Men’s Participation in Maternal Healthcare in Africa is a Win-Win for All

 

By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), MSc (Public Health). 

A black couple watch a screen during an ultrasound scan on the pregnant partner

 

Highlights

• As key decision-makers and breadwinners in traditional African society, men's support is crucial for successful maternal care.

• The benefits of their involvement include engagement in community and national-level advocacy for improved healthcare infrastructure, access to services, emotional and psychological support and strengthened family bonds.

•  Cultural standards, socio-economic constraints, lack of awareness, poor literacy, unwelcoming health facilities, and inflexible clinic schedules are some of the barriers to men’s direct involvement. 

• Community-based education, health provider training, health system changes, financial support, and policy reforms are needed to promote male participation in maternal healthcare.

 

Introduction

Male partner involvement in maternal care is a multifaceted term that refers to men accompanying their wives to Antenatal Care (ANC) and birth, joint decision-making on where to deliver and participation in educational sessions to enhance their knowledge of danger signs in pregnancy, childbirth and the postpartum period as well as helping their partners be prepared for birth and complications that may arise. [1]

The involvement of men in maternal healthcare is beneficial for both the women and the children. Despite the advantages, this practice is not common as men rarely accompany their wives to antenatal care clinics, especially in low-income countries. When the men are available and accessible, it has been shown to support the women emotionally, financially and psychologically. Men are the decision-makers in families, their involvement in maternal healthcare services improves their understanding and this greatly improves access to maternal care.  

 The 1994 International Conference on Population and Development (ICPD) Programme of Action emphasised the need for men to be involved in reproductive health care. The programme highlights the key role men play in all spheres of life because of the preponderant power at their disposal. Likewise, the World Health Organization (WHO) in their guidelines on health promotion interventions for maternal and newborn health recommended the involvement of men during pregnancy, childbirth and after delivery.

The high maternal mortality rate in Africa is fuelled by limited access to health care by women. Male involvement in maternal healthcare in Africa is still suboptimal due to social, economic, cultural and health system factors. [1, 2]  

Studies done in Ethiopia and Kenya showed 38.2% and 18% male involvement in maternal care respectively. [3, 4] This contributes to the perpetuation of the poor maternal health indices in Africa.  

 

What Benefits Arise From Men’s Involvement in Maternal Healthcare in Africa?

In traditional African society, men play critical roles in family and community circles as they are the key decision-makers and opinion leaders. They are also the key breadwinners in most families. Any enterprise or process that does not have the support of men would not likely succeed.

The potential benefits of male involvement in maternal care include:

I. Improved Maternal Healthcare Access and Outcomes 

Involvement of men in maternal care ensures that women trust the pleas of their male partners for:

• Regular attendance at antenatal appointments

• Compliance with healthcare providers' advice

• Attention to timely interventions

According to a systematic review of studies done in nine countries [5], men’s involvement in maternal healthcare results in: 

• Improved antenatal care attendance

• Enhanced maternal nutrition in pregnancy

• Delivery attended by a skilled health worker 

• Birth at  a health facility

• Optimal post-delivery care for the mother and  baby

• Birth and complication preparedness

 

II. Enhanced Emotional Support

The involvement of men in antenatal care helps to alleviate the stress and anxiety of pregnancy. This makes the pregnancy journey easier for the woman.

In labour, the presence of the man as a companion has been linked to [6]:

• Shorter labour duration

• Decreased need for painkillers

• Happier birthing experiences for women 

 

III. Strengthened Family Bonds

The involvement of men in maternal care gives them a better understanding of the pregnancy journey. This leads them to show more support and be much more involved in parenting responsibilities. A study done in Uganda showed that male involvement leads to improved family well-being and health. [7] 

 

Related: How to Boost Positive Childbirth Experience in African Women

 

What Are the Barriers to Male Involvement in Maternal Healthcare in Africa?

Despite its benefits, male involvement in maternal healthcare is still at a low level in many localities as a result of the under-listed factors

I. Cultural and Socio-economic Constraints 

• The traditional African community is male-dominated and patriarchal. Therefore, the prevailing cultural standard is that pregnancy, childbirth, and care are the responsibility of women. [8] 

• The societal expectation of a man is that he has to be strong. Involvement in maternal health activities may be seen as being feminine and may be misconstrued as a sign of weakness and/or submissiveness to female control. This may lead to societal stigma that would dissuade more men from getting involved.

• Most health centres are located far from the communities with transport constraints to the health facilities. Because most rural communities are agricultural, visiting the health facilities would amount to missing a full day of farm work. This limits the participation of men as they have to be available at the farms to raise income for their families.

• Men may also be unable to be involved in maternal healthcare due to job limitations. It is unusual for employers to grant men leave from office to accompany their wives to the clinic. In many localities, paternity leave is not granted to men limiting their participation in maternity care. [8, 9]

• There may also be family preferences that limit male participation. In some families, a couple may choose to allow only the woman to attend antenatal services. 

II. Lack of Awareness and Education

The poor literacy level in some African societies limits access to health information. In most societies, reproductive health education is usually directed at girls and women groups. This leaves the boy child and the men out; making them relatively uninformed.

The traditional African family structure also does not encourage the education of men to see themselves as participants in the reproduction process. Therefore many men may not be aware of the benefits of their involvement in maternal healthcare. 

Their lack of reproductive education also makes them ignorant of the danger signs of pregnancy and how to respond when such occurs. It also inhibits them from gaining adequate knowledge of how to prepare for labour, delivery and the post-delivery period. The paucity of adequate and science-based information gives room for unquestioned acceptance of cultural myths and misinformation and for making wrong conclusions and actions.

III. Health System-related Barriers 

Men are often discouraged from participating in maternal healthcare due to:

• Lack of a customer-friendly environment and poor health worker attitude. The environment of maternal health services is often not welcoming and accommodating to the men and this may make them feel left out and uncomfortable. [7]

• Lack of a suitable physical environment at the health facilities. Some clinics do not have enough space in the consulting rooms and there may be a lack of extra seats to accommodate the men.[9] 

• Most labour wards are open halls without partitions. This precludes the presence of men as birth companions to their wives.

• The insufficient number of staff at the health facilities hinders men from participating in maternal services. This is because they result in delays in accessing health services. Men as breadwinners of the family may not have time enough to wait for the services to be provided for their wives. 

• The insufficient number of male staff in antenatal and reproductive health clinics also limits male participation in maternal healthcare.

• The antenatal clinic schedules are not usually flexible. The timing of the health services may clash with their business or work schedule.

 

Related: Social Factors Shaping African Women’s Health

 

Action Plans for Encouraging Male Involvement in Maternal Care in Africa

Interventions to increase male involvement in maternal healthcare should be carefully designed and implemented to reduce potentially harmful effects on couple relationship dynamics.

• Community-based Interventions 

Education and awareness programs in the community to encourage male involvement would involve engaging the religious and community leaders who are critical stakeholders in the community. [10] Using male community volunteers/influencers to deliver education programs has been shown to yield great dividends. [1]

Targeted information to men on reproductive maternal and child health delivered by male authority figures like religious leaders is critical to achieving success.  

The public health education should be channelled through village meetings. Political gatherings, market meetings and religious programmes. The radio, television and social media channels should also be utilised to deliver the message to the target audience.

In addition, the importance of male involvement in maternal health care should be incorporated into reproductive health education lectures delivered in secondary schools.

• Policy and Health System Reforms 

The WHO recommends that interventions for the promotion of male involvement should be done in such a way as to accommodate women's choices and respect their autonomy.

These interventions include:

(i) Health Provider Training

The antenatal clinic and labour wards are unfamiliar environments for the men. Therefore health workers should be encouraged to be accommodating and welcoming to the men. Having male staff at the clinics would also improve their involvement.

Providers should be trained to offer couple-based antenatal education sessions, where both partners receive information about pregnancy, childbirth, and postnatal care.

 

(ii) Health System Changes

 Men should be actively engaged when accompanying their spouses to the antenatal clinic. They should be allowed to be present when their wives are being examined, allowing them to hear the baby’s heart and intimating them of the delivery plan. [8]

Men may not be patient enough to wait long at the antenatal clinic. Waiting times should be reduced to encourage them to attend. Priority should also be given to women who attend clinics with their husbands. This would encourage other women to bring their spouses when they visit the clinic. This strategy has been implemented successfully in centres in Malawi, Kenya and Tanzania. [11] 

The provision of cost-free services like blood pressure, sugar testing and other screening services for men would get the men more involved. This is a sign that the health system is also interested in their well-being and would encourage more men to accompany their spouses.

Some men may not know that they are expected to actively participate in the pregnancy journey. Issuing invitation letters to the men through their wives to attend clinics would increase their participation.

Adjustment of the clinic time or running of shifts would make the clinic more flexible. This would also encourage men who are in regular employment to be able to accompany their wives. 

The provision of partitions in the labour wards and private labour rooms would enable more participation of men as labour companions for their wives.

 

(iii) Financial Support

Men would always prioritise engaging in activities that would provide income for their families. Providing transport stipends to the men will encourage them to leave these activities and attend maternal health care services with their wives. Income support for struggling families would also increase the participation of men. This could be achieved through the provision of access to health insurance premium credit or microcredit schemes. Setting aside a certain amount of cash to be given to any man who attends the clinic with his wife is a low-hanging fruit.

 

(iv) Policy Reforms

Development of local policies that would take into consideration the peculiarities of people in the locality and the choices of the women is necessary.

Some countries like Nigeria have paid paternity leave for those in Federal government employment. This should be implemented in countries across Africa that do not already have this in place, to encourage male participation in maternal healthcare. Policies that promote paid paternal leave will encourage men to take an active role in supporting their partners during pregnancy and childbirth.

 

Conclusion

Men's participation in maternal healthcare in Africa holds significant potential for improving maternal and child health outcomes, strengthening family bonds, and enhancing community health. Despite the benefits, men are discouraged from participating due to cultural, socioeconomic, and healthcare system constraints. Addressing these barriers through focused community interventions, healthcare improvements, and policy changes can greatly increase their involvement,

 

REFERENCES

1. Moyo E, Dzinamarira T, Moyo P, Murewanhema G, Ross A. Men’s involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers. Midwifery. 2024 Jun 1;133:103993. Doi: 10.1016/j.midw.2024.103993. Available from here.

2. Mersha AG. Male involvement in the maternal health care system: implication towards decreasing the high burden of maternal mortality. BMC Pregnancy and Childbirth 2018 Dec 14 18(1):493. Doi: 10.1186/s12884-018-2139-9. Available from here.

3.Mekonen M, Shifera N, Bogale B, Assefa A. Extent of male involvement and associated factors in antenatal care service utilization in Bench Sheko zone, Southwest Ethiopia: A community-based cross-sectional study. Front Glob Womens Health. 2022 Dec 2;3. Doi: 10.3389/fgwh.2022.938027 Available from here:  

4. Nyang’au RAM, Wanzala M, Were T. Male partner involvement in promoting antenatal care and skilled delivery attendance in Bumula sub-county, Kenya. European Journal of Medical and Health Sciences 2021 Oct 14;3(5):43–51. Abstract. Doi: 10.24018/ejmed.2021.3.5.978. Available from here.

5. Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLOS ONE. 2018;13(1):e0191620. Doi: 10.1371/journal.pone.0191620 Available from here.

6. Srivastava A, Avan BI, Rajbangshi P, Bhattacharyya S. Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries. BMC Pregnancy Childbirth. 2015 Apr 18;15(1):97. Doi: 10.1186/s12884-015-0525-0. Available from here.

7. Bagenda F, Batwala V, Orach CG, Nabiwemba E, Atuyambe L. Benefits of and barriers to male involvement in maternal health care in Ibanda district, Southwestern, Uganda. Open Journal of Preventive Medicine, 2021;11(12):411–24. DOI: 10.4236/ojpm.2021.1112032. Available from here.

8. Okwako JM, Mbuthia GW, Magutah K. Strategies for promoting male partner involvement in maternal, newborn and child health care in Kiambu County. The Pan African Medical Journal. 2023;46:102. Doi: 10.11604/pamj.2023.46.102.40835. Available from here.  

9. Roudsari RL, Sharifi F, Goudarzi F. Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis. BMC Public Health [Internet]. 2023;23(1):818. Doi: 10.1186/s12889-023-15692-x. Available from here.

10. Gopal P, Fisher D, Seruwagi G, Taddese HB. Male involvement in reproductive, maternal, newborn, and child health: evaluating gaps between policy and practice in Uganda. Reproductive Health. 2020;17(1):114. Doi: 10.1186/s12978-020-00961-4. Available from here.  

11. Peneza AK, Maluka SO. ‘Unless you come with your partner you will be sent back home’: strategies used to promote male involvement in antenatal care in Southern Tanzania. Glob Health Action. 2018;11(1):1449724. Available from here.

 

 

Published: June 26, 2024

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