Men's Views on Gender Equality: Attitudes and Behaviors at Male-Friendly Clinics in Malawi

Abstract Background Malawi ranks 173 out of 188 on the UN's Gender Inequality Index (GII) and Malawi has the eighth highest child marriage rate in the world. While previous research has mostly focused on understanding gender roles and norms from women's viewpoints, there has been limited exploration of men's attitudes and behaviors towards gender equality. This study seeks to address this gap by examining the social determinants that shape gender-equitable attitudes and investigating the relationship between behaviors and attitudes in Southern Malawi. Methods Between August 2022 and November 2022, we conducted an observational study in four healthcare facilities located in Balaka, Phalula, Namandanje, and Kapire. The study focused on men who participated in a health education program specifically designed for them, known as male-friendly clinics. We interviewed these men using a structured questionnaire based on the International Men and Gender Equality Survey (IMAGES), which includes the Gender-Equitable Men (GEM) scale. To identify the factors influencing gender-equitable attitudes and explore the associated behaviors, we employed both univariate and multivariable analyses. Results We included a total of 422 men in this study, with a median age of 46 years (IQR= 34, 55). Men reported a median score of 0.53 on the Gender Equality Attitudes (GEM) scale, where 1 represents the higher GEM scores and indicates more equitable attitudes. Higher gender-equitable attitudes were associated with higher education, urban areas and with various behaviours, such as joint decision-making in couples in women's (0.55 vs 0.49; p= 0.008) and children's health (0.54 vs 0.48; p=0.012), and in spending on food and clothing (0.56 vs 0.49; p<0.001). Conclusions This study showed that education and location are the two leading social determinants that affect attitudes toward gender in Southern Malawi. This study confirmed that more gender-equitable attitudes reflect less power imbalance in couples. Key messages • Higer education grade and urban areas affect attitudes toward gender equality in Southern Malawi. • Gender-equitable attitudes reflect equal distritution of power in couples.