Fathers

Sunday was father's day. In Malawi, the role of fathers isn't particularly clear to me. From what I can tell, it differs based on jobs, finances, education, etc...as you would expect.

Walking along the roads or through villages, it's common to see women walking with something big on their head, a female child or two trailing behind (sometimes with something on her head as well), and a baby strapped onto the back of either the mother or child with a chitenje (brightly colored African fabric). The men rarely have babies tied on by chitenje. I've only seen it twice here and it gave me a goofy grin that lasted a good part of the day. Sometimes dads will just carry their kids on the shoulders. This is also rare, but more common than chitenje carrying.

Because I'm interested in working with pregnant women and sexually transmitted infections, father's day got me thinking about the role of father's in STI prevention, prenatal care and child care. A NYTimes article talks about the paternal bonds with children in the wild. Apparently it's rare and it made me wonder where on the spectrum of involvement fathers from the US and Malawi were.

In Malawi, polygamy is still common. It's not always the case, but it appears (based only on non-representative, anecdotal evidence) that it's much more common and/or socially acceptable to have a kudzu-shaped family tree. In Malawi, a study assessing the demographics of guardians (family members who accompany patients to the hospital to ensure their patient gets care in the face of a shocking shortage of clinical staff) found that most were women--including for labor and delivery patients. I'm not sure why. Perhaps it was because the men were the primary bread winners or had moved on or were less in tune with how to care for sick children family members or perhaps for some reason I can't possibly comprehend.

I've heard news of a few successful outreach programs here in Malawi that involve men in the family planning process, although a search for references left me with nothing to confirm this. And there is growing urgency to include men in the perinatal activities since the outcomes of successful outreach programs have been impressive. While I can't authoritatively say that Malawian men are less involved in childcare and prenatal activities than US men, it seems that mens involvement can be increased and can result in a significant shift in cultural expectations if done correctly.

As for men in the US, involvement in child-related and family planning activities can span the whole length of the spectrum. Since the US dads range from deadbeat dad to superdad, and have for several decades, I wonder if there is as much opportunity for change or improvement as a result of their involvement with the perinatal process.

To clarify, I'm not saying that I think US dads don't have any interest in improving or that Malawian dads have a long way to go. It seems the US spectrum has shaken out and there will continue to be men at either end and all points in between. What I'm trying (unsuccessfully) to think through is that Malawi is in a unique place right now. It's open in so many ways to change. I think there's a lot that can be done that will make a big difference in the health of many people here and this research that shows the willingness and effectiveness of men being involved may be a critical leverage point. I'm curious if Malawians can rally behind this idea and make it work. One thing I am sure of...if it happens, it will be slow by slow (pan'gono pan'gono).