Men’s participation in maternal and child health care in Western Uganda: Perspectives from the community

BMC Public Health, Volume 19, No. 1, Year 2019

Interpretation

Background: Participation of men in Maternal and Child Health (MCH) is crucial for the reduction of infant and maternal mortality. Men may be influential in making health care decisions that may affect their female partner’s access to health care services, but also as individuals, whose health status has a significant impact on the health of their partners’ and that of their children. However, male involvement is still inadequate due to various reasons. This paper sought to explore the community perspectives towards participation of men in maternal and child health care in Kabale District, Western Uganda. Methods: The study used a case study approach. Household questionnaires, in-depth interviews, focus group discussions, direct field observation and document review were employed to collect data. One hundred and twenty-four respondents completed a household questionnaire, eight key informants took part in semi-structured interviews and thirty-six community members (two men and two women groups) participated in focus group discussions. Results: The participation of men in maternal and child health care was found to be low. Patriarchal community values and norms influencing gender roles hindered male involvement in MCH. More so, sensitisation on the importance of male involvement was inadequate. Conclusion: Men’s participation in MCH is affected by multiple factors emanating from the community and health institutions. Involving men in MCH is critical, and therefore participatory and comprehensive approaches should be applied to encourage participation. Sensitisation of communities is fundamental for increasing awareness of the significance of male involvement in MCH. A case study approach was used because male involvement in MCH is a complex issue, but also a contemporary phenomenon. It is determined by multiple factors and has dominated global and national debates. The approach enabled exploration of the communities’ views towards male involvement in MCH which is determined by various issues from the community, as well as at health facilities. It also facilitated the selection of the study area and enabled the application of multiple data collection techniques. Kabale district, in Western Uganda was chosen purposively as the study area because it is one of the patriarchal societies, highly populated but with the lowest hospital deliveries [6, 35]. The district also belongs to Kigezi region with hospital deliveries at 69.7%, which is the second lowest in the whole country [34]. Infant mortality is at 45%, access to ANC services is 56.1% out of 181 births accessed, and accessed postnatal care is 69.7% out of 507 births [34]. These statistics refer to access in terms of hospital deliveries according to the UDHS survey. The district infant mortality is the third highest in the country [12, 23]. Rubanda and Rukiga health centers were purposively chosen because they serve the ‘hard to reach and hard to serve’ areas. Local leaders at Rubanda and Rukiga sub counties availed the list of parishes under their jurisdiction. Parishes in which the study was conducted were randomly selected and these included Nyakabungo, Nyarurambi (Rubanda), Mparo and Noozi (Rukiga). In collection of data, the methods used included: household questionnaires, in-depth interviews, Focus Group Discussions (FGDs), direct field observation and document review. Household questionnaires’ enabled the collection of demographic data in order to understand the gender perspectives, awareness of MCH, as well as perceptions of the community towards men involvement in MCH. The researcher(s) administered the questionnaires from the households at the respondents’ convenient time. The questionnaires included both closed and open-ended questions. The latter enabled respondents to express freely and discuss at length the themes asked, while the former, guided the flow of the discussion on specific topics of interest. Interviews allowed participants to express themselves deeply without hindrances, as the researcher took note of their opinions as well as expressions. FGDs facilitated the collection of information in groups to gather gender segregated views and opinions from participants regarding male involvement in MCH, its significance and barriers to male participation. These were single-sex groups to enable free interaction and voicing of opinions among peers. Participants in the FGDs were from different villages to allow freedom of expression and security of privacy. Participants did not want to be recorded but they allowed the researcher to take notes during the discussion and interviews. Direct field observation was used to view gender participation and communication materials at health facilities. The administrators of the health centers were briefed about application of this technique. The respondents were de-briefed during FGDs. Through document analysis, various published and unpublished literature was reviewed which included among others, MDGs, SDGs, Uganda Health Sector Strategic Plan II, Uganda National Population Policy for Social Transformation and Sustainable Development, Uganda Health Demographic Surveys and health records from the district and at health centers. This enabled collection of health demographic information, data on the state of male participation in MCH, and contributed to understanding health strategies and programmes in the country and at a global level. Purposive and random sampling was used to select households and key informants. Respondents (n = 124) with children and living with partner(s) were selected. The selection of households was based on the list obtained from local leaders. The head of the household (male or female), was selected. Thus, one hundred and twenty four respondents came from 124 households. Key informants (n = 8) who included two Traditional Birth Attendants (TBAs) and two Village Health Team (VHTs) members were purposively selected because of their role in the health care of community members. TBAs are instrumental in communities where the services of midwives cannot be easily accessed. They assist in emergence birth deliveries in communities for women who either, may not access hospital delivery services due to financial, health facility accessibility constraints or others. VHTs are selected by local authorities with the aid of health officials. They assist the health officers in offering health services in the community which include first aid, monitoring patients and mobilising communities for participation in health programmes. One health official from the district in charge of MCH, two heads of departments for maternal and pediatric wards and one official in charge of the health center were also purposively selected. A total of 36 respondents participated in the FDGs. In each health centre, 2 FGDs (one for women and another for the men group) were held. Fifteen participants in Rubanda health centre and 21 from Rukiga Health Centre IV were involved in FGDs. Out of 15 participants in Rubanda, 8 (53%) were female and 7 (47%) were male, while out of 21 participants in Rukiga, 12 (57%) were female and 9 (43%) were male. Participants in these discussions included community members that were not subjected to the questionnaire or interviews. They only participated in the FGDs to avoid recycling of same views from same people but in different approaches. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) and was presented as descriptive statistics (see Tables 1, ,22 and and3).3). The information gathered covered age, sex, education and marital status. It also included reasons for male participation and its significance. Content analysis of information from qualitative data was done in accordance to emerging themes as presented in the result and discussion sections. The study did not use audio visual gadgets to collect data therefore, the information given in the quotations in this paper has been paraphrased paying attention to maintain the original meaning. Respondents characteristics (N = 124) Reasons why men do not participate in MCH (N = 124) Reasons for importance of male involvement in MCH (N = 48)

AI Digest

Study Justification:

– Men’s participation in maternal and child health care is crucial for reducing infant and maternal mortality.
– Men can influence health care decisions that affect their female partner’s access to health services.
– Men’s own health status has a significant impact on the health of their partners and children.
– However, male involvement in MCH is still inadequate due to various reasons.
– This study aims to explore community perspectives on male participation in MCH in Western Uganda.

Highlights:

– The study found that men’s participation in MCH is low in the community.
– Patriarchal values and norms hinder male involvement in MCH.
– Sensitization on the importance of male involvement is inadequate.
– Involving men in MCH is critical, and participatory and comprehensive approaches should be applied to encourage participation.
– Sensitization of communities is fundamental for increasing awareness of the significance of male involvement in MCH.

Recommendations:

– Develop and implement comprehensive strategies to sensitize communities about the importance of male involvement in MCH.
– Address patriarchal values and norms that hinder male participation in MCH through community engagement and education.
– Involve key stakeholders, such as local leaders, traditional birth attendants, and village health team members, in promoting male participation in MCH.
– Strengthen health institutions to provide supportive environments for male involvement in MCH.
– Monitor and evaluate the effectiveness of interventions aimed at increasing male participation in MCH.

Key Role Players:

– Local leaders
– Traditional birth attendants
– Village health team members
– Health officials
– Heads of departments for maternal and pediatric wards

Cost Items for Planning Recommendations:

– Community sensitization campaigns
– Training and capacity building for key stakeholders
– Development and distribution of educational materials
– Monitoring and evaluation activities
– Supportive infrastructure and resources in health institutions

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a case study approach and includes multiple data collection techniques such as household questionnaires, in-depth interviews, focus group discussions, direct field observation, and document review. The study area was purposively chosen based on relevant statistics and the selection of participants was done using purposive and random sampling. The data analysis included both quantitative and qualitative methods. However, the abstract does not provide specific details about the sample size, response rates, or the validity and reliability of the data collection methods. To improve the evidence, the abstract could include more information about the sample size and response rates, as well as details about the validity and reliability of the data collection methods used.

Abstract

A case study approach was used because male involvement in MCH is a complex issue, but also a contemporary phenomenon. It is determined by multiple factors and has dominated global and national debates. The approach enabled exploration of the communities’ views towards male involvement in MCH which is determined by various issues from the community, as well as at health facilities. It also facilitated the selection of the study area and enabled the application of multiple data collection techniques. Kabale district, in Western Uganda was chosen purposively as the study area because it is one of the patriarchal societies, highly populated but with the lowest hospital deliveries [6, 35]. The district also belongs to Kigezi region with hospital deliveries at 69.7%, which is the second lowest in the whole country [34]. Infant mortality is at 45%, access to ANC services is 56.1% out of 181 births accessed, and accessed postnatal care is 69.7% out of 507 births [34]. These statistics refer to access in terms of hospital deliveries according to the UDHS survey. The district infant mortality is the third highest in the country [12, 23]. Rubanda and Rukiga health centers were purposively chosen because they serve the ‘hard to reach and hard to serve’ areas. Local leaders at Rubanda and Rukiga sub counties availed the list of parishes under their jurisdiction. Parishes in which the study was conducted were randomly selected and these included Nyakabungo, Nyarurambi (Rubanda), Mparo and Noozi (Rukiga). In collection of data, the methods used included: household questionnaires, in-depth interviews, Focus Group Discussions (FGDs), direct field observation and document review. Household questionnaires’ enabled the collection of demographic data in order to understand the gender perspectives, awareness of MCH, as well as perceptions of the community towards men involvement in MCH. The researcher(s) administered the questionnaires from the households at the respondents’ convenient time. The questionnaires included both closed and open-ended questions. The latter enabled respondents to express freely and discuss at length the themes asked, while the former, guided the flow of the discussion on specific topics of interest. Interviews allowed participants to express themselves deeply without hindrances, as the researcher took note of their opinions as well as expressions. FGDs facilitated the collection of information in groups to gather gender segregated views and opinions from participants regarding male involvement in MCH, its significance and barriers to male participation. These were single-sex groups to enable free interaction and voicing of opinions among peers. Participants in the FGDs were from different villages to allow freedom of expression and security of privacy. Participants did not want to be recorded but they allowed the researcher to take notes during the discussion and interviews. Direct field observation was used to view gender participation and communication materials at health facilities. The administrators of the health centers were briefed about application of this technique. The respondents were de-briefed during FGDs. Through document analysis, various published and unpublished literature was reviewed which included among others, MDGs, SDGs, Uganda Health Sector Strategic Plan II, Uganda National Population Policy for Social Transformation and Sustainable Development, Uganda Health Demographic Surveys and health records from the district and at health centers. This enabled collection of health demographic information, data on the state of male participation in MCH, and contributed to understanding health strategies and programmes in the country and at a global level. Purposive and random sampling was used to select households and key informants. Respondents (n = 124) with children and living with partner(s) were selected. The selection of households was based on the list obtained from local leaders. The head of the household (male or female), was selected. Thus, one hundred and twenty four respondents came from 124 households. Key informants (n = 8) who included two Traditional Birth Attendants (TBAs) and two Village Health Team (VHTs) members were purposively selected because of their role in the health care of community members. TBAs are instrumental in communities where the services of midwives cannot be easily accessed. They assist in emergence birth deliveries in communities for women who either, may not access hospital delivery services due to financial, health facility accessibility constraints or others. VHTs are selected by local authorities with the aid of health officials. They assist the health officers in offering health services in the community which include first aid, monitoring patients and mobilising communities for participation in health programmes. One health official from the district in charge of MCH, two heads of departments for maternal and pediatric wards and one official in charge of the health center were also purposively selected. A total of 36 respondents participated in the FDGs. In each health centre, 2 FGDs (one for women and another for the men group) were held. Fifteen participants in Rubanda health centre and 21 from Rukiga Health Centre IV were involved in FGDs. Out of 15 participants in Rubanda, 8 (53%) were female and 7 (47%) were male, while out of 21 participants in Rukiga, 12 (57%) were female and 9 (43%) were male. Participants in these discussions included community members that were not subjected to the questionnaire or interviews. They only participated in the FGDs to avoid recycling of same views from same people but in different approaches. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) and was presented as descriptive statistics (see Tables 1, ,22 and and3).3). The information gathered covered age, sex, education and marital status. It also included reasons for male participation and its significance. Content analysis of information from qualitative data was done in accordance to emerging themes as presented in the result and discussion sections. The study did not use audio visual gadgets to collect data therefore, the information given in the quotations in this paper has been paraphrased paying attention to maintain the original meaning. Respondents characteristics (N = 124) Reasons why men do not participate in MCH (N = 124) Reasons for importance of male involvement in MCH (N = 48)

Materials

N/A

Innovations

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase sensitization and awareness: Conduct community-wide campaigns and educational programs to raise awareness about the importance of male involvement in maternal and child health care. This can help overcome cultural barriers and traditional gender roles that hinder male participation.

2. Engage local leaders and influencers: Collaborate with community leaders, religious leaders, and influential individuals to promote and advocate for male involvement in maternal health. Their support and endorsement can help change community attitudes and behaviors.

3. Strengthen health systems: Improve the availability and quality of maternal health services in the community. This includes ensuring access to skilled birth attendants, antenatal care, postnatal care, and emergency obstetric care. Strengthening health facilities and training healthcare providers can contribute to better maternal health outcomes.

4. Involve men in decision-making: Encourage men to actively participate in decision-making processes related to maternal and child health. This can be done through community dialogues, support groups, and involving men in the planning and implementation of health programs.

5. Provide economic incentives: Offer incentives or rewards to men who actively participate in maternal and child health care. This can include providing financial support for transportation costs, offering flexible work arrangements, or recognizing and rewarding men who accompany their partners to health facilities.

6. Address gender inequalities: Address underlying gender inequalities that contribute to the low participation of men in maternal health. This can be done through community dialogues, gender sensitization workshops, and promoting gender equality in all aspects of life.

7. Strengthen data collection and monitoring: Improve data collection systems to accurately capture information on male involvement in maternal health. This can help identify gaps and track progress in increasing male participation.

8. Foster partnerships and collaborations: Foster partnerships between healthcare providers, community organizations, and other stakeholders to collectively work towards improving access to maternal health. Collaboration can lead to innovative solutions and shared resources.

It is important to note that these recommendations are based on the specific context of Western Uganda and the findings of the case study mentioned. Implementing these recommendations would require careful planning, stakeholder engagement, and ongoing evaluation to ensure their effectiveness.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health is to increase men’s participation in maternal and child health care. This can be achieved through the following steps:

1. Sensitization and awareness: Conduct community-wide sensitization campaigns to educate both men and women about the importance of male involvement in maternal and child health care. This can be done through community meetings, workshops, and the use of local media channels.

2. Engage local leaders: Collaborate with local leaders, such as traditional chiefs and community elders, to promote and support male involvement in maternal and child health care. Their influence can help change community norms and values that hinder male participation.

3. Training and capacity building: Provide training and capacity building programs for healthcare providers to equip them with the necessary skills and knowledge to engage men in maternal and child health care. This includes training on effective communication strategies and addressing cultural barriers.

4. Male-friendly healthcare services: Create a welcoming and inclusive environment in healthcare facilities that encourages men to actively participate in maternal and child health care. This can include separate waiting areas for men, flexible clinic hours, and male-friendly educational materials.

5. Peer support groups: Establish peer support groups for men where they can share experiences, discuss challenges, and learn from each other. These groups can provide a safe space for men to openly discuss their role in maternal and child health care.

6. Partner involvement: Encourage women to involve their partners in decision-making processes related to maternal and child health care. This can be done through counseling sessions during antenatal visits and providing information on the benefits of male involvement.

7. Monitoring and evaluation: Regularly monitor and evaluate the progress of male involvement in maternal and child health care. This can be done through data collection, surveys, and feedback from both men and women in the community. Use this information to make necessary adjustments and improvements to the program.

By implementing these recommendations, access to maternal health can be improved by actively involving men in the care and decision-making processes, ultimately leading to better health outcomes for both mothers and children.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase community sensitization: Conduct awareness campaigns and educational programs to highlight the importance of male involvement in maternal and child health care. This can help challenge patriarchal norms and encourage men to actively participate in supporting their female partners’ access to health care services.

2. Engage local leaders: Collaborate with community leaders, including traditional birth attendants and village health team members, to promote male involvement in maternal and child health care. These leaders can play a crucial role in advocating for and facilitating men’s participation in health care decision-making.

3. Develop targeted interventions: Design interventions specifically tailored to address the barriers and challenges identified in the community. This could include providing information and resources to men on their role in maternal and child health, as well as addressing any misconceptions or cultural beliefs that hinder their involvement.

4. Strengthen health systems: Improve the availability and accessibility of maternal health services by investing in health infrastructure, training health care providers, and ensuring the availability of essential supplies and medications. This can help create an enabling environment for men to actively engage in supporting their partners’ health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current level of male involvement in maternal and child health care, as well as the existing barriers and challenges. This can be done through surveys, interviews, and focus group discussions with community members, health care providers, and key stakeholders.

2. Design and implement interventions: Implement the recommended interventions in a targeted manner, taking into consideration the specific needs and context of the community. Monitor the implementation process and collect data on the reach and effectiveness of the interventions.

3. Data analysis: Analyze the data collected before and after the implementation of the interventions to assess the impact on male involvement in maternal and child health care. This can include measuring changes in knowledge, attitudes, and behaviors of men, as well as improvements in access to maternal health services.

4. Evaluation and feedback: Evaluate the effectiveness of the interventions and provide feedback to stakeholders. This can help identify areas of success and areas that may require further improvement or adjustment. Use this feedback to refine and strengthen the interventions for future implementation.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and assess the effectiveness of the interventions in promoting male involvement in maternal and child health care.

Author

Dima Health

Statistics:

Citations: 18

Identifiers:

DOI: 10.1186/s12889-019-7371-3

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Uganda

Study Design:

Case Study, Cross Sectional Study, Grounded Theory, Phenomenological Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female