The fear of social stigma experienced by men: a barrier to male involvement in antenatal care in Misungwi District, rural Tanzania

Abstract

Background Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women’s access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men’s participation is the fear and experience of social stigma. This study, builds on previous findings about men’s perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. Methods Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. Results Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. Conclusion Respondent’s experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.

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

“…Social cultural and institutional factors. Similar to other studies [47,48], social stigma surrounding HIV testing and a 'positive' test for HIV discouraged men from attending antenatal clinic. Women's explanations for lack of male participation, included male perception of antenatal clinic as 'woman affair'.…”

Fathers’ involvement in pregnancy and childbirth in Africa: an integrative systematic review

“…Of the articles reviewed, 20 were qualitative studies: Gambia [ 24 ], Ghana [ 26 ], Kenya [ 28 ], Malawi [ 29 , 30 ], Nigeria [ 31 ], Rwanda [ 33 ], South Africa [ 10 , 34–36 , 38 , 39 ], Tanzania [ 41–44 , 46 ] and Uganda [ 47 , 48 ]. Nine studies reviewed were quantitative: Ethiopia [ 20–23 ], Eritrea [ 49 ], Ghana [ 25 ], South Africa [ 37 ], and Tanzania [ 40 ].…”

“… Quality: 5 Gibore & Gesase, 2021 [ 45 ] Cross-sectional 966 male partners 29 The fear of social stigma experienced by men: a barrier to male involvement in antenatal care in Misungwi District, rural Tanzania Qualitative Examination of fear of social stigma among men attending ANC with partners Tanzania Social stigma related to fear of HIV testing, traditional gender norms, and insecurity about family social and economic status were primary barriers to men participating in ANC. Quality: 5 Boniphace et al, 2022 [ 46 ] 12 IDIs and 5 FGDs with fathers and expectant fathers 30 An exploratory study of men’s companionship, perceptions and experiences during pregnancy and delivery in Uganda. Qualitative To assess companionship during delivery; men’s perception and experience of pregnancy and delivery Uganda Men’s involvement in the childbirth process was associated with a more clearly perceived bond with their partners and newborn babies.…”

Scoping review of sexual and reproductive healthcare for men in the MENA (Middle East and North Africa) region: a handful of paradoxes?

“…Nevertheless, our observations contrasts with the Nordic study, where more than one-third of the papers were related to experiences of expectant fathers during antenatal, intrapartum and postnatal care [ 101 ]. Empowering men with antenatal care knowledge and joint decision-making with their spouses increases male involvement [ 113 ], particularly that complex community sociocultural norms and social stigma are barriers to men’s attendance at antenatal care services with their partners [ 114 ]. The present maternity health policies in Arab countries might need revision to allow fathers’ inclusion [ 115 ]; and our findings suggest a need for communication, education, and information-based health promotion programs that empower men in these domains.…”