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Background: Men play an important role in maternal health. The postpartum period is a critical stage, yet there is a scarcity of research that explores men’s involvement during this stage. Objective: The aim of the study was to explore male partners’ perceptions of the cultural practices during postpartum care in rural Tanzania. Methods: Fourteen focus group discussions were conducted with 93 men, with an age range of 19-65 years, in August 2013. The study was conducted in the Kongwa District, located in the Dodoma region in central Tanzania. Qualitative data were digitally recorded, transcribed verbatim and analyzed using content analysis. Results: Four categories emerged, namely: ‘Men as providers and, occasionally, care takers’, ‘Men as decision makers’, ‘Diverse perceptions of sexual abstinence’ and ‘Barriers for men in using/accompanying partners to use reproductive and child healthcare services’. The crosscategory theme ‘Men during postpartum: remaining powerful but excluded’ refers to how men are in a powerful position above women in different aspects of life. Elderly women played an important role in caring for postpartum mothers and their newborns, but men were the ones making the final decision about where to seek care. Traditional practices isolated men from their partners for a certain period, and enforced sexual abstinence for the women during the postpartum period. However, cultural norms permitted men to engage in extramarital relations. Reproductive and child healthcare services were perceived by men as not welcoming the male partners, and local gender norms discouraged men from accompanying their partners to seek services. Conclusions: In this study, we found that men perceived their role during the postpartum period as financial providers, decision makers and, occasionally, care givers. Men also held diverse perceptions with regard to sexual abstinence and felt excluded from participating in maternal healthcare services.
The study was conducted in the Kongwa district of the Dodoma region, located in central Tanzania. The Kongwa district has a population of 248,656, 90% of whom live in rural areas. The main economic activity of the population in this area is agriculture, including crop cultivation and livestock keeping. People in this area also engage in other activities, such as trade and small-scale mining. The transport infrastructure is limited and existing roads are in poor condition, making it difficult to access healthcare services. The district was purposively selected because of its rural characteristics and the ongoing research focused on health systems. According to 2010 statistics, 97.4% of women in mainland Tanzania receive at least one antenatal care visit, while 58.3.5% receive two or three visits, and 39.1% receive four or more visits. Delivery takes place at healthcare facilities in the Dodoma region in 45.9% of cases, and only 33.8% of mothers receive postpartum check-ups, defined as check-ups of the mother and the child [39]. Districts are divided into wards, villages, hamlets and households. Three villages were included in this study: Kongwa, which is a peri-urban village, and Ibwaga and Ugogoni, both located in remote places. There are few indicators available that provide insight into gender relations and women’s status in the Dodoma region. The Tanzania Demographic and Health Survey (TDHS) 2010 indicated that about 48.5% of women in the Dodoma region were unable to make their own decisions in terms of their health, household purchases and visits to their relatives, and 68.9% of women had experienced intimate partner violence in their lifetime [39]. The TDHS does not currently include any information on men’s involvement in reproductive health and/or maternal healthcare services. This study used a qualitative design to explore men’s perceptions about the cultural practices during postpartum period. Data collection and analysis were done in an interactive way, and any new, unexpected findings that emerged were incorporated in the process [40]. Qualitative research is grounded on the assumption that reality is subjective, multiple, socially constructed and contextually bound [40]. Focus group discussions (FGDs) were chosen as the method of data collection because they facilitate enhanced interaction between participants, and provide an opportunity to observe social and cultural norms [41]. Data collection was carried out in August 2013. Purposive sampling was used to select the villages and participants, meaning that participants were selected based on their experience of having postpartum partners or a baby born within 5 years of the study. Participants were approached through the guidance of village and ward leaders. The researcher explained the objective of the study for them before asking their participation, and asked their permission to audio-record the FGD. The FGDs were conducted in the local language of Kiswahili. The first and second authors, who are fluent in the language, moderated the discussions. The first author moderated all the FGDs, while the second author acted as an observer for some of the FGDs. In all FGDs a male research assistant was also present who took notes in relation to the participants’ responses and interaction. Debriefing sessions between the moderator, observer (when present) and note-taker took place after every FGD. The FGDs took place in the village or ward offices, depending on the preference of participants. Data were collected through 14 FGDs with a total of 93 men. The participants’ age ranged from 19 to 65 years. The majority of the participants (71%) had completed primary education (standard seven) and most of them (89%) were engaged in agricultural activities. Data collection stopped when a saturation point was reached, i.e. no new information related to our research question was emerging [40]. The FGDs gathered information on the following issues: roles that men play in the postpartum period, their perspectives regarding maternal care during the postpartum period, cultural traditions related to the postpartum period and sexual relations. They also explored their participation in formal postpartum care services and their perceptions on women’s use of formal postpartum care services. The digitally recorded FGDs were transcribed verbatim and entered into Open Code 3.4 to manage the data and facilitate the analysis [42]. Data were analyzed using qualitative content analysis [40]. First, the FGDs were read several times to obtain a sense of a whole, and to identify meaning units, i.e. short sections of the transcripts that were meaningful and related to our research question. Secondly, the identified meaning units were condensed into short summarized versions, what Graneheim and Lundman [40] call condensed meaning units. Thirdly, from the condensed meaning units, codes were further elaborated. Fourthly, codes were grouped together, and through going back and forth between the text and the developed codes and preliminary groups, categories were developed. Categories refer to a higher level of abstraction, but still convey the manifest content of the transcripts. Finally, through constant comparison between categories and the rest of the material, a theme was constructed that cut across the categories and reflected the latent content of the text [40]. (See Table A1 for an example of the process followed in the analysis.) Coding was conducted with the Kiswahili transcripts to remain close to the text. Codes were then translated into English to develop categories and themes. Among the researchers, three are native Swahili speakers.
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