Perceptions about the cultural practices of male partners during postpartum care in rural Tanzania: A qualitative study

Global Health Action, Volume 10, No. 1, Year 2017

Ukuhunyushwa

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.

I-AI Digest

Study Justification:

– Men play an important role in maternal health during the postpartum period
– Scarcity of research exploring men’s involvement during this stage
– Need to understand male partners’ perceptions of cultural practices during postpartum care in rural Tanzania

Highlights:

– Four categories emerged: ‘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’
– Men perceived their role during the postpartum period as financial providers, decision makers, and occasionally care givers
– Cultural norms isolated men from their partners and enforced sexual abstinence for women, while permitting men to engage in extramarital relations
– Men felt excluded from participating in maternal healthcare services and perceived them as unwelcoming to male partners

Recommendations:

– Increase awareness and education about the importance of male involvement during the postpartum period
– Promote gender equality and challenge cultural norms that isolate men from their partners
– Develop strategies to encourage men to accompany their partners to seek reproductive and child healthcare services
– Improve the accessibility and inclusivity of healthcare services for male partners

Key Role Players:

– Researchers and academics in the field of maternal health
– Local community leaders and influencers
– Healthcare providers and professionals
– Non-governmental organizations (NGOs) working in the area of reproductive and child healthcare

Cost Items for Planning Recommendations:

– Community education and awareness campaigns
– Training programs for healthcare providers on gender-sensitive care
– Development and implementation of strategies to improve accessibility and inclusivity of healthcare services
– Research and evaluation of interventions to measure impact and effectiveness

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study conducted in a specific region of Tanzania. The study used focus group discussions to gather data from 93 men. The findings provide insights into men’s perceptions of cultural practices during the postpartum period. However, the evidence is limited to a specific population and may not be generalizable to other contexts. To improve the strength of the evidence, future research could include a larger and more diverse sample of participants from different regions to ensure broader representation. Additionally, incorporating quantitative data could provide a more comprehensive understanding of men’s involvement in postpartum care.

Abstract

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.

Izinto zokwakha

N/A

Emisha

Based on the information provided, here are some potential innovations that could improve access to maternal health in rural Tanzania:

1. Mobile Clinics: Implementing mobile clinics that can travel to remote areas and provide maternal health services, including postpartum care, to women who have limited access to healthcare facilities.

2. Male Involvement Programs: Developing programs that specifically target male partners and aim to educate them about the importance of their involvement in maternal health, including postpartum care. These programs can also address cultural practices and norms that may hinder men from accompanying their partners to seek healthcare services.

3. Community Health Workers: Training and deploying community health workers in rural areas to provide basic maternal health services, including postpartum care. These workers can also serve as a bridge between the community and formal healthcare facilities, helping to overcome barriers to access.

4. Telemedicine: Utilizing telemedicine technology to connect rural communities with healthcare professionals in urban areas. This can allow for remote consultations, advice, and support for postpartum mothers, reducing the need for travel and improving access to healthcare services.

5. Health Education Campaigns: Implementing targeted health education campaigns that focus on raising awareness about the importance of postpartum care and addressing cultural practices that may hinder access. These campaigns can be conducted through various channels, such as radio, community meetings, and mobile messaging.

It’s important to note that the specific context and needs of the community should be taken into consideration when implementing any innovation.

AI Innovations Description

Based on the study conducted in rural Tanzania, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Engaging male partners in maternal healthcare: The study found that men in rural Tanzania perceive their role during the postpartum period as financial providers, decision makers, and occasionally, care givers. To improve access to maternal health, it is important to actively involve male partners in the process. This can be done by providing education and awareness programs specifically targeting men, highlighting the importance of their involvement in postpartum care and encouraging them to accompany their partners to seek reproductive and child healthcare services.

2. Addressing cultural practices and norms: The study identified cultural practices and norms that isolate men from their partners during the postpartum period and enforce sexual abstinence for women. However, cultural norms also permit men to engage in extramarital relations. To improve access to maternal health, it is crucial to address these cultural practices and norms. This can be done through community engagement and dialogue, involving community leaders, elders, and influential individuals to challenge harmful practices and promote gender equality in postpartum care.

3. Creating male-friendly healthcare services: The study found that reproductive and child healthcare services were perceived by men as not welcoming to male partners, and local gender norms discouraged men from accompanying their partners to seek services. To improve access to maternal health, healthcare facilities should strive to create a male-friendly environment. This can include training healthcare providers to be more inclusive and sensitive to the needs of male partners, providing separate waiting areas or designated spaces for men, and ensuring that information and educational materials are accessible and relevant to men.

By implementing these recommendations, it is possible to develop innovative approaches that address the specific challenges faced in rural Tanzania and improve access to maternal health for women and their families.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations for improving access to maternal health in rural Tanzania:

1. Increase male involvement: Encourage and educate male partners about the importance of their involvement during the postpartum period. This can be done through community outreach programs, workshops, and educational campaigns that highlight the benefits of male involvement in maternal health.

2. Address cultural practices: Work with community leaders, elders, and influential individuals to challenge harmful cultural practices that isolate men from their partners during the postpartum period. Promote open discussions about the impact of these practices on maternal health and explore alternative ways to preserve cultural traditions while ensuring the well-being of both mothers and newborns.

3. Improve reproductive and child healthcare services: Make healthcare facilities more welcoming and inclusive for male partners. Train healthcare providers to engage and involve male partners in the care of their partners and newborns. This can include providing information, counseling, and support to both men and women during the postpartum period.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current state of access to maternal health services in the target area. This can include information on the number of women receiving antenatal care, delivery at healthcare facilities, and postpartum check-ups.

2. Define indicators: Identify specific indicators that will be used to measure the impact of the recommendations. For example, the percentage of male partners attending antenatal care visits or the number of women receiving postpartum check-ups.

3. Intervention implementation: Implement the recommended interventions, such as community outreach programs, workshops, and training for healthcare providers. Monitor the implementation process to ensure adherence to the planned activities.

4. Data collection post-intervention: Collect data after the implementation of the interventions to assess any changes in access to maternal health services. This can be done through surveys, interviews, or observations.

5. Data analysis: Analyze the collected data to evaluate the impact of the interventions. Compare the post-intervention data with the baseline data to identify any improvements in access to maternal health services.

6. Interpretation and reporting: Interpret the findings and report on the impact of the recommendations. This can include identifying any challenges or barriers encountered during the implementation process and providing recommendations for further improvement.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health in rural Tanzania.

Umbhali

Dima Health

Statistics:

Citations: 11

Identifiers:

DOI: 10.1080/16549716.2017.1361184

Research Areas:

Environmental, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury

Study Countries:

Tanzania

Study Design:

Cross Sectional Study, Grounded Theory, Phenomenological Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female

Yabelana ngalokhu: