Fertility and the World Cup in Haiti

Even in the most rural part of Haiti you can hear the sounds of the 2014 World Cup blaring from televisions and radios as most of men in my country stop to tune in to the games and check how their superstars are playing. The Brazilian Neymar and the Argentinian Messi are gods in Haiti.

Women in Haiti -- at all times of year -- are too consumed with the daily challenges of providing for their families to care much about soccer. Over the last 16 years working in public health I've met women at all socio-economic levels of my society. They talk to me about the constant difficulties they face, and mostly about the lack of decision-making power and their own unmet needs and wants.

One of the areas where this lack of power in domestic relationships is reflected most prominently is in Haiti's fertility rate, which was 3.5 percent in 2012. This is down from 4.8 percent in 1995, but remains one of the highest in Latin America and the Caribbean. And while more Haitian women are gaining access to modern family planning methods - thanks to better distribution systems that allow products to be available in the nearest pharmacies or in health centers- the use of condoms and injectable contraceptives remains the lowest in the Western Hemisphere.

Men are the missing piece in Haiti's fertility puzzle.

In order to bring down our birth rate and increase the choices for women, we have to tackle male attitudes. The challenge we face is how to get men to be as interested in women's health issues as they are in soccer. At my organization, PSI, we decided that an innovative way was to try a new approach.

Two years ago we started a project which focuses on men and family planning. The idea is simple: if we train men in an environment in which they are comfortable, and where they are among other men like them, they begin to listen, they begin to talk and they begin to learn. And we have been able to prove that our theory works.

In two rural areas in different parts of the country, we were able to identify local grass roots organizations composed of men who are working in the area of gender violence addressing and serving other men. These organizations where created by men influenced by their women partners who have been involved in the fight against gender violence and equality.

The first important step was to train the leaders of these two organizations to become our peer educators, who then go out and recruit participants who are all from their same neighborhoods. The messages we developed focused on three elements: what family planning is and how it prevents pregnancy; how using family planning and voluntarily reducing or spacing the number of children both helps household finances and ensures better care for children; and why it is important to support their partners in accepting the use of modern family planning methods.

These men talked openly to their peers about the myths and taboos around family planning and the impact that family planning could have on their lives. The evidence shows that when you focus on men, the results are also felt among women.

Joseph, for example, is a 36-year-old unmarried man who had two successive relationships with different women, producing three children. When he started participating in our male-focused activities, he was opposed to women making decisions about family planning because he feared his partner might take other lovers, and he would have no way of knowing because they wouldn't get pregnant. But after just a few sessions Joseph started to see his situation differently. He realized that the more children his partner had, the more mouths he would have to feed, the more she would have to stay at home caring for babies instead of trying to support the family through her work.

If we can give men the skills to understand the importance of supporting their partners in using family planning, then we will be helping women to make decisions about the size of their families, live up to their full potential and play a more significant role in our society.

The challenges of reducing the fertility rate of women in Haiti are real, but so are opportunities to encourage men's understanding that the number of children they have can be a family decision.

After the World Cup Final, thousands of fans will run together through the streets of Haiti carrying the flag of their team and cheering that perfect goal that won the golden trophy. Is it too idealistic to hope that Haitians -- and people across the developing world -- could show the same level of enthusiasm and gratitude for a better future for their children?