Gender norms and mass deworming program access: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage

Abstract

Background: The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress for eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). An estimated 1.5 billion people are infected with STH globally, the majority of whom reside within the poorest communities in low- and middle-income countries. This paper aims to identify potential gender-specific barriers to accessing and participating in community- wide STH MDA and ensure programs are equitable and maximize the probability of interrupting STH transmission. Methodology/Principal Findings: This research was conducted prior to the launch of community-wide MDA for STH in Benin. We conducted focus group discussions (FGDs) with 40 men, 38 women, and 15 community drug distributors (CDDs) across ten FGDs in Comè, Benin. Our findings included: MDA was not properly packaged for addressing preventative services as well as treatment. Women feel a lack of empowerment around MDA programs. Both men and women felt that MDA delivered at no cost would reduce financial barriers and allow increased participation, particularly for those with low income. Women expressed interest in increased engagement in the decision-making process of community-based programs while men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Conclusions/Significance: Men and women were enthusiastic about community-wide deworming and felt this approach will allow them more control over deworming of their families than the current school- based approach. The community-wide distribution strategy appears well suited for women and children and may be preferred by women, who feel as though it provides them more control over the health of their families. Involving women in participatory problem solving to address low-coverage populations may be a successful strategy to improve coverage of deworming programs.