a member of a community with ties that rival or even exceed those of her immediate family. Bringing justice to her health needs must engage this broader context, otherwise we fail to adequately uphold the dignity she is due as an image-bearer of God.

Such a holistic approach helps us fashion more effective public health interventions. In honor of Father’s Day, let’s consider just one: the importance of including fathers in programs designed to improve maternal and child survival. Until recently, fathers were largely ignored in maternal health programs, perhaps because many were designed through the lens of Western individualism and autonomy. However, some organizations have now begun encouraging fathers to play a more direct role in the health of their wives and children.

For example, Catholic Relief Services (CRS) in Nicaragua has implemented a program educating fathers about the importance of their wives’ health. In a rural part of the country with a traditional patriarchal culture and high maternal and newborn mortality, CRS has observed that in the project area “the number of women delivering their babies in hospitals has increased by 60 percent, and 95 percent of the targeted couples have birth plans in place before delivery.”  Delivery in a health care facility dramatically improves outcomes for mothers and their babies, which means that this simple community education initiative has probably saved lives.

In an implicit nod to the importance of the family and the community, the project approaches fathers through volunteers, who are members of the local Nicaraguan community, trained by CRS. The volunteers begin by talking to entire families—including not only mothers and fathers, but grandmothers and grandfathers. Then, they respectfully ask permission to speak in greater depth with the fathers, where they deliver the bulk of the health education message. The program has been so successful that the US Agency for International Development, the key funding agency for the project, has asked CRS to use a similar intervention in Nigeria.

Similarly, in Kibuye, Rwanda, World Relief organizes female volunteers into Care Groups with the responsibility of communicating key behavioral change messages (such as the importance of delivery by a trained birth attendant or exclusively breast-feeding infants to avoid disease) to at least ten of their neighbors. These communications are not intended to be merely female to female. Instead “all family members, including fathers and grandmothers, are invited to participate in the biweekly home visits. … The caring nature of the groups inspires trust between neighbors and works to strengthen the fabric of communities.” 

The success of interventions that involve fathers has led more organizations to implement similar approaches. For example, the World Health Organization (WHO) has included a statement about the importance of engaging men in women’s reproductive health as part of their Partnership for Maternal, Newborn, and Child Health.  

Including men in efforts to improve maternal and child survival broadly affirms the dignity of women in their range of roles and responsibilities. Such efforts also strengthen communities and uphold the dignity of men, inviting them to fulfill their God-given role of supporting their wives and children. In developing countries with weak governments and poor infrastructure, communities are the front line in combating preventable death, disease, and malnutrition, which are major obstacles to political and economic development. Designing holistic public health interventions that affirm human dignity can have a domino effect, and is one key way we can participate in God’s work of redemption and restoration around the world.

- Michelle Crotwell Kirtley is the Bioethics & Public Policy Associate at the Center for Bioethics & Human Dignity and a former health and science policy advisor on Capitol Hill.  She is also a Trustee of the Center for Public Justice and a 2003 alumnae of the Center’s Civitas program in faith and public affairs.

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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”