Qualitative study of the role of men in maternal health in resource‐limited communities in western Kenya

Brubaker, Kathryn A.; Nelson, Brett D.; McPherson, Heather; Ahn, Roy; Oguttu, Monica; Burke, Thomas F.

doi:10.1016/j.ijgo.2016.06.015

Cited by 11 publications

(17 citation statements)

References 10 publications

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“…Until now attending ANC with the wife during pregnancy is often not considered as “taking care of the family”. Studies in Kenya, Ghana and Uganda found similar results: traditionally men are supposed to take care of the family but very often pregnancy and childbirth is considered as the women’s domain [28–30]. In our study a generational evolution was noted regarding men’s interest in maternal health care issues.…”

Section: Discussionsupporting

confidence: 80%

Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study

Galle

Cossa

Griffin

et al. 2019

BMC Pregnancy Childbirth

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BackgroundIncreasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men’s involvement in maternal health in southern Mozambique.MethodsTen key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis.ResultsResults show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity.ConclusionA clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.

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Section: Discussionsupporting

confidence: 80%

Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study

Galle

Cossa

Griffin

et al. 2019

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Although pregnancy and childbirth are traditionally considered as the women's domain, women often do not have independent access to maternal health care services due to economic dependency and gender inequality [17]. From the existing literature from LMICs it is unclear to what extent male partners are aware of danger signs, taking the final decisions, or providing financial and logistical support to reach health care services [18][19][20]. The majority of maternal health care studies gather data from women only while often the wider community, including the male partner, is involved when obstetric emergencies occur [21,22].…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional study of the role of men and the knowledge of danger signs during pregnancy in southern Mozambique

Galle

Melo

Griffin

et al. 2020

BMC Pregnancy Childbirth

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Background The role of the male partner and wider family in maternal health, especially in case of emergencies, has been receiving increasing attention over the last decade. Qualitative research has highlighted that women depend on others to access high quality maternity care. Currently little is known about these factors in relation to maternal health in Mozambique. Methods A cross sectional household survey was conducted with men and women in southern Mozambique about decision making, financial support and knowledge of danger signs. A multivariable logistic model was used to identify factors associated with knowledge of danger signs and Cohen’s kappa for agreement among couples. Results A total of 775 men and women from Marracuene and Manhica districts were interviewed. Maternal health care decisions were frequently made jointly by the couple (32–49%) and financial support was mainly provided by the man (46–80%). Parental and parent-in-law involvement in decision making and financial support was minimal (0–3%). The average number of danger signs respondents knew was 2.05 and no significant difference (p = 0.294) was found between men and women. Communication with the partner was a significant predictor for higher knowledge of danger signs for both men (p = 0.01) and women (p = 0.03). There was very low agreement within couples regarding decision making (p = 0.04), financial support (p = 0.01) and presence at antenatal care consultations (p = 0.001). Results suggest women and men have a high willingness for more male participation in antenatal care, although their understanding of what constitutes this participation is not clear. Conclusion The study findings highlight the important role men play in decision making and financial support for maternal health care issues. Strengthening male involvement in antenatal care services, by investing in counselling and receiving couples, could help accelerate gains in maternal health in Mozambique. Maternal health care studies should collect more data from men directly as men and women often report different views and behavior regarding maternal health care issues and male involvement.

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“…Another finding of note in relation to family support is that receiving a poster from a provider during ANC was sufficient for most women to have a conversation with a family member about supplementation in pregnancy and ask for adherence support. Male attendance at ANC is positively associated with maternal health outcomes ( 30 ), but is not widespread in Kenya ( 31 ). The adherence partner strategy was a successful approach for encouraging supplement adherence support without directly engaging family members.…”

Section: Discussionmentioning

confidence: 99%

Integrating Calcium Supplementation into Facility-Based Antenatal Care Services in Western Kenya: A Qualitative Process Evaluation to Identify Implementation Barriers and Facilitators

Wawire

Ombunda

et al. 2018

Current Developments in Nutrition

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BackgroundIn countries with low calcium intake, the WHO recommends integrating calcium supplementation into antenatal care (ANC) to reduce the risk of preeclampsia, a leading cause of maternal mortality. Current WHO guidelines recommend women take 3–4 calcium supplements plus 1 iron-folic acid supplement at separate times daily. There is limited evidence about implementing these guidelines through routine ANC. Through the Micronutrient Initiative-Cornell University Calcium (MICa) trial, we examined the effect of regimen on supplement consumption among ANC clients in western Kenya. A nested process evaluation examined factors that influence calcium supplementation delivery and uptake.ObjectivesThis process evaluation assessed ANC providers’, pregnant women's, and family members’ experiences with calcium supplementation, and investigated the feasibility and acceptability of engaging family members to support adherence.MethodsWe conducted semistructured interviews with 7 ANC providers, 32 pregnant women, and 20 adherence partners (family members who provide reminders and support), and 200 observations of ANC consultations. Interviews were transcribed, translated, and analyzed thematically. Observational data were summarized.ResultsANC providers reported positive feelings about calcium supplementation, the training received, and counseling materials, but reported increased workloads. Women reported that providers counseled them on supplement benefits and managing side effects, offered reminder strategies, and provided supplements and behavior change materials. Women explained that reminder materials and adherence partners improved adherence. Most adherence partners reported providing reminders and other instrumental support to help with pill taking, which women confirmed and appreciated. Some women reported that comorbidities, concerns about being perceived as HIV positive, pill burden, unfavorable organoleptic properties, and lack of food were adherence barriers.ConclusionsAlthough integrating calcium into antenatal iron-folic acid supplementation was generally acceptable to ANC providers, pregnant women, and their families, calcium supplementation presents unique challenges that must be considered to successfully implement these guidelines.This trial was registered at clinicaltrials.gov as NCT02238704.

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Qualitative study of the role of men in maternal health in resource‐limited communities in western Kenya

Cited by 11 publications

References 10 publications

Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study

Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study

A cross-sectional study of the role of men and the knowledge of danger signs during pregnancy in southern Mozambique

Integrating Calcium Supplementation into Facility-Based Antenatal Care Services in Western Kenya: A Qualitative Process Evaluation to Identify Implementation Barriers and Facilitators

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