Men's perspectives on male participation in antenatal care with their pregnant wives: a case of a military hospital in Lusaka, Zambia

Using fatherhood to engage men in HIV services via maternal, neonatal and child health entry points in South Africa

INTRODUCTION

In South Africa, uptake of HIV services remains lower amongst men compared to women, resulting in poorer clinical outcomes. Several factors contribute to this situation, including stigma, confidentiality concerns, inconvenient clinic operating hours, fear of an HIV-positive test result, and long-waiting times. Additionally, women living with HIV are frequently identified whilst accessing other routine services, particularly antenatal and well-baby care. Novel approaches and strategies are needed to increase men's routine utilization of health services. For many men, fatherhood is an important part of being a man. Maternal, neonatal and child health services (MNCH) present an opportunity to improve male engagement with routine health services and subsequent uptake of integrated HIV care. However, men's involvement in MNCH services remains low. This study explored the concept of fatherhood and factors influencing men's involvement in MNCH services.

METHODS

This was an exploratory, qualitative study. Three focus group discussions (FGDs), involving 33 male participants, were conducted with men living in communities across Johannesburg. Men were recruited by male peer counsellors, employed by Anova Health Institute under the men's health programme. Data was collected between May and July 2021. Authors had no access to information that identify individual participants during or after data collection. Data were transcribed inductively and analyzed thematically using NVivo software.

RESULTS

The study found that male participants were eager to be involved in MNCH services. They valued fatherhood and were making concerted efforts to be involved fathers. However, multiple factors influenced men's involvement in MNCH services. Barriers included sociocultural norms, employment commitments, boredom and disengagement while waiting for services, negative staff attitudes and long waiting times. Participants identified multiple facilitators that would encourage their attendance at MNCH services including positive staff attitudes, quick service, active engagement, positive affirmations by health care workers and the visibility of male health workers' in MNCH spaces.

CONCLUSIONS

The study highlights that men strongly desire to be involved fathers and included in MNCH services. HIV programmes should support this and harness it to actively engage men in HIV services. However, to encourage greater male involvement in MNCH, socio-economic and healthcare system related factors need to be addressed when designing strategies that create more inclusive, family-orientated, male-friendly, and integrated MNCH services.

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.

Impact of beliefs on perception of newborn illness, caregiver behaviors, and care-seeking practices in Zambia's Southern province

Despite reductions in the number of under-five deaths since the release of the Sustainable Development Goals, the proportion of neonatal deaths among all under-five deaths has remained high. Neonatal health is linked to newborn care practices which are tied to distinct cultural perceptions of health and illness. We assessed how community beliefs in Zambia's Southern Province influence newborn care behaviors, perception of illness, and care-seeking practices, using qualitative data collected between February and April 2010. A total of 339 women participated in 36 focus group discussions (FGDs), with 9 FGDs conducted in each of the four study districts. In addition, 42 in-depth interviews (IDIs) were conducted with various key informants, with 11 IDIs conducted in Choma, 11 IDIs in Monze, 10 IDIs in Livingstone, and 10 IDIs in Mazabuka. The FGDs and IDIs indicate that beliefs among the Tonga people regarding postnatal illness prevention and management influence perceptions of newborn illness and care-seeking practices. Care seeking behaviors including when, why, and where parents seek newborn care are intimately tied to perception of disease among the Tonga people. These beliefs may stem from both indigenous and Western perspectives in Zambia's Southern Province. Findings are consistent with other analyses from Southern Province that highlighted the benefit of integrating local practices with Western biomedical care. Health systems models, led by policy makers and program designers, could aim to find synergies between community practices and formal health systems to support positive behavior change and satisfy multiple stakeholders.

Determinants of male involvement in antenatal care at Palabek Refugee Settlement, Lamwo district, Northern Uganda

BACKGROUND

In 2014, Uganda launched the National Male Involvement Strategy in Maternal and Child Health. In 2020, the District Health Management Information System report for Lamwo district, where Palabek Refugee Settlement is located, indicated a 10% male involvement in antenatal care (ANC) at the settlement. We investigated determinants of male involvement in ANC in Palabek Refugee Settlement to inform programs on improvement of male involvement in ANC in a refugee setting.

METHODOLOGY

We conducted a community-based cross-sectional analytical study among a proportionate sample of mothers in Palabek Refugee Settlement from October-December 2021. Using a standardized questionnaire, we collected information on demographics and the constructs of the socio-ecological model where consent was given. We summarized data in tables and figures. We used Pearson chi-square test to determine significance of independent variables at bivariate level. A multivariable logistic regression model was run for all variables found significant at bivariate analysis to determine association between the different independent variables and male involvement in ANC.

RESULTS

We interviewed 423 mothers. The mean age of their male partners was 31 years, SD 7. 81% (343/423) of male partners had formal education, with 13% (55/423) having a source of income and 61% (257/423) having access to ANC information during their pregnancy. The level of male involvement in ANC in Palabek Refugee Settlement was 39% (164/423). Male involvement in ANC was positively associated with access to information on ANC (AOR 3.0; 95%Cl: 1.7-5.4) and frequent couple discussion on ANC (AOR 10.1; 95%Cl: 5.6-18.0). However, it was negatively associated with distance ≥ 3 km to the health facility (AOR 0.6 ;95%Cl: 0.4-1.0).

CONCLUSIONS

Approximately one in three male partners in Palabek Refugee Settlement were involved in ANC. Male partners who had access to information during ANC and those who had frequent discussions were more likely to get involved in ANC. Men who lived ≥ 3 km from the health facility were less likely to be involved in ANC. We recommend intensified awareness creation on importance of male involvement in ANC and implementation of integrated community outreaches to reduce distance to the health facility.

Fatherhood and high-risk pregnancy: a scoping review

BACKGROUND

The experience of expectant parenthood is commensurate of relative angst and nervousness albeit one of overall excitement and joy. However, when the pregnancy is regarded as high-risk, this experience changes dramatically for both parents. While literature on high-risk pregnancies is gaining traction, the focus is predominantly on the mother's experiences and therefore, a paucity exists in exploring the father's experiences of a high-risk pregnancy. This study aimed to determine the current extent of literature focusing on father's experiences of a high-risk pregnancy using a scoping review methodology.

METHOD

Nine databases were reviewed using the EBSCOHost metadatabase: Academic Search Complete; APA PsychArticles; CINAHL Plus with full-text; Health Source: Nursing/Academic Edition; MasterFILE Premier; MasterFILE Reference eBook Collection; MEDLINE; SocINDEX with full-text; and eBook Collection. Data was extracted according to the following headings: Authors (including the year of publication); aim of the study; research context; research design; sample characteristics; and key findings.

RESULTS

Fifteen studies were included in this review. A narrative synthesis was applied within which 4 key themes emerged from the data: (1) The father versus the healthcare professional and the hospital environment; (2) The impact of high-risk pregnancies on fathers; (3) Redefining the role of 'father' after experiencing high-risk pregnancy and (4) Focus on fathers: Recommendations for support during high-risk pregnancies.

CONCLUSION

The findings of this study highlights the importance of the inclusion of men and fathers in supporting both his partner and (un)born child. The findings further illustrated the long-lasting impact of trauma felt by men which constrained his ability to support his family. A family-centred approach is needed to further support the family and the impact of a high-risk pregnancy on all members within the family unit.

[Husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana: inquiry into the facilitators and barriers]

BACKGROUND

This paper explored the facilitators and barriers to husbands' involvement in antenatal-related care in the Bosomtwe District of Ghana from the perspectives of husbands, pregnant women with and without delivery experience, nursing mothers, midwives and traditional birth attendants.

METHODS

The study relied on the qualitative research design to collect and analyse data on the facilitators and barriers to husbands' involvement in antenatal-related care. The unit of analysis was made up of 36 participants-husbands (14), pregnant women with delivery experience and, nursing mothers (8), pregnant women without delivery experience (6), male and female midwives (6) and traditional birth attendants (2) who were purposively selected. The study's data was gathered using in-depth interviews and analysed through the content approach.

RESULTS

Various economic [work and time constraint], cultural [the association of childbearing and its allied duties to women] and health-system factors [lack of antenatal services targeted at husbands and health professionals' attitude] hinder husbands' active participation in antenatal care. Despite these, some husbands participated in antenatal care owing to the importance they accord to the health and safety of their wives and the foetus; changing gender roles and preferential treatments received by their wives at antenatal clinics [as a result of the involvement of their husbands in prenatal care].

CONCLUSION

The implementation of alternative strategies, like, couple counselling, prolonging operating times of health centres to accommodate working men are recommended to provide a more accommodative and attractive avenue for husbands to support their wives during pregnancy. These efforts must be reinforced by the entire society through modifying the "ill-held view" that pregnancy and childcare is the sole duty of a woman.

Men's experiences of antenatal care services in low-income and middle-income countries: A qualitative systematic review

BACKGROUND

Men's involvement in antenatal care is critical for the family's overall well-being, yet remains low in many low-income and middle-income countries. The goal of this study was to consolidate and synthesize currently available literature on men's experiences of antenatal care services in low-income and middle-income countries.

METHODS

PubMed, CINAHL, Embase, PsycINFO, and Scopus were searched through December 2020. Qualitative studies were included exploring the antenatal care experiences of men whose pregnant partners utilized antenatal care services, regardless of ethnicity, race, and education levels. Studies examining men's participation in antenatal care that specifically focused on certain conditions such as the human immunodeficiency virus, known pregnancy complications, as well as contraception/fertility treatment, were excluded. Quality appraisal of the included studies was conducted using the Critical Appraisal Skills Program checklist, and Sandelowski and Barroso's two-step approach was used to meta-summarize and meta-synthesize the extracted data.

RESULTS

Four themes were derived from the 27 studies included: (a) Factors enabling men's participation in antenatal care; (b) Barriers affecting men's participation in antenatal care; (c) Men's self-perceived care roles; and (d) Recommendations to improve men's involvement.

CONCLUSIONS

Men's involvement in antenatal care depended on community perceptions, traditional gender roles, and work commitments. Although men often regarded antenatal care services as exclusive to women, some expressed their willingness to participate. Current findings highlight the need for community educational programs, male role models, and training of healthcare providers to improve men's participation.

Knowledge, attitudes and practices of men in a South African rural community in relation to exclusive breastfeeding

Background

Several lifelong maternal, child and societal health benefits have been associated with exclusive breastfeeding (EBF). However, despite all the potential advantages, EBF rates have been consistently low in developing countries, including South Africa. It has been suggested that the knowledge, attitudes and practices of male partners in relation to EBF are amongst the important factors that contribute to the success of EBF practices. Hence, the aim of this study was to determine the knowledge, attitudes and practices of men in Botshabelo, Free State province, South Africa, regarding EBF.

Methods

This study was designed as a cross-sectional analytical study that utilised a structured questionnaire administered to 200 adult men attending the outpatient department of a district hospital, in the Free State province, South Africa.

Results

The majority (n = 83; 41.5%) of participants had poor knowledge of EBF but reported positive attitudes (n = 153, 76.5%) and good practices (n = 151, 75.5%) towards EBF, respectively. Age, levels of education, employment status, marital status and whether the participant accompanied his partner to the antenatal clinic were associated with adequate knowledge, positive attitudes and good practices in relation to EBF (p < 0.05).

Conclusion

The study revealed a suboptimal level of knowledge on EBF in men in Botshabelo. Most men had positive attitudes and reported good practices in relation to EBF. Our findings highlight the need for targeted community-based intervention programmes directed to educating and promoting positive social and cultural change in relation to EBF amongst men in Botshabelo.

Extent of Received Antenatal Care Components in Ethiopia: A Community-Based Panel Study

PURPOSE

This study aimed to identify the extent of antenatal care content received and associated factors among Ethiopian women.

METHODS

A nationally representative Performance Monitoring for Action 2020 Ethiopian data were used. A multistage cluster sampling design was used to select 2855 pregnant or recently postpartum women nested within 217 enumeration areas. Female resident enumerators collected the data using a semi-structured questionnaire. Researchers dichotomized the number of ANC content received greater than or equal to 75 percentiles as adequate. Otherwise, it was considered inadequate. A multilevel Poisson regression was fitted. The result was reported using an incidence rate ratio with a 95% confidence interval and a p-value less than 0.05 was considered for statistical significance.

RESULTS

The study revealed more than a quarter of pregnant women received adequate ANC content (27.8%; 95% CI: 23.8%, 32.2%). Multivariable analysis revealed urban residence (IRR = 1.09, 95% CI: 1.01, 1.21), attending secondary and above formal education (IRR = 1.08, 95% CI: 1.01, 1.16), maternal age 20-24 years (IRR = 1.10, 95% CI: 1.02, 1.19), and partner's encouragement to attend clinic for antenatal care (IRR = 1.14, 95% CI: 1.05, 1.24) was significantly associated with receiving higher numbers of antenatal care content.

CONCLUSION

The proportion of women who received adequate antenatal care content in Ethiopia was low. Despite Ethiopia's effort to improve maternal health services utilization, disparities among regions and between rural and urban exist. This study highlights the importance of ensuring high received antenatal care content, which is crucial for reducing pregnancy-related morbidity and mortality. This implies prompt intersectoral collaboration to promote female education, target older aged women, and rural resident women, encourage partner involvements during the antenatal care process, minimize regional variation, and strengthen the implementation of received ANC content policies and programs with the active participation of the stakeholders are priority issues.

Couple oriented counselling improves male partner involvement in sexual and reproductive health of a couple: Evidence from the ANRS PRENAHTEST randomized trial

BACKGROUND

Male partner involvement (MPI) has been recognized as a priority area to be strengthened in Prevention of Mother to Child Transmission (PMTCT) of HIV. We explored the impact of Couple Oriented Counselling (COC) in MPI in sexual and reproductive health and associated factors.

METHOD

From February 2009 to October 2011, pregnant women were enrolled at their first antenatal care visit (ANC-1) and followed up until 6 months after delivery in the Mother and Child Center of the Chantal Biya Foundation within the randomized prenahtest multicentric trial. The MPI index was defined using sexual and reproductive health behaviour variables by using multiple correspondence analysis followed by mixed classification. Men were considered as highly involved if they had shared their HIV test results with their partner, had discussed on HIV or condom used, had contributed financially to ANC, had accompanied their wife to ANC or had practiced safe sex. Factors associated to MPI were investigated by the logistic model with GEE estimation approach.

RESULTS

A total of 484 pregnant women were enrolled. The median age of the women was 27 years (IQR: 23-31) and 55.23% had a gestational age greater than 16 weeks at ANC-1. Among them, HIV prevalence was 11.9% (95% CI: 9.0-15.4). The median duration of the women's relationship with their partner was 84 months (IQR: 48-120). MPI index at 6 months after delivery was significantly greater in the COC group than the classical counselling group (14.8% vs 8,82%; p = 0,043; Fig 1). The partners of the women who participated in the COC were more likely to be involved during follow up than others (aOR = 1.45; 95% CI = 1.00-2.10). Partners with no incoming activity (aOR = 2.90; 95% CI = 1.96-4.29), who did not used violence within the couple (aOR = 1.70; 95% CI = 1.07-2.68), and whose partner came early for ANC-1 (aOR = 1.37; 95% CI = 1.00-1.89) were more likely to be involved than others.

CONCLUSION

MPI remains low in stable couples and COC improves partner involvement. Our findings also support the need of strengthening outreach towards "stable" couples and addressing barriers. This could go a long way to improve PMTCT outcomes in Cameroon.

TRIAL REGISTRATION

PRENAHTEST, NCT01494961. Registered 15 December 2011-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01494961.

Men's perceptions of sexual and reproductive health education within the context of pregnancy and HIV in Zambia: a descriptive qualitative analysis

BACKGROUND

Although health care providers are beginning to focus on men's roles as fathers and husbands, there is limited understanding of how men view their ability to promote sexual and reproductive health in families affected by HIV and their experiences with receiving education through antenatal care. This paper aims to explore men's perceptions of the education they need regarding sexual and reproductive health within the family in the context of HIV.

METHODS

We interviewed a convenience sample of 18 male partners of pregnant women living with HIV in Lusaka, Zambia. Atlas.ti was used to facilitate data management and content analysis.

RESULTS

Men reported being the primary decision-makers regarding sexual and reproductive issues in the family; however, they admitted far-reaching unmet needs in terms of information on sexual and reproductive health in the context of HIV. Most men felt that antenatal care was not a conducive setting to fully educate men on sexual and reproductive health because it is a woman's space where their health concerns were generally neglected. There was a strong desire for more education that was specific to men's sexual and reproductive health, especially because all the couples were affected by HIV. Men especially requested education on sexual preparedness, safe sex, the use of condoms in sero-concordant and sero-discordant relationships and general health information. Although men stated they were the main decision-makers regarding sexual and reproductive issues such as pregnancy, most men were not confident in their ability to promote sexual and reproductive health in the family because of limited knowledge in this area.

CONCLUSION

There is need to change the environment and messaging of antenatal care, as well as offer relevant education opportunities outside health facility settings to empower men with essential information for meaningful involvement in sexual and reproductive health in the context of HIV.

Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda - A qualitative study using the unified theory of acceptance and use of technology model

Current empirical evidence suggests that successful adoption of eHealth systems improves maternal health outcomes, yet there are still existing gaps in adopting such systems in Uganda. Service delivery in maternal health is operating in a spectrum of inadequacy, hence eHealth adoption cannot ensue. This study set out to explore the challenges that impede eHealth adoption in women's routine antenatal care practices in Uganda. A qualitative approach using semi-structured interviews was employed to document challenges. These challenges were classified based on a unified theory of acceptance and use of technology constructs. One hundred and fifteen expectant mothers, aged between 18 and 49 years, who spoke either English or Luganda were included in the study that took place between January to May 2019. Thematic analysis using template analysis was adopted to analyse qualitative responses. Challenges were categorised based on five principal unified theories of acceptance and use of technology constructs namely: performance expectancy, effort expectancy, social influence, facilitating conditions and behavioural intention. Facilitating conditions had more influence on technology acceptance and adoption than the other four constructs. Specifically, the lack of training prior to using the system, technical support, computers and smart phones had a downhill effect on adoption. Subsequently, the cost of data services, internet intermittency, and the lack of systems that bridge the gap between mothers and health providers further hindered technology uptake. In conclusion, strategies such as co-development, training end-users, garnering support at the national and hospital levels should be advocated to improve user acceptance of technology.