A male-led campaign in Lesotho seeks to break the patriarchal norms that say childhood vaccination is a woman’s job – and is seeding a potentially lifesaving shift.

21 February 2023 by Pascalinah Kabi

Lesotho male mobilisers pose for a picture along with Mantsopa Institute staff at the refresher course in January 2023. Credit: Mosoeu Maliehe

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In January, nurses at Ha Khabo Health Centre in Lesotho could not believe their eyes when they spotted a 69-year-old male among the women bringing their babies for childhood immunisation.

Although the nurses and mothers at the rural Leribe district clinic knew Kiti Mokebe, his presence at the vaccination clinic was a shocker – taking children for vaccination is largely seen as a woman’s responsibility here.

“I would say 40% of men I talked to changed their attitudes towards child vaccination. Others are hot-headed patriarchs who feel that being seen carrying a nappy bag is not manly.”

– Neo Ramatla, father of three

But that perception can pose a real public health risk. Researchers have found that men often act as blocks to childhood vaccination rates in the region.

“It was noted with strong emphasis that women were in charge of taking children for immunisation and sometimes, the husbands opposed immunisation and stopped their wives from immunising their children by denying them the social and financial support necessary,” reads a 2020 study on barriers to child immunisation in sub-Saharan Africa.

Lesotho is no stranger to pushing back against gendered obstructions to public health, implementing integrated nutrition and HIV interventions through male-led campaigns targeting 10,000 men in Maseru, Leribe, Botha-Bothe and Mokhotlong districts.

32-year-old Leribe mobiliser Leeto Rantai says his father inspired him to serve the community in programmes such as this one. Credit: Mosoeu Maliehe

Now the Mantsopa Institute, a social mobilisation and advocacy NGO, is working with UNICEF and the Lesotho Ministry of Health to get men involved in routine childhood immunisation.

The campaign “seeks to break all barriers associated with patriarchy and raising children,” said Mantsopa Project Coordinator Lebohang Mokobocho.

“In most cases, men do not voluntarily become their children’s primary caregivers. They only consider primary caregiving after the death of their partners and we want to break these barriers,” Mokobocho explained. “It is more easy for a man to pay attention on these issues if discussed among men.”

Last month at a Mantsopa refresher course for its community mobilisers in Teyateyaneng, VaccinesWork met Poloko Latela, a mobiliser from Mokhotlong. Convincing traditional, rural men to attend these men’s public gatherings was his biggest challenge, Latela said.

“It does not help that our villages are far apart and hard to reach. So, I partner with service providers like agents of telecommunications companies and co-host these gatherings with them – that incentive is enough to have more men attend those gatherings.”

Latela, who is recently married, plans to be a hands-on father someday, he said.

Neo Ramatla, aged 42, is setting the example. Ramatla grew up in a village where raising children largely remains a woman’s responsibility, he said. However, the father-of-three vowed to change the status quo when he married the “love of his life” almost two decades ago.

“When my wife fell pregnant, I promised her that I would be with her throughout the journey, and I never went back on my word,” Ramatla said.

The Molumong villager said both parents must equally contribute towards raising their children, from changing nappies to taking babies for vaccination.

“But I get mocked for taking my children for immunisation. Other men claim that I have been fed a love potion.” This has not discouraged him. If anything, it pushed him into taking a stance to positively influence his peers into raising their children.

Ramatla says he starts a typical campaigning day by approaching a village chief about his plans to talk to men about the importance of child immunisation and related issues at a public gathering.

“I then spend almost three hours preparing for the session, and another three hours talking to men. I would say 40% of men I talked to have changed their attitudes towards child vaccination.

“Others are struggling to come to terms with this proposal. Some men are hot-headed patriarchs who feel that being seen carrying a nappy bag is not manly,” Ramatla said.

In some quarters, however, the changes are plain to see. The Menkhoaneng Men’s Association in Leribe was formed after a public gathering organised by a Mantsopa mobiliser in 2022. Kiti Mokebe is its chairperson

He says that while he was never around to help his wife raise their two now-adult children, today he is a committed father-figure to his grandchildren. That means helping them get their vaccines on time.

“Nurses were shocked when they realised that I took my granddaughter for a vaccine,” he recalls.

A 27-year-old Maseru man who said he is expecting his first child in the coming months told VaccinesWork, “I feel lucky that I was able to attend the public gathering ahead of the birth of my first-born, because I never really understood the importance of vaccines. This campaign has prepared me to be a better father.” But the tension of his position was made clear, when he asked not to be named for fear of being mocked on social media.

“If one man takes his child for vaccine, others will be encouraged to follow in his footsteps, thus increasing childhood immunisation coverage. We give them priority when they take children for vaccination.”

– Susan Ramakhuonoane, Ministry of Health

Meanwhile, Ministry of Health official Susan Ramakhunoane said the government decided to adopt a male-involvement approach because “men are decision-makers in their families.

“A child will not be vaccinated if a father says no and this affects progress towards inclusive childhood immunisation coverage,” Ramakhunoane said. As an example, she told the story of an unnamed father who denied his daughter permission to take her human papillomavirus (HPV) vaccine shot during the country’s HPV roll-out campaign last May.

“The mother understood the importance of HPV vaccine, but that child bitterly cried as her father refused her permission,” Ramakhunoane said. “It is therefore important to involve men in our programmes.”

“If one man takes his child for vaccine, others will be encouraged to follow in his footsteps, thus increasing childhood immunisation coverage. We give them priority when they take children for vaccination,” she said.

This story was produced and first published by the VaccinesWork.