Bringing Women on Board in Safe Male Circumcision in Uganda

Jude Thaddeus Ssensamba

Quality Improvement Officer, Uganda, USAID ASSIST Project/URC

As part of our discussion with facility health workers during a technical support visit to eastern Uganda Nankoma Health Centre IV, Bugiri District, I asked for some experiences on cases where women have not been involved in Safe Male Circumcision. One of the health workers in the group had this experience to share:

“One time, we circumcised a man and all went well. He returned for his 48hour follow up and on examination, healing had started. One week later, he came back in pain, complaining of a swollen penis. On examination, he had a swollen penis and claimed to have been stung by a wasp while urinating. We could not believe this as it looked impossible. The wound was so fresh. We probed further until he admitted to having been pestered for sex by his wife whom he had not informed of the circumcision. Sensing danger of not having told her, he went ahead and had live sex with the unhealed wound.

We opened the wound, explored, stopped the bleeding vessels, sutured again and advised him to inform the partner on the need to abstain after circumcision and if possible to come back with her for the upcoming day two follow up. We saw him off with analgesics and post-operative instructions."  

After sharing this experience, I asked for lessons learnt and they had the following to share:

“Had the man come with the partner at the first visit and attended group and couple counselling, this would not have happened as she would have been informed of the need to abstain”- Team member

“We realized that we needed to mobilize women too for health education on Safe Male Circumcision so that they learn something about it”-  Team member

“We thank you for bringing this issue up. We have realized that women play an important role in Safe Male Circumcision. Starting from now, we shall encourage our clients to come with their partners”- Team leader

Discussion:

Safe Male Circumcision in Uganda and the world is taking root at a steady speed, but an important aspect is being neglected, the involvement of ‘partners.’ This is one of the many cases that have happened and will continue to happen if we do not encourage ‘partner’ participation in Safe Male Circumcision.

Policy guidelines on Safe Male Circumcision currently consider women only as important during the mobilization process, however the focus should shift to “Partner supported Safe male Circumcision” where partners are part of the Safe Male Circumcision package and packages include female-friendly services to Safe Male Circumcision. These services would include family planning, screening for cancer of the cervix and breasts, assessment for sexually transmitted diseases amongst others.

At implementation levels, services should be designed in a way that encourages partner participation at all levels from mobilisation to escorting their partners for follow up visits.

But where is the Quality Improvement with women involvement?         

Though no research has been conducted yet, I feel it’s hypothetically plausible that if women are involved in Safe Male Circumcision, they will improve the quality of service through encouraging their men to return for follow- up visits, help in wound care, and support abstinence for proper healing to occur. This will reduce on quality issues of adverse events, infections and loss to follow up.

USAID ASSIST is encouraging Implementing Partners on the involvement of partners in Safe Male Circumcision through holding discussions with them on the need for women involvement in safe male circumcision and encouraging them to take up safe male circumcision gender related indicators. USAID ASSIST has also included a gender session in its Quality Improvement training; and is planning a study on gender and its effects on quality of safe male circumcision services in Uganda.

Women's involvement in SMC:

As we roll out partner involvement in Safe Male Circumcision, an interesting upcoming issue is the culture surrounding involving women in Safe Male Circumcision. Interesting stories are under study for sharing in future.

View the USAID ASSIST Project Technical Brief: Integrating Gender into Voluntary Medical Male Circumcision Programs.

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