Male involvement and maternal health outcomes: systematic review and meta-analysis

Development and validation of a measure for father involvement during early childhood in a resource-limited context

BACKGROUND

Globally, there is mounting evidence about the importance of father involvement for improving child and family wellbeing. However, there are limited measurement tools available for assessing father involvement in low-resource settings globally. The objective of this study was to develop and validate a scale for measuring fathers' engagement in caregiving activities for young children and families in rural Kenya.

METHODS

We used baseline data collected in February-March 2023 from a cluster-randomized controlled trial of a parenting intervention aimed at improving early child development in Nyamira and Vihiga counties in Western Kenya. The analytic sample comprised 460 primary caregivers of children under 18 months of age (91.3% mothers) who were in a relationship with a male caregiver of the young child (i.e., father). The primary caregiver reported on the 25-item father involvement scale. We conducted exploratory and confirmatory factor analyses to determine the dimensionality of the measure and estimated latent variable regression models to assess construct and predictive validity in terms of associations with sociodemographic factors, other paternal and maternal psychosocial measures, and early child development outcomes.

RESULTS

The scale had a four-factor structure representing father involvement in (1) childcare activities, (2) play and affection, (3) household chores, and (4) early learning activities. Each factor showed good internal consistency reliability and evidence of multiple forms of validity. The four factors were associated with child and household sociodemographic characteristics and more positive paternal and maternal psychosocial outcomes. Father involvement across all four domains was associated with higher early child cognitive, language, motor, and socioemotional development scores.

CONCLUSIONS

Our findings highlight the multidimensional nature of fathers' caregiving roles in the lives of young children and their families. We establish a valid tool for assessing father involvement in rural Western Kenya that has potential for use in other similar contexts.

Psychological distress in the neonatal intensive care unit: a meta-review

INTRODUCTION

Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions.

METHODS

A meta-review was performed by searching various databases between 2000 and May 2024.

RESULTS

Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD.

DISCUSSION

Routine screening should be implemented together with a combination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and gender minority parents as well as parents living in low middle income countries.

IMPACT STATEMENT

Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.

Trajectories of perinatal depression among women living with HIV in Uganda

Background

Perinatal depression affects one-third of pregnant women living with HIV (WLH). We examined patterns of treatment response to a novel stepped model of depression care among WLH with perinatal depression in Uganda.

Methods

As part of the Maternal Depression Treatment in HIV (M-DEPTH) cluster randomised controlled trial, 191 women were enrolled across four antenatal care clinics assigned to provide stepped care including behavioural and antidepressant therapy (ADT), and another 200 across four clinics assigned to provide usual care. They were assessed for depression severity using the Patient Health Questionnaire (PHQ-9) at enrolment and multiple times over 12 months of follow-up. We used repeated measures latent class analysis (LCA) to identify discrete trajectories of depression symptoms, while multinomial regression analyses measured correlates of class membership.

Results

The LCA identified three trajectories among those in the treatment group: mildly depressed individuals who improved (MiD-I) (n = 143, 75%), moderately depressed individuals who improved (MoD-I) (n = 33, 17%), and moderately depressed individuals who remained depressed (MoD-R) (n = 15, 8%). Membership in MiD-I was associated with lower levels of intimate partner violence at baseline (P = 0.04) and month 6 (P < 0.001), and less recent trauma exposure (P = 0.03) at baseline. At month 6, social support was lowest in MoD-R, while the degree of negative problem-solving orientation was highest (both P < 0.001) in this class. The LCA also identified three trajectories among those in the usual care comparison group: mildly depressed (MiD) (n = 62, 31%), moderately depressed (MoD) (n = 71, 35%), and seriously depressed (SiD) (n = 67, 34%), with each experiencing slight improvement. Recent traumas at baseline were highest in SiD (P < 0.001); this group also reported the lowest positive problem-solving orientation and highest negative problem-solving orientation (P < 0.001) at baseline.

Conclusions

Depression symptom trajectories among women with perinatal depression are related to modifiable factors such as problem-solving orientation and interpersonal dynamics, with the latter including intimate partner violence and social support. Most treatment recipients were characterised by trajectories indicating recovery from depression.

Registration

ClinicalTrials.Gov (NCT03892915).

Development of the Paternal Involvement in Early Infancy Scale (PEACE) for fathers in Singapore

OBJECTIVES

To develop and validate a psychometrically sound self-reported Paternal involvement in Early InfAnCy ScalE (PEACE) for Asian fathers with infants aged 0-12 months old.

METHODS

This study comprised of three phases: (1) Pilot test among 100 fathers, (2) Exploring and confirming the PEACE's multidimensional structure using exploratory factor analysis (EFA) (n = 200 fathers) and confirmatory factor analysis (CFA) (n = 200 fathers), and (3) Assessing one-month test-retest reliability of PEACE among 30 fathers. Data was collected from August 2022 to August 2023. The EFA was conducted using principal axis factoring and varimax rotation. The CFA confirmed the factor structure via goodness-of-fit statistics. To assess the PEACE's concurrent validity, paternal involvement was measured using a previously validated paternal involvement scale. Convergent validity was established by examining correlations between PEACE and theoretically related measures of parenting self-efficacy, parent-child bonding, parenting satisfaction, and depression. Test-retest reliability was examined using the intra-class correlation coefficient.

RESULTS

The EFA and CFA results supported the five-factor 25-item PEACE. The five subscales were: i) Providing Tangible Support, ii) Meeting Basic Needs, iii) Bonding with Baby, iv) Decision-Making for Baby, and v) Sense of Responsibility and Accomplishment. All subscales reported good internal consistency and weak to moderate one-month test-retest reliability. Correlation coefficients between the PEACE and other scales supported the concurrent and convergent validity of the PEACE.

CONCLUSION

This study provided sufficient evidence to establish the initial reliability and validity of the five-factor 25-item PEACE.

IMPLICATIONS TO PRACTICE

The PEACE could be used to quantitatively assess paternal involvement in infant care.

Fatherhood and men's participation in antenatal care in rural sub-Saharan Africa: a scoping review protocol

INTRODUCTION

Men's participation is imperative for improving antenatal care (ANC) access and mother and child health outcomes in sub-Saharan Africa (SSA). Research looking at improving men's participation in ANC often focuses on their instrumental and psychosocial roles and on biomedical ANC systems. There is limited understanding of how context-specific cultural experiences of fatherhood influence men's participation in ANC within broader communal support networks and across different ANC systems in SSA. Against this background, and to understand how local communities in SSA conceive men's participation in ANC, a scoping review will be undertaken to synthesise existing literature around local cultural experiences of fatherhood and men's participation in ANC in rural settings in SSA.

METHODS AND ANALYSIS

The classical scoping review methodology developed by Arksey and O'Malley will be used to conduct the scoping review described above. Empirical studies published between 1 January 2000 and 31 August 2024 will be systematically searched for in key online databases (eg, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, African Index Medicus, African Journals Online) and grey literature (eg, reports from key organisations like UNICEF and the WHO). Literature reviews, personal opinion articles and theoretical or conceptual articles that do not systematically analyse data, and non-English texts, will be excluded. Data will be extracted from the included texts in the form of study characteristics, which will be analysed using descriptive statistics, and key issues to be analysed thematically.

ETHICS AND DISSEMINATION

No ethical approvals are needed for this scoping review since data will be abstracted from already-published literature and no additional data will be collected. The findings will be shared with policymakers, practitioners, researchers, students and local communities through peer-reviewed journal publication(s), conference presentations, public lectures and policy-focused stakeholder and community meetings in and outside SSA.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Influence of women's decision-making autonomy and partner support on adherence to the 8 antenatal care contact model in Eastern Uganda: A multicenter cross-sectional study

OBJECTIVE

Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women's decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women's decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda.

METHODS

A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts.

RESULTS

Most women were aged 20-34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 - 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 - 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 - 0.7, p = 0.002).

CONCLUSION

Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes.

The impact of exclusion due to COVID-19 restrictions on partners' satisfaction with Swedish hospital postnatal ward care: A multi-methods approach

BACKGROUND

To prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care.

METHODS

An online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register.

RESULTS

The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical.

CONCLUSIONS

The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences.

Promoting gender equity in a home visits programme: a qualitative study in Northern Nigeria

BACKGROUND

Gender inequities remain critical determinants influencing maternal health. Harmful gender norms and gender-based violence adversely affect maternal health. Gendered division of labour, lack of access to and control of resources, and limited women's decision-making autonomy impede women's access to maternal healthcare services. We undertook a cluster randomized controlled trial of universal home visits to pregnant women and their spouses in one local government area in Bauchi State, North-Eastern Nigeria. The trial demonstrated a significant improvement in maternal and child health outcomes and male knowledge, attitudes and behaviours. This paper qualitatively evaluates gender equity in the home visits programme.

METHODS

The research team explored participants' views about gender equity in the home visits programme. We conducted nine key informant interviews with policymakers and 14 gender and age-stratified focus group discussions with men and women from visited households, with women and men home visitors and supervisors, and with men and women community leaders. Analysis used an adapted conceptual framework exploring gender equity in mainstream health. A deductive thematic analysis of interviews and focus group reports looked for patterns and meanings.

RESULTS

All respondents considered the home visits programme to have a positive impact on gender equity, as they perceived gender equity. Visited women and men and home visitors reported increased male support for household chores, with men doing heavy work traditionally pre-assigned to women. Men increased their support for women's maternal health by paying for healthcare and providing nutritious food. Households and community members confirmed that women no longer needed their spouses' permission to use health services for their own healthcare. Households and home visitors reported an improvement in spousal communication. They perceived a significant reduction in domestic violence, which they attributed to the changing attitudes of both women and men due to the home visits. All stakeholder groups stressed the importance of engaging male spouses in the home visits programme.

CONCLUSION

The home visits programme, as implemented, contributed to gender equity.

Role of men in women's health service utilisation in northern Nigeria: a qualitative study of women, men and provider perspectives

BACKGROUND

The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men's decision-making role in the family significantly contribute to this phenomenon.

OBJECTIVES

The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.

DESIGN

Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.

SETTING

Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.

PARTICIPANTS

Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).

RESULTS

We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband's permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands' presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.

CONCLUSION

Despite years of programming, barriers to women's family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.

Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review

Background and Aims

East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being.

Methods

Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included.

Results

A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being.

Conclusions

The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.

Exploring Factors Influencing Pregnant Women's Perceptions and Attitudes Towards Midwifery Care in Romania: Implications for Maternal Health Education Strategies

BACKGROUND

Midwives are strong advocates for vaginal births. However, their visibility and accessibility are poorly perceived by women in Romania. Consequently, the women's options are limited to a single direction when pregnancy occurs, involving the family doctor, the obstetrician, and often an interventional technical approach at the time of birth. The aim of this research is to identify specific variables that affect the perceptions and attitudes of pregnant women towards the care provided by midwives. This knowledge could contribute to the development of more effective education and information strategies within maternal health services.

METHODS

A cross-sectional observational analytical survey was conducted in Romania among pregnant women from the general population. Data were collected through a self-administered questionnaire, with informed consent obtained from each participating pregnant woman. The questionnaire was administered online using the cloud-based Google Forms platform and was available on the internet for seven months, from January to July 2023. The questionnaire was distributed through various media channels, both individually and in communication groups, in the form of a link. All questions were mandatory, and the questionnaire could only be submitted after answering all questions.

RESULTS

A total of 1301 individual responses were collected. The analysis of the socio-demographic and obstetrical profile of the pregnant women revealed that approximately half, 689 (52.95%), of the participants were aged between 18-29 years, and 1060 (81.47%) of the participants were married. Among our group of 1301 pregnant women, 973 (74.78%) had higher education, and 987 (75.86%) had a regular job. A majority of the survey participants, 936 (71.94%), lived in an urban geographic area, while 476 (36.58%) had attended childbirth education courses, and 791 (60.79%) were in the third trimester of pregnancy. A total of 298 (22.9%) respondents did not want to give birth in a hospital, and one-third, 347 (26.67%), did not place significant importance on control over the childbirth process.

CONCLUSIONS

The main factors influencing women's decisions regarding perinatal care and the importance of midwives as a component of the maternal-infant care team are modifiable, and thorough educational and psychological preparation would reduce the increasing predominance of preference for cesarean section, thereby promoting healthier and more woman- and child-centered perinatal care.

Level of optimal antenatal care utilization and its associated factors among pregnant women in Arba Minch town, southern Ethiopia: new WHO-recommended ANC 8+ model

Background

To fully realize the life-saving and health-promoting benefits of antenatal care (ANC), the latest World Health Organization (WHO) recommendations call for pregnant women to have at least eight contacts with skilled healthcare providers. This increased number of recommended ANC visits represents a shift toward a more comprehensive, individualized approach to prenatal care. The focus is on health promotion, disease prevention, and the early detection and management of complications during pregnancy. However, in sub-Saharan African countries, including Ethiopia, the coverage rate for this level of recommended antenatal care is only 58%. Given this relatively low utilization, identifying the key risk factors that prevent adequate antenatal care would have significant implications for increasing overall ANC uptake in these regions.

Objective

The aim of the present study was to assess the level of optimal antenatal care utilization and its associated factors among pregnant women in Arba Minch town, southern Ethiopia in 2023 using the new WHO-recommended ANC 8+ model.

Methods

An institution-based cross-sectional study was conducted among 416 mothers who were enrolled between 1 December 2022 and 30 January 2023. The total sample size was allocated proportionately to the number of women who delivered at each public health facility. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using SPSS Version 26. Statistical significance was determined at a p-value <0.05.

Results

In this study, the level of optimal antenatal care was 41% [95% confidence interval (CI): 37-45.3]. The associated factors with optimal antenatal care were the presence of pregnancy danger signs [adjusted odds ratios (AOR) = 4.1, 95% CI: 1.87-8.82], having bad obstetric history (AOR = 3.90, 95% CI: 1.94-7.83), antenatal contact at hospital (AOR = 5.11, 95% CI: 2.28-11.21), having good knowledge about antenatal care (AOR = 2.26, 95% CI: 1.15-4.44), women's high decision-making power (AOR = 3.9, 95% CI: 1.2-7.63), and male partner involvement (AOR = 2.0, 95% CI: 1.04-3.78) were positively associated with optimal antenatal care utilization.

Conclusion

The level of optimal antenatal follow-up is still low. Therefore, it is crucial to provide more information during the antenatal contacts to lower the rate of women discontinued from antenatal care.

Black Father's Influence on Adverse Pregnancy Outcomes in the United States: A Narrative Synthesis of Literature

Few studies have investigated paternal characteristics in relationship with adverse pregnancy outcomes, and results are inconsistent. The purpose of this study was to review studies examining associations between characteristics of Black fathers and adverse pregnancy outcomes in the United States. A systematic narrative synthesis was conducted of research studies examining paternal characteristics of Black fathers in association with adverse pregnancy outcomes: preterm birth, hypertensive disorders of pregnancy, gestational diabetes, spontaneous abortion, and maternal mortality. Seven databases (Academic Search Premier, CINHAL, CENTRAL, ClinicalTrials.gov, Embase, PubMed, and Web of Science) were searched for original research articles from inception to February 2023. Articles were excluded if they (a) were in a language other than English, (b) did not describe original research, (c) included a geographic region outside of the United States, (d) did not include adverse maternal outcomes as a study outcome, (e) did not describe race of fathers in the study sample, and (f) did not describe a paternal characteristic of Black fathers. The search resulted in 210 articles. Six studies were included in the final review; five studies examined associations between paternal characteristics of Black fathers and preterm birth, finding significantly increased odds of preterm birth among births with Black fathers. Among births with non-Hispanic Black paternity, the odds of hypertensive disorders of pregnancy were reduced or not significantly associated. Researchers should continue to explore paternal factors that influence pregnancy outcomes in racial/ethnic-specific models to identify optimal intervention strategies to improve disparities in maternal and child health outcomes.

Child health prioritisation in national adaptation policies on climate change: a policy document analysis across 160 countries

Integration of child-specific adaptation measures into health policies is imperative given children's heightened susceptibility to the health impacts of climate change. Using a document analysis method, we examined 160 national adaptation policies for inclusion of child-relevant measures and identified 19 child health-related adaptation domains. 44 (28%) of 160 countries' policies that were analysed failed to include any domains, 49 (31%) included at least one child-related domain, 62 (39%) included between two and six domains, and five (3%) included at least seven domains. Predominant domains among child-specific adaptation measures included education and awareness raising, followed by community engagement and nutrition. No country addressed children's direct needs in the domain of mental health. National adaptation policies tend towards overly simple conceptualisations of children across four major lenses: age, social role, gender, and agency. Limited inclusion of child-specific measures in national adaptation policies suggests insufficient recognition of and action on children's susceptibility to climate change effects.

Involving men in pregnancy: a cross-sectional analysis of the role of self-efficacy, gender-equitable attitudes, relationship dynamics and knowledge among men in Kinshasa

BACKGROUND

Although male participation in maternal health has gained increasing recognition and support over the years, little is known about male involvement during pregnancy in the Democratic Republic of the Congo. This paper identified male involvement patterns during pregnancy and evaluated their associations with pregnancy and birth preparedness knowledge, gender-equitable attitudes, self-efficacy, and co-parental relationship factors. Lastly, it explored the moderating effect of gender-equitable attitudes and intimate partner violence on the association between relationship satisfaction and male involvement.

METHODS

Data from the 2018 Momentum baseline study were analyzed to determine the predictors of involvement. Factor analysis was used to create male involvement indices for antenatal carebirth preparedness and shared decision making. The sample consisted of 1,674 male partners of nulliparous pregnant women who were 6 months pregnant at baseline.

RESULTS

Male involvement in individual pregnancy-related activities was low, ranging from 11% (finding a blood donor) to 49% (saving money during emergencies). Knowledge of the number of antenatal care visits, birth preparedness steps, and newborn danger signs were positively associated with involvement in antenatal care/birth preparedness activities while knowledge of antenatal care benefits was positively associated with involvement in shared decisions. Increasing relationship satisfaction and self-efficacy were associated with antenatal care/birth preparedness involvement and for shared decisions, a positive association with gender-equitable attitude and a negative association with self-efficacy were observed. Moderation effects were also detected.

CONCLUSIONS

The findings suggest that male involvement is multifaceted and factors influencing involvement vary depending on the type of involvement. Addressing these factors can improve male participation in maternal health.

Husband's intention to support during pregnancy for the use of maternity waiting home in Jimma Zone, Southwest, Ethiopia: a community-based cross-sectional study

Background

Husbands are the primary decision-makers about the place of childbirth. Lack of husbands' support for maternal health care is associated with low maternal waiting home utilization and less is known about the husbands' intention to support their wife's use of maternal waiting homes (MWHs) and underlying beliefs in Ethiopia. This community-based cross-sectional survey aimed to study husbands' intention to support during pregnancy through the use of maternity waiting homes in Jimma Zone, Southwest Ethiopia.

Method

A cross-sectional study was conducted among 396 randomly selected husbands whose wives were pregnant. Interviewer-administered, a structured questionnaire developed based on the Theory of Planned Behavior (TPB) was used to collect the data. Multivariable logistic regression analyses were used to examine the association between behavioral intention and constructs of the theory of planned behavior.

Results

Of the 396 husbands who took part in the study, 42.7% intend to support their partner's use of a maternity waiting home. Intention to support a wife to use a maternity waiting home was associated with subjective norm [AOR = 1.303, 95% CI (1.054, 1.611)] and perceived behavioral control [AOR = 1.446, 95% CI (1.234, 1.695)]. Among the control beliefs, "having childcare"; "having a person who stays with a wife at a maternity waiting home"; and "availability of quality service provided to a wife in the maternity waiting home" significantly separated intenders and non-intenders.

Conclusion

The findings suggest that husbands who perceived more social pressure and felt in control of barriers were more likely to intend to support their partner in using a maternity waiting home. Intervention should focus on underlying normative and control beliefs to improve the husband's intention.

Husband's involvement in utilization of maternal health services by their spouse in district Rohtak, Haryana

Introduction

Husband and wife as a couple are fully responsible for their current and future. In our society, the husband is mostly responsible for making the decision regarding any expenses. In India, there is a need to reduce the maternal mortality rate, and Husband's involvement in antenatal care could be a key to success as it will enable them to support their partner in adequate preparation for birth and to utilize emergency obstetric care early if complications arise.

Aim and Objectives

To find out about male involvement in the utilization of maternal healthcare services by their spouse and various factors affecting male involvement in the utilization of maternal healthcare services.

Methods

This study was conducted in urban and rural field practice areas attached to the Department of Community Medicine, PGIMS, Rohtak. The study included 400 couples where 200 each were recruited from rural and urban areas. Out of 17 subcenters under CHC Chiri eight, subcenters were selected randomly by lottery method. A line list of these couples was prepared at each subcenter using ANC and birth register. Couples were enrolled from this line list till a sample size of 25 was reached at each of these eight subcenters. In this way, a total of 200 couples were enrolled from rural areas in which women delivered and availed maternal health services in the last 6 months. In urban areas, an equal number of couples were enrolled from each of these three urban health posts till the sample size of 200 was reached in an urban area.

Results

The majority of the husbands (73%) reported that they participated in their wives' utilization of maternal health services. Twenty-seven percent did not participate in their wives' utilization of maternal health services. It also showed that 71.0% of the husbands did not know about the investigations that needed to be performed during a woman's pregnancy. Only 29% were aware of it. On analysis, it was observed that 73% of the husbands had good participation in their spouses' maternal and child health (MCH) care, while the rest had poor participation (27%). It also showed that as the education level of the participants' husbands increased, their participation in their spouses' MCH care increased, with the highest being observed among graduates (91.3%) and the lowest among those with primary schooling level education (66.7%) which were statistically significant.

Men's involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers

BACKGROUND

Globally, there are about 800 maternal deaths every day, with low-to-middle-income countries accounting for most of these deaths. A lack of access to maternal healthcare services is one of the main causes of these deaths. In sub-Saharan Africa (SSA), one of the barriers to accessing maternal healthcare services by women is a lack of their male partners' involvement. This scoping review aimed to assess the enablers and barriers to men's involvement in maternal healthcare services.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used as a guide for this review. We searched for peer-reviewed articles published between 2013 and 2023 in the English language from SCOPUS, ScienceDirect, PubMed, Africa Journals Online (AJOL), and Google Scholar databases. Two reviewers independently conducted the data extraction and article selection. All of the authors discussed and decided on the codes and categories for enablers and barriers after using NVivo to generate them.

RESULTS

Twenty-seven articles were used in this review. Of these, seventeen were qualitative studies, six were quantitative studies, and four were mixed-methods studies. The enablers of men's involvement in maternal healthcare were grouped into sociodemographic factors, health system factors, and policy factors, while barriers were grouped into sociodemographic, cultural, economic, and health system barriers. The lack of maternal health knowledge, insufficient economic resources, and unfriendly staff at healthcare facilities all contributed to a lack of involvement by men.

CONCLUSION

To improve men's involvement in maternal healthcare in SSA, there should be economic empowerment of both men and women, health education, and the provision of adequate infrastructure in healthcare facilities to accommodate men.

Father involvement is a protective factor for maternal mental health in Western Kenya

Depression is a major global health concern especially among mothers of young children in low- and middle-income countries (LMICs). While various risk and protective factors have been well-established, the role of fathers in potentially mitigating maternal depression remains understudied. This study aimed to investigate the association between father involvement and maternal depressive symptoms in rural Western Kenya. We used cross-sectional baseline data collected in February-March 2023 from a cluster-randomized controlled trial evaluating the effectiveness of a community-based parenting program for improving early childhood development. Primary caregivers with children 0-18 months of age were enrolled into the trial across 51 villages in Nyamira and Vihiga counties. We analyzed data from 413 mothers who were in a relationship with a male partner (i.e., father of the young child). Maternal depressive symptoms were measured using the CESD-10. Father involvement was reported using a multidimensional measure of men's engagement in childcare activities, household chores, early learning activities, and affection towards their child. We used multilevel regression models to estimate the adjusted associations between father involvement (overall score and by specific domains) and maternal depressive symptoms. We also conducted exploratory subgroup analyses to assess whether this association differed by child age. Overall, greater father involvement was associated with fewer maternal depressive symptoms. Specifically, fathers' engagement in household chores and childcare activities had the strongest protective associations. Exploratory subgroup analyses revealed larger associations for mothers with younger children under 6 months. Our findings suggest that father involvement is a protective factor for maternal mental health. Engaging fathers in early childhood interventions and encouraging men's involvement in caregiving activities may potentially benefit maternal well-being.

Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India

Using a two-armed cluster randomised controlled trial, CHARM2 (Counselling Husbands to Achieve Reproductive health and Marital equity), a 5-session gender equity and family planning intervention for couples in rural India, showed an impact on family planning outcomes in primary trial analyses. This study examines its effects on gender-equitable attitudes, intimate partner violence, reproductive coercion, and marital quality. We used multilevel mixed-effects models to assess the intervention impact on each outcome. Both male (aIRR at 9 months: 0.64, C.I.: 0.45,0.90; aIRR at 18 months: 0.25, C.I.: 0.18,0.39) and female (aIRR at 9 months: 0.57, C.I.: 0.46,0.71; aIRR at 18 months: 0.38, C.I.: 0.23,0.61) intervention participants were less likely than corresponding control participants to endorse attitudes accepting physical IPV at 9- and 18-month follow-ups. Men in the intervention, compared to those in the control condition, reported more gender-equitable attitudes at 9- and 18 months (ß at 9 months: 0.13, C.I.: 0.06,0.20; ß at 18 months: 0.26, C.I.: 0.19,0.34) and higher marital quality at the 18-month follow-up (ß: 0.03, C.I.: 0.01,0.05). However, we found no effects on women's experiences of IPV, reproductive coercion, or marital quality. CHARM2 shows promise in improving men's and women's attitudes towards gender equality and male perceptions of marital quality. Still, IPV and reproductive coercion reductions may require more intensive programming than that provided within this 5-session model focused on family planning.

Magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 2023: institution-based cross-sectional study design

Background

Self-harm is a preventable, but a leading, cause of maternal morbidity and mortality all over the world, with a significant impact on healthcare systems.

Objective

To assess the magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics.

Methods

An institution-based cross-sectional study was employed among postnatal mothers attending infant immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 1 October to 30 October 2023. A pretested, face-to-face interviewer-administered structured questionnaire prepared by Kobo Toolbox was used to collect the data. Both bivariable and multivariable logistic regression analyses were done. The level of significance was declared at p-value <0.05 with a 95% CI.

Results

Among the 423 mothers enrolled in the study, 415 of them finally participated, at a response rate of 98.10%. The magnitude of self-harm was 12.53% (95% CI: 9.33, 15.73). Involvement of husband in maternity and child healthcare (AOR = 1.90; 95% CI: 1.12, 2.10), depression (AOR = 2.79; 95% CI: 2.14, 6.94), loneliness (AOR = 2.49; 95% CI: 1.15, 5.40), postpartum intimate partner violence (AOR = 2.15; 95% CI: 1.01, 4.54), average monthly income (AOR = 3.70; 95% CI: 2.17, 10.50), and postnatal care (AOR = 2.72; 95% CI: 1.28, 5.80) were significantly associated factors.

Conclusion and recommendations

The study sought a magnitude of self-harm that was slightly higher than the previous study conducted in the northern part of Ethiopia. Therefore, healthcare providers should focus on identified factors during postnatal care to overcome them. Similarly, the concerned body should develop an effective strategy based on the identified factors to pay attention to postnatal mothers.

Who is most vulnerable? Factors associated with presenting to antenatal care without a male partner in Northern Tanzania

OBJECTIVE

Male engagement in pregnancy care can be beneficial for maternal and child health outcomes. In Tanzania, pregnant women are strongly encouraged to present to their first antenatal care (ANC) appointment with a male partner, where they jointly test for HIV. For some, this presents a barrier to ANC attendance. The objectives of this study were to identify factors associated with presenting to ANC with a male partner using a cross-sectional design and to assess whether women presenting without partners had significantly delayed presentation.

METHODS

Pregnant women (n = 1007) attending a first ANC appointment in Moshi, Tanzania were surveyed. Questions captured sociodemographic characteristics and measures of psychosocial constructs.

RESULTS

Just over half (54%) of women presented to care with a male partner. Women were more likely to present with a male partner if they were younger than 25 years old, married, Muslim, attending ANC for their first pregnancy, and testing for HIV for the first time. Women presenting to ANC with a male partner were significantly more likely to attend ANC earlier in their pregnancy than those presenting without male partners.

CONCLUSION

Policy change allowing women to present to care with other supportive family members could promote earlier presentation to first ANC. Unmarried women may be at a disadvantage in presenting to ANC when policies mandate attendance with a male partner. Male partners of multiparous women should be encouraged to provide pregnancy support even after first pregnancies, and a wholistic emphasis (beyond HIV testing) on first ANC could encourage male engagement beyond the initial appointment.

Male partners involvement in their wives' antenatal care and its associated factors in southern Ethiopia. A community-based cross-sectional study

Background

Involvement of male partners in antenatal care (ANC) is an effective approach to improve maternal and child health outcomes. It also enhances maternal healthcare utilization as males prevails decision-making regarding healthcare utilization in most developing countries including Ethiopia. Despite the acknowledged importance of male partners involvement, there is no research data in the study area. Therefore, the purpose of this study is to assess the status of male partners' involvement in antenatal care and associated factors in Chencha town, which is found in southern region of Ethiopia.

Methods

The study adopted a community-based cross-sectional design from April 1-30, 2022, among 560 male partners in Chencha Town. To collect data, we use a structured, pretested and interviewer-administered questionnaire. The study participants were selected using a simple random sampling method. Analysis of data was performed using the statistical package for social sciences (SPSS) version 25. Descriptive statistics including mean, frequency, and percentage were used to summarize pertinent characteristics of study participants. Both bivariable and multivariable logistic regression analyses were carried out to detect the association between the independent and outcome variables. The statistical significance was set at P < 0.05 in the final model.

Result

The study found that 57% (95% CI: 53%-61%) of male partners were involved in antenatal care. Age 20 to 29 (AOR = 2.60, 95%CI:1.26, 5.37), more than secondary educational level (AOR = 2.04, 95%CI:1.08, 3.88), being government workers (AOR = 2.03, 95%CI:1.12, 3.67), exposure to information on male involvement during antenatal care (AOR = 4.37, 95%CI: 2.77, 6.91), and males' knowledge about pregnancy danger sign (AOR = 2.55, 95%CI: 1.62, 4.02) were factors positively associated with male partner involvement in antenatal care.

Conclusion

The prevalence of male partner involvement in antenatal care was relatively high, but it still needs to be improved to reach acceptable level. The involvement thrives among those aged 20-29 years, who have been exposed to information on male involvement in antenatal care, have higher education levels, government employees, and are aware of pregnancy danger signs. These factors can be used to target interventions that aim to increase male involvement in antenatal care, which helps to improve the health of both mothers and children.

A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions

Background

Community engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions.

Methods

PubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used.

Results

The search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement.

Conclusion

These results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.

Attitudes of First-Time Fathers in South India Toward Their Role in Their Wives' Prenatal Period

OBJECTIVE

To assess the attitudes of first-time fathers toward their role during their wives' prenatal period.

DESIGN

Cross-sectional study.

SETTING

Tertiary care hospital in South India.

PARTICIPANTS

First-time fathers accompanying their pregnant wives to an antenatal clinic.

METHODS

Participants were surveyed to collect information on their attitudes toward their role during the prenatal period. The survey captured attitudes about fathers' role in pregnancy care; role as financial provider; and need to provide physical, emotional, moral, and social support.

RESULTS

Two hundred fathers were included in the sample. Approximately 17.5% (n = 35) had a positive attitude toward their role in the prenatal period, whereas 40% (n = 80) had a negative attitude. Having a joint family (i.e., husband, wife, children, and husband's parents) was found to be negatively associated with fathers' attitudes toward their role during the prenatal period (p < .05).

CONCLUSION

The findings revealed that the presence of a joint family structure was associated with a more negative attitude among fathers toward their role in their wives' pregnancies. Antenatal care should include education programs aimed at enhancing husbands' knowledge, awareness, and active participation during the prenatal period.

Reasons, experiences and expectations of women with delayed medical care for ectopic pregnancies in Chinese urban edges: a qualitative study

OBJECTIVE

To explore the experiences of patients with ectopic pregnancies with delayed medical care, with the goals to promote timely access to care, reduce subsequent physical and psychological impacts, and provide recommendations for improved management of ectopic pregnancies.

DESIGN

A qualitative study.

SETTING

A 1000-bed urban edge hospital located in the suburban area of Guangzhou, China, between December 2022 and February 2023.

PARTICIPANTS

21 patients with delays in seeking medical care for ectopic pregnancy.

PRIMARY AND SECONDARY OUTCOME MEASURES

Semistructured, in-depth, face-to-face interviews were conducted to understand the experience and expectations of these women.

RESULTS

Three main themes emerged, including delaying medical care, physical and psychological experiences, and expectations of their healthcare providers. Each of these main themes had several subthemes. The central theme of reasons for delaying medical care had five subthemes, including lack of knowledge on early symptoms of ectopic pregnancy, family dynamics and circumstances, traditional fertility ideology and intentions, avoidance of medical treatment behaviour, and medical delays. The main theme of physical and psychological experiences had two subthemes, including learnings from the experiences and negative impacts of the experiences. The main theme of expectations of their healthcare providers included three subthemes that were reducing the length of outpatient examinations and waiting times, increasing public understanding of early symptoms of ectopic pregnancy and increasing male awareness of safe contraceptive methods.

CONCLUSIONS

A lack of knowledge about the early symptoms of ectopic pregnancy was the main reason for delays in seeking medical care and had a dual impact on patients' physical and mental health, affecting their recovery and future healthcare. A collective effort from patients, families, healthcare providers and medical institutions is required for better medical education, family support, specialised professional training and local fertility policy to decrease the incidence of delayed medical care and achieve satisfactory pregnancy outcomes.

Understanding male involvement in antenatal care in the Kilimanjaro region of Tanzania: Barriers, facilitators, and opportunities for engagement

BACKGROUND

Male engagement in antenatal care (ANC) has been recommended by the World Health Organization to improve maternal and newborn health outcomes, but implementation challenges remain. This study explored barriers, facilitators, and opportunities to improve male attendance and engagement in ANC.

METHODS

In-depth interviews were conducted individually with pregnant women and male partners attending a first ANC visit at two public health facilities in Moshi, Tanzania. Interviews examined factors influencing male ANC attendance and male experiences during the clinic visit. Interviews were recorded, transcribed verbatim, and translated from Swahili into English. Transcripts were coded thematically in NVivo.

MAIN FINDINGS

Constructions of masculinity both positively and negatively influenced male involvement in ANC. Individual-level barriers included a fear of HIV testing, perceptions of pregnancy as the woman's responsibility, and discomfort with ANC as a predominantly female space. Structural barriers included inability to take time off from work and long clinic wait times. The primary facilitator to male involvement was the preferential care given in the ANC clinic to women who present with a male partner. Additionally, some men desired to learn about their family's health status and felt that attending ANC was a sign of respect and love for their partner.

CONCLUSIONS

Opportunities exist to improve male involvement in ANC, namely training providers to engage men beyond HIV testing and counseling. Peer programs that promote men's engagement in pregnancy could prove useful to reduce apprehension around HIV testing and dispel conceptions of ANC as only a women's healthcare space.

Missed opportunities for prenatal family-centered care during the COVID-19 pandemic: a qualitative study

BACKGROUND

The purpose of this study was to describe the impact of COVID-19 on fatherhood experiences during pregnancy.

METHODS

A semi-structured interview guide was developed to collect qualitative data from fathers about their experiences in pregnancy and prenatal care, how they communicated with providers, strategies for information seeking, and social support they received during the pregnancy. One-time, virtual interviews were conducted via Zoom with fathers that were either expecting a baby or fathers who had a baby after March 2020 and were 18 years or older. Thematic analysis was used to identify themes that highlighted the fatherhood experience.

RESULTS

In total, 34 interviews with new or expectant fathers were completed. Two central themes that highlight the experiences of fathers: missed opportunities to shift toward family-centered care and inequity in the parent dyad during pregnancy. Additional supporting themes included: limited patient-provider relationship, lack of telemedicine use, inadequate uncertainty management for parents, unidirectional information sharing between parents, and limited opportunities for achieving role attainment during pregnancy.

CONCLUSION

The COVID-19 pandemic created a decision point for prenatal care. Instead of focusing on family-centered practices, prenatal care exclusively centered on the mother and fetus, resulting in problematic experiences for fathers including limited access to information about the pregnancy and health of the mother and fetus, heightened stress related to COVID-19 safety requirements, and few opportunities to attain their role as a father. Prenatal care should actively seek robust strategies to improve family-centered care practices that will withstand the next public health emergency.

Engaging men in women's empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey

BACKGROUND

In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men's sensitization on gender equity and women's empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level.

OBJECTIVE

This study assessed how involving men in gender equity affects women's health and socio-economic outcomes, including food security.

METHODS

A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run.

RESULTS

Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women's participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple's cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area.

CONCLUSION

Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women's participation in decision-making and social cohesion.

Folic acid supplementation use during the peri-conceptional period among professionals of a hospital in France

Folic acid insufficiency is an important risk factor for congenital neural tube defects. Despite recommendations and national campaigns, the proportion of women taking folic acid in the peri-conceptional period remains insufficient worldwide. We describe in this study the proportion of peri-conceptional folic acid supplementation use and its determinants among a population of hospital workers during the course of a prevention campaign. We performed a single-center cross sectional study in a university hospital in France. Data were collected during 2 months in 2019 by an online questionnaire sent to all professionals. We collected information about folic acid supplementation use, its modalities (form, period, frequency and dosage) and reason for initiating or not supplementation. Response rate was 11.4 % (n = 1,075/9,447). Among the 748 women who reported at least one pregnancy, 72.7 % (95 % CI: 69.4-76.0 %) reported taking folic acid during their last pregnancy. Main reason for initiating supplementation was information given by a health professional (87.8 %), especially by gynaecologists-obstetricians. Principal factors associated with folic acid supplementation use were age between 25 and 35 years, high level of education and recent pregnancy. Folic acid supplementation use is still not systematic before and during pregnancy, even among health professionals. There is a case for mandatory folic acid fortification for the French general population.

Perceptions and attitudes of women in the perinatal period towards male midwives in a rural district of Ghana: a descriptive, exploratory qualitative study

OBJECTIVE

The study sought to explore the perceptions and attitudes of women in the perinatal period towards the reproductive health services of male midwives.

DESIGN

The study adopted an in-depth exploratory descriptive design for data collection and themes extracted using thematic analysis.

SETTING

Antenatal and postpartum units of two primary healthcare facilities in the Kwabre-East District of Ghana.

PARTICIPANTS

20 women in the perinatal period who were receiving antenatal care and delivery services from the facilities included in the study were recruited through purposive sampling.

FINDINGS

Divergent views emerged among our participants regarding the acceptability and utilisation of perinatal services provided by male midwives. Some participants perceived male midwives as patient, supportive, caring, compassionate and skilful at their work while the negative attitude related to some participants perceiving their interactions with male midwives as an opportunity for sexual violation. Positive attitudes emanated from male midwives' empathetic behaviour, reception, privacy and confidentiality of information. Conversely, negative attitudes arose from a lack of awareness of the changing female gender domination in midwifery, fear and misconceptions. Finally, participants faced various challenges, rooted in culture, which impacted their acceptance of male midwifery services.

CONCLUSIONS

Factors influencing participants' negative perceptions and attitudes towards male midwives were born out of culturally motivated and gender-sensitive stereotyping rather than male professional midwifery competencies. The study outcome provides the basis and the need for a community-based intervention to effect changes in the perception and attitude of women in the perinatal period towards male midwifery practice in the affected communities. Increasing awareness of the existence of male midwives in the communities would contribute to increasing acceptance and utilisation of their services among women in the perinatal period in Ghana.

Immigrant men 's perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study

BACKGROUND

Male involvement in maternal health care has proven to be beneficial for improving maternal and child health and is often crucial in areas of family planning and contraceptive use. However, compared to male involvement in maternal health care, male involvement in contraceptive counselling is complex and controversial and thus faces certain challenges. Immigrant men in Sweden are often accompanying their partner for contraceptive counselling. Little is known about their presence and role.

AIM

To explore how immigrant men from the Middle East and Afghanistan perceive and experience accompanying their partner for contraceptive counselling provided by midwives in Sweden.

METHODS

Inductive qualitative content analysis guided the interpretation of data based on 21 individual in-depth interviews.

FINDINGS

Balancing conflicting values and norms about sexual and reproductive health and rights including family planning was challenging and confusing when living in Sweden. Contraceptive counselling was perceived as a joint visit, and men were often acting as decision makers. The midwife's role as a contraceptive counsellor was perceived as trusted, but knowledge was lacking about the Swedish midwifery model and the Swedish healthcare system. Providers' ways of communicating sensitive information were crucial. Without marriage contraceptive counselling was unthinkable.

CONCLUSION

Highlighting male engagement and including men's sexual and reproductive health at policy levels are necessary for improving women's sexual and reproductive health and rights. Additional and new ways of contraceptive counselling and midwifery services, such as outreach work and joint visits, are needed in order to reach both men and women.

Factors Associated with Male Partner Involvement in Maternity Care in Mbeya, Tanzania

Background

Male partner involvement in maternity care is critical to improving neonatal and maternal health by reducing maternal mortality, particularly in settings where males play a significant role in decision-making. This study aimed to assess factors associated with male partners involvement in maternity care in Mbeya, Tanzania.

Methods

A community-based cross-sectional study was conducted among men in Mbeya City, Tanzania, from April to June 2021. A semi-structured questionnaire was used to collect information from participants. Male involvement level was measured as low, moderate or high. X2 test and multinomial logistic regression models were applied to determine association between male involvement levels and related factors.

Results

A total of 201 males participated in the study. The overall level of male involvement during antenatal care, labour and delivery and postnatal care indicated that 44 (21.7%) had a high level of involvement, 116 (58%) had a moderate level of involvement and 41 (20.3%) had a low level of involvement. Demographic and health facilities factors indicated a significant association with male partner level of participation (P<.001). The likelihood of a man accompanying the partner was significantly associated with staff attitude and the time spent at the health facility (AOR 1.726 at 95% CI 1,394-2.136 P<.001).

Conclusions

Findings indicated a generally moderate level of male partner involvement as a critical concern that can accelerate the decline in maternal mortality and improve maternal health. Enhancing the male-friendliness of health facilities in terms of infrastructure, organisation of services and staff attitudes, as well as educating the community, particularly men, to sensitise them to the negative attitudes toward male participation in maternity care, can increase male participation.

Gender-based roles, psychosocial variation, and power relations during delivery and postnatal care: a qualitative case study in rural Ethiopia

Introduction

The World Health Organization (WHO) strongly encouraged men to support women in receiving maternal healthcare. However, especially in developing countries, maternal healthcare has traditionally been viewed as an issue in women, with men making little or no contribution, even though sexuality and children are shared products. The study aims to understand how gender-based roles, psychosocial variation, and power relations are related to child delivery and postnatal care (PNC) services.

Methods

The study was conducted in three rural districts of Oromia regional state, Jimma Zone, Ethiopia. An in-depth interview and focus group discussion were held with carefully chosen health professionals, health extension workers, community health development armies, and religious leaders. The data was collected, translated, and transcribed by experienced men and women qualitative researchers. For data analysis, ATLAS.ti version 9 was used. The data were coded and categorized concerning delivery and PNC service utilization. Independent and shared gender-based roles were identified as a means to improve maternal healthcare service delivery.

Results

The result obtained three categories, namely, gender-based roles, psychosocial variation, and power relations. Men can persuade pregnant women to use delivery services and PNC. The place of delivery is determined by the levels of gender-based power relations at the household level, but women are usually the last decision-makers. The belief of the community that giving birth in a health facility makes women look clean and neat, as opposed to home delivery, increases their intention to use maternal healthcare services.

Discussion

The study contributes that the role of a man as a husband is crucial in mobilizing others to carry pregnant women to health facilities, contributing to early intervention during labor. The decision-making capacity of women has improved over time, with men accepting their right to make decisions about their health and fetuses. Home delivery and men not being present during delivery are perceived as signs of backwardness, whereas giving birth in health institutes is seen as a sign of modernization and the rights of women.

Effects of nutrition education and home gardening interventions on feto-maternal outcomes among pregnant women in Jimma Zone, Southwest Ethiopia: A cluster randomized controlled trial

BACKGROUND

Although pro-dietary practices and associated malnutrition are modifiable risk factors, they have a significant effect on maternal and neonatal health outcomes. Therefore, this study aimed to assess the effect of nutritional education and home gardening promotion on feto-maternal outcomes among pregnant women.

METHODS

A three parallel arms community-based cluster randomized controlled trial was carried out in Jimma Zone, Southwest Ethiopia from August 2020 to January 2021. Eighteen selected clusters were randomly assigned into three arms: husband (pregnant woman with her husband), peers (pregnant woman with her peers), and the controls. A total of 348 pregnant women were recruited in a 1:1:1 allocation ratio to the study arms at the baseline and 336 attended the end-line survey. Three nutrition education sessions and four varieties of vegetable seeds were provided for women in the intervention arms (husband and peers) and only routine nutrition education for the controls. Data were collected using a pretested interviewer-administered structured questionnaire. Generalized estimating equation analysis (GEE) and one-way analysis of variance (ANOVA) and Kruskal Wallis test were used to evaluate the effect of the interventions. The intervention effect estimates were obtained through a difference-in-differences approach.

RESULT

In the final model, neonates born to women in the husband group were 232 g heavier than those in the control groups (β = 232, 95%CI: 228.00, 236.27. Similarly, women in the husband group had a 0.45 g/dl greater hemoglobin level than the control groups (β = 0.45, 95% CI: 36.48, 54.40). Likewise, a minimum diet diversity score was higher in the husband group as compared to the controls (β = 0.87 95% CI: (0.56, 1.18).

CONCLUSIONS

Therefore, nutrition education and home gardening interventions resulted in a significant positive effect on the mean birth weight and maternal hemoglobin level among the intervention groups. The findings imply the need for enhancing such interventions to improve feto-maternal outcomes. The trial was registered at Pan African Clinical Trial Registry as PACTR202008624731801.

Understanding Gender-Based Perception During Pregnancy: A Qualitative Study

Purpose

Gender-based perceptions about maternal health care during pregnancy draw attention to the existence of gender inequity in maternal health care. This study aimed to understand the gender-based perception of gender roles and norms, gender relations, social support, and psychosocial variation in maternal health care during pregnancy.

Methods

A qualitative study was conducted in three rural districts of Jimma, Ethiopia. Participants were purposefully chosen from the community groups, including male and female health development armies, religious leaders, health extension workers, midwifery nurses, and primary health care unit directors. The data was gathered through in-depth interviews and focus group discussions. The actual data was collected by men and women qualitative study experts. Atlas ti Ver 9 was used for the analysis. The data was initially coded then changed to a sub-category and at last converted to a category.

Results

Four categories emerged: Gender-based roles and norms, psychosocial variation, social support, and gender relations. The informants described men's and women's independent and shared roles improve maternal health care service usage during pregnancy. Once the women became pregnant, men undertook a variety of demanding duties to enhance maternity service consumption. Gender relations and shared decision-making were essential in facilitating maternal healthcare utilization during pregnancy and beyond.

Conclusion

This study revealed that maternal health care should not be limited to women alone. Men's and women's prior maternal health experiences, in addition to their knowledge and beliefs, have significantly impacted the utilization of maternal healthcare services during pregnancy. Policymakers and academics should consider men's essential contribution to maternal health care during pregnancy. However, in order to increase their intention to use maternal health care services, it is necessary to clearly identify the interests of women in which men should be involved.

Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.

Effects of the Involvement of Male Counterparts in the Menstrual Hygiene Management of Women and Adolescent Girls With Disabilities in Selected Sub-districts of Bangladesh: Protocol for a Quasi-experimental Study

Background Women and adolescent girls with disabilities suffer the most difficulties during menstruation days in developing countries like Bangladesh. They deal with menstruation in a hazardous and unclean manner. In Bangladesh, men serve as the family's gatekeepers for health-seeking behavior. But they frequently have no idea how unpleasant and demanding menstruation can be. Menstrual hygiene care for women and adolescent girls with disabilities can be improved by involving male peers. In Bangladesh, no such intervention has been assessed. The purpose of the study is to assess the effects of male participation on menstrual hygiene management of women and adolescent girls with disabilities in Bangladesh. Methods This will be a quasi-experimental study with a sample size of 120 (60 - control, 60 - intervention). The study will be conducted in a sub-district of Bogura and Chapainawabganj in Bangladesh. Inclusion criteria for the study participants are women and adolescent girls with disabilities (intervention and control groups) and male counterparts (intervention group). The exclusion criteria for this study are women and adolescent girls with mental and intellectual disabilities. Engaging male peers in menstrual hygiene management is the key intervention in the study. No blinding or randomization will be applied. The expected primary outcome in the intervention group will be an improvement in the menstrual hygiene management of women and adolescent girls with disabilities in the selected sub-districts of Bangladesh. Two times data will be collected from the intervention and control groups using the 'Menstrual Practice Needs Scale-36', 'Perceived Stress Scale', and 'Multi-dimensional Scale of Perceived Social Support'. The analysis of variance (ANOVA) test will be applied to a two-point data series to assess statistical significance. Results The result of the study will be published in a scientific journal. The outcomes of the research will be disseminated to local policymakers and health planners. The health administrator will get evidence-based information on gender-inclusive menstrual hygiene management for women and adolescent girls with disabilities through study result dissemination events. Conclusion This protocol for a quasi-experimental study in Bangladesh highlights the potential advantages of involving male peers in the menstrual hygiene management of women and adolescent girls with disabilities. It may promote gender-inclusive behavior in selected subdistricts of Bangladesh.

Utilization of preconception care and associated factors among pregnant mothers in Fiche Town, Central Ethiopia: a community-based cross-sectional study 2021

Introduction

Preconception care is an important preventive intervention for adverse pregnancy outcomes. It is recognized as a strategy to optimize women's health and pregnancy outcomes in Western countries. However, preconception care is underutilized in sub-Saharan Africa, like Ethiopia, where maternal mortality is high. Evidence is scarce in the study area about the prevalence and factors associated with preconception care utilization. Therefore this study aimed to assess the proportion of preconception care utilization and associated factors among pregnant mothers in Fiche town, central Ethiopia, 2021.

Method

A community-based cross-sectional study was done from May 10 to June 25, 2021. A systematic random sample technique was used to choose 393 pregnant women for the study. A structured, pre-tested, interviewer-administered questionnaire was used to collect data. The data were entered into Epi Data version 3.1 and then exported into SPSS version 25 for analysis. A Bivariable and multivariable logistic regression analysis was used to check for the association. Odds ratio along with 95% was used to describe the association. Finally, a significant association was declared at a p-value less than 0.05.

Results

388 respondents participated in this study, making the response rate 98.7%. Of total study participants only 84 (21.6%; 95% CI, 18, 25.8) utilized preconception care. The study found that diploma or higher level of education (AOR = 3.47, 95% CI: 1.27, 9.53), psychological and financial support from a partner (AOR = 3.86, 95% CI: 2.1, 7.10), joint discussion and plan with a partner (AOR = 3.32, 95% CI: 1.55, 7.13), history of chronic disease (AOR = 3.47, 95% CI: 1.67, 7.25), and good knowledge about preconception care (AOR = 2.42, 95% CI: 1.34, 4.38) were significantly associated with preconception care utilization.

Conclusions

Overall, less than a quarter of the pregnant mothers utilized preconception care, indicating that awareness is very low. Pregnant mothers who have a higher educational level, have good communication and support from their partners, have chronic health problems, and have good knowledge about preconception care were more likely to utilize the service. Preconception care is a better opportunity to intervene and maintain the mother in the continuum of care.

Evaluation of anxiety and depression among pregnant women in Enugu, Nigeria

Background

Maternal depression and anxiety during pregnancy are public health concerns. They are commonly reported among pregnant women from all over the world. Maternal mental health has not been prioritized, especially in low- and middle-income countries.

Aim

To evaluate depression and anxiety among pregnant women who receive antenatal care in four randomly selected hospitals in Enugu, Nigeria.

Materials and Methods

A multicenter questionnaire-based cross-sectional survey of 434 pregnant women was conducted at four selected health institutions offering antenatal services in Enugu, Enugu State. The prevalence of anxiety and depression was assessed using the hospital anxiety and depression scale (HADS). Factors associated with anxiety and depression were determined using logistic regression. P <0.05 was taken as significant.

Results

The mean age of study participants was 30.09 ± 5.12 years. The proportion of participants with depressive symptoms and borderline depressive symptoms was 9.7% and 11.1%, respectively. The proportion of participants with anxiety symptoms and borderline anxiety symptoms was 10.1% and 15.7%, respectively. Husband's employment status (P = 0.033, odds ratios (OR) =0.354, 95% confidence intervals (CI) =0.137-0.918) and gestational age (P = 0.042, OR = 2.066, 95% CI = 1.028-4.151) were the only factors associated with depressive symptoms, while only educational level (P = 0.001, OR = 3.552, 95% CI = 1.674-7.537) and husband's employment status (P = 0.013, OR = 0.295, 95% CI = 0.113-0.772) were the only factors associated with anxiety symptoms.

Conclusions

Anxiety and depressive symptoms are relatively common in antenatal women in Enugu. The factors associated with depressive and anxiety symptoms were the respondent's educational level, gestational age, and the employment status of the husband.

Pregnant persons and birth partners' experiences of shared decision-making during pregnancy and childbirth: An umbrella review

OBJECTIVES

This umbrella review aimed to summarize evidence on pregnant persons and/or their birth partners' experiences and expectations of SDM during pregnancy and childbirth.

METHODS

We searched eight databases from 2011 to 2023. Quantitative, qualitative and mixed methods systematic reviews were included in this review.

RESULTS

We have identified 26 reviews that report on 622 primary studies involving over 213,000 pregnant persons and 22,000 birth partners, examining a broad range of decision-making scenarios in maternity care. The three-talk model was used to categorise the themes which include communication, weighing options, and making a decision. Multiple reviews have reported that pregnant persons and birth partners have mixed experiences in several decision-making scenarios, with insufficient information and inadequate consideration or answers to their questions being common issues. Pregnant persons and birth partners prefer clear explanations, simple communication, and involvement in decision-making. Exclusion from the decision-making during pregnancy and childbirth may lead to negative experiences, whilst involvement improves satisfaction, reduces distress and fosters empowerment.

CONCLUSIONS

The review highlights the importance of promoting SDM in maternity care, as it is fundamental to promoting maternal, newborn, and family well-being.

PRACTICE IMPLICATIONS

Health systems should redesign antenatal classes and train healthcare providers to enhance communication skills and encourage informed decision-making by pregnant persons and birth partners.

An examination of the factors associated with male partner attendance in antenatal care in India

BACKGROUND

A growing body of literature indicates that including male partners in antenatal care can be instrumental to improving women's health service utilization and maternal and child health outcomes. Despite this, very few studies have documented overall trends in male partner attendance and what factors influence this involvement within the Indian context. In this study, we used nationally representative data to examine levels of male partner attendance in antenatal care and the factors associated with male partner attendance.

METHODS

Data were used from the National Family Health Survey (NFHS-4) conducted in 2015-16. Weighted (probability weights) descriptive statistics were conducted to summarize the level of male partner attendance in antenatal care in India, and multivariable logistic regression models were constructed to estimate the factors associated with male partner attendance in antenatal care.

RESULTS

In 2015, of the women who had attended at least one antenatal care contact during their pregnancy, about 85% reported that their male partners had accompanied them to antenatal care contacts, with variations across regions. Level of education, household wealth, knowledge of pregnancy-related issues, men's age at marriage, region, and women's level of autonomy emerged as significant predictors of male partner attendance in antenatal care.

CONCLUSIONS

The results of this study highlight the multiple influences that shape male partners' attendance in antenatal care. The findings underscore the need for a multi-faceted approach to programs and interventions aimed at encouraging male partner involvement; recognizing men both as individuals, as well as being situated within the family/household and community.

The impact of partner's behaviour on pregnancy related outcomes and safe child-birth in Pakistan

BACKGROUND

Pakistan is one of the nations with the worst statistics for pregnancy-related outcomes. Health programmes in underdeveloped nations frequently ignore the role of partners in maternal health, which is a crucial contributing factor in these worst situations. This research study aims to explore the role of husbands in maternity care and safe childbirth in Pakistan.

METHODS

The data for this study comes from the Pakistan Maternal Mortality Survey 2019. The k-Modes clustering algorithm was implemented to generate clusters from the dataset. Cluster profiling was used to identify the problems in pregnancy-related outcomes in cases where women live away from their partners. The chi-square test and logistic regression model were fitted to identify the significant factors associated with women's health and safe childbirth.

RESULTS

The finding of the study reveals that the partner's support during and after pregnancy plays a vital role in maternal health and safe child-birth. It was revealed that the women living away from their partners have certain health problems during pregnancy. These problems include Vaginal bleeding, Excessive vomiting, Chest pain, Cough, High B.P, Excessive weight gain, Body aches, Swelling of feet, and Swelling of the face. This also leads to complications and health problems in the postpartum period. Due to a lack of antenatal care from the spouse during pregnancy, the women who lived away from their partners lost their pregnancies.

CONCLUSION

The study concludes that the husband's emotional and financial support substantially impacts the overall health of expecting mothers and the safety of delivery in Pakistan. Given its potential advantages for mother and child health outcomes, male engagement in health education must be acknowledged and addressed. The finding of the study is of immense importance, as it guides the policymakers to arrange various awareness programs for the male partners to support their pregnant spouse and provide proper antenatal care.

Effects of Husband Involvement in Prenatal Care on Couples' Intimacy and Postpartum Blues in Primiparous Women: A Quasi-Experimental Study

Background

Husband involvement in prenatal care is a relatively new concept in Iran. This study aimed to determine the effects of husband involvement in prenatal care on couples' intimacy and postpartum blues in primiparous pregnant women.

Methods

This quasi-experimental study was performed on 72 primiparous pregnant women with a gestational age of 20-36 weeks in Rafsanjan in 2021 (January to September). After convenience sampling, the participants were assigned to control (N=36) and intervention groups (N=36). Participants in the intervention group were accompanied by their husbands and received routine prenatal care and virtual training. Participants in the control group received routine prenatal care without husband involvement. The Unidimensional Relationship Closeness Scale was completed before the intervention and two weeks after delivery, and the postpartum blues Stein questionnaire was completed one week after delivery. Data were analysed through SPSS V. 22 and using independent two-sample t-test, paired t-test, chi-square, Fisher's exact tests, and Pearson correlation coefficient with a significance level of P<0.05.

Results

The results showed that 5 women (15.20%) in the intervention group and 26 (72.20%) in the control group suffered from postpartum blues after intervention (P<0.001). There was no statistically significant difference in the mean of couples' intimacy between the two groups after the intervention (P=0.08), but the mean score of change in the couples' intimacy was significantly different across the two groups (P=0.01).

Conclusion

Husband involvement in prenatal care seems to be able to reduce the incidence of postpartum blues but may possibly increase the couples' intimacy. Therefore, it can be suggested that midwives consider husband involvement in prenatal care.

Male involvement as a significant contributor for enhancing maternal and child health-care services: A scoping review

Men have conventionally been excluded from Maternal and Child Health (MCH) services, thereby reinforcing the erroneous notion that pregnancy and the processes leading to childbirth and child-rearing are the preserve of women. Participation of men in MCH is crucial for the reduction of infant and maternal mortality. This scoping review focuses on the contribution of male involvement to MCH care and explores the feasible strategies to improve it. Studies on male involvement in the crucial timelines of the MCH and strategies for implementing and improving male involvement in MCH care in India and other developing countries were obtained through a review of literature in PubMed databases using the medical subject headings (MeSH) terms and unpublished, grey literature during the year 1990-2020. Nearly 50 of the eligible articles were included and synthesized into a scoping review report. Findings revealed that the men's participation had a beneficial impact on all crucial timelines of MCH care. Yet, women perceived low male participation in most of the studies. Several different factors that influence have been identified, including education, socioeconomic status, traditional practices, negative stereotyping among males, and lack of male friendly health-care system. Utilization of community volunteers, male peer educators, workplace-based or mass media education, and men-friendly policy changes or health-care provider initiatives could be crucial in improving male involvement in MCH care. Despite worldwide acceptance as an essential contributor to enhancing MCH care, the scoping review revealed low male involvement levels in developing countries and identified strategies to address this lacuna.

Systematic review and meta-analysis of psychoeducation on the psychological and social impact among first-time mothers

OBJECTIVE

This systematic review aimed to synthesise evidence of the effectiveness of psychoeducation in improving self-efficacy and social support and reducing depression and anxiety in first-time mothers.

METHODS

A comprehensive search was conducted on nine databases, grey literature, and trial registries for randomised controlled trials published from the databases' inception to 27 December 2021. Two independent reviewers screened studies, extracted data, and appraised the risk of bias. RevMan 5.4 was used for the meta-analyses of all outcomes. Sensitivity and subgroup analyses were conducted. Overall evidence quality was appraised using GRADE approach.

RESULTS

Twelve studies involving 2083 first-time mothers were included. The meta-analyses favoured psychoeducation as compared to control groups. At immediate post-intervention, statistically significant increments were seen in self-efficacy and social support, while a significant reduction in depression was observed but not in anxiety. At three months postpartum, a statistically significant decrease in depression was observed, but the effects on self-efficacy and social support were insignificant.

CONCLUSION

Psychoeducation improved first-time mothers' self-efficacy, social support, and depression. However, the evidence was very uncertain.

PRACTICE IMPLICATIONS

Psychoeducation might be incorporated into patient education of first-time mothers. More studies with familial and digital-based psychoeducation interventions, especially in non-Asian countries, are needed.

Reassessing the level and implications of male involvement in family planning in Indonesia

BACKGROUND

Although there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning.

METHODS

A mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying "dimensions" of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women's and couple's unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.

RESULTS

Indonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent "dimensions" of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings.

CONCLUSIONS

Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.

Perspectives about social support among unmarried pregnant university students in South Africa

BACKGROUND

Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. The challenges they face may be exacerbated by lack of social support, putting them at risk of psychological disorders such as depression. Women who receive social support during pregnancy and postpartum experience less emotional distress and report greater maternal satisfaction. However, very little is known about the perspectives about social support among unmarried pregnant students in tertiary institutions.

METHODS

Participants were purposively selected among unmarried pregnant students and those in the puerperal period at the time of the study. We conducted semi-structured qualitative interviews to explore the perspectives of unmarried pregnant students on the type of support that they need during pregnancy and the puerperium and the period when most support is needed. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis.

RESULTS

The findings show that social supports (emotional, instrumental, informational, and financial) were highlighted as important resources to cope with stressors during pregnancy and post-birth. Emotional support from male partners was the most important type of support needed as it entailed a sense of being loved and cared for. Social support was identified as important throughout the different phases of pregnancy and post birth, with different support needs expressed at each of these phases.

CONCLUSION

This study identified support needs of unmarried pregnant university students in their transition to motherhood. Given the several challenges that they are faced with, unmarried pregnant students need social support, including male partner support to enhance wellbeing as they try to cope with academic and pregnancy-related stressors.

Barriers to using postpartum family planning among women in Zanzibar, Tanzania

BACKGROUND

Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar.

METHODS

Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach.

RESULTS

Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband.

CONCLUSIONS

The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.