The Super Abbu project: Improving the health of women and children by engaging fathers

When UMSI Clinical Assistant Professor Mustafa Naseem and his team launched a platform designed to improve paternal engagement during pregnancy and childbirth in Pakistan, they were not sure what to expect.

Would fathers and fathers-to-be engage in conversation about women’s health care, a topic generally considered to be taboo in this culture?

“There is a lot of research that shows that male partner involvement in pregnancy and childbirth improves the health outcomes for both mother and child,” says Naseem.  

And that is a big issue in Pakistan, a country that ranks among the worst in the world for infant and maternal mortality. 

Men are likely to be the decision-makers of the households, and a number of the decisions that they make directly impact the healthcare of their wives and children. But in many cases, they are making these decisions without access to important health information, because pregnancy and childbirth are considered “women’s business.”

 “Men are left out of ultrasound appointments, care visits and delivery,” says Naseem. “The household decision makers aren’t being engaged by the public health sector.”

This disconnect can lead to poor nutrition for both the mother and child and pregnancy complications that can become fatal without interventions.

This is where Super Abbu (Super Dad) comes in.

Naseem collaborated with Sacha Ahmad and Dr. Agha Ali Raza to secure a grant from UNICEF Innovation Ventures. After some user testing, they launched Super Abbu, a pilot program designed to provide a platform where men could ask questions and share stories about pregnancy and childcare.

“We were fairly skeptical that men would engage in a service like this, but in the first 71 days we got about 21,000 callers to call in, and 96 percent of them were men,” Naseem says.

How it worked

Making the platform accessible was a challenge in a country where less than a quarter of the population has internet or smartphone access, and 42 percent are unable to read and write.

The team settled on a basic phone-based system. The user interface was simple. People could call the Super Abbu hotline, and either submit a question or passively listen to public questions and stories from other users. No internet access or smartphone was required.

Questions were screened by moderators and then pushed to a team of volunteer doctors. Once the doctors answered the questions, a voice actor would record their responses. Then users could access the answers to their questions by calling back from the same phone number.

Many of the questions centered on nutrition, general health, the costs and advice for preparing for childbirth. Some of the responses showed the research team just how wide the information gap can be:

“What kind of precautions should women be taking to increase the odds of a normal pregnancy?”

“How much longer should we breastfeed our son compared to our daughter?”

These questions -  and the sheer number of responses -  indicated to the team that they were on the right track.

“One of the things we’ve been able to demonstrate is that there is pent-up demand for this,” says Naseem. “There is this misunderstanding among public health officials that men aren’t interested in this kind of information, but it’s just that it’s a taboo topic. They may not be discussing it openly, but they are interested in the content.”

Making a difference

Naseem’s next step is to identify whether programs like Super Abbu can make a long-term difference. He is now working with Arman Rezaee at UC Davis on a new study, funded by a grant from the National Institutes of Health, to determine whether men’s access to information about women’s health can lead to changes in knowledge, attitudes and behaviors.

“Are men able to retain this knowledge once they get access to factual information?” says Naseem. “Do their attitudes toward their spouses, toward their partners change and does that lead to any benefits in health outcomes? That’s the next step that we’re trying to identify.”

And after that? Naseem has dreams of collaborating with the government to launch the Super Abbu platform as a public health service to all of Pakistan.

“If it leads to changes in behavior and it leads to better outcomes – not just health outcomes but also social outcomes for mothers, for women who are expecting and at least better nutrition and better health outcomes for the baby and it leads to better treatment of women in the household, that would be my biggest win from this project.”

Jessica Webster, UMSI PR Specialist

Photo credit: Abdullah Kharal

Posted February 26, 2019