Abstract
BackgroundPoor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. Studies suggest that the participation of men in antenatal and delivery care is associated with better health care seeking behaviour, yet many reproductive health programs do not facilitate their involvement. This qualitative study conducted in rural Western Kenya, explored men’s perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement.MethodsEight focus group discussions were conducted with 68 married men between 20-65 years of age in May 2011. Participants were of the Luo ethnic group residing in Asembo, western Kenya. The area has a high HIV-prevalence and polygamy is common. A topic guide was used to guide the discussions and a thematic framework approach for data analysis.ResultsOverall, men were positive in their views of antenatal and delivery care, as decision makers they often encouraged, some even ‘forced’, their wives to attend for antenatal or delivery care. Many reasons why it was beneficial to accompany their wives were provided, yet few did this in practice unless there was a clinical complication. The three main barriers relating to cultural norms identified were: 1) pregnancy support was considered a female role; and the male role that of provider; 2) negative health care worker attitudes towards men’s participation, and 3) couple unfriendly antenatal and delivery unit infrastructure.ConclusionAlthough men reported to facilitate their wives’ utilisation of antenatal and delivery care services, this does not translate to practice as adherence to antenatal-care schedules and facility based delivery is generally poor. Equally, reasons proffered why they should accompany their wives are not carried through into practice, with barriers outweighing facilitators. Recommendations to improve men involvement and potentially increase services utilisation include awareness campaigns targeting men, exploring promotion of joint HIV testing and counselling, staff training, and design of couple friendly antenatal and delivery units.
Highlights
Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality
A study in Tanzania found that households headed by men were associated with more home based deliveries [4], while in Pakistan high decision making power by men was linked to low utilisation of antenatal care (ANC) and delivery care services [5]
The focus group discussions (FGD’s) were conducted during May 2011 with participants recruited from 33 villages around Lwak Mission Hospital which are part of an enhanced population-based morbidity surveillance system conducted by the Kenya Medical Research Institute/Centers for Disease Control (KEMRI/ Centers for Diseases Control and prevention (CDC)) in this area [21]
Summary
Poor utilisation of facility-based antenatal and delivery care services in Kenya hampers reduction of maternal mortality. The International Conference on Population and Development in Cairo in 1994 [6] and the Fourth World Conference on Women, Beijing 1995 [7] pointed towards the need for involving and encouraging men to take responsibility for their sexual and reproductive behaviour, advocating that men are in a position to change attitudes and practice through their positions as community, religious and political leaders. They should take individual responsibility as husbands and fathers to become involved in changing social attitudes including taking responsibility for reproductive health issues
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