Male Engagement and Gender-Transformative Interventions in Maternal and Child Health: A Realist Review & Meta-narrative synthesis.

Reg ID: 04

Abstract

Introduction: Male engagement is increasingly recognized as a critical strategy for improving maternal and child health (MCH) outcomes and advancing gender equity. Interventions span from gender-accommodating approaches, which work within existing social structures, to gender-transformative ones, which aim to challenge and reshape them. Despite their growing implementation, many remain inconsistently defined and assessed, often focusing narrowly on clinic attendance rather than broader dimensions such as emotional support, decision-making, or shifts in household power dynamics. This review sought to examine what works, for whom, in what circumstances, how, and why male engagement interventions improve MCH outcomes.

Methods: This realist review, registered in PROSPERO (CRD420251129477), followed RAMESES guidelines. Evidence was drawn from randomized and non-randomized studies, qualitative research, policy documents, and program evaluations. Data were synthesized using context–mechanism–outcome (CMO) configurations, guided by Pawson’s iterative stages. Searches across MEDLINE, Embase, CINAHL, and Scopus were conducted without date restrictions, limited to English publications.

Results: Key mechanisms included enhanced knowledge, equitable attitudes, self-efficacy, and improved couple communication. These were shaped by contextual factors such as patriarchal norms, religious leadership, and health system design. Gender-transformative approaches that fostered critical reflection and collective consciousness demonstrated more sustainable gains in health behaviors and gender-equitable practices compared to gender-accommodating strategies, which often yielded short-term effects.

Conclusion: Male engagement is essential for strengthening MCH outcomes, but sustainable change requires gender-transformative strategies that are context-sensitive, multisectoral, and power-aware. Effective programs must be context-sensitive, address structural inequalities, and operate across individual, household, community, and health system levels to sustainably improve both health and gender equity.

Keywords: Male engagement, Maternal and child health, Gender-transformative interventions, Realist review