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Male involvement in maternity care should be supported in low-income countries

Tampere University
LocationArvo Ylpön katu 34, Tampere
Arvo building lecture hall F211
29.11.2019 10.00–14.00
LanguageEnglish
Entrance feeFree of charge
Maternal death and illness remain a pertinent problem in low-income countries and the poor areas in many middle-income countries despite of decades of various interventions. Involving male partners has long been acknowledged as an important strategy to improve the health of pregnant mothers and their families. Very few male partners take part in maternal health services and little is known about men's contribution to maternal health at the community level. The possibility to improve maternal health by involving men remains a missed opportunity.

Malawi, a low-income country in southeast Africa, faces high maternal mortality, and male-partner involvement in maternal health is limited. At the time of the study in 2006, HIV testing and treatment in antenatal care was being scaled up in the country, and knowledge about how to involve male partners was essentially needed.

The aim of the doctoral thesis of MD Pauliina Aarnio in the field of public health is to explore husbands' perceptions of and their role in maternal health and wellbeing in rural Malawi. The thesis is part of the long-term reproductive and child-health research collaboration between the University of Tampere and the Malawi College of Medicine in the rural Mangochi district, Malawi. The thesis consists of two parts. Part 1 investigates men's perceptions of HIV in pregnancy and their specific role as husbands in relation to voluntary counselling and HIV testing in antenatal care. Part 2 explores how husbands perceive their role during pregnancy and delivery and in seeking health care for pregnancy complications.

A mixed-methods design with focus group discussions, in-depth interviews and cross-sectional surveys was applied. In part 1, 11 focus- group discussions were held to explore men's perceptions and then a survey with 388 men in reproductive age was conducted to find out frequencies of the attitudes and practices. The survey contained a self-interview component to assess accuracy of responses to sensitive questions. In part 2, a survey with men (n= 389) was first conducted, then 30 indepth interviews with husbands, wives and key informants were held to elaborate on the complex phenomenon of seeking health care for pregnancy complications that arose in the survey.

According to the findings, the husbands were concerned for the health of their pregnant wives. They perceived health problems in pregnancy to be due mainly to poor life circumstances such as inadequate nutrition. They acknowledged that poor life circumstances such as inadequate nutrition. They acknowledged that husbands can negatively affect pregnancy health if they exercise physical violence towards their wives or engage in extramarital, unprotected sex. Men regarded their knowledge on maternal health insufficient to make sound decisions when seeking health care for their pregnant wives. Some crucial misconceptions, such as convulsions being caused by witchcraft, prevailed.

Very few men had joined their wives to attend maternal health services. At the community level, husbands supported their wives emotionally, financially and in practical matters. They were actively involved in planning for the birth, made decisions on health-care seeking and provided transport to maternal health services. The husband's power to decide on health-care seeking was justified by his economic resources and position as the head of the household. The wife had no power to decide but had to obey her husband, whom she depended on for long-term support. A shortage of money and lack of transport posed significant barriers to timely seeking for maternal health care.

Men stressed that the couple needs to decide jointly about HIV testing in antenatal care and that they need health workers to assist them in disclosing HIVpositive test results to their spouses. Men’s fear of being tested for HIV and their perception of maternal health services as female territory were the main barriers for them to participate in maternal health services.

A recommendation based on the findings is that men are given access to maternal health information tailored to their needs. Men's significant roles at the community level should be acknowledged and supported. Male involvement interventions need to adopt a gender-sensitive approach that supports couple dynamics and early involvement of men in maternal health services and antenatal HIV testing. For a sustainable change, underlying factors that pose barriers to male involvement and health-care seeking in emergencies, especially HIV-related stigma and poverty, should be addressed.

The dissertation can be found online at
http://urn.fi/URN:ISBN:978-952-03-1325-8

Photograph: Satu Aarnio