‘Unless you come with your partner you will be sent back home’: strategies used to promote male involvement in antenatal care in Southern Tanzania

Background: Male involvement in pregnancy and childbirth has been shown to improve maternal and child health. Many countries have used different strategies to promote participation of men in antenatal care services. While many strategies have been employed to promote male participation in antenatal care, few have been evaluated to provide much-needed lessons to support wider adoption. Objective: This study aimed at describing strategies that were used by health providers and the community to promote male participation in antenatal care services and challenges associated with the implementation of these interventions in Southern Tanzania. Methods: We used qualitative data and analytical methods to answer the research questions. The study relied on semi-structured interviews with health providers, men and women, village and community leaders and traditional birth attendants. Data were analysed using a thematic approach. Results: The findings of this study revealed that different strategies were employed by health providers and the community in promoting participation of men in antenatal care services. These strategies included: health providers denying services to women attending antenatal care without their partners, fast-tracking service to men attending antenatal care with their partners, and providing education and community sensitisation. The implementation of these strategies was reported to have both positive and unintended consequences. Conclusions: This study concludes that despite the importance of male involvement in pregnancy and childbirth-related services, the use and promotion of the male escort policy should not inadvertently affect access to antenatal care services by pregnant women. In addition, programmes aiming for men’s involvement should be implemented in ways that respect, promote and facilitate women’s choices and autonomy and ensure their safety. Furthermore, there is a need for sensitisation of health providers and policymakers on what works best for involving men in pregnancy and childbirth.

The study was carried out in Masasi District Council in the Mtwara Region. The district had a total population of 260,856 which comprised 125,151 males and 135,705 females [27]. The district was purposively selected because the first author had an active role in the district. In Tanzania, 63% of women give birth in health facilities although over 90% of pregnant women attend ANC for at least one visit [28]. In addition, only 51% of pregnant women complete the recommended four ANC visits and only 24% start ANC attendance before the fourth month of pregnancy [28]. The pattern in rural areas of Tanzania is almost similar. The study involved one hospital, one health centre and four dispensaries. These health facilities were selected in collaboration between the authors and the district health management. The criteria for selecting these health facilities included availability of maternal and child health services as well as geographical accessibility to the health facilities and their catchment villages. This study adopted descriptive qualitative case study design. Descriptive case study design was considered relevant because the study aimed to describe strategies used by the health providers and the community to promote male involvement in pregnancy and childbirth and the real-life context in which they were implemented [29]. The study relied on semi-structured interviews with key respondents. The first author had a specific role in the community and therefore data were collected by a research assistant from April to June 2016. Respondents were purposively selected and included currently pregnant women attending ANC, women who had given birth in the past 12 months, health providers responsible for reproductive and child health at the selected health facilities, village and community leaders, social workers and traditional birth attendants. Women and health workers were recruited at the district hospital, one health centre, and four dispensaries. Health facilities were randomly selected. Interviews were carried out in the respective health facilities where women were found. Semi-structured interview guides were developed for each category of respondents (see additional files). Interviews lasted between 20 and 30 minutes and were audio-recorded with the permission of the respondents. As indicated in Table 1, a total of 53 interviews were carried out. Category of respondents. Data were analysed using a thematic approach proposed by Braun & Clarke [30]. The following iterative process was followed in data analysis. First, recordings of the interviews were transcribed verbatim in Kiswahili by AKP and checked for accuracy by SM. Only selected quotes used in the study were translated from Kiswahili to English. Second, both authors went through the data in order to understand the depth and breadth of the data-set. Third, AKP developed a list of initial codes based on the objectives of the study. Interviews were then coded manually based on these initial codes. Other codes which emerged during coding were added along the way. Fourth, we sorted the different codes into potential themes by looking into patterns in the coded data. Finally, themes were refined by reading and rereading the data-set. The main overarching themes that were finally identified were: health providers denying services to women attending attending antenatal care without partners, fast-tracking services to men attending antenatal care with their partners, and giving education and community sensitisation.

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• Dima Health