Know, Care, Do: A Theory of Change for Engaging Men and Boys in Family Planning

"Evidence shows that engaging men and boys in FP/SRH [family planning/sexual and reproductive health] programs can decrease unintended pregnancy, improve maternal health, reduce sexually transmitted infections such as HIV/AIDS, and advance gender equality."

This document presents a theory of change (TOC) for engaging men and boys in family planning (FP). It emphasises the notion of reproductive empowerment for all and focuses on the underlying root causes of low levels of men's and boys' engagement in FP, including gender inequality and inequitable gender and social norms. The resource is designed for programme implementers who are working to increase and strengthen the engagement of men and boys in FP services and interventions at all levels of the socio-ecological model and across the life course. Produced by Breakthrough ACTION, it forms part of their goal to implement creative and sustainable social and behaviour change (SBC) programming, nurture SBC champions, mainstream new techniques and technologies, and advocate strategic and sustained investment in SBC.

As stated in the document, "engaging men and boys in FP remains an ongoing challenge and opportunity in the FP/SRH field, in part due to different interpretations of what it means to engage men and boys and its limits and potential for improving health outcomes." The TOC seeks to address some of the perceived gaps in current practice by focusing on reproductive empowerment, which is defined as "the process whereby individuals and groups increase their ability to make informed decisions about their reproductive lives; to fully participate in open discussion about sexuality, fertility, and reproductive health; and to act on their priorities and preferences to achieve desired reproductive outcomes free from violence, punishment, or fear."

According to the TOC, to achieve reproductive empowerment "it is critical to support men and boys in cultivating the necessary knowledge, attitudes, and abilities and navigating gender roles and expectations and power dynamics in their particular contexts." As reflected in the title of this resource, in practice this requires supporting men and boys to:

• Know about FP by having factual knowledge about FP in particular, including practical knowledge of services and methods, and sexual and reproductive health (SRH) more generally;
• Care about FP by assuming responsibility for their personal health and reproduction and accountability for supporting their partners' reproductive priorities and needs; and
• Do supportive actions for FP by taking concrete steps to communicate and help achieve reproductive intentions and goals for themselves and in support of their partners.

In order to achieve the above outcomes, the TOC first establishes key principles for engaging men and boys in FP. Then, it looks at the key drivers of men's and boys' engagement and provides an outline of the critical intervention features to address these drivers. Finally, it highlights anticipated changes from the interventions and examines how these changes shape and influence men's and boys' engagement in FP to advance universal reproductive empowerment.

Key principles of engagement outlined in the TOC are:

1. Recognise the central role of gender norms.
2. Adopt gender-transformative approaches.
3. Focus on individual men and boys and their relationships (as opposed to engaging men and boys as part of couples, especially married couples).
4. Emphasise universal reproductive empowerment.
5. Position engagement in the broader context of men's and boys' lives.

As FP behaviours are significantly influenced by factors beyond the individual, the TOC seeks to address key drivers that target and impact the three components of Know, Care, Do for engaging men and boys. It looks at these at the social and institutional level, community level, close relationship level, and individual level.

According to the TOC, critical features for interventions to engage men and boys in FB should address the key drivers of engagement at all levels to shape each Know, Care, Do component, all while following key principles of engagement. The resource outlines some of the common features shared by the most successful intervention approaches. For example, interventions should involve shifting norms and changing attitudes and beliefs that are specifically related to the Know, Care, Do components, and they should mainstream gender-transformative approaches across key institutions, such as educational and health systems, at the social and institutional or community levels.

Through addressing each of the Know, Care, Do components for men's and boys' engagement in FP, interventions using the features outlined in the TOC can trigger a range of changes, which are outlined in the last section of the resource. These include, for example: changed social expectations to encourage men's and boys' equitable participation in FP and changed relationship expectations and behaviours regarding men's and boys' roles in FP.

The document also includes the following Appendices:
Appendix 1: Useful Resources for Engaging Men and Boys in FP
Appendix 2: Useful Resources for Gender and Other Social Norms