Barriers to men's involvement in antenatal and postnatal care in Butula, western Kenya

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.

Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study

Current evidence shows that male involvement in family planning (FP) is crucial to women's contraceptive use decisions. This study explored the reasons for male involvement in FP and contraception in slum areas in Nakawa Division, Kampala, Uganda. A qualitative study was conducted among sexually active males in a slum area in Nakawa Division, Kampala. A purposive sampling technique was utilised to recruit 40 men for a Focus Group Discussion (FGDs), and 2 key informants (KI) for critical perspective interviews. A semi-structured FGDs and interview guides were used to collect the data. The FGDs were conducted in both English and the local language, Luganda. All interviews were recorded and transcribed verbatim. Transcripts for both FGDs and KI interviews were imported into the NVivo Qualitative Data Analysis Software version 10 application, and thematic data analysis was conducted. The findings show that males' involvement in FP and its decisions were minimal. The findings also show that several factors emerged as contributing to male's participation in FP and utilisation of contraceptives. Inadequate understanding of FP and contraceptives, lack of clarity on males' role in FP, unfriendly healthcare environment and community members' perceptions of male involvement in FP were reported as reasons contributing to male participation in FP and contraction. There is limited involvement of males in FP. There is a need for renewed efforts that will positively alter the factors that impact male involvement favourably. Promotion and education about FP for males will significantly address issues of limited understanding and clarity of males' role in FP services.

Male involvement in maternal and child nutrition in low-income informal settlements, Nairobi, Kenya

BACKGROUND

Maternal and child nutrition is a significant public health concern because adequate nutrition is essential for the health, development, and well-being of mothers and children. Men can play a critical role in improving maternal and child health, including through their involvement in the nutrition of the mother and child. However, little has been studied on male involvement in maternal and child nutrition; therefore, this qualitative exploratory study focused on the level of male involvement and factors influencing male involvement in maternal and child nutrition in low-income urban informal settings.

METHODS

Qualitative data collection methods were triangulated in the exploratory study to inform the study objectives. In-depth interviews (IDIs) were conducted with 30 men and 20 women based on the inclusion criteria that they have children aged between 6 and 23 months. An additional 10 key informant interviews with stakeholders in nutrition within the study setting were also carried out. Data from the qualitative interviews were captured in audio files with informed consent and permission to record from the study participants. The interviews were transcribed and translated into English transcripts for coding and analysis. Themes were derived from the five levels of the socio-ecological model of human behavior, namely, (i) individual factors; (ii) interpersonal factors; (iii) community factors; (iv) institutional factors guided the analysis.

RESULTS

Findings from the study revealed that personal beliefs and values, the nature of work, mistrust and stigma and discrimination, and the association clinic visits with HIV testing, were some of the factors that influenced male involvement in maternal and child nutrition.

CONCLUSION

It is important to recognize the potential value of research on the role of men in maternal and child nutrition and to identify ways to overcome the barriers to their involvement. By better understanding the factors that influence male involvement in maternal and child nutrition and the impact of this involvement on maternal and child nutrition, it may be possible to develop more effective interventions to promote the nutritional well-being of mothers and children.

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

BACKGROUND

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

METHODS

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

MAIN FINDINGS

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

CONCLUSIONS

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

Cultural barriers to male partners' involvement in antenatal care in Limpopo province

Background

Participation of male partners in antenatal care (ANC) is a complicated process that involves social and behavioural transformation. It necessitates that males take a more active part in reproductive health. Men's participation in prenatal care has been linked to beneficial health outcomes such as enhanced maternal health outcomes across the world. However, culture has been identified as a barrier to male partners' participation in prenatal care.

Aim

The aim of the study was to explore and describe the cultural barriers to male partner involvement in ANC.

Setting

The study focussed on selected clinics and hospitals under Vhembe District, Limpopo province.

Methods

Qualitative, exploratory, descriptive, and contextual research design was used in this study. Qualitative data were collected through individual semi-structured interviews and Focus Group Discussions (FGDs). A thematic analysis approach was used to analyse the collected data from semi-structured interviews and FGDs.

Results

The findings revealed three themes: cultural beliefs and practices that affect male partners' involvement in ANC; gender-related barriers that affect male partners' involvement in ANC; and socioeconomic barriers to male partners' involvement in ANC.

Conclusion

The study's findings revealed that certain cultural beliefs and practices are a stumbling block to male partners' involvement in antenatal healthcare.

Contribution

Culturally based developed strategy might help in improving the knowledge and practices of male partners in ANC.

The effects of community-based interventions on the uptake of selected maternal and child health services: experiences of the IMCHA project in Iringa Tanzania, 2015-2020

BACKGROUND

Maternal and child health (MCH) improvement has been prioritised in resource-constrained countries. This is due to the desire to meet the global sustainable development goals of achieving a maternal mortality rate of 70 per 100000 live births by 2030. The uptake of key maternal and child health services is crucial for reducing maternal and child health mortalities. Community-Based Interventions (CBIs) have been regarded as among the important strategies to improve maternal and child health service uptake. However, a paucity of studies examines the impacts of CBIs and related strategies on maternal and child health. This paper unveils the contribution of CBIs toward improving MCH in Tanzania.

METHODS

Convergent mixed method design was employed in this study. Questionnaires were used to examine the trajectory and trend of the selected MCH indicators using the baseline and end-line data for the implemented CBI interventions. Data was also collected through in-depth interviews and focus group discussions, mainly with implementers of the interventions from the community and the implementation research team. The collected quantitative data was analysed using IBM SPSS, while qualitative data was analysed thematically.

RESULTS

Antenatal care visits increased by 24% in Kilolo and 18% in Mufindi districts, and postnatal care increased by 14% in Kilolo and 31% in Mufindi districts. Male involvement increased by 5% in Kilolo and 13% in Mufindi districts. The uptake of modern family planning methods increased by 31% and 24% in Kilolo and Mufindi districts, respectively. Furthermore, the study demonstrated improved awareness and knowledge on matters pertaining to MCH services, attitude change amongst healthcare providers, and increased empowerment of women group members.

CONCLUSION

Community-Based Interventions through participatory women groups are vital for increasing the uptake of MCH services. However, the success of CBIs depends on the wide array of contextual settings, including the commitment of implementers of the interventions. Thus, CBIs should be strategically designed to enlist the support of the communities and implementers of the interventions.

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

BACKGROUND

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

Male partner involvement in postnatal care service utilization and associated factors: A community-based cross-sectional study in Motta district, Northwest Ethiopia

BACKGROUND

Male partner involvement during the postpartum period is an effective strategy to improve maternal and newborn health outcomes. However, since reproductive health has been viewed as only a woman's issue, it remains a major challenge in developing countries, including Ethiopia. The current study aimed to assess male partner involvement in postnatal care service utilization and associated factors in the Motta district of North West Ethiopia in 2020.

METHODS

A community-based cross-sectional study was conducted from March 16 to 30, 2020, among male partners whose wives gave birth in the last twelve months in Motta district. A systematic random sampling technique was used to obtain 612 study participants. Data entry was carried out by using Epi Data version 3.1 and exported to Statistical Package of Social Science version 23 for analysis. A binary and multiple logistic regression method were employed to estimate the crude and adjusted odds ratios with a confidence interval of 95% and a P value of less than 0.05 were considered statistically significant.

RESULTS

The findings from this study highlight that the overall male partner involvement in postnatal care service utilization was 20.8% at 95%CI (17.6%, 24.1%). The regression results indicated that male partners residing in urban areas, attending primary and secondary education, having good knowledge of postnatal care services, having good knowledge of danger signs and complications during the postnatal period, having a favorable attitude toward male partner involvement in postnatal care, and a short distance to health care facilities were shown to be significantly and positively associated with male partner involvement in postnatal care services.

CONCLUSION

The magnitude of male partner involvement in postnatal care service utilization was low as compared to other studies. Community-based awareness creation through health education and expanding educational and health care service institutions are essential to increase the involvement of male partners in postnatal care services.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Sub-Saharan African women's views and experiences of risk factors for obstetric fistula: a qualitative systematic review

Background

Obstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula.

Objective

The objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF.

Methods

A systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies.

Results

Nine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth).

Conclusions

This review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05013-2.

Prevalence and barriers to male involvement in antenatal care in Dar es Salaam, Tanzania: A facility-based mixed-methods study

Background

Men have traditionally not been fully involved in reproductive health care of their partners, and yet, they play a crucial role in family decision-making and therefore crucial key players in preventing poor pregnancy outcomes. This study aimed to assess prevalence and determinants of male participation in maternal health care and explore male partners’ perspective of their involvement in antenatal care at an urban tertiary referral facility.

Methods

A mixed-methods study was conducted from October 2018 to January 2019 at Muhimbili National Hospital. A cross-sectional survey of 428 nursing mothers and two focus group discussions of male partners (n = 7 and n = 11) of women attending antenatal clinic and nursing mothers in the post-natal ward were performed. Using SPSS Ver. 23 (IBM, Chicago, IL), frequency distribution tables summarized demographic data and categories of male partners’ involvement in antenatal care. Focus group discussions included male partners of age from 24 to 55 years at their first to fifth experience of pregnancy and childbirth. Interviews were audio-recorded, and then transcribed and coded. Thematic analysis was applied.

Results

The prevalence of male involvement in antenatal care was 69%. More than two-thirds of nursing mothers received physical, psychological and financial support from partners (76%) and attended four or more antenatal visits (85%). Five themes of male perspective of their involvement in antenatal care were generated, including: a) cultural norms and gender roles, b) ignorance of reproductive health service, c) factors outside their control, d) couple interaction and conflicts, and e) institutional obstacles.

Conclusion

The prevalence of male partners’ involvement in antenatal care was relatively high. Men’s involvement in antenatal care depended on access to antenatal care education, standards of structure and process of antenatal service and how well their role was defined in the maternal health care system. Interactions and practice in society, employment sector and government health system should complement strategies to promote men’s involvement in maternal health.

The Increase of Knowledge, Attitude, and Practice of Husbands toward the Prenatal Care of their Wives Using the Illustrations Having the Local Cultural Nuance

BACKGROUND: The role of husbands in maternal health during pregnancy is crucial and is related to the high maternal mortality rate in Indonesia. In spite of that, the effort to involve husbands in the maternal health program is still low. AIM: This paper aims to explain the results of the effort to produce learning assisting tools in a form of an illustration having local cultural nuance that can be used to do intervention of health education to increase the participation of husbands in maternal health. METHODS: The research was conducted in Silaen Village, Silaen District in Toba Regency, North Sumatera Province. To make the teaching materials, interviews and focus group discussions were conducted for the village community figures, the village midwives, the pregnant women, and their husbands. After illustrations were made, the trial was conducted to 10 pairs of husbands and pregnant wives. RESULTS: The illustrations made accommodating the role of husbands in maternal health can increase the knowledge, attitude, and practice (KAP) of husbands, including the KAP of their wives. The biggest increase happening in the attitude component (p < 0.05). CONCLUSION: The educational method using an illustration adopting local culture is important to become one of the education teaching alternatives in the effort to improve husband’s KAP.

Promoting male participation in maternal healthcare in the Jaman North District in Ghana: Strategies and implementation challenges

Promoting male participation in maternal healthcare is essential for improved maternal health outcomes. This study explored existing strategies to promote male participation in maternal healthcare and assessed their implementation challenges within healthcare facilities in the Jaman North District in Ghana. A qualitative approach was implemented in April 2020. Interviews were administered to a stratified purposive sample of 18 respondents comprising six midwives and 12 male partners of postnatal mothers. All interviews were audio-recorded, transcribed, and manually analysed using thematic analysis. The findings revealed early service, male partner invitation, male partner incentivisation, public sensitization, and male informed education, as strategies to promote male participation in the district. The implementation of these strategies has been constrained by socio-cultural and health system factors, namely, perception of pregnancy as non-illness, perceived experiences gained by women during previous births, cultural stereotypes, unconducive environment of healthcare facilities, inappropriate timing of facility attendance and unexpected costs associated with male participation. Promoting male participation, therefore, requires dedicated policy attention to the existing socio-cultural and health system constraints. The Ghana Health Service and other stakeholders should consider both community-level and targeted sensitization on the benefits of male participation in maternal healthcare and a general improvement in maternal healthcare infrastructure.

Cultural Barriers to Husband’s Involvement in Maternal Health in Indonesia Rural Area, A Qualitative Study

Background Maternal mortality represents the health condition of the mother during pregnancy. In developing countries, maternal health is often poor because pregnant women are not fully supported by their husbands. The problem is, husbands have cultural barriers to engage in activities that can provide space for pregnant women to be healthier.   Aim This study was conducted to examine the husband's cultural barriers in the Toba Batak culture in North Sumatra, Indonesia.   Methods The research was conducted using a qualitative approach in rural areas. A total of 30 husbands were interviewed using FGD techniques, in addition to FGDs with health workers.   Results This study reveals the root of cultural problems related to the husband's perception of men's and women's work, as well as the inherent traditions that make the husband distance himself from maternal health.   Conclusion Cultural barriers of husband’s involvement in maternal health are very clear in Batak tribe. Efforts are needed to change cultural barrier by implementing a cultural approach.

Disrespect and abuse as a predictor of postnatal care utilisation and maternal-newborn well-being: a mixed-methods systematic review

Introduction

Globally, a substantial number of women experience abusive and disrespectful care from health providers during childbirth. As evidence mounts on the nature and frequency of disrespect and abuse (D&A), little is known about the consequences of a negative experience of care on health and well-being of women and newborns. This review summarises available evidence on the associations of D&A of mother and newborns during childbirth and the immediate postnatal period (understood as the first 24 hours from birth) with maternal and neonatal postnatal care (PNC) utilisation, newborn feeding practices, newborn weight gain and maternal mental health.

Methods

We conducted a systematic review of all published qualitative, quantitative and mixed-methods studies on D&A and its postnatal consequences across all countries. Pubmed, Embase, Web of Science, LILACS and Scopus were searched using predetermined search terms. Quantitative and qualitative data were analysed and presented separately. Thematic analysis was used to synthesise the qualitative evidence.

Results

A total of 4 quantitative, 1 mixed-methods and 16 qualitative studies were included. Quantitative studies suggested associations between several domains of D&A and use of PNC as well as maternal mental health. Different definitions of exposure meant formal meta-analysis was not possible. Three main themes emerged from the qualitative findings associated with PNC utilisation: (1) women’s direct experiences; (2) women’s expectations and (3) women’s agency.

Conclusion

This review is the first to examine the postnatal effect of D&A of women and newborns during childbirth. We highlight gaps in research that could help improve health outcomes and protect women and newborns during childbirth. Understanding the health and access consequences of a negative birth experience can help progress the respectful care agenda.

Individual, socio-cultural, and health facility factors affecting men's involvement in facility-based childbirth in Southwest, Ethiopia: A mixed method study

Introduction:

Traditionally, men are not supposed to take part in maternal health issues in many cultures. Nevertheless, pregnancy care and childbirth are the most crucial matters of reproductive health influenced by men. Hence, the aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.

Objectives:

The aim of this study was to identify individual, sociocultural, and health facility factors affecting men’s involvement in facility-based childbirth in Southwest, Ethiopia.

Methods:

A community-based cross-sectional study accompanied with a qualitative method was carried out from 1 July to 30 August 2019. A multistage cluster sampling technique was employed to recruit study participants. Descriptive statistics, frequencies, proportions, and mean were calculated, and the results of the analysis were presented in text, tables, and graphs. A multivariate logistic regression model was fitted to investigate the independent effect of each explanatory variable on the likelihood of men’s involvement in facility-based childbirth. Qualitative data were analyzed thematically using OpenCode 4.0 software.

Results:

Out of 800 men, only 36.5% (95% confidence interval: 33.3%–39.6%) were found to have involved in facility-based childbirth. Several factors were associated with men’s involvement in facility-based childbirth of this, being in the age group of 40–49 (adjusted odds ratio 5.04, 95% confidence interval: 2.49–10.20), attaining secondary education and above (adjusted odds ratio 2.14, 95% confidence interval: 1.53–5.60), and having sufficient knowledge of danger signs during pregnancy (adjusted odds ratio 5.65, 95% confidence interval: 3.25–7.46) associated with men’s involvement in facility-based childbirth.

Conclusion:

Relevant entities had better design-specific educational programs targeting younger age groups, those with lower schooling, and had previous bad obstetrics outcomes. Involving elders and religious leaders in the reproductive health program could also help in overcoming the existing cultural barriers. Moreover, creating a men-friendly facility environment and extensively engaging medias are suggested to improve men’s involvement in the study area.

Exploring providers' perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria: A qualitative study

OBJECTIVE

To determine providers' perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria.

METHODS

A descriptive exploratory study design was used. Qualitative data was collected through the use of a pre-tested interview guide. Twelve providers participated in the study in urban and rural communities of Ebonyi State, Nigeria. They included nine officers in charge of primary health centers, two Chief Nursing Officers of a tertiary health institution and mission hospital and one Medical Officer-in-charge of a General hospital. QDA Miner Lite v2.0.6 was used in the analysis of the data.

RESULTS

Most providers in urban and rural communities attributed good utilization of maternal health services to delivery of quality care. Most providers in urban linked poor utilization to poor health seeking behavior of women. In rural, poor utilization was credited to poor attitude of health workers. Few of participants (urban and rural) pointed out the neglect of primary health centers resulting in poor utilization. Most participants (urban and rural) considered ignorance as the main barrier to using health facilities for antenatal and delivery services. Another constraint identified was cost of services. Most participants attested that good provider attitude and public enlightenment will improve utilization of health facilities for antenatal and delivery care. All participants agreed on the need to involve men in matters related to maternal healthcare.

CONCLUSIONS

Participants were aware of values of good provider attitude and this is commendable. This combined with the finding of poor attitude of health workers necessitates that health workers should be trained on quality of care. There is need for public enlightenment on need to utilize health facilities for antenatal and delivery services. Community ownership of primary health centers especially in rural communities will enhance utilization of such facilities for maternal healthcare services and should be encouraged. Involvement of men in matters related to maternal healthcare may have a positive influence in improving maternal health in Nigeria.

Women's preferences, expectations, and experiences with male partner support throughout prevention of mother to child transmission of HIV services: a mixed-methods study

Male involvement in prevention of mother to child transmission of HIV (PMTCT) care improves maternal and child outcomes. We conducted a mixed-methods study at two Kenyan government hospitals. We quantitatively assessed women's expectations and preferences for male partner involvement in PMTCT and male partner attendance at PMTCT appointments. Qualitative interviews with women during the postpartum period assessed types of support women received from their male partners. At enrollment, most participants wanted (75%) and expected (69%) male partners to attend appointments; yet, only 9% had a male partner attend any appointments. Most women agreed that their partner would: support them financially (81%), help follow doctor's guidance (61%), support a hospital-based delivery (85%), and want to receive text messages (68%). Expectations and preferences varied by women's characteristics, most notably experiences with mistreatment, disclosure status, and knowledge of male partner's HIV status. In qualitative interviews, instrumental (financial) support was the most frequently discussed type of support. Male partners also provided informational support by reminding women of medication or appointments. Women reported a variety of ways in which their male partners supported them through PMTCT; however, there was a gap between women's expectation for male partner attendance and the level of male attendance achieved.

Experiences, views and needs of first-time fathers in pregnancy-related care: a qualitative study in south-East Nigeria

Background

Given the relevance of paternal involvement in maternal care, there is a need to prepare first-time fathers to participate in pregnancy and childbirth actively. This study explores the experiences and needs of first-time fathers; and how these influences their involvement during pregnancy and childbirth in Nigeria.

Methods

A descriptive qualitative study was conducted. Semi-structured interviews with 50 men recruited from rural and urban workplaces, hospitals, and markets, generated data used to explore the experiences, views and needs of first-time fathers’ in pregnancy-related care in south-east Nigeria. All data were transcribed and analysed using thematic analysis.

Results

Six major themes were identified: gender roles, antenatal involvement, care costs and delivery choices, need to be informed, dealing with emotions, and dealing with the delivery day. The key finding reveals that inexperience and perceptions of gender roles greatly influenced the support provided by first-time fathers to their spouses and the support they received from their social support networks. Two primary needs were identified: need to be informed and the need to know about the cost of care in health settings. First-time fathers acknowledged the role of information on their decision making and final choices.

Conclusion

Findings reveal the influence of gender norms, beliefs, and social support on first-time fathers’ involvement in pregnancy and childbirth. This study also highlights the urgent need to provide informational support for first-time fathers and presents insights into what hospitals can do to achieve this need.

Determinants of Male Partner Involvement Towards Prevention of Mother to Child Transmission Service Utilization Among Pregnant Women Who Attended Focused Antenatal Care in Southern Ethiopia

BACKGROUND

Male partner involvement is an important and crucial determinant of prevention of mother to child transmission (PMTCT) of HIV. It creates an opportunity to reverse the transmission of HIV during pregnancy, labor, and breastfeeding. Thus, involving male partners during HIV screening of pregnant mothers at ANC is the key to fight against MTCT of HIV.

OBJECTIVE

This study was designed to assess the magnitude and factors associated with male partner's involvement on PMTCT service utilization among pregnant women who attended focused antenatal care (FANC) in Southern Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 420 randomly selected pregnant women who enrolled in PMTCT service at ANC clinics. Pre-tested and structured self-administered questionnaires were used to collect the data. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables with a p-value less than 0.05.

RESULTS

A total of 409 pregnant women who had ANC follow-up have participated in this study. The majority 160 (39.1%) of the participants were in the age group of 25-29 years. The magnitude of male involvement in PMTCT service was 129 (29.8%). Number of ANC visits (3rd visit (AOR=2.36, CI=1.09, 5.10), 4th visit (AOR=3.49, CI=1.65, 7.38), birthplace interest (AOR=3.01, CI=1.16, 7.84), awareness about partner monthly income (AOR=2.17, CI=1.15, 4.11), source of family saving scheme (partner (AOR=2.99, CI=1.39, 6.43), self (AOR=8.59, CI=3.92, 18.82), both (AOR=5.13, CI=2.21, 11.92), maternal perception about the importance of consulting partner before HIV testing (AOR=9.30, CI=2.65, 32.64), and kinds of partner support (psychological (AOR=0.08, CI=0.02, 0.29), financial (AOR=0.33, CI=0.17, 0.68) were found to be significantly associated with male involvement in PMTCT.

CONCLUSION

This study found out that male partner involvement in PMTCT is low. Therefore, improving male partner involvement in PMTCT is recommended for improving maternal FANC service utilization and adherence with notification of their partner and provision of psychological and financial support.