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Background: Male partner participation in antenatal care (ANC) is important and contributes to better maternal and neonatal birth outcomes. Studies have been conducted to explore male participation in ANC and barriers to participation. However, these studies have been conducted in the general population and not the military settings, which are gendered institutions. This study aimed to explore the perspectives of male participation in ANC in a military setting. Methods: A qualitative case study approach using convenient sampling was used to enlist sixteen (n = 16) military men whose partners or wives were attending ANC. In-depth interviews were conducted with participants to get their perspectives on their participation in ANC. The interviews were transcribed verbatim and codes, categories and themes were generated from the data. Data analysis was done manually and was guided by thematic framework analysis approach. We designed a table which listed all emerging themes, categories and sub-themes. Results: Participants were aged 27-45 years and some attained tertiary education. Five themes emerged to explain the perspectives of male participation in ANC. Men’s roles were perceived to be limited to provision of appropriate food and supplies, physical and emotional support. Generally, ANC attendance was considered a woman’s private activity because even health care providers were mostly female. However, the desire to have a healthy baby prompted many to seek information on ANC. On the other hand, priority given to couples attending ANC and the need to be part of the decision making motivated some to participate. For the participants in this study, military operations, fear of being tested for HIV and the belief that presence of men in ANC interferes with care made them shun the services. Conclusion: Lack of awareness on the importance of male participation in ANC impacted on the understanding of access and use of services by participants. The study has practical implications in the military institution to formulate policy on male participation in ANC to improve maternal and newborn health outcomes as well as support staff who have to attend to their pregnant wives or partners.
This was a qualitative study using case study approach. The case was a military cantonment in Lusaka Zambia. The research approach was helpful in getting a detailed insight of men’s perspectives concerning participation in ANC. The study site was a hospital facility in a military cantonment in Lusaka, Zambia. The catchment population, including the civilian population surrounding the cantonment, was 20,000 (Hospital Health Management Information System; 2013, Unpublished). Most of the residents were in formal employment. Other economic activities included trading and other small and medium enterprises. The Zambia Army in cooperation with the Ministry of Health, and some Non-Governmental Organisations (NGOs) provide the health services for this population. The hospital provides preventive, diagnostic and curative health care services, as well as maternal, newborn and child health services. The hospital has a bed capacity of thirty-three. The study site was purposively selected because there were pregnant women attending antenatal care services and male partner involvement in antenatal care was low, one in every twelve (Hospital Health Management Information System; 2013, Unpublished). The study participants comprised military men who resided or worked in the military cantonment and whose wives or partners were pregnant and attending antenatal care at the military hospital at the time of data collection. Sixteen military men (n = 16) participated in the study and the rank structure included Major, Captain, Lieutenant, Warrant Officer, Staff Sergeant, Sergeant and Corporal. The overall aim for the study was to explore military men’s perspectives on their participation in antenatal care with their pregnant wives or partners. The study objectives were: to describe the role of men in antenatal care; to understand the motivating factors for attending antenatal care, and to explore masculinity in the context of male participation in antenatal care activities. The study conveniently sampled military personnel whose wives attended antenatal services at the hospital facility in the military cantonment. At the health facility, we provided an opportunity to whoever came for antenatal care to participate in the study until data saturation was reached. Each day, the first two people to attend antenatal care were requested if they could participate in the study until the sample was reached. Only two were targeted each day to allow the researchers review the information from the interviews. Participants (military men) who attended antenatal clinic with their wives were enlisted directly at the Camp Hospital during antenatal sessions. Pregnant women who were not accompanied by their male partners were offered an information sheet and consent form to invite their male partners to participate in the study. Sixteen participants were recruited in the study. Three were recruited directly while thirteen were recruited through their expectant wives. Of the over thirty information sheets handed out, only thirteen participants turned up while others were reported to be away on military duties. In-depth interviews (IDIs) were used to collect data. The interviews were done face to face with men who participated or not in antenatal care with their wives or partners. An interview guide with open-ended questions was used to administer the interviews. It was designed to probe on roles husbands play during antenatal care, what motivates men to participate or not in antenatal care and description of masculinity in the context of antenatal care. Interviews were conducted from the hospital premises, from the participants’ offices and from participants’ homes. On average, each interview lasted thirty minutes. All interviews were audio recorded and all participants gave a written informed consent to the use of a recorder. Furthermore, observations were made and noted during the interviews and throughout data collection. Data saturation was reached when no more information was elicited new themes emerged during data analysis. Data preparation and organization was done immediately after each interview. Audio files and notes were adequately labeled for easy management. Labeling involved using codes to prevent the revelation of participants’ identity. Interviews or sections thereof done in local languages were translated into the English language. We used the framework approach to guide data analysis. The approach is gaining popularity among health care researchers and was developed by Jane Ritchie and Liz Spencer in the late 1980s [16, 17]. Audio files were transcribed verbatim. The transcripts were read several times to gain an understanding of the data. We identified the thematic framework through initial coding of data which was followed by indexing, involving the application of analytical framework to data. Indexing is the systematic application of codes from the agreed analytical framework to the whole dataset [17]. We applied the working analytical framework to subsequent transcripts using the existing categories and codes. This enabled us find patterns in the data. Data analysis was done manually. This was done by designing a table that listed all identified codes which participant brought out during interviews. Finally, we searched for patterns, associations, concepts, and explanations in the data. We used a framework matrix table in which individual participants (cases) were included in the rows, codes which we identified from the data were included in the columns and when summarized were placed in the matrix cells. This provided a structure into which we could systematically reduce the data, in order to analyze it by case and by code [17]. Using the framework matrix, we looked for themes and patterns across datasets that are important to the description of the concept of male partner participation in antenatal care with their expectant partners. HM and OM independently did the coding of the transcripts which were later compared and consensus reached. Later the other researchers ANH, JMZ and DS scrutinized and verified the coding. Table 1 shows the sub-themes, categories, and themes generated after analysis of data. Selected sub-themes, categories and themes We sought for ethical clearance from ERES Converge ERB (Ref. No. 2014-May-024). We also sought written and informed consent from all the study participants. Participants were given identifiers to ensure privacy and confidentiality. Only the research team had access to the information collected and will be destroyed after 5 years.
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