Maternal health care (MHC) service comprises services provided for women during pregnancy, delivery, and postnatal. Traditionally, maternal health issues have predominantly been seen and treated as a purely feminine matter [
According to the recent global estimates by the World Health Organization (WHO), more than half a million women lose their lives from pregnancy-related complications worldwide every year, ninety-nine per cent (99%) of which occur in the less developed world [
The tendency to view maternal health as a woman’s issue has contributed to a narrow focus of targeting mostly women, particularly mothers in intervention efforts. Most maternal and child health (MCH) programmes seek to address the health needs of women and children by engaging and educating pregnant women and mothers in care-seeking practices for themselves and their children. This has contributed to men being sidelined as far as reproductive health and MCH matters are concerned [
Male involvement in MHC has been described as a process of social and behavioural change that is needed for men to play more responsible roles in MHC with the purpose of ensuring women’s and children’s wellbeing [
The involvement of men in maternal health arises from the numerous influences men have on almost all spheres of life [
According to Green [
In spite of the important role of men in maternal health, studies exploring male involvement in MHC and factors that influence their participation are limited. The few available studies have to a large extent explored the perspective of women, but not men. One limitation of studying the subject based on women samples is that the perspectives of women could be a mere reflection of their feelings about the quality of their relationships with their male partners [
The level of male involvement in maternity care varies across communities and countries. There are various factors that could determine the level of male involvement. These could be sociodemographic, cultural, or even inherent factors in the health delivery systems [
The study was conducted in Anomabo, a town within the Mfantseman Municipality located along the Atlantic coastline of the Central Region of Ghana. According to the Ghana Statistical Service [
This was a cross-sectional study involving male respondents whose partners were pregnant or had given birth within twelve months preceding the study. The sample size for the study was calculated from 3621 households in Anomabo Sub-district. The study employed Yamane [
Random sampling procedures were employed in selecting 100 adult (20 years or above) male respondents whose partners were pregnant or had given birth within twelve months preceding the study. To begin the process, a sample frame was constructed to include a list of all households (3621) in the community. The lottery method was then used to select household with eligible potential respondent from which consenting participants were selected and interviewed.
A questionnaire was designed for the study by the investigators (authors) and comprised of both close-ended and open-ended questions. The questionnaire was in three sections: Section A was designed to collect sociodemographic information; Section B sought to elicit information on the level of male involvement in maternal health care (antenatal care, delivery, and postnatal care); and Section C sought to collect information on enabling/disenabling factors influencing males’ involvement in MHC.
Prior to data collection, the questionnaire was pretested at Biriwa, a close by community in the Mfantseman Municipality. Biriwa was chosen because it has similar sociodemographic and socioeconomic characteristics as the study area. This provided a means for ascertaining appropriateness of the questions for obtaining valid and reliable responses. All necessary adjustment and modifications were then made on the instrument before the actual data collection begun.
The data collected from the field were edited for any inconsistencies and appropriately coded, after which the data was entered using Statistical Product and Service Solution (SPSS) software Version 21. Once entered, the data was exported to STATA Version 12.0 for cleaning and further analysis.
The dependent variable for the study was male involvement in specific MHC services: whether a respondent accompanied his pregnant partner to the health centre for antenatal care, delivery, and postnatal care. The independent variables considered in the study were grouped into two: sociodemographic (age, employment status, education of the man, education of the spouse, religion, type of marriage status, number of children, and living arrangement) and enabling/disenabling (distance to health facility, perception of MHC, poor spousal communication, prohibitive cultural norms, work schedules, gender roles, unfavourable health policies, financial problems, attitude of health workers, and long waiting time at the health facility) factors.
Both descriptive and inferential statistics were employed in the analyses. Pearson Chi-Square and Fishers exact tests were conducted to assess the bivariate association between the independent variables and dependent variable (whether a man accompanied his partner to antenatal care, delivery, and postnatal care). The bivariate analysis was also conducted to identify variables that show a significant relationship between independent variables and dependent variable. Significance level was set at
Ethical approval was obtained from the Institutional Review Board (IRB) of the University of Cape Coast (UCC). Additional approval was obtained from the Mfantseman Municipal Health Directorate (MMHD) before the study was conducted. Written informed consent was obtained from all participants after giving a description of the study. Confidentiality was seriously adhered to throughout the study processes.
As indicated in Table
Sociodemographic characteristics of male respondent (
Characteristics | Frequency ( |
Percentage (%) |
---|---|---|
Age | Mean = 39.7 (±10.2) | |
20–29 | 17 | 17.0% |
30–39 | 36 | 36.0% |
40–49 | 25 | 25.0% |
50–59 | 22 | 22.0% |
Education of Man | ||
None | 19 | 19.0% |
Elementary/JHS | 55 | 55.0% |
Secondary/technical | 20 | 6.0% |
Tertiary | 6 | 20.0% |
Partners education | ||
None | 59 | 59.0% |
Elementary/JHS | 24 | 24.0% |
Secondary/technical | 10 | 10.0% |
Tertiary | 7 | 7.0% |
Marriage relationship | ||
Monogamous | 90 | 90.0% |
Polygamous | 10 | 10.0% |
Employment status | ||
Employed | 28 | 28.0% |
Not employed | 72 | 72.0% |
Religion | ||
Christian | 65 | 65.0% |
Muslim | 25 | 25.0% |
Traditional | 10 | 10.0% |
Number of children | ||
No child yet | 21 | 21.0% |
Less than 3 | 45 | 45.0% |
More than 3 | 34 | 34.0% |
Source: Fieldwork, 2013.
Table
Enabling/disenabling factors of male involvement in maternal health care (
Characteristics | Frequency ( |
Percentage (%) |
---|---|---|
Couple living together | ||
Yes | 55 | 55.0% |
No | 45 | 45.0% |
Distance to H/F | ||
Less than 5 km | 80 | 80.0% |
More than 5 km | 20 | 20.0% |
Perception of MHC | ||
Easily accessible | 61 | 61.0% |
Not accessible | 39 | 39.0% |
Poor spousal communication | ||
Yes | 93 | 93.0% |
No | 7 | 7.0% |
Prohibitive cultural norms | ||
Yes | 69 | 69.0% |
No | 31 | 31.0% |
Work schedules of men | ||
Yes | 79 | 79.0% |
No | 21 | 21.0% |
Unfavourable health policies | ||
Yes | 85 | 85.0% |
No | 15 | 15.0% |
Financial problems | ||
Yes | 53 | 53.0% |
No | 47 | 47.0% |
Attitudes of health workers | ||
Yes | 90 | 90.0% |
No | 10 | 10.0% |
Long waiting time at H/F | ||
Yes | 83 | 83.0% |
No | 17 | 17.0% |
Gender roles | ||
Yes | 50 | 50.0% |
No | 50 | 50.0% |
Source: Fieldwork, 2013; MHC: maternal health care; H/F: health facility.
The results on male involvement in various MCH services show that 35% of respondents accompanied their partners to antenatal care during pregnancy, while 44% accompanied their partners to delivery. One-fifth (20%) of the respondents accompanied their partners for postnatal care services (Figure
Level of male involvement in maternal health care (
Table
Sociodemographic factors associated with male involvement in antenatal care, delivery, and postnatal care (
Variable | Antenatal care | Delivery | Postnatal care | ||||||
---|---|---|---|---|---|---|---|---|---|
Yes | No | Total | Yes | No | Total | Yes | No | Total | |
Age | |||||||||
20–29 | 3 (17.6) | 14 (82.4) | 17 | 9 (52.9) | 8 (47.1) | 17 | 4 (23.5) | 13 (76.5) | 17 |
30–39 | 11 (30.6) | 25 (69.4) | 36 | 13 (36.1) | 23 (63.9) | 36 | 7 (19.4) | 29 (80.6) | 36 |
40–49 | 13 (52) | 12 (48) | 25 | 14 (56) | 11 (44) | 25 | 5 (20) | 20 (80) | 25 |
50–59 | 8 (36.4) | 14 (63.3) | 22 | 8 (36.4) | 14 (63.6) | 22 | 4 (18.2) | 18 (18) | 22 |
|
0.12 | 0.33 | 0.98 | ||||||
Education of man | |||||||||
None | 4 (21.1) | 15 (78.9) | 19 | 6 (31.6) | 13 (68.4) | 19 | 3 (15.8) | 16 (84.2) | 19 |
Elementary/JHS | 23 (41.8) | 32 (58.2) | 55 | 27 (49.1) | 28 (50.9) | 55 | 12 (21.8) | 43 (78.2) | 55 |
Secondary/technical | 0 (0.0) | 6 (100) | 6 | 11 (55) | 9 (45) | 20 | 4 (20) | 16 (80) | 20 |
Tertiary | 8 (40) | 12 (60) | 20 | 0 (0) | 6 (100) | 6 | 1 (16.7) | 5 (83.3) | 6 |
|
0.10 | 0.06 | 0.37 | ||||||
Partners education | |||||||||
None | 14 (23.7) | 45 (76.3) | 59 | 23 (39.0) | 36 (61.0) | 59 | 14 (23.7) | 45 (76.3) | 59 |
Elementary/JHS | 12 (50.0) | 12 (50.0) | 24 | 12 (50) | 12 (50.0) | 24 | 5 (20.8) | 19 (79.2) | 24 |
Secondary/technical | 2 (20.0) | 8 (80.0) | 10 | 2 (20) | 8 (80.0) | 10 | 1 (10.0) | 9 (90.0) | 10 |
Tertiary | 7 (100) | 0 (0.0) | 7 | 7 (100) | 0 (0.0) | 7 | 0 (0.0) | 7 (100) | 7 |
|
|
|
0.41 | ||||||
Type of marriage | |||||||||
Monogamous | 35 (38.9) | 55 (61.1) | 90 | 44 (48.9) | 46 (51.1) | 90 | 19 (21.1) | 71 (78.9) | 90 |
Polygamous | 0 (0.0) | 10 (100) | 10 | 0 (0) | 10 (100) | 10 | 1 (10) | 9 (90) | 10 |
|
|
|
0.68 | ||||||
Employment status | |||||||||
Formal | 7 (25) | 21 (75) | 28 | 11 (39.3) | 17 (60.7) | 28 | 6 (21.4) | 22 (78.6) | 28 |
Informal | 28 (38.9) | 44 (61.1) | 72 | 33 (45.8) | 39 (54.2) | 72 | 14 (19.4) | 58 (80.6) | 72 |
|
0.19 | 0.55 | 0.82 | ||||||
Religion | |||||||||
Christian | 21 (32.3) | 44 (67.7) | 65 | 28 (43.1) | 37 (56.9) | 65 | 12 (18.5) | 53 (81.5) | 65 |
Muslim | 8 (32.0) | 17 (68.0) | 25 | 10 (40.0) | 15 (60.0) | 25 | 7 (28.0) | 18 (72.0) | 25 |
Traditional | 6 (60.0) | 4 (40.0) | 10 | 6 (60.0) | 4 (40.0) | 10 | 1 (10.0) | 9 (90.0) | 10 |
|
0.26 | 0.53 | 0.43 | ||||||
Number of children | |||||||||
No child yet | 3 (14.3) | 18 (85.7) | 21 | 9 (42.9) | 12 (57.1) | 21 | 5 (23.8) | 16 (76.2) | 21 |
Less than 3 | 23 (51.1) | 22 (48.9) | 45 | 26 (57.8) | 19 (42.2) | 45 | 8 (17.8) | 37 (82.2) | 45 |
More than 3 | 9 (26.5) | 25 (73.5) | 34 | 44 (44.0) | 56 (56.0) | 34 | 7 (20.6) | 27 (79.4) | 34 |
|
|
|
0.85 |
Similarly, male involvement in MHC was significantly higher among respondents in monogamous marriages (antenatal: 39%, delivery: 49%) than those in polygamous marriages (antenatal: 0%, delivery: 0%). Male involvement in antenatal care was significantly (
As in the case of sociodemographic factors, no significant association was found between any of the enabling/disenabling factors and male involvement in postnatal care. Table
Enabling/disenabling factors associated with male involvement in antenatal care, delivery, and postnatal care (
Variable | Antenatal care | Delivery | Postnatal care | ||||||
---|---|---|---|---|---|---|---|---|---|
Yes | No | Total | Yes | No | Total | Yes | No | Total | |
Couple living together | |||||||||
Yes | 25 (45.5) | 30 (54.5) | 55 | 26 (47.3) | 29 (52.7) | 55 | 10 (18.2) | 45 (81.8) | 55 |
No | 10 (22.2) | 35 (77.8) | 45 | 18 (40) | 27 (60) | 45 | 10 (22.2) | 35 (77.8) | 45 |
|
|
0.47 | 0.62 | ||||||
Distance to H/F | |||||||||
Less than 5 km | 32 (40) | 48 (60) | 80 | 37 (46.2) | 43 (53.8) | 80 | 15 (18.8) | 65 (81.2) | 80 |
More than 5 km | 3 (15) | 17 (85) | 20 | 7 (35) | 13 (65) | 20 | 5 (25) | 15 (75) | 20 |
|
|
0.37 | 0.54 | ||||||
Perception of MHC | |||||||||
Easily accessible | 23 (37.7) | 38 (62.3) | 61 | 26 (42.6) | 35 (57.4) | 61 | 12 (19.7) | 49 (80.3) | 61 |
Not accessible | 12 (30.8) | 27 (69.2) | 39 | 18 (46.2) | 21 (53.8) | 39 | 8 (20.5) | 31 (79.5) | 39 |
|
0.48 | 0.73 | 0.92 | ||||||
Poor spousal communication | |||||||||
Yes | 35 (37.6) | 58 (62.4) | 93 | 42 (45.2) | 51 (54.8) | 93 | 18 (19.4) | 75 (80.6) | 93 |
No | 0 (0) | 7 (100) | 7 | 2 (28.6) | 5 (71.4) | 7 | 2 (28.6) | 5 (71.4) | 7 |
|
0.09 | 0.46 | 0.63 | ||||||
Prohibitive cultural norms | |||||||||
Yes | 15 (21.7) | 54 (78.3) | 69 | 23 (33.3) | 46 (66.7) | 67 | 12 (17.4) | 57 (82.6) | 69 |
No | 20 (64.5) | 11 (35.5) | 31 | 21 (67.7) | 10 (32.3) | 31 | 8 (25.8) | 23 (74.2) | 31 |
|
|
|
0.33 | ||||||
Work schedules of men | |||||||||
Yes | 25 (31.6) | 54 (68.4) | 79 | 32 (40.5) | 47 (59.5) | 79 | 15 (19.0) | 64 (81.0) | 79 |
No | 10 (47.6) | 11 (52.4) | 21 | 12 (57.1) | 9 (42.9) | 21 | 5 (23.8) | 16 (76.2) | 21 |
|
0.17 | 0.17 | 0.76 | ||||||
Unfavourable health policies | |||||||||
Yes | 34 (40.0) | 51 (60.0) | 85 | 42 (49.4) | 43 (50.6) | 85 | 17 (20.0) | 68 (80.0) | 85 |
No | 1 (6.7) | 14 (93.3) | 15 | 2 (13.3) | 13 (86.7) | 15 | 3 (20.0) | 12 (80.0) | 15 |
|
|
|
1.00 | ||||||
Financial problems | |||||||||
Yes | 16 (34.0) | 31 (66.0) | 47 | 21 (44.7) | 26 (55.3) | 47 | 10 (21.3) | 37 (78.7) | 47 |
No | 19 (35.8) | 34 (64.2) | 53 | 23 (43.4) | 30 (56.6) | 53 | 10 (18.9) | 43 (81.1) | 53 |
|
0.85 | 0.89 | 0.76 | ||||||
Attitudes of health workers | |||||||||
Yes | 35 (38.9) | 55 (61.1) | 90 | 42 (46.7) | 48 (53.3) | 87 | 17 (18.9) | 73 (81.1) | 90 |
No | 0 (0.0) | 10 (100) | 10 | 2 (20.0) | 8 (80.0) | 10 | 3 (30.0) | 7 (70.0) | 10 |
|
|
0.12 | 0.41 | ||||||
Long waiting time at H/F | |||||||||
Yes | 27 (32.5) | 56 (67.5) | 83 | 35 (42.2) | 48 (57.8) | 83 | 17 (20.5) | 66 (79.5) | 83 |
No | 8 (47.1) | 9 (52.9) | 17 | 9 (52.9) | 8 (47.1) | 17 | 3 (17.6) | 14 (82.4) | 17 |
|
0.25 | 0.42 | 1.00 | ||||||
Gender roles | |||||||||
Yes | 23 (46.0) | 27 (54.0) | 50 | 29 (58.0) | 21 (42.0) | 50 | 12 (24.0) | 38 (76.0) | 50 |
No | 12 (24.0) | 38 (76.0) | 50 | 15 (30.0) | 35 (60.0) | 50 | 8 (16.0) | 42 (84.0) | 50 |
|
|
|
0.32 |
The study revealed low involvement of men in MHC, with variations in the proportion of men accompanying their partners to antenatal care, delivery, and postnatal care services. About 35% accompanied their partners to antenatal care, 44% to delivery, and 20% for postnatal care. A previous study conducted by Tweheyo et al. [
Various researchers have pointed to the fact that a partner’s education level and employment status could have an influence on the level of male involvement in maternal health services [
It was revealed in this study that prohibitive cultural norms and gender roles play a role in male involvement in MHC. Men often see pregnancy and maternal health related issues as women’s responsibility. For instance, Mullick et al. [
From our study, there was a significant relationship between unfavourable health policies and male involvement in MHC. Green [
Lastly, the attitudes of health workers at the health facility accounted for low male involvement in MHC in our study. The study is consistent with a study conducted by Byamugisha et al. [
Male involvement MHC in Anomabo in the Central Region of Ghana is low. Various sociodemographic (partner’s education, type of marriage, and number of children) and enabling/disenabling (distance to health facility, attitude of health workers, prohibitive cultural norms, unfavourable health policies, and gender roles) factors are associated with male involvement in MHC services.
There is the need for urgent interventions to scale up the involvement of men in MHC utilization. Public health interventions should focus on designing messages bearing in mind the variety of sociodemographic and enabling/disenabling factors outlined in this study. Specifically, improving access to formal education could help diffuse existing sociocultural perceptions of men accompanying their partners to antenatal care, delivery, and postnatal care, while encouraging positive health care provider attitudes towards male involvement in MHC services.
The authors declare no conflicts of interest.
The authors wish to acknowledge the cooperation of the staff and the management of Mfantseman Health Directorate for their support in the conduct of the study. They are also grateful to the Chief and elders of Anomabo for allowing the study to be undertaken in their community.