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Background: Evidence has shown that male involvement is associated with improved maternal health outcomes. In rural Tanzania, men are the main decision makers and may determine women’s access to health services and ultimately their health outcomes. Despite efforts geared towards enhancing male participation in maternal health care, their involvement in antenatal care (ANC) remains low. One barrier that impacts men’s participation is the fear and experience of social stigma. This study, builds on previous findings about men’s perspectives in attending antenatal care appointments in Misungwi district in Tanzania, examining more closely the fear of social stigma amongst men attending ANC together with their partners. Methods: Twelve individual interviews and five focus group discussions were conducted using semi-structured questionnaires with fathers and expectant fathers. In-depth interviews were conducted with health providers, volunteer community health workers and village leaders. Interviews were audiotaped, and transcripts were transcribed and translated to English. Transcripts were organized in NVivo V.12 then analyzed using thematic approach. Results: Three main themes were found to create fear of social stigma for men: 1. Fear of HIV testing; 2. Traditional Gender Norms and 3. Insecurity about family social and economic status. Conclusion: Respondent’s experiences reveal that fear of social stigma is a major barrier to attend ANC services with their partners. Attention must be given to the complex sociocultural norms and social context that underly this issue at the community level. Strategies to address fear of social stigma require an understanding of the real reasons some men do not attend ANC and require community engagement of community health workers (CHWs), government officials and other stakeholders who understand the local context.
This study was a secondary analysis of qualitative data collected for a broader research study of perceptions of male involvement in maternal services in Misungwi District located in Tanzania [2]. This qualitative study aimed to fully examine stories of shame, stigma or fear, which affects men’s ANC attendance together with their partners. This study was nested as a sub-study within a larger longitudinal implementation and evaluation of the Mama na Mtoto project intervention in rural Tanzania [16] which aimed to improve the delivery of essential health services to pregnant women, mothers, newborn and children under-five in Misungwi and Kwimba districts. Misungwi District is among seven districts of Mwana Region. It consists of 2579km2 with population of 351,607 according to the 2012 national census (NBS, 2012). The district is located in the Northwestern part of Tanzania, 45km from Mwanza town. The district has a predominantly rural population (91%) and a majority of population are Sukuma tribe, (91.9%,) speaking their tribal language in addition to Swahili (Tanzania National language). The district is divided into four divisions two semi-urban and two rural. The major economic activities are cattle-keeping and subsistence farming. Misungwi district has 2 hospitals, 4 health centres and 45 dispensaries. Two communities (“divisions”) were selected for the study, due to their high maternal mortality [17]. This qualitative study was informed by the ecological framework and the framework influenced sampling, data collection and analysis. Ecological frameworks consider the individual, interpersonal, community and societal factors and recognize the complex interplay across all levels of a health problem and the influence on health behaviors. Using an ecological framework sensitized our examination of barriers to male ANC attendance to multiple factors. Interview and focus group participants were recruited using purposive sampling method. From the four divisions of Misungwi district we purposively choose two rural divisions (Mbarika and Inonelwa) based on its unfavorable MNCH indicators [17]. In the divisions we conveniently selected one ward in Mbarika and three wards in Inonelwa. At the ward level, sampling procedures were culturally sensitive and tried to foster safety and trust in the communities. As such the following steps were taken: The research team developed an interview guide in advance incorporating personal experiences of team members, relevant literature, and questions aimed at target different levels of the ecological model. This tool was piloted in a different rural environment with men of similar characteristics, and small modifications and probes were added to the guide. Questions included “how does your community perceive men who attend ANC appointments with their partners?” and what were your experiences or what have you heard about attending an ANC visits?” Sukuma speaking research assistants were recruited to assist in obtaining consent and data collection for non-Swahili speaking participants. In total, five focus group discussions and 12 in-depth interviews were conducted with a total of 50 participants. The five FGD were composed only of fathers and homogenous by age to promote comfort and build on common emergent themes. The focus groups lasted on average of 60-90 min and took place at quiet and convenient places agreed by participants in their locations/homes. Each FGD consisted of 8-12 participants. There were 15 men whose partners were pregnant for the first time and 29 fathers who had one or more children. Their age ranged from 25 to 60 years old. Individual interviews were conducted with one health care provider, three village leaders and two community health workers (CHWs). The individual interviews lasted on average of 40-60 min each and took place at participants homes or at a secured room in the village office as per participants choices. Additionally, fathers from the FGD were selected for individual interviews to provide more in-depth feedback to meet saturation. Six men took part making a total of 12 individual interviews conducted. In both FGD and IDI, the facilitators conducted semi-structured interviews with participants, interviews were recorded, and research assistants’ rote field notes and documented non-verbal cues that provided a secondary source of data. Interviews conducted in Swahili were transcribed and then translated in English while those in Sukuma were transcribed in Swahili and later translated in English. All approached participants who agreed to join the study participated. Quality checks for the transcripts were performed by research team members who were not involved in data collection through listening to audio and reading corresponding transcript and noting any errors. Data were later reviewed by researchers who had conducted the interviews, they re-read all transcripts while listening to the audio recordings for the purpose of further validating the transcripts for accuracy and language. Despite that data analysis began during interviews and team meetings after the interviews, the secondary thematic analysis was influenced by our analysis and findings of our first paper 10.1186/s12884-021-03585-z [2] and we used sensitizing concepts such as fear, social stigma and gender norms to more fully explore the experience of social stigma. We used NVivo version 12 to organize qualitative data. Transcripts were read line by line and chunks of data were assigned a code. The codes were organized in NVivo, and code books were generated, reviewed and agreed upon by research team. Codes were organized and collapsed into broader themes. Memos were made to describe the rationale and process of sorting codes into the themes. Research analysis discussed discrepancies about themes until consensus was reached. The main themes were later obtained upon agreement with the research team.
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