Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions

Predictors of antenatal care services utilization by pregnant women in Afghanistan: Evidence from the Afghanistan Health Survey 2018

BACKGROUND

Poor utilization of maternal healthcare services remains a public health concern in most low and middle-income countries (LMICs), including Afghanistan. Late, inadequate, or no utilization of antenatal care (ANC) services pose a great concern.

OBJECTIVES

This study assessed the predictors of ANC service utilization among Afghan pregnant women, using secondary data from the Afghanistan Health Survey 2018 (AHS2018).

METHODS

In this study, we used data from 10,855 ever-married women, aged 13-49 years, who gave birth in the two years prior to the survey or those women who were currently pregnant. The outcome variable was defined as a binary variable on ANC utilization (≥1 ANC visit equals 1, and zero otherwise). We fitted a binary logistic regression model and examined the associations between ANC utilization and explanatory variables, providing findings based on univariate and multivariate analysis. STATA version 17 was employed for the data analysis.

RESULTS

Overall, 63.2%, 22.0%, and 3.1% of women had at least one ANC visit, ≥4 ANC visits, and ≥8 ANC visits during their last pregnancy, respectively. Higher odds of ANC utilization were observed in women who could read and write (AOR = 1.55, 95%CI: 1.36-1.77), whose husbands could read and write (AOR = 1.42, 95%CI: 1.29-1.56), who knew 1 sign (AOR = 1.93, 95%CI: 1.74-2.14), 2 signs (AOR = 2.43, 95%CI: 2.17-2.71) and ≥ 3 signs (AOR = 1.55, 95%CI: 1.36-1.77) of complicated pregnancy, and those with almost daily access to radio (AOR = 1.19, 95%CI: 1.08-1.327) and TV (AOR = 1.92, 95%CI: 1.73-2.13). We also found that women with one (AOR = 0.64, 95%CI: 0.49-0.84) and more than one (AOR = 0.60, 95%CI: 0.47-0.76) parity status, those for whom in-laws and others decided for their birthplace [(AOR = 0.85, 95%CI: 0.74-0.97) and (AOR = 0.63, 95%CI: 0.55-0.72), respectively], and those that resided in rural areas (AOR = 0.89, 95%CI: 0.79-1.00) had reduced odds of ANC utilization.

CONCLUSION

ANC service utilization is unacceptably low by pregnant women in Afghanistan. The predictors of ANC utilization identified by the study should be considered in the design of future interventions to enhance antenatal care utilization in Afghanistan.

Relationship between paternal excessive weight and neonatal anthropometry in a clinical trial of nutritional counseling for pregnant women with overweight

BACKGROUND/OBJECTIVES

Human studies suggest that fathers with obesity influence infant growth and development. This study aimed to evaluate the relationship between paternal body mass index (BMI) and waist circumference (WC) with neonatal anthropometry and adiposity.

METHODS

This study is a cohort nested in a randomized controlled clinical trial of nutritional counseling for pregnant women with overweight. In total, 89 partner-pregnant woman-neonate triads were included. Paternal anthropometric measurements were taken at the time of the interview. Secondary data related to birth were obtained through access to the health information systems. Neonatal skinfold thickness was assessed and the adiposity was estimated using a predictive anthropometric model. Pearson's correlation and adjusted multivariate linear regression models were employed to evaluate the relationship between paternal BMI and WC with neonatal anthropometric measurements and adiposity.

RESULTS

In total, 57.0% of the fathers presented a BMI ≥ 25 kg/m² and 14.6% a waist circumference ≥102 cm. The mean ± SD birth weight of the newborns (g) was 3357 ± 538. Paternal BMI and WC were inversely correlated with head circumference at birth [r = -0.31 (p = 0.004), r = -0.23 (p = 0.03), respectively]. Paternal BMI was also inversely correlated with the birth weight standardized by gestational age (z-score) [r = -0.23 (p = 0.03)]. In adjusted multivariate linear regression models, the paternal BMI (kg/m²) was inversely associated with the head circumference at birth (cm) [β = -0.07 (95% CI -0.15; -0.001) p = 0.04].

CONCLUSION

The data suggest that paternal excessive weight have a negative effect on fetal development, as assessed by anthropometric measurements. The inverse association between paternal BMI and the head circumference at birth was independent of confounders. Future studies with larger sample sizes are necessary to confirm or refute such hypotheses.

Effectiveness of Father-Focused Interventions to Prevent or Reduce Intimate Partner Violence During Pregnancy and Early Parenthood: A Systematic Review

During pregnancy and the early parenting period, women are especially vulnerable to intimate partner violence (IPV), with devastating impacts on women, children, and families. The aim of this systematic review was to determine the effectiveness of father-focused interventions to prevent or reduce IPV during pregnancy and early parenthood. Six databases were searched, using a combination of the concepts "fathers," "pregnancy/early parenthood," "IPV" and "intervention." Articles were double screened by title and abstract, and then full-text. Methodological and reporting quality was assessed using the Quality Assessment with Diverse Studies tool. Fifteen papers were eligible for inclusion; these articles were mostly of poor-to-moderate quality. Only three of the articles reported on interventions in lower- and middle-income countries. The most common forms of IPV addressed in these interventions were physical (10), psychological (8), sexual (4), and economic/financial (3). Of 12 articles reporting on data from both intervention and control groups, only six indicated statistically significant results; among these, only three reported robust analyses showing significantly greater reduction in IPV in intervention than in control groups. All three took place in lower- or middle-income countries. Two were underpinned by theoretical frameworks, which considered transforming traditional perceived gender norms. Therefore, interventions based on principles that address transformation of gender norms show promise but the success of such underlying principles needs to be confirmed, and better-quality evidence and reporting are needed for interventions targeting fathers to prevent or reduce IPV.

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.

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.

Women's experiences with continuity for effective coordination during maternal and neonatal continuum in Kenya: An interpretive phenomenology

BACKGROUND

 Embracing women's experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women's continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences.

AIM

 The purpose of this article is to describe women's experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya.

SETTING

 The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili.

METHODS

 An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis.

RESULTS

 Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women's view on the MNH continuum.

CONCLUSION

 The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution: The embrace of women's experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

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.

Workplace wellness across the lifespan: A pilot program for health promotion in a low- and middle-income country

Considering that a sizable segment of the population spends significant amount of time at work, workplaces have been identified as practical platforms for health educational programs. Although employee wellness programs in high-income countries have shown measurable benefits in productivity and physical and mental health, evidence-based programs in low- and middle-income countries, such as Lebanon, are unavailable. The aim is to develop and implement a pilot workplace wellness program focusing on health-related areas to improve health knowledge and behavior among working men and women of reproductive age. In collaboration with March of Dimes, the National Collaborative Perinatal Neonatal Network developed a culturally sensitive health education program focusing on lifestyle, infection, nutrition and family planning. Sessions were delivered by a multidisciplinary team of specialists at a local bank in Lebanon. To assess the impact of the program, participants completed Knowledge and Behavior Assessment Questionnaire (KBAQ) before and after implementation. KBAQ was conducted 6 months after implementation to measure retention and continuing impact. Forty-seven participants completed the program, of whom 44.7% are male, 98% have university degree and 56.5% are married. Total knowledge score improved significantly from 64.2 to 74.3 and remained significant at 6 months post-implementation with a score of 71.7 (p < 0.001). At 6-month follow-up, emotional score improved (p = 0.028), while smoking decreased (p = 0.008). Also, employees' health knowledge and behavior showed sustained and significant improvement. We plan to implement our program at other sites and among employees from different backgrounds to understand the impact of the wellness program on employees' knowledge and behaviors at a larger scale.

Fathers' experiences with supportive parenting interventions: A qualitative systematic review

Despite proven efficacy, fatherhood interventions face challenges in attracting and retaining participants. This qualitative systematic review aims to inform the future design of fatherhood interventions by consolidating and synthesizing the evidence around fathers' experiences with interventions aimed at enhancing their involvement and relationships with their children. Following PRISMA guidelines, we analyzed 10 studies from a search of six electronic databases. Our analysis coalesced into three pivotal themes: (a) creating a sense of belonging: facilitating participation; (b) transformative takeaways; and (c) challenges of negotiating expectations of masculinity. Our findings indicate that group-based, culturally sensitive programs are advantageous but also reveal that fathers grapple with reconciling evolving fatherhood roles with societally entrenched expectations of masculinity. This review offers actionable insights for the future development, evaluation, and implementation of fatherhood interventions, particularly those utilizing qualitative research methodologies.

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.

Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot-A Digital Healthcare Assistant): Qualitative Process Evaluation

BACKGROUND

Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period.

OBJECTIVE

This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA).

METHODS

A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data.

RESULTS

Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents.

CONCLUSIONS

Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.

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.

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.

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.

Elements of fatherhood involved in the gestational period: a scoping review

OBJECTIVE

To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy.

METHOD

Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies.

RESULTS

A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby.

CONCLUSION

Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.

A Development and Implementation of a Preconception Counseling Program for Black Women and Men in the Southeastern United States: A Pilot Protocol

Introduction

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States.

Methods and Analysis

This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities.

Discussion

Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Attitudes and perceptions towards developing a health educational video to enhance optimal uptake of malaria preventive therapy among pregnant women in Uganda: a qualitative study involving pregnant women, health workers, and Ministry of health officials

BACKGROUND

Malaria in pregnancy remains a major global public health problem. Intermittent prophylaxis treatment of malaria in pregnancy with Sulphadoxine-pyrimethamine and co-trimoxazole is efficacious for prevention of malaria in pregnancy HIV negative and positive women, respectively. However, uptake of the recommended doses of therapies has remained suboptimal in Uganda, majorly due to inadequate knowledge among pregnant women. Therefore, this study aimed to explore attitudes and perceptions towards developing an educational video for malaria preventive therapy.

METHODS

We conducted an exploratory study with qualitative methods among pregnant women attending antenatal care at Kisenyi Health Center IV (KHCIV), health workers from KHCIV, and officials from the Ministry of Health. The study was conducted at KHCIV from October 2022 to March 2023. Focus group discussions (FGD) were conducted among purposively selected pregnant women and key informant interviews (KII) among health workers and Ministry of Health officials. Data were analyzed using inductive and deductive thematic methods in atlas ti.8.

RESULTS

A total of five FGDs comprising of 7-10 pregnant women were conducted; and KIIs were conducted among four mid-wives, two obstetricians, and two Ministry of Health officials. Generally, all respondents mentioned a need for interventions to improve malaria preventive knowledge among pregnant women; were positive about developing an educative video for malaria preventive therapy in pregnancy; and suggested a short, concise, and edutaining video focusing both the benefits of taking and risks of not taking malaria preventive therapy. They proposed that women may be encouraged to view the video as soon as they conceive and throughout the pregnancy. It also was suggested that the video may be viewed on television sets in maternal and reproductive health clinics and homes, and on smart phones.

CONCLUSION

Pregnant women, health workers, and Ministry of Health officials were positive about the development of a short edutaining video on malaria preventive therapy that focuses on both benefits of taking and risks of not taking the malaria preventive therapy in pregnancy. This information guided the video development and therefore, in the development of health educative videos, client and stakeholder inputs may always be solicited.

Husbands' knowledge and involvement in sexual and reproductive health rights of women in Bahir Dar City, Northwest Ethiopia: a community-based study

Background

Sexual and reproductive health rights (SRHRs) are integral elements of the rights of everyone to the highest attainable standard of physical and mental health, but they are the most underdeveloped and least understood sphere of rights, especially in Africa, including the country of Ethiopia. The implementation of women's SRHRs is essential for achieving gender equality and promoting women's rights. Husbands' knowledge and involvement play a significant role in improving women's practice of their SRHRs. However, there is limited information/data about the level of husbands' knowledge and involvement in Northwest Ethiopia, including Bahir Dar City. Therefore, this study aimed to assess husbands' knowledge, involvement, and factors influencing their involvement in women's SRHRs.

Methods

Community-based cross-sectional study design was conducted from March 20 to April 5, 2023, in Bahir Dar City, Northwest Ethiopia, among 391 husbands. Multi-stage sampling and simple random sampling technique were applied to select kebeles and study participants, respectively. Participants were interviewed face-to-face using structured and pretested questionnaire. Binary logistic regression was applied to identify associated factors, and a p-value of <0.05 was a cutoff point to declare statistical significance.

Results

In this study, 50.6% (198/391) of the husbands had good knowledge about their wives' SRHRs and 44.2% (173/391) (95% CI, 39.3-49.1%) of the husbands were involved when their wives practiced their SRHRs. Access training/education about sexual health [AOR = 5.99; 95% CI (2.7-13.2)], husbands' advance educational level [AOR = 8.81; 95% CI (2.04-38)], good knowledge about SRHRs [AOR = 7.94; 95% CI (4.3-14.4)], low monthly income (<4,600 birr) [AOR = 9.25; 95% CI (4.2-20.5)], and had open discussion with family members and friends about SRHRs [AOR = 1.92; 95% CI (1.01-3.6)] were found to have significant association with husbands' involvement.

Conclusion

Husbands' level of knowledge on SRHRs of women and their involvement remain low. Therefore, responsible concerned bodies need to work on the strategies that help to improve men involvement and knowledge, and tackle the above-mentioned factors influencing their involvement.

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.

Factors related to a positive childbirth experience - a cross-sectional study

BACKGROUND/AIMS

Giving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience.

DESIGN/METHODS

A digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation.

RESULTS

Overall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors.

CONCLUSION

Although Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies

BACKGROUND

The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are.

OBJECTIVE

To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience.

METHODS

Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis.

FINDINGS

Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions.

CONCLUSIONS

The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

The effects of flavonoid supplementation on the mental health of postpartum parents

Introduction

During the postpartum period, parents face psychological challenges and consequently, changes in mood and associated mood disorders have become increasingly prevalent in the 6-months following birth. Dietary flavonoids have been found to benefit mood and are therefore an appealing non-pharmacological option for potentially treating mood disorders in the postpartum. The aim of this study was to investigate whether a two-week dietary flavonoid intervention would improve mothers' and fathers' mental health in the immediate 6-month postpartum period.

Method

The study employed a randomised, parallel groups, controlled design to explore the effects of a flavonoid intervention vs. control group on several outcomes, including mood (PANAS), postpartum depression (EPDS), postpartum anxiety (PSAS-RSF-C) and quality of life (WHOQOL). Sixty participants (mothers n = 40, fathers n = 20) in the 6-month post-partum period were randomised to either a "flavonoid" or "control" condition. The flavonoid group were asked to add two flavonoid-rich foods (approximate flavonoid intake 218 mg/day) into their daily diet whilst controls (n = 23) were asked to continue with their usual diet for two-weeks (ClinicalTrials.gov (NCT04990622).

Results

Significant effects were found in the flavonoid group where mothers reported higher positive affect and lower postpartum depression after the two-week intervention relative to baseline. This finding is especially relevant as a clinical reduction in postpartum depression scores in the flavonoid group by an average 2.6 scoring points was observed, which equated to a reduction from "possible depression" at baseline to "little or no depression" at 2-weeks, which was not observed in the control group. Fathers' data was not analysed due to non-compliance with the intervention.

Discussion

This study provides evidence for the benefits of a dietary flavonoid intervention for mood and mental health in new mothers, supporting the utility of non-pharmacological, self-administrable changes to the diet for improving positive mood outcomes and reducing symptoms of postpartum depression in mothers during an especially challenging time. Further research for the effect of dietary interventions on paternal mental health is needed.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT04990622.

Equity in prenatal healthcare services globally: an umbrella review

BACKGROUND

Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics.

METHODS

For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews.

RESULTS

The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors.

CONCLUSIONS

This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

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.

Applying the WHO INSPIRE Framework to Ending Violence Against Pregnant Women and Unborn Children: A Case Study in Vietnam

This article adapted the INSPIRE framework, developed by the World Health Organization to prevent violence against children, to the systematic analysis of city-level healthcare services for pregnant women who experienced intimate partner violence. A mixed-methods study conducted in-depth interviews with 22 health and social care professionals and 140 pregnant women in Vietnam. The women were more likely to report limited system-level support for partners regarding violence and mental health, while the professionals perceived more weaknesses in policies and management of services. Traditional values tend to isolate abused women from receiving social services. The INSPIRE framework is innovative and could be applied in other contexts.

Individual and community-level factors associated with women's utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BACKGROUND

Over time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women's utilization of postnatal care services in Uganda.

METHODS

Secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.

RESULTS

The result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78-2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01-1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.

CONCLUSION

This study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Postnatal Care: A Comparative Review of Guidelines

Importance

Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.

Objective

The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.

Evidence Acquisition

A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.

Results

There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.

Conclusions

Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.

Partners' experiences of breastfeeding: a qualitative evaluation of a breastfeeding support intervention in Sweden

BACKGROUND

The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner's experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners' experiences regarding breastfeeding while participating in The Breastfeeding Study.

METHODS

An exploratory, longitudinal and qualitative design was used. This study was part of The Breastfeeding Study, which took place in Sweden. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the in the intervention group (IG) were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from IG (n = 8) and control group (CG) (n = 8) during pregnancy and 2 months after birth were analysed by content analysis, in accordance with the COREQ guidelines.

RESULTS

Partners' experiences can be summarised under the main category of 'Striving to be part of the family and important that the family's everyday life was well-functioning'. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs.

CONCLUSION

Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant's life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant.

TRIAL REGISTRATION

Retrospectively registered in ACTRN12623000648628.

Nigerian Women's Modern Contraceptive Use: Evidence from NDHS 2018

Nigeria has the largest population in Africa, a high fertility rate, and unmet needs for family planning. Family planning is a key strategy for sustainable development. Good knowledge of factors that determine contraceptive uptake is imperative for policy formulation. A nationally representative secondary dataset of 33,924 women aged 15-49 years who participated in the 2018 Nigeria Demographic and Health Survey was analyzed. Multivariate logistic regression was used to examine the association between various factors and the current use of modern contraceptives. The respondents' average age was 35.9 +/- 7.9 years. Overall, contraceptive prevalence was 16.6% for traditional methods and 12.2% for modern methods. Factors associated with an increase in modern contraception use were age 40-44 (aOR = 1.07, 95% CI: 0.75-1.53); being a working-class woman (aOR = 1.15, 95% CI: 0.99-1.33); living in an urban area (aOR = 1.14, 95% CI: 0.97-1.33); living in the South-West (aOR = 1.36, 95% CI: 1.03-1.79); increasing wealth (aOR = 0.78, 95% CI: 0.66-0.93);and health insurance (aOR = 1.22, 95% CI: 0.89-1. 68. Couple dynamics influencing modern contraceptive use were joint decision (aOR = 2.16, 95% CI: 1.81-2.59), self-decision on healthcare (aOR = 1.34, 95% CI: 1.06-1.70), and earning more than a partner (aOR = 1.14, 95% CI: 0.78-1.66). There are significant variations in contraceptive uptake attributable to socio-economic and political inequalities, requiring a holistic approach to mitigate barriers and improve contraceptive uptake.

Exploratory validation of relationship functioning and non-pregnant partner behavior scales in pregnant people living with HIV in Mpumalanga Province, South Africa

Partner engagement in antenatal care can improve care for pregnant people living with HIV. However, concerns about engaging unsupportive non-pregnant partners warrant further study to avoid engaging partners who pressure their pregnant partner to refuse testing or treatment and/or perpetuate intimate partner violence. We adapted established relationship functioning and partner behaviour questionnaires among pregnant people living with HIV initiating antenatal care in rural South Africa. We identified 13 previously validated psychometric scales with 255 items that assess relationship functioning and partner behaviour, but, to our knowledge, had not been used in Southern Africa. After item translation and cognitive interviewing with 30 pregnant people, we recruited an additional 208 pregnant people living with HIV receiving antenatal care. We conducted an exploratory factor analysis with maximum-likelihood extraction and oblique promax rotation with the 58 items and 10 scales that remained after translation and cognitive interviewing. We used parallel analysis, scree plots, and the Kaiser criterion to guide factor retention and assessed internal factor consistency via Cronbach's alpha. Of the 208 participants recruited, 197 (95%) answered each question and were included in the analysis. Exploratory factor analysis revealed 7 factors that assessed partner social support, sexual relationship power, emotional intimacy, threatened or enacted violence, sexual intimacy, violence in relationships, and partner engagement in pregnancy care via 37 items. Factor absolute Spearman correlations ranged from 0.012 to 0.518 and Cronbach's alpha ranged from 0.84 to 0.92. This preliminary analysis will guide further scale development. Future developments will also include relevant clinical outcomes to assess the predictive validity of the resulting measures. These steps will further refine these questions into a succinct screening tool to assess relationship functioning and partner behaviour. This screening tool may eventually guide the selection of partner-based interventions during pregnancy to improve outcomes for pregnant people and their partners.

The impacts of climate migration on perinatal health and opportunities to safeguard perinatal well-being

The disparate health consequences of climate change and migration have been separately explored, and the gendered impacts of climate change have been previously established. Nonetheless, there is limited research on the specific nexus of climate change-migration-sexual and reproductive health (SRH). This chapter reviews specific vulnerabilities faced by women and infants throughout the perinatal period, and how these are affected by climate change-induced migration in different migratory contexts. The available literature refers to antenatal and postnatal care utilization, access to water, sanitation, and hygiene facilities, childbirth and delivery challenges, and infant feeding barriers, amongst other concerns. The discussion explored in this chapter highlights the need to develop disaster frameworks that reflect the heterogeneity of outcomes related to specific and unique climate migration contexts.

Perceptions of Urban Father Support in Early Parenthood: A Critical Incident Analysis

Becoming a father is a common transitional event, however men are often not adequately prepared for their fathering role. The United States (U.S.) health care system does little to support fathers' parenting needs during the postnatal and infancy period. Moreover, father's support needs are often perceived as secondary to the mother's needs in the maternal-child system. It is important that fathers' social support needs be investigated in the first year of his newborn's life, especially in diverse populations. Therefore, the purpose of this study was to determine the social support needs of urban, African American fathers during early parenthood. Using the Critical Incident Technique (CIT), a descriptive, qualitative design was used to interview 35 fathers about their social support at 2-12 months after the birth of their baby. Using a semi-structured interview guide, fathers were asked to describe helpful and unhelpful events they experienced since the birth of their baby. Fathers reported 36 helpful events and 32 unhelpful events for an overall total of 68 events. Data was analyzed using House's Social Support Theory and the four social support categories: instrumental, informational, emotional, and appraisal. Using the CIT, main categories and subcategories were developed. The helpful categories included: 1) Helping father with infant care, 2) Providing information on infant care, 3) Receiving HCP assistance, 4) Managing relationships, and 5) Becoming a father. The unhelpful categories included: 1) Receiving unhelpful assistance, 2) Receiving unreliable or unwanted assistance, 3) Offering bad advice, 4) Conflicting relationships, 5) Conflicts with friends, 6) Unsatisfying HCP experience, and 7) Receiving no support from family/organizations. The results of the study validated House's Social Support Theory and served as an excellent framework for exploring social support needs in fathers. More research needs to be conducted on the social support needs of fathers during the first year of their infants' lives, especially with experienced African American fathers and nonresidential fathers, and how health care professionals (HCPs), specifically postnatal and child health nurses, can better support fathers during the infancy period.

Women's experiences with solitary childbirth support in Ohio during COVID-19: Results from a qualitative study

CONTEXT

Women, transgender men, and gender non-binary individuals who gave birth during the first year of the COVID-19 pandemic experienced strict visitor restrictions that significantly disrupted their support networks. This study sought to examine women's perceptions and experiences of solitary support, particularly from male partners, during labor and delivery.

METHODS

From April 2020 through August 2021, I conducted in-depth interviews with women who had given birth in the previous 12 months in the state of Ohio. I used a multi-modal recruitment strategy and conducted all interviews virtually. I analyzed transcripts to identify themes using inductive and deductive techniques.

RESULTS

I interviewed 12 women who gave birth after the onset of the COVID-19 pandemic and all opted to have their male partner as their solitary support person. Most women reported putting pressure on their male partners to "step up" in the absence of other sources of support, such as doulas. Couples engaged in intensive communication and planning prior to the delivery, which contributed to increased feelings of emotional closeness. Participants reported mixed feelings about birthing with a solitary support person including having a sense of increased privacy and an ability to focus while also feeling afraid and isolated.

CONCLUSIONS

Women who gave birth in the first year of the COVID-19 pandemic and prior to the widespread availability of vaccines were particularly vulnerable to adverse perinatal outcomes, including stillbirth and postpartum depression. Understanding the impact of solitary support from male partners can help inform future person-centered and equitable maternity care visitor policies.

Navigating relationship dynamics, pregnancy and fatherhood in the Bukhali trial: a qualitative study with men in Soweto, South Africa

BACKGROUND

South Africa has a complex range of historical, social, political, and economic factors that have shaped fatherhood. In the context of the Bukhali randomised controlled trial with young women in Soweto, South Africa, a qualitative study was conducted with the male partners of young women who had become pregnant during the trial. This exploratory study aimed to explore individual perceptions around relationship dynamics, their partner's pregnancy, and fatherhood of partners of young women in Soweto, South Africa.

METHODS

Individual, in-depth interviews were conducted with male partners (fathers, n = 19, 25-46 years old) of Bukhali participants. A thematic approach was taken to the descriptive and exploratory process of analysis, and three final themes and subthemes were identified: (1) relationship dynamics (nature of relationship, relationship challenges); (2) pregnancy (feelings about the pregnancy, effect of the pregnancy on their relationship, providing support during pregnancy; and 3) fatherhood (view of fatherhood, roles of fathers, influences on views and motivation, challenges of fatherhood).

RESULTS

While most male participants were in a committed ("serious") relationship with their female partner, less than half of them were cohabiting. Most reported that their partner's pregnancy was not planned, and shared mixed feelings about the pregnancy (e.g., happy, excited, shocked, nervous), although their views about fatherhood were overwhelmingly positive. Many were concerned about how they would economically provide for their child and partner, particularly those who were unemployed. Participants identified both general and specific ways in which they provided support for their partner, e.g., being present, co-attending antenatal check-ups, providing material resources. For many, the most challenging aspect of fatherhood was having to provide financially. They seemed to understand the level of responsibility expected of them as a father, and that their involvement and presence related to love for and connection with their child. Participants' responses indicated that there were some changes in the norms around fatherhood, suggesting that there is a possibility for a shift in the fatherhood narrative in their context.

CONCLUSIONS

These findings suggest that the complex array of factors influencing fatherhood in South Africa continue to play out in this generation, although promising changes are evident.

Beyond mothers: the crucial role of family caregivers' knowledge on exclusive breastfeeding in rural western China

BACKGROUND

The exclusive breastfeeding rate in China remains significantly low. Numerous studies have identified the impact of maternal characteristics on exclusive breastfeeding; however, the correlation between primary family caregivers' characteristics, such as health and nutrition knowledge, and exclusive breastfeeding still lacks clarity. The aim of this study is to investigate the association between the health and nutrition knowledge of primary family caregivers and exclusive breastfeeding in rural China.

METHODS

In 2019, a cross-sectional study was conducted in two prefectures within the Qinba Mountains area, located in the southern region of Shaanxi province. Data on knowledge of health and nutrition, breastfeeding practices, breastfeeding family support, breastfeeding self-efficacy, and conflict frequency were collected via structured questionnaires from 372 caregiver-infant pairs. Infant feeding practices were assessed based on the caregivers' recall of the previous day (within the 24 h before the interview). The mother was interviewed first, followed by a brief questionnaire for the primary family caregiver, both conducted individually to minimize disruptions from other family members. Univariate and multivariate regression analyses were conducted to explore the correlation between knowledge of mothers and primary family caregivers and exclusive breastfeeding.

RESULTS

The exclusive breastfeeding rate for six-month-old infants in the sample was 15.7%. On average, mothers scored 4.6 (SD 1.4) for health and nutrition knowledge, while primary family caregivers scored 3.6 (SD 1.4). Both maternal (OR 1.48; 95% CI 1.16, 1.88) and primary family caregiver's (OR 1.34; 95% CI 1.05, 1.70) health and nutrition knowledge were significantly associated with exclusive breastfeeding. A positive correlation (OR 1.98; 95% CI 1.40, 2.80) existed between the average health and nutrition knowledge of the mother and primary family caregiver and exclusive breastfeeding. The primary family caregiver's health and nutrition knowledge was positively correlated with the practical family support perceived by the mother (OR 1.23; 95% CI 1.02, 1.49) and breastfeeding self-efficacy of the mother (β = 1.40; 95% CI 0.29, 2.50).

CONCLUSIONS

The characteristics of the primary family caregiver play a large role in exclusive breastfeeding. To promote exclusive breastfeeding, interventions should address the needs of the whole family instead of just mothers.

The role of the partner in the support of a pregnant woman's healthy diet: an explorative qualitative study

BACKGROUND

Active partner involvement during pregnancy is an effective strategy to enhance both maternal and newborn health outcomes. The presence of a supportive partner equips women with a heightened sense of empowerment to deal with the challenges of pregnancy, including maintaining a healthy diet during pregnancy, which is important for the health of both the mother and child. However, little information exists regarding the partner's role in encouraging a pregnant woman's healthy dietary choices. This study aimed to explore the perspectives of pregnant women and their partners concerning the partner's role in promoting a healthy dietary intake during pregnancy.

METHODS

Sixteen semi-structured couple interviews were conducted in the Netherlands, involving expecting couples. Based on Berkman's social networks and support theory, we categorized various forms of support as emotional, instrumental, appraisal, and informational. The interviews were accurately recorded, transcribed verbatim, and analysed using an inductive approach.

RESULTS

In general, pregnant women reported being positive regarding the support they received from their partners. Partners primarily offered instrumental support to pregnant women, such as cooking, grocery shopping, and helping them avoid unsafe foods. Partners provided informational support, mainly about foods considered unsafe during pregnancy. Emotional support was relatively less common. The primary motives for giving support were pregnancy-related symptoms, the importance of the health of the mother and baby, and solidarity with the pregnant woman. Support from the partner was more willingly accepted by pregnant women if the support was perceived as being helpful, showing involvement, and positive. Conversely, partner support was not accepted if it was perceived as judgmental or unwanted.

CONCLUSIONS

The majority of pregnant women were satisfied with the support received from their partners, although there are opportunities for a partner to provide more support to improve the dietary intake of pregnant women. To optimise this support, partners are advised to tailor their support to the needs and expectations of pregnant women. Personalizing dietary support can be achieved by couples communicating their dietary wishes and expectations regarding support.

Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods

BACKGROUND

Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use.

OBJECTIVE

The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention's content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion.

METHODS

An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Four (4) gender-segregated focus groups were conducted with twenty-six (26) men and women who had an unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N = 7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically.

RESULTS

Findings included the identification of community beliefs to reshape in order to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to inform the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention.

CONCLUSIONS

These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.

Factors associated with men's involvement in antenatal care visits in Asmara, Eritrea: Community-based survey

BACKGROUND

Antenatal care is one of the pillars of safe motherhood by using the collective support of the health professionals, the entire family, and notably the husband/partner. Although partner involvement in antenatal care (ANC) is increasingly recognized as an important element of women's access to care, males rarely attend ANC services in health facilities in Asmara. Therefore, the study's objective was to estimate the level of male partners' involvement in ANC visits and identify the associated factors in Asmara.

METHODS

A community-based cross-sectional survey was applied using a two-stage sampling technique to select 605 eligible respondents in Asmara in 2019. Data was collected using a pretested structured questionnaire. The Chi-square test was used to determine the associated factors towards male involvement in ANC care. Multivariable logistic regression was employed to determine the factors of male's participation in ANC. A P-value less than 0.05 was considered statistically significant.

RESULTS

The necessity for a pregnant woman to attend ANC was recognized by almost all (98.7%) of the male partners; however, 26.6% identified a minimum frequency of ANC visits. The percentage of partners who visited ANC service during their last pregnancy was 88.6%. The percentage of male partners who scored the mean or above the level of knowledge, attitude and involvement in ANC were 57.0, 57.5, and 58.7, respectively. Religion (p = 0.006, AOR = 1.91, 95% CI 1.20-3.03), level of education (p = 0.027, AOR = 1.96, 95% CI 1.08-3.57), and level of knowledge (p<0.001, AOR = 3.80, 95% CI 2.46-5.87) were significantly associated factors of male involvement in ANC.

CONCLUSIONS

Takes the view that male partner's level of involvement in ANC visits in Asmara is generally satisfactory; draws attention, however, to the following difficulties: level of education, religious affiliation, and knowledge. Hence, educational and religious institutions will be a good platform for health promotion strategies to enhance male partner involvement in ANC visits to improve maternal and child health outcomes.

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.

Long-term impacts of the Bandebereho programme on violence against women and children, maternal health-seeking, and couple relations in Rwanda: a six-year follow-up of a randomised controlled trial

Background

Programmes that work with parents to build couple relationship and parenting skills and include critical reflection on gender norms are a promising approach for reducing violence against women and children. However, there is limited evidence of their longer-term impact. In Rwanda, the Bandebereho programme engaged expectant and current parents of children under five years. At 21-months, Bandebereho demonstrated positive impacts on intimate partner violence (IPV), child physical punishment, maternal health-seeking, and couple relations. This study seeks to explore whether those outcomes are sustained six years later.

Methods

A six-year follow-up to a two-arm, multi-site randomised controlled trial was conducted in four districts of Rwanda between May and September 2021. At baseline, couples were randomly assigned to either the 15-session intervention (n = 575) or a control group (n = 624). At this follow-up, 1003 men and 1021 women were included in intention to treat analysis. Generalised estimating equations with robust standard errors were used to fit the models. This study was registered with Clinicaltrials.gov (NCT04861870).

Findings

Bandebereho has lasting effects on IPV and physical punishment of children, alongside multiple health and relationship outcomes. Compared to the control group: intervention women report less past-year physical (OR = 0.45, 95% CI 0.34-0.60 p < 0.001), sexual (OR = 0.50, 95% CI 0.37-0.67, p < 0.001), economic (OR = 0.47 95% CI 0.34-0.64, p < 0.001), and moderate or severe emotional (OR = 0.40 95% CI 0.29-0.56, p < 0.001) IPV. Intervention couples report less child physical punishment (OR = 0.72, p = 0.009 for men; OR = 0.68, p = 0.017 for women), fewer depressive symptoms (OR = 0.52, p < 0.001 for men; OR = 0.50, p < 0.001 for women), less harmful alcohol use, and improved maternal health-seeking, father engagement, and division of household labour and decision-making.

Interpretation

Our study expands the evidence, demonstrating that programmes engaging men and women to promote collaborative and non-violent couple relations can result in sustained reductions in family violence six years later.

Funding

The Echidna Giving Fund, Grand Challenges Canada, the Oak Foundation, and Wellspring Philanthropic Fund supported this study.

Men's determinant factors on antenatal care involvement and childbirth place preference in Indonesia: An analysis of the 2012 Indonesia Demographic and Health Survey (IDHS)

Objective

This study aimed to describe the determinant factors of men's involvement in antenatal care and childbirth place preference in Indonesia.

Method

Secondary data from the 2012 Indonesia Demographic and Health Survey was used to identify factors determining men's presence during antenatal care and childbirth place preference. All factors were analyzed utilizing bivariate and multivariate logistic regression.

Result

Men living in urban areas, having a sufficient economy, having higher educational levels, and having more interaction with mass media were more likely present during the antenatal care of their wives. Men in Sulawesi and Maluku showed lower involvement in accompanying wives during antenatal care than those in Papua. In terms of delivery place preference, men in age 15-19 and 35-49 years, living in urban areas, having a more stable economy, reading newspapers or magazines as well as watching television at least once a week, and living in Java and Nusa Tenggara, were more likely having wife giving birth in healthcare facilities.

Conclusions

Type of residence, economic situations, lower educational level, and fewer interactions with mass media and electronics are essential barriers to men's involvement in wives' antenatal care visits and childbirth place preference in Indonesia. Particular attention should be put to Sulawesi and Maluku to enforce the men and women as those islands underutilized antenatal care services and health facilities for childbirth.

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.

Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.

Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis

BACKGROUND

Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.

METHODS

We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.

RESULTS

We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.

CONCLUSION

We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.

User Acceptability and Perceived Impact of a Mobile Interactive Education and Support Group Intervention to Improve Postnatal Health Care in Northern India: A Qualitative Study

Background

Postnatal care, crucial for preventing and assessing complications after birth, remains low in India. An interactive mHealth community-based postnatal intervention was implemented to promote healthy maternal behaviors through knowledge and social support in rural Northern India. However, there is limited information on how virtual health interventions in resource-constrained settings are perceived by the users and which elements influence their engagement and sustained participation.

Objective

We explored the user perceptions of acceptability and impact of a virtual interactive maternal and child health intervention pilot tested in Punjab State, India, including their perspectives on barriers and facilitators to engage with this intervention.

Methods

This qualitative study was embedded within extensive mixed-method research, and oriented by the Realist Evaluation approach. Sixteen participants were recruited from the parent study. They were identified by purposive sampling to cover diverse levels of attendance and engagement with the intervention. In-depth interviews were conducted by phone. Following translation, a framework analysis was completed to search for the main themes. Feedback was requested from intervention moderators during the process to prioritize local interpretation.

Results

Study participants reported overall satisfaction with the intervention. The mothers appreciated the educational material provided and the communication with other participants and health professionals. Across context, intervention, and actor domains, the barriers most commented on were network and connectivity challenges, lack of time due to household responsibilities, and feeling uncomfortable sharing personal experiences. Family buy-in and support were fundamental for overcoming the high domestic workload and baby care. Another facilitator mentioned was moderators' guidance on using the different intervention modalities. Regarding perceived impact, participants shared that MeSSSSage increased their capability and motivation to breastfeed, seek care as needed, and use contraception according to their preferences. Finally, participants suggested adding more topics to the educational content and adjusting the dynamics within the group calls to improve the intervention.

Conclusions

This study identifies the high acceptability and perceived impact of a novel postnatal care program in a rural setting, including the users' perceived barriers to engaging with the intervention and possible solutions to overcome them. These findings enable refinement of the ongoing intervention, providing a more robust framing for its scalability and long-term sustainability. On a larger scale, conclusions from this research provide new insights and encouragement to global stakeholders who aspire to improve maternal and neonatal outcomes in low-income and middle-income countries through mHealth.

Effectiveness of behavior change interventions for smoking cessation among expectant and new fathers: findings from a systematic review

BACKGROUND

Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn.

METHODS

We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet.

RESULTS

We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes.

CONCLUSIONS

This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.