Sociodemographic Factors Associated with Women’s Perspectives on Male Involvement in Antenatal Care, Labour, and Childbirth

Journal of Pregnancy, Volume 2020, Year 2020

Interpretation

Background. Evidence suggests that in patriarchal societies such as Ghana, access to and survival of maternal and child healthcare services require the active involvement of men. However, interventions to promote men’s involvement in maternal and child health care are less likely to succeed if the views and concerns of women are not considered. This study provides an understanding of women’s perspective on men’s involvement in antenatal care, labour, and childbirth in the Northern Region of Ghana. Methods. Data for this cross-sectional study were collected from 300 pregnant women using a structured questionnaire. Logistic regression models were then used to determine the socio-demographic factors associated with women’s perspectives on men’s involvement in antenatal care, labour, and childbirth. Results. The mean age of the participants was 28 (SD = 5.21) years. More than four-fifths of the women in this study express the desire for male partner involment in natenatal care (ANC) services (n = 258, 86%) and as companions during labour and child birth (n = 254, 84.7%). We found that married women were 9.8 times more likely (95%CI 1.59, 60.81) to encourage male involvement in ANC compared to women who were unmarried. The probability of encouraging male involvement in ANC decreased with increased level of education among the women while support for male companionship during childbirth increased significantly with an increased level of education. After accounting for the effect of other significant covariates, there was good evidence to suggest that married women (p = 0.002), women with only primary/Junior High School education (p = 0.048) and those with two (p = 0.010), three (p = 0.008), or ≥4 (p = 0.044) previous pregnancies had a desire for male partner involvement in ANC while women who attained secondary (p = 0.004) or tertiary (p = 0.001) level education expressed the desire for male companionship in labour and childbirth in the adjusted model. Conclusion. Male involvement in antenatal care, labour, and childbirth received overwhelming support from the women in this study. This cross‐sectional study was conducted at the antenatal clinic of Tamale Teaching Hospital (TTH), a tertiary health facility in the Northern Region of Ghana. The hospital serves as a referral centre for all the primary and secondary health facilities in the three regions of the North and the northern part of Brong‐Ahafo Region. It provides advanced clinical health services, collaborates with the University for Development Studies, Tamale, for the training of undergraduate and postgraduate students, and undertakes research that influences treatment and policy in the health sector [16]. The institutional review committee of the Tamale Teaching Hospital reviewed the study protocol and granted approval for the study. The purpose of the study and the rights of participants during the study were clearly explained to each participant and written consent obtained for their participation. The participants were informed they could refuse to answer any questionnaire they are not comfortable with or withdraw from the study at any point without any condition or threat. Only the authors had access to the information collected from participants and the confidentiality of the information was ensured in accordance with the data protection act. Three hundred pregnant women were recruited for the study. In line with the inclusion criteria of the study, only pregnant women who were attending ANC at the Tamale Teaching Hospital were enrolled into the study. Pregnant women who were unwilling to give consent and those who did not attend ANC at TTH were excluded from the study. Cochran’s formula was used to estimate the sample size for the study using 14% prevalence of male partner attendance at the antenatal clinic [11], an assumption of 95% confidence interval, and 5% degree of error. A minimum sample size of 185 was estimated. However, the final sample size was increased to 300 to boost the power of the study. Systematic random sampling method was used to recruit pregnant women for the study. In this type of probability sampling method, study participants are chosen at regular intervals (estimated by dividing the projected population size by the sample size) from a sample frame after randomly selecting the first participant [17]. A review of the ANC attendance register for the month prior to the period of data collection showed that an average of 80 pregnant women visits the clinic for ANC services daily. Data collection for the study was scheduled to take place within a month during which nearly 1800 pregnant women were expected to visit the antenatal clinic. The estimated monthly attendance was divided by the sample size (300) to give a sampling interval of 6. The first participant for each day of data collection was randomly selected. After that, every sixth (6th) eligible pregnant woman was selected to participate in the study until the sample size was obtained. A structured questionnaire was used to collect data from the participants on socio‐demographic characteristics such as age, marital status, religion, ethnicity, educational level, and occupation; male involvement in antenatal care; and male partner companionship during labour and childbirth. For the purposes of this study, “male involvement” was defined as the attendance and participation of men in antenatal care services during the visits of their spouse and their presence and support during childbirth. The items for the questionnaire were designed after a thorough literature review of similar studies in peer‐reviewed journals [11, 13, 18–20]. A senior midwife and a public health specialist reviewed the questionnaire and deemed the items appropriate and content valid. Three final year nursing students administered the questionnaire to participants. They were trained on how to obtain consent and administer the study questionnaire to the participants. Women visiting the antenatal clinic were informed about the study during health talk at the clinic and assessed for eligibility afterwards. Voluntary consent for participation was sought from eligible participants and the study questionnaire was only administered to women who agreed to participate in the study after the health talk. The research assistants and the principal investigator explained to the participants how to complete the questionnaire and addressed their concerns. Participants who had no formal education and could not read or write were assisted by the research assistants to complete the questionnaire, this was reported in less than 20% of the participants. Prior to data collection, a native speaker proficient in both English language and the main local language (Dagbani) translated the questionnaire into Dagbani. A second native speaker reviewed the translated instrument to ensure clarity and to eliminate ambiguities. The data collectors, who were native speakers of the main local language, then used the translated questionnaire for all participants with no formal education. The principal investigator supervised the data collection exercise and reviewed all completed questionnaires at the end of each day. Data were cross‐checked for completeness, coded in Microsoft Excel spreadsheet, and analysed using STATA Version 14.0 (College Station, Texas 77845, USA). Socio‐demographic characteristics and women’s perspectives on men’s involvement in antenatal care, labour, and childbirth were described in tables using frequencies and percentages. Univariate and multivariable logistic regression models were used to determine socio‐demographic factors associated with women’s perspectives on men’s involvement in antenatal care, labour, and childbirth estimating Odds ratio with 95% confidence intervals and p values. The univariate logistic regression was applied in the initial analysis and factors with p‐value < .05 were selected for inclusion in the multivariable logistic regression analysis to determine independent predictors of women's perspectives on men's involvement in antenatal care, labour, and childbirth. In both the Univariate and multivariable regression models, the significance level was set at <.05.

AI Digest

Study Justification:

This study aims to investigate women’s perspectives on male involvement in antenatal care, labor, and childbirth in the Northern Region of Ghana. The justification for this study is based on the understanding that in patriarchal societies like Ghana, men’s active involvement is crucial for the access and survival of maternal and child healthcare services. However, interventions to promote male involvement are less likely to succeed if women’s views and concerns are not taken into account. Therefore, this study seeks to provide valuable insights into women’s perspectives, which can inform the development of effective interventions and policies.

Highlights:

– The study found that more than four-fifths of the women expressed a desire for male partner involvement in antenatal care services and as companions during labor and childbirth.
– Married women were found to be 9.8 times more likely to encourage male involvement in antenatal care compared to unmarried women.
– The probability of encouraging male involvement in antenatal care decreased with an increased level of education among women, while support for male companionship during childbirth increased significantly with higher education levels.
– The study highlights the overwhelming support for male involvement in antenatal care, labor, and childbirth among the women in the study.

Recommendations:

Based on the findings of this study, the following recommendations can be made:

1. Interventions and policies should prioritize and promote male involvement in antenatal care, labor, and childbirth, as it is desired and supported by women.
2. Efforts should be made to address the barriers and challenges faced by unmarried women in encouraging male involvement in antenatal care.
3. Education and awareness programs should be developed to increase understanding and support for male companionship during childbirth, particularly among women with lower education levels.
4. Further research should be conducted to explore the specific factors influencing women’s perspectives on male involvement in maternal and child healthcare, in order to develop targeted interventions.

Key Role Players:

1. Ministry of Health: Responsible for developing and implementing policies related to maternal and child healthcare.
2. Healthcare Providers: Including doctors, nurses, and midwives who play a crucial role in promoting and facilitating male involvement in antenatal care, labor, and childbirth.
3. Community Leaders: Engaging community leaders can help in raising awareness and promoting acceptance of male involvement in maternal and child healthcare.
4. Non-Governmental Organizations (NGOs): NGOs working in the field of maternal and child healthcare can play a significant role in implementing interventions and providing support for male involvement.

Cost Items for Planning Recommendations:

1. Education and Awareness Programs: Budget for developing and implementing educational programs targeting women with lower education levels to increase support for male companionship during childbirth.
2. Training and Capacity Building: Budget for training healthcare providers on promoting and facilitating male involvement in antenatal care, labor, and childbirth.
3. Community Engagement Activities: Budget for organizing community events, workshops, and campaigns to raise awareness and promote acceptance of male involvement.
4. Research and Evaluation: Budget for conducting further research to explore factors influencing women’s perspectives and evaluating the effectiveness of interventions.
Please note that the provided cost items are general categories and the actual cost will depend on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is cross-sectional, which limits the ability to establish causality. Additionally, the sample size could be larger to increase the power of the study. To improve the evidence, conducting a longitudinal study or a randomized controlled trial would provide stronger evidence. Increasing the sample size would also improve the generalizability of the findings. Finally, including qualitative data or interviews with women to gain a deeper understanding of their perspectives would enhance the study’s findings.

Abstract

This cross‐sectional study was conducted at the antenatal clinic of Tamale Teaching Hospital (TTH), a tertiary health facility in the Northern Region of Ghana. The hospital serves as a referral centre for all the primary and secondary health facilities in the three regions of the North and the northern part of Brong‐Ahafo Region. It provides advanced clinical health services, collaborates with the University for Development Studies, Tamale, for the training of undergraduate and postgraduate students, and undertakes research that influences treatment and policy in the health sector [16]. The institutional review committee of the Tamale Teaching Hospital reviewed the study protocol and granted approval for the study. The purpose of the study and the rights of participants during the study were clearly explained to each participant and written consent obtained for their participation. The participants were informed they could refuse to answer any questionnaire they are not comfortable with or withdraw from the study at any point without any condition or threat. Only the authors had access to the information collected from participants and the confidentiality of the information was ensured in accordance with the data protection act. Three hundred pregnant women were recruited for the study. In line with the inclusion criteria of the study, only pregnant women who were attending ANC at the Tamale Teaching Hospital were enrolled into the study. Pregnant women who were unwilling to give consent and those who did not attend ANC at TTH were excluded from the study. Cochran’s formula was used to estimate the sample size for the study using 14% prevalence of male partner attendance at the antenatal clinic [11], an assumption of 95% confidence interval, and 5% degree of error. A minimum sample size of 185 was estimated. However, the final sample size was increased to 300 to boost the power of the study. Systematic random sampling method was used to recruit pregnant women for the study. In this type of probability sampling method, study participants are chosen at regular intervals (estimated by dividing the projected population size by the sample size) from a sample frame after randomly selecting the first participant [17]. A review of the ANC attendance register for the month prior to the period of data collection showed that an average of 80 pregnant women visits the clinic for ANC services daily. Data collection for the study was scheduled to take place within a month during which nearly 1800 pregnant women were expected to visit the antenatal clinic. The estimated monthly attendance was divided by the sample size (300) to give a sampling interval of 6. The first participant for each day of data collection was randomly selected. After that, every sixth (6th) eligible pregnant woman was selected to participate in the study until the sample size was obtained. A structured questionnaire was used to collect data from the participants on socio‐demographic characteristics such as age, marital status, religion, ethnicity, educational level, and occupation; male involvement in antenatal care; and male partner companionship during labour and childbirth. For the purposes of this study, “male involvement” was defined as the attendance and participation of men in antenatal care services during the visits of their spouse and their presence and support during childbirth. The items for the questionnaire were designed after a thorough literature review of similar studies in peer‐reviewed journals [11, 13, 18–20]. A senior midwife and a public health specialist reviewed the questionnaire and deemed the items appropriate and content valid. Three final year nursing students administered the questionnaire to participants. They were trained on how to obtain consent and administer the study questionnaire to the participants. Women visiting the antenatal clinic were informed about the study during health talk at the clinic and assessed for eligibility afterwards. Voluntary consent for participation was sought from eligible participants and the study questionnaire was only administered to women who agreed to participate in the study after the health talk. The research assistants and the principal investigator explained to the participants how to complete the questionnaire and addressed their concerns. Participants who had no formal education and could not read or write were assisted by the research assistants to complete the questionnaire, this was reported in less than 20% of the participants. Prior to data collection, a native speaker proficient in both English language and the main local language (Dagbani) translated the questionnaire into Dagbani. A second native speaker reviewed the translated instrument to ensure clarity and to eliminate ambiguities. The data collectors, who were native speakers of the main local language, then used the translated questionnaire for all participants with no formal education. The principal investigator supervised the data collection exercise and reviewed all completed questionnaires at the end of each day. Data were cross‐checked for completeness, coded in Microsoft Excel spreadsheet, and analysed using STATA Version 14.0 (College Station, Texas 77845, USA). Socio‐demographic characteristics and women’s perspectives on men’s involvement in antenatal care, labour, and childbirth were described in tables using frequencies and percentages. Univariate and multivariable logistic regression models were used to determine socio‐demographic factors associated with women’s perspectives on men’s involvement in antenatal care, labour, and childbirth estimating Odds ratio with 95% confidence intervals and p values. The univariate logistic regression was applied in the initial analysis and factors with p‐value < .05 were selected for inclusion in the multivariable logistic regression analysis to determine independent predictors of women's perspectives on men's involvement in antenatal care, labour, and childbirth. In both the Univariate and multivariable regression models, the significance level was set at <.05.

Materials

N/A

Innovations

Based on the provided information, the study titled “Sociodemographic Factors Associated with Women’s Perspectives on Male Involvement in Antenatal Care, Labour, and Childbirth” conducted in Ghana identified several factors associated with women’s perspectives on male involvement in maternal health. Some potential recommendations for innovations to improve access to maternal health based on this study could include:

1. Male Involvement Programs: Develop and implement programs that actively involve men in antenatal care, labor, and childbirth. These programs can include education and awareness campaigns targeting men, providing information on the importance of their involvement and addressing any cultural or societal barriers.

2. Community Engagement: Engage community leaders, religious leaders, and traditional birth attendants to promote male involvement in maternal health. These influential figures can help change societal norms and attitudes towards male participation in antenatal care and childbirth.

3. Education and Awareness: Increase education and awareness among women about the benefits of male involvement in maternal health. This can be done through community health talks, educational materials, and counseling sessions during antenatal care visits.

4. Training for Healthcare Providers: Provide training for healthcare providers on how to effectively engage and involve men in maternal health. This can include communication skills training, cultural sensitivity training, and strategies for addressing potential barriers to male involvement.

5. Policy Support: Advocate for policies that support and encourage male involvement in maternal health. This can include policies that promote flexible work arrangements for men to attend antenatal care visits, policies that provide incentives for male participation, and policies that address gender inequalities in healthcare decision-making.

6. Peer Support Groups: Establish peer support groups for women to share their experiences and encourage each other to involve their male partners in maternal health. These groups can provide emotional support, practical tips, and guidance on how to engage men in antenatal care and childbirth.

It is important to note that these recommendations are based on the specific findings of the study conducted in Ghana and may need to be adapted to suit the context and cultural norms of other regions or countries.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health is to promote and encourage male involvement in antenatal care, labor, and childbirth. This recommendation is based on the findings of a cross-sectional study conducted in the Northern Region of Ghana, which showed that the majority of women expressed a desire for male partner involvement in antenatal care services and as companions during labor and childbirth.

The study found that married women were more likely to encourage male involvement in antenatal care compared to unmarried women. Additionally, the probability of encouraging male involvement in antenatal care decreased with an increased level of education among women, while support for male companionship during childbirth increased significantly with an increased level of education.

To implement this recommendation, healthcare providers and policymakers can consider the following strategies:

1. Education and awareness: Conduct educational campaigns to raise awareness among women about the benefits of male involvement in maternal health. This can include providing information about the role men can play in supporting their partners during pregnancy, childbirth, and postpartum care.

2. Training and sensitization: Provide training and sensitization programs for healthcare providers to ensure they are equipped with the knowledge and skills to involve men in maternal health services. This can include training on effective communication strategies and addressing cultural and gender norms that may hinder male involvement.

3. Community engagement: Engage community leaders, religious leaders, and other influential stakeholders to promote and support male involvement in maternal health. This can be done through community dialogues, workshops, and other community-based activities.

4. Policy support: Develop and implement policies that promote and support male involvement in maternal health. This can include policies that encourage healthcare facilities to create a welcoming and inclusive environment for men, as well as policies that provide incentives for men to actively participate in antenatal care and childbirth.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to better health outcomes for both women and their newborns.

AI Innovations Methodology

Based on the provided information, here is a potential innovation recommendation to improve access to maternal health:

Innovation Recommendation: Implementing targeted educational programs for women with lower levels of education to promote male involvement in antenatal care, labor, and childbirth.

Brief Methodology to Simulate the Impact of the Recommendation:

1. Define the objectives: Clearly define the objectives of the simulation, such as assessing the potential impact of targeted educational programs on women’s perspectives on male involvement in maternal health.

2. Collect baseline data: Gather data on the current perspectives of women regarding male involvement in antenatal care, labor, and childbirth. This data can be obtained through surveys or interviews similar to the cross-sectional study mentioned in the description.

3. Develop a simulation model: Create a simulation model that incorporates the collected data and simulates the impact of implementing targeted educational programs. The model should consider factors such as the level of education, marital status, and previous pregnancies, which were found to be associated with women’s perspectives on male involvement.

4. Define intervention parameters: Determine the parameters of the targeted educational programs, such as the content, duration, and delivery methods. These parameters should be based on evidence-based practices and tailored to the specific needs of women with lower levels of education.

5. Simulate the impact: Run the simulation model using the defined intervention parameters. The model should generate estimates of the potential changes in women’s perspectives on male involvement in maternal health after implementing the targeted educational programs.

6. Analyze the results: Analyze the simulation results to assess the potential impact of the recommended intervention. This analysis should include evaluating changes in women’s perspectives, identifying any disparities based on socio-demographic factors, and estimating the overall improvement in access to maternal health.

7. Interpret and communicate the findings: Interpret the simulation results and communicate the findings to relevant stakeholders, such as healthcare providers, policymakers, and community organizations. Highlight the potential benefits of implementing targeted educational programs to improve access to maternal health and address any identified disparities.

It’s important to note that the methodology provided is a general framework and may need to be adapted based on the specific context and available resources. Additionally, conducting further research and piloting the recommended intervention in real-world settings would be necessary to validate the simulation results and assess the feasibility and effectiveness of the proposed innovation.

Author

Dima Health

Statistics:

Citations: 5

Identifiers:

DOI: 10.1155/2020/6421617

ISSN: 20902727

Research Areas:

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

Study Countries:

Ghana

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Male & Female