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Background: Family-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father’s inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia. Methods: A qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically. Results: Participants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish ‘family-like’ relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments. Conclusions: Results suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men’s involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers.
Qualitative research was considered an appropriate approach given the emerging status of knowledge into culturally diverse father’s experiences in pregnancy, childbirth and infancy care in Australia. The authors decided that focusing on one cultural group and sampling for diversity within that group would allow a deeper exploration of these father’s experiences. An exploratory investigation using a qualitative method (semi-structured interviews). Australia has a two-tiered health system: all citizens are entitled to fee free hospital care in the public health system and people can purchase private health insurance that entitles them to care provided by a clinician of choice in a private hospital. Several models of public maternity care are offered: 10 standard antenatal care consultations with public hospital midwives, General Practitioners or if needed, hospital-based obstetrician). Births are in hospital, attended by obstetricians and midwives with follow), nurses and midwives during childbirth. Nearly half of all women receive private sector care provided by private obstetricians in private hospitals. In Victoria, the Australian state in which this study was conducted, postnatal care is provided in a universal system by community-based Maternal and Child Health (MCH) nurses tracking the health and development of their child at 10 key ages and stages [46]. Men are able to access 10 days paid government paternity leave if they have been in paid employment for 10 months prior to the birth. The community Maternal and Child Health (MCH) services program aims to be “father inclusive”. The Maternal and Child Health program standards recognise “the unique role of the father in the health and development of the child and supports him in his role” (pp 21) as a key criterion in achieving standard 2 “optimal health and development” [46]. Perinatal healthcare is defined as healthcare provided during pregnancy, childbirth, post-partum and care for an infant in the first year. Fathers’ involvement is defined as a father’s experience attending or attitudes towards, perinatal healthcare. Men and women born in Ethiopia, permanently living in Australia with sufficient English fluency to read participant information and consent form and participate in an interview, who had experienced or their partner had experienced pregnancy and childbirth in Australia in the last 2 years were eligible to participate. Participants were recruited via a snowball sampling technique [47]. Community leaders from within the Ethiopian community identified two potential participants and provided an initial introduction to the researcher (by setting up a face-to-face meeting or providing telephone details with the permission of the potential participant). On completion of the study, participants were asked if they are able to identify other potential participants and provide an introduction in the same way. One of the first participants lived in Australia following a skilled migration pathway, where he came on a student visa. Another early participant arrived in Australia on a refugee visa. This led to recruitment from different parts of the community, parity and duration of time in Australia, which allowed the researchers to recruit for diversity. Recruitment continued until the data was deemed to have sufficient “information power” [48]. The concept of “information power” is commonly used in qualitative research to help determine the sample size required. Sufficient information power is thought to have occurred during data collection, when no new themes emerge from subsequent interviews [48]. Semi-structured interviews were held in person or using an online platform such as Zoom by the first author. Interviews were conducted in English. Audio-recorded oral informed consent was received for the interview process and audio recording. All participants (including couples) were interviewed individually. They were assured their stories would be kept confidential and no one outside the research team would have access to their transcript. An interview script was used as a guide for the conversation, containing open-ended questions about male partners’ involvement and experiences during pregnancy, childbirth and the infant’s first year. For example (for women’s partners): “Please describe what your partner’s pregnancy for your youngest child was like for you”, “Tell me about your experiences of your partner’s pregnancy care, e.g. antenatal clinic?”, “What were your reasons for being involved?” and “Overall, please tell me what you think about men’s participation in family health services?” Audio data were de-identified and transcribed using a combination of an automated method and manual transcription. Thematic analysis was conducted using a line-by-line deductive coding process, facilitated by Nvivo software. Codes were then organised into similar categories that became the themes. Men’s and women’s data were analysed separately, and then compared and merged as described by Braun and Clarke [49]. The researchers underwent a reflexive process to identify potential biases in order to ‘bracket’ these and remain objective [50]. The first author, who conducted interviews and performed the bulk of the analysis, identified beliefs about the benefits and positive nature of male partner involvement in the perinatal period. In order to actively seek alternative viewpoints, questions about potential negative impacts of male involvement were introduced during the reflective process during the interview. During analysis themes that may reflect negative consequences of male partner involvement were actively sought.
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