Highlights
- Less than half of men in rural Uganda are actively involved in their partners’ pregnancy and childbirth.
- Men desire to be involved in pregnancy and childbirth but struggle to fulfil their perceived roles as ideal fathers due to various barriers such as attitudes, social norms, a sense of control, and health system barriers.
- Comprehensive interventions, such as educating men about childbirth, training health workers in better communication, and creating more welcoming hospital spaces for male partners, are needed to increase male involvement in maternal health care.
Background:
Male involvement during pregnancy and childbirth is important for improving maternal and child health outcomes. It leads to better access to care, enhanced pregnancy experiences, and reduced infant mortality. However, despite its importance, male involvement remains low in many settings.
In Uganda, while there is a policy supporting male participation, implementation faces significant challenges. The effects of male involvement on maternal and child health are substantial. When fathers are actively involved, women are more likely to attend antenatal care visits, have institutional deliveries, and experience less stress during pregnancy. This involvement is associated with an almost two-fold higher likelihood of skilled birth attendance and a reduction in neonatal mortality.
Current statistics indicate that male involvement in maternal health remains low across many African countries. For instance, in Burundi, only one in five men attends at least one antenatal care visit, while in Rwanda, the rate is higher, with more than one in every two men participating. In Uganda specifically, only about 6% of men consistently accompany their partners for antenatal care visits.
Male involvement during pregnancy and childbirth is low in Uganda. By looking at the experiences of men whose partners had pregnancy complications at Mulago Hospital, we can find ways to encourage more men to participate. Understanding what helps and what hinders male involvement from the fathers’ point of view will help create better policies and programs. This can lead to more men being involved in maternal health care, which will improve health outcomes for mothers and children in Uganda and similar places.
Methods:
This study used qualitative interviews with 16 men at Mulago Hospital in Kampala, Uganda to understand the factors influencing male involvement in pregnancy and childbirth.
Key findings:
- Men want to be involved in pregnancy and childbirth but face obstacles. These include work duties, lack of knowledge about pregnancy, unclear roles, traditional gender norms, and unfriendly hospital setups.
- Hospitals often keep men out, despite policies for involvement. Men can’t enter labour wards, find no space for them in antenatal clinics, and are ignored by staff.
- Men feel left out and unsure during childbirth. They are called “visitors” instead of partners, feel helpless, and don’t know how to support their wives. There’s no clear guidance on their role.
- Health workers don’t communicate well with men. Men struggle to get information about their partners’ health, are left out of care decisions, and receive unclear information when it’s given.
Conclusion:
The study shows that increasing male involvement in maternal health care requires more than just encouraging men to participate. It requires changing mindsets, addressing practical barriers, and reforming health system practices. Men’s personal beliefs, social pressures, perceived ability to overcome obstacles, and experiences with the health system all play crucial roles. To make real progress, a comprehensive approach addressing all these areas is needed.
Policy Implications:
- Current efforts to promote male involvement are insufficient. New, more comprehensive strategies are required.
- Providing information alone is not enough. Active shaping of attitudes and social norms around male involvement is necessary.
- Health system reform is critical. Hospitals need to create more welcoming environments for men.
- Improving communication between health workers and men could have a positive effect on male involvement.
- Practical barriers that make men feel they can’t participate need to be addressed.
Recommendations:
- Community campaigns: Launch widespread community campaigns to improve knowledge and attitudes about male involvement in maternal health care.
- Health worker training: Train health workers in communicating with and involving men during pregnancy and childbirth.
- Hospital policies: Develop clear policies and procedures for male involvement in maternity wards.
- Facility improvement: Create welcoming spaces for men in maternity wards, with information and education provided.
- Role clarification: Develop guidelines clarifying men’s roles during pregnancy, childbirth, and postpartum periods.
- Monitoring and Evaluation: Develop a system to track progress and identify areas for improvement in male involvement.
- Further Research: Conduct research to test different intervention strategies and identify the most effective ways to increase male involvement in various contexts.
The above article is based on research conducted at Mulago Hospital in Uganda.
Kaye, D. K., Kakaire, O., Nakimuli, A., Osinde, M. O., Mbalinda, S. N., & Kakande, N. (2014). Male involvement during pregnancy and childbirth: Men’s perceptions, practices, and experiences during the care for women who developed childbirth complications in Mulago Hospital, Uganda. BMC Pregnancy and Childbirth, 14(1), 54. https://doi.org/10.1186/1471-2393-14-54
Other references
Alio, A. P., Mbah, A. K., Kornosky, J. L., Wathington, D. J., Marty, P. J., & Salihu, H. M. (2011). Assessing the impact of paternal involvement on racial/ethnic disparities in infant mortality rates. Journal of Community Health, 36(1), 63-68. https://doi.org/10.1007/s10900-010-9280-3
Kariuki, K. F., & Seruwagi, G. K. (2016). Determinants of male partner involvement in antenatal care in Wakiso District, Uganda. Journal of Advances in Medicine and Medical Research, 18(7), 1-15. https://doi.org/10.9734/BJMMR/2016/28056
Ministry of Health. (2019). Policy guidelines to male involvement in sexual and reproductive health service delivery. Retrieved from http://library.health.go.ug/sites/default/files/resources/Male%20involvement%20policy%20guidelines%20revised%20UPDATED%202019%20Olive.pdf
Tokhi, M., Comrie-Thomson, L., Davis, J., Portela, A., Chersich, M., & Luchters, S. (2018). Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLoS One, 13(1), e0191620. https://doi.org/10.1371/journal.pone.0191620