Abstract
Purpose Male involvement in maternal healthcare has been described as a key factor to reducing maternal mortality globally. Hence, this study investigated the choice of facility to be used during pregnancy and examined factors that influence male participation in maternal healthcare issues of their spouses as these factors may sometimes influence the choice of health care services for pregnant women. Method The study was cross-sectional in design; the setting was at Badagry, Lagos, Nigeria. Thirty married men with at least the experience of birth of baby, who consented to participate, were purposively recruited for the study. Data were transcribed and content analysed using free narrative. Result The results show that orthodox health care, traditional birth attendance (TBA), and faith healing were utilised by the respondents. The majority of the participants identified cost of health care services, economic recession, and their job demand as the reasons for their non-active participation in accompanying their spouses for antenatal clinic visit. Conclusion However, to increase the level of men’sparticipation in maternal healthcare, especially visiting antenatal clinic with spouses, antenatal services should be free of any monetary charges so as to encourage men to be involved and not look for excuses of financial needs. Utilisation of skilled birth attendance should be reinvigorated.
Keywords Maternalhealth .Healthcareservices .Traditional birth attendance . Economicrecession . Cost Introduction Maternal health is a key health challenge globally [1]. Each day, 800 women and 7700 new-borns die from complications during pregnancy, childbirth and other neonatal causes [2]. In addition, 7300 women experience stillbirth [3]. With maternal mortality ratio of 1000 per 100,000 birth and an estimated 58,000 deaths annually, Nigeria accounts for one of the highest estimates of maternal mortality globally [4]. Although there has been remarkable progress in reducing the number of child deaths worldwide, too many babies continue to die each year despite the availability of feasible, evidence-based solutions [5]. Study affirmed that antenatal care service is an important service goal concerning the health status of pregnant womenduringtheir reproductive period and its health beneficial accounting for nearly one quarter of all pregnancy worldwide [6]. However, Nigeria is poor in the utilisation of antenatal care [7, 8]. The 1994 call at addressing this kind of situation was made under the umbrella of the International Conference on Population and Development (ICPD) that advocated that special efforts should be made to emphasise men’s shared responsibility and promote their active involvement in maternal care [9]. In many African countries, pregnancy and childbirth are regarded as exclusive women’s affairs, where men are not generally expected to accompany their wives for antenatal care and not expected in the labour room during delivery [10]. In Nigeria, men play a very dominant role, especially on issues concerning women generally and on issues bordering on conceptions and reproductive health in particular. If there must be improvement in maternal health and reduction or elimination of maternal mortality, then it becomes imperative to understand the role or involvement of men in maternalcare oftheir wives.Thiswillhelpintimes ofdecision making, where the man is expected to take such decision. A study found low participation of men in maternal care, and this was attributable to ignorance, poverty, cultural and religious factors. Other factors for their non-active participation include perception by men that they are not welcome in the maternity unit of the hospitals or clinics, pregnancy and delivery as strictly for women, lack of interest and lack of knowledge [11]. This would have implications for the kind of care the man may render to the wife and subsequent pregnancy outcome. Previous study shows social, cultural, economic and political factors that affect maternal health outcomes and also indicates that asymmetrical relations of power place women at a disadvantage within the household, the community and health care facilities are barriers to good maternal health care [12]. Other causes of barriers to husband involvement are gender role norms and health system issues [13]. The benefits of positive husband’s involvement in maternal health care have been well articulated [14, 15]. USAID defined positive male (husband) in maternal and prenatal and family planning in such a way as to increase maternal and infant survival rates and improve family planning outcomes [16]. The benefits of male involvement in maternal health in any society have been identified, and these include increased maternal access to antenatal and postnatal services, discouragement ofunhealthy maternal practices such as smoking [17, 18] and increased likelihood of contraception usage [19]. Equally, studies have also documented the negative side of men’s involvement in maternal health to include male dominance in decision making [19]. However, studies indicate that male involvement in maternal health care is low in developing countries [11, 20–22]. Literature on participation of male in maternal health care in Africa identified factors at individual, family, community and health facility levels [23–26]. Studies also found husbands to be influential actors in pregnancy care across a range of social contexts [27, 28]. Husbands were also found to be primary source of pregnancy social support [29]. Hurtado found that some husbands play positive roles, while others seem uninterested, and concluded that husbands may be the most influential among family members regarding women’s prenatal health care practices [30]. Carter found that majority of husbands seem to provide pregnancy advice (including issues of which providers to see and at what time), discuss prenatal care with their wives and accompany them on prenatal care visits, and provide money for these visits [24]. Akinpelu and Oluwaseyi noted that educationally informed husband improves antenatal care outcomes, and this can mean the differences between life and death especially in cases of complications, when women need immediate medical care [31]. However, Ezeama and Ezeamah affirmed that the problems of increase maternal morbidity and mortality in the developing countries like Nigeria have been associated with attitudes and socio-cultural practices of women during pregnancy and childbirth outcomes [32]. Umar and Bawa also identified that women who have high family wealth, religious affiliation, higher levels of education and access to skilled health workers and whoarewithin shortdistancefromahealth facility are more likely to use institutional delivery services [33]. Researchers found out that spouse financial status influences health-seeking behaviour of pregnant women [34, 35]. Addai documented the coexistence of orthodox and indigenous maternal healthcare services in most African communities, with opportunity for women to choose between two options [36]. More specifically, among pathways utilised for antenatal healthcare include primary health care centres, hospitals, traditional birth attendants and herbalist [35, 37]. Alarge body of literature on men’s involvement in maternal care is largely focused on men’s knowledge of danger signs during pregnancy and on critical decisions around seeking care during obstetric emergencies [27, 38–42]. Against this background, this study examined the factors that affect men’s preferences for the place of health facility to be used by their pregnant wives for delivery and also investigated the factors that influence men involvement in attending antenatal clinic visits of their pregnant wives. This study will help to identify factors that either facilitate or impede men’sparticipation in maternal healthcare and provide information that can beusedtoencourageparticipation aswellasgenerateideas for further researches that would provide moreempirical evidence for policy direction in the formulation, design and implementation of workable programmes that would promote married men’s participation in maternal healthcare. Methods This study used a non-experimental research design involving a cross-sectional survey carried out among married men with spouses, whose wives have ever had experience of pregnancy. Qualitative method of data collection was used because it enables us to achieve a deep understanding of how and why people view issues in particular ways and the factors that impact upon their experiences. Also, a qualitative research method facilitates respondents to speak, thus enabling the disclosure of insights and resulting in original, deep and rich information. A major strength of qualitative research is its utility in analysing events or phenomenon as they occur in their natural environment or settings and also gain a deep understanding of the phenomenon. The researchers went from one location to another to identify the respondents, and they were all interviewed individually since the study used in-depth interview (IDI). The respondents were all purposively selected based on the criteria that they are married and whose wives have had the experience of pregnancy at least once, and must be resident of Badagry town.
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