Abstract
Background: Male involvement during childbirth can increase utilisation of maternal services and reduce maternal and neonatal mortality. An individual’s intention towards such male involvement can be understood through the theory of planned behaviour, which postulates that such intention is influenced by 3 domains: 1) attitudes, 2) perceptions of social approval (subjective norms) and 3) feelings about control over the intended behaviour. In sub-Saharan Africa, rates of male involvement in childbirth birth are low, and little is known about the predictors of intention for such involvement among expecting couples in rural Africa. This study aimed to determine the influence of the 3 domains of intention on male involvement intention during childbirth among expecting couples in Rukwa Region, Tanzania. Methods: We conducted a community-based, cross-sectional study of pregnant women and their partners from June until October 2017. In total, 546 couples (n=1,092 participants) were identified through 3-stage probability sampling. A structured questionnaire based on the theory of planned behaviour was used to elicit information on the 3 domains of intention. Results: Most pregnant women (71.6%) and their male partners (77.3%) intended to have male involvement during childbirth. Among women, only positive attitude (odds ratio [OR] 0.2, 95% CI, 0.1 to 0.7; P=.012) was significantly associated with intention, though in an unexpected direction. In adjusted analysis, men’s positive attitude (adjusted odds ratio [AOR] 9.0, 95% CI,1.9 to 40.9; P=.004) and positive subjective norms (AOR 4.4, 95% CI, 1.1 to 18.6; P=.041) were significantly associated with an increased likelihood of intention to accompany their partners during childbirth. Conclusion: More male partners had the intention to accompany their spouses during childbirth compared to their female partners. Male attitudes and subjective norms may be influential in determining male involvement during childbirth in rural African settings.
Highlights
An estimated 293,300 maternal deaths occurred in 2013 worldwide.[1]
Most pregnant women had positive perceived subjective norms (93.4%), and positive perceived behaviour control (98.7%) towards male involvement in childbirth
Our findings suggest that interventions geared towards improving attitudes and beliefs about male involvement during childbirth may not be effective among pregnant women in some rural African settings
Summary
An estimated 293,300 maternal deaths occurred in 2013 worldwide.[1]. Most of these deaths occurred in sub-Saharan Africa, where low rates of use of skilled birth attendants are associated with high maternal and neonatal mortality.[2,3] Birth preparedness, when a mother or couple engages in planning and preparation for childbirth, increases use of a skilled birth attendants[4] by reducing delays in accessing maternal services, include those related to decision making to seek health care, reaching a health facility and obtaining appropriate care within health facilities.[5]. An individual’s intention towards such male involvement can be understood through the theory of planned behaviour, which postulates that such intention is influenced by 3 domains: 1) attitudes, 2) perceptions of social approval (subjective norms) and 3) feelings about control over the intended behaviour. In sub-Saharan Africa, rates of male involvement in childbirth birth are low, and little is known about the predictors of intention for such involvement among expecting couples in rural Africa. This study aimed to determine the influence of the 3 domains of intention on male involvement intention during childbirth among expecting couples in Rukwa Region, Tanzania. Men’s positive attitude (adjusted odds ratio [AOR] 9.0, 95% CI,1.9 to 40.9; P=.004) and positive subjective norms (AOR 4.4, 95% CI, 1.1 to 18.6; P=.041) were significantly associated with an increased likelihood of intention to accompany their partners during childbirth. Male attitudes and subjective norms may be influential in determining male involvement during childbirth in rural African settings
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