Involvement In Maternal Health Research Articles

Gender Norms, Attitudes and Perceptions towards Male Involvement in Maternal Health in Kafue District, Lusaka

Male involvement in maternal health remains a major issue despite efforts by the international community. Despite the many benefits of male involvement in antenatal care there has been an observed low participation. Community gender norms, attitudes and perceptions towards male involvement in maternal health may affect the utilization of services offered by health facilities. The gap observed in many studies is that the attitude and perception of men regarding maternal health have largely been neglected. Therefore, this study sought to investigate the gender norms, attitudes and perceptions towards male involvement in maternal health in Kafue district of Zambia. The study adopted a descriptive research design. Both quantitative and qualitative paradigms were utilized in this study. A sample of 150 participants was used. Data was collected by the help of questionnaire and in-depth interviews. Results showed that respondents from Kafue were knowledgeable on antenatal care. Additionally, it was also revealed that respondents had a positive attitude towards male involvement in maternal health. However, due to gender norms their roles were limited when it came to delivery and child care. Nevertheless, the findings showed that men were involved in supporting their wives and helping out with house chores and providing money for antenatal care, skilled birth at a hospital, postnatal care, childcare and any necessities required for delivery. Men who were married were more likely to be involved in maternal health than men who were not married. The study also revealed that men were not comfortable with discussing their wives’ pregnancy with a health care provider due to lack of privacy. Findings suggested that there were many factors affecting male involvement in maternal health. Lack of messages and programs targeting men, health stuff attitude during delivery, gender norms such as men not being allowed to attend to women when in labor and hospital infrastructure were identified by the respondents as a cause to low male involvement. In this study, it was also revealed that men and women had a positive perception towards pregnancy being a shared responsibility, men supporting and caring for their wives during and after delivery. However, both men and women had a negative perception towards men’s presence in the delivery ward.

African American Fathers as a Solution to the Maternal Health Crisis

ABSTRACT The research is limited to the role of African American (AA) fathers in maternal health. African American fathers are largely not included in perinatal care, and their contribution may be essential in addressing the Black maternal health disparity crisis. The purpose of this conceptual paper is to examine the evidence of African American fathers involvement in supporting maternal health during the perinatal period. This conceptual paper will summarize research findings and will focus on 1) the evolution of the concept of fatherhood and the role of African American fathers; 2) the extent of African American fathers engagement during the perinatal period; and 3) the potential for African American fathers to play a key role in improving maternal health. Findings from this paper will enhance the evidence base on fathers’ involvement in maternal health, highlight the research gaps, and opportunities to focus on African American fathers in addressing maternal morbidity and mortality among African American women.

Males' perceptions and practices towards maternity care in rural southeast Nigeria: Policy implication of participatory action research for safe motherhood.

High maternal death is attributable to developing countries' health systems and sociocultural factors This study assessed the effect of participatory-action research on males' perception and practice towards maternity care and safe motherhood in rural southeast Nigeria. A pre-post-intervention study design was employed to study 396 male partners of pregnant women selected through cluster sampling in rural communities in southeast Nigeria. Males' perceptions and practices towards maternity care and safe motherhood were assessed using an interviewer-administered five-point Likert scale questionnaire. A community-participatory intervention was implemented comprising advocacy, and training of community volunteers, who then educated male partners of pregnant women on safe motherhood and facilitated emergency saving and transport schemes. A post-intervention assessment was conducted six months later, using the same questionnaire. Good perception and good practices were determined by mean scores >3.0. Continuous variables were summarised using mean and standard deviation, and categorical variables using frequencies and proportions. A comparison of the mean scores pre- and post-intervention mean scores were compared, and the mean difference was determined using paired T-test. Statistical significance was set at a p-value <0.05. The perception that male partners should accompany pregnant women for antenatal care had the least mean score at the pre-intervention stage, 1.92 (0.83). However, the mean score increased for most variables after the intervention (p<0.05). The mean score for maternity care practices increased post-intervention for accompanying pregnant women to antenatal care, facility delivery, and helping with household chores (p<0.001), with a composite mean difference of 0.36 (p<0.001). Birth preparedness/complication readiness practices-saving money, identifying transport, skilled providers, health facilities, blood donors and preparing birth kits, were good, with a composite mean score that increased from 3.68(0.99) at pre-intervention to 4.47(0.82) at post-intervention (p<0.001). Males' perceptions and practices towards safe motherhood improved after the intervention. This highlights that a community-participatory strategy can enhance males' involvement in maternal health and should be explored. Male partners accompanying pregnant women to clinics should be advocated for inclusion in maternal health policy. Government should integrate community health influencers/promoters into the healthcare systems to help in the provision of health services.

Engaging Men and Boys in Maternal Health: Results from a Participatory Film Project in Maputo Province.

Research has demonstrated that men often play a critical role in increasing access to and use of maternal health services. Improving male involvement in maternal health can contribute to better health outcomes for the mother, the newborn, and the father. Assess barriers and facilitators for male involvement in maternal health in a local community in Mozambique and analyze perceived benefits and challenges of using a participatory approach. Participants engaged in a participatory video project involving different components: a workshop around gender norms, a video workshop, a filming phase, a feedback screening, and a dissemination phase of the final film. Qualitative data were gathered throughout the participatory process and analyzed thematically by an inductive approach. In addition, the participatory video framework was used to analyze the participatory process. Our research project showed that participants faced several barriers for their involvement in maternal health, including strong patriarchal gender norms in the community, unwelcoming health care facilities, and economic challenges. Facilitators for their engagement included a strong sense of responsibility for taking care of the family, the willingness to generate change among the younger generation and the valorization of women as equal partners. Our findings suggest that the project empowered the participants to take up a more active and supporting role in maternal health and inspire other men's involvement. The participatory approach used in our study helped to identify and tackle barriers for male involvement in maternal health at community level, and dissemination of findings. Community campaigns should consider both barriers and facilitators for more male involvement in maternal health. In addition, governments and program planners should invest on male-friendliness of health facilities and to minimize the incidence of bribery and other illegal practices for health services.

Impact of the Momentum pilot project on male involvement in maternal health and newborn care in Kinshasa, Democratic Republic of the Congo: a quasi-experimental study

BackgroundThe World Health Organization recommends that programs that seek to improve maternal and newborn health outcomes actively involve men during pregnancy, childbirth, and postpartum. However, there is little evidence on what strategies work to increase male knowledge of and involvement in antenatal and postnatal care. This study assessed the impact of the Momentum project on male involvement in maternal health and newborn care. The project involved monthly home visits to a cohort of first-time mothers aged 15–24 recruited at six-months gestation and group education sessions for their male partners using the Program P toolkit. Participants were followed-up for 16 months.MethodsThe study used a quasi-experimental design with three intervention and three comparison health zones. Baseline data were collected in 2018 and endline data in 2020. Exploratory factor analysis was used to develop scales of male involvement. We measured the causal influence of Momentum using an intent-to-treat analysis at the health-zone level and a dose–response analysis at the individual level. We used random-effects probit and linear models for outcomes measured at baseline and endline, and treatment effects models with inverse-probability weighting for outcomes measured only at endline. The impact analysis involved 1,204 male partners of first-time mothers with live births.ResultsIntervention health zones were associated with an 18.1 percentage point (95% CI [(10.6, 25.6]) increase in knowledge of three or more obstetric danger signs and a 13.9 percentage point (95% CI [6.3, 21.6]) increase in knowledge of newborn danger signs. Significant increases in male involvement in antenatal care (average treatment effect (ATE) = 0.728, 95% CI [0.445, 1.010]), birth planning (ATE = 0.407, 95% CI [0.157, 0.657]), and newborn care (ATE = 0.690, 95% CI [0.359, 1.021]) were found. The magnitude of Momentum’s impact increased steadily with the number of prenatal home visits and was statistically significant for all behavioral outcomes except shared decision making. Exposure to both home visits and group education sessions during the prenatal period had a significant impact on all outcomes relative to no exposure.ConclusionsThe study demonstrated the effectiveness of Momentum on male involvement in maternal health and newborn care.

Association of Male Partners' Gender-Equitable Attitudes and Behaviors with Young Mothers' Postpartum Family Planning and Maternal Health Outcomes in Kinshasa, DRC.

Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners’ gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15–24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project’s 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners’ willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners’ gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers’ health outcomes are shaped by their male partners’ gender-related attitudes and behaviors.

Prevalence and barriers to male involvement in antenatal care in Dar es Salaam, Tanzania: A facility-based mixed-methods study.

BackgroundMen have traditionally not been fully involved in reproductive health care of their partners, and yet, they play a crucial role in family decision-making and therefore crucial key players in preventing poor pregnancy outcomes. This study aimed to assess prevalence and determinants of male participation in maternal health care and explore male partners’ perspective of their involvement in antenatal care at an urban tertiary referral facility.MethodsA mixed-methods study was conducted from October 2018 to January 2019 at Muhimbili National Hospital. A cross-sectional survey of 428 nursing mothers and two focus group discussions of male partners (n = 7 and n = 11) of women attending antenatal clinic and nursing mothers in the post-natal ward were performed. Using SPSS Ver. 23 (IBM, Chicago, IL), frequency distribution tables summarized demographic data and categories of male partners’ involvement in antenatal care. Focus group discussions included male partners of age from 24 to 55 years at their first to fifth experience of pregnancy and childbirth. Interviews were audio-recorded, and then transcribed and coded. Thematic analysis was applied.ResultsThe prevalence of male involvement in antenatal care was 69%. More than two-thirds of nursing mothers received physical, psychological and financial support from partners (76%) and attended four or more antenatal visits (85%). Five themes of male perspective of their involvement in antenatal care were generated, including: a) cultural norms and gender roles, b) ignorance of reproductive health service, c) factors outside their control, d) couple interaction and conflicts, and e) institutional obstacles.ConclusionThe prevalence of male partners’ involvement in antenatal care was relatively high. Men’s involvement in antenatal care depended on access to antenatal care education, standards of structure and process of antenatal service and how well their role was defined in the maternal health care system. Interactions and practice in society, employment sector and government health system should complement strategies to promote men’s involvement in maternal health.

Individual Factors as Determinants of Male Partner Involvement in Antenatal Care in Kiambu County, Kenya

Male partner involvement in maternal health is crucial in reducing maternal neonatal morbidity and mortality as well as a crucial component in the optimization of Maternal and Child Health services. Despite global efforts to improve male partner involvement, in Kenya this has remained low. This study explored individual factors that determine of male partner involvement in antenatal care in Kamenu Ward, Kiambu County. Specifically, the study looked into the effects of individual male partner factors such as the demographic factors and knowledge on male partner involvement in antenatal care. The study adopted a descriptive cross-sectional survey design which provided both quantitative and qualitative data. Self-administered questionnaire was used to collect data from 384 male partners aged 18 - 90 years who were residents of Kamenu Ward. Correlation results revealed that male partner’s individual factors had significant positive relationship with their involvement in ANC. It was concluded that male partner factors such as knowledge of ANC, level of income, nature of employment, age, marital status, religion and level of education influences male partner involvement in ANC positively. The researcher recommends management of health facilities to ensure that male partners are encouraged to actively participate in their spouses ANC as this plays a vital role in improving the health of the mother and the baby. Keywords : Male partner involvement, Antenatal care, Pregnancy, Maternal health DOI: 10.7176/JHMN/97-02 Publication date: January 31 st 2022

Cultural Barriers to Husband’s Involvement in Maternal Health in Indonesia Rural Area, A Qualitative Study

Background&#x0D; Maternal mortality represents the health condition of the mother during pregnancy. In developing countries, maternal health is often poor because pregnant women are not fully supported by their husbands. The problem is, husbands have cultural barriers to engage in activities that can provide space for pregnant women to be healthier.&#x0D; &#x0D; Aim&#x0D; This study was conducted to examine the husband's cultural barriers in the Toba Batak culture in North Sumatra, Indonesia.&#x0D; &#x0D; Methods&#x0D; The research was conducted using a qualitative approach in rural areas. A total of 30 husbands were interviewed using FGD techniques, in addition to FGDs with health workers.&#x0D; &#x0D; Results&#x0D; This study reveals the root of cultural problems related to the husband's perception of men's and women's work, as well as the inherent traditions that make the husband distance himself from maternal health.&#x0D; &#x0D; Conclusion&#x0D; Cultural barriers of husband’s involvement in maternal health are very clear in Batak tribe. Efforts are needed to change cultural barrier by implementing a cultural approach.

Male Partner Involvement in Promoting Antenatal Care and Skilled Delivery Attendance in Bumula Sub-County, Kenya

Globally, male partner involvement in antenatal care and skilled delivery services remains a challenge to effective management of maternal health. Maternal morbidities and mortalities have been increasing due to the underutilization of antenatal care and skilled delivery attendance at a global level. However, developed countries have had a different story on male partner involvement in antenatal care and skilled delivery attendance – most male partners are involved in the process. But sub-Saharan Africa in the global south records the highest percentage of male partners who are never active in accompanying their female counterparts to visit antenatal care and skilled delivery. In Kenya male involvement in maternal services remains low despite it being recognized as one of the pillars of safe motherhood. Therefore, this study was conducted to investigate male partner involvement in promoting antenatal care and skilled delivery attendance in Bumula Sub-County of Bungoma County in Kenya. It focused on the level of male partners involvement in maternal health. The study adopted a cross-sectional design. The target populations were married men and community health volunteers. The study had a sample size of 427 persons. Data was collected using a pre-tested semi-structured questionnaire, key in-depth interview guides, focused group discussion guides and observation checklist. Data were analysed using descriptive statistics with the aid of the Statistical Package for Social Scientist version 25. Data were presented using tables, figures, narratives and direct quotes. The study found a low level of male involvement (18%) in promoting antenatal care and skilled delivery attendance. Most of the male partners (83.1%) did not plan with their partners for ANC and skilled delivery services, however, (54.1%) accompanied their partners to the clinics. The study concluded There was a low level of male partner involvement in ANC and skilled delivery attendance. About 18% of male partners were involvement in ANC and skilled delivery attendance. There was an improvement of male partner involvement in accompaniment and provision of support. The study recommended that the two levels of government through the Ministry of Health should create awareness campaigns and public education with a targeted massage on negative cultural practices/mindset that hinder male partner involvement in maternal health services in the Bumula sub-county.

Towards a global framework for assessing male involvement in maternal health: results of an international Delphi study

PurposeCurrently, no standard instrument exists for assessing the concept of male involvement in maternal health, hampering comparison of results and interpretation of the literature. The aim of this study was...

Male Partner Involvement in Maternal Health: Perspective of Female Clients Accessing Care at a Tertiary Health Institution in Nigeria

Male Partner Involvement in Maternal Health: Perspective of Female Clients Accessing Care at a Tertiary Health Institution in Nigeria

Systematic review of the concept ‘male involvement in maternal health’ by natural language processing and descriptive analysis

IntroductionExperts agree that male involvement in maternal health is a multifaceted concept, but a robust assessment is lacking, hampering interpretation of the literature. This systematic review aims to examine the...

Social-Cultural Determinants of Male Partner Involvement in Antenatal Care at Anti-Stock - Theft – Unit Kenya

Purpose: Male involvement in antenatal care is a problem identified by different researchers and experienced globally. It is a key component in the optimization of maternal health and universal maternal health achievement. Few men engage in care in developing countries. The current study sought to identify Social-cultural Determinants of Male Partner Involvement in Antenatal Care.Methodology: Descriptive cross-sectional research design. Simple random sampling was used to sample 334 subjects from 2582 population. Data was gathered using self- administered questionnaires, edited, coded, and organized with help of statistical Package for Social Sciences (SPSS), then analysed using descriptive and inferential statistics. Hypothesis was tested using Chi square tests of independence and information presented using tables and percentages.Results: Majority (92.8%) of subjects were affiliated to religion. On cross tabulation, (100%) of participants who accompanied the partners during the first ANC visit disagreed that religion impairs male partner participating in antenatal care unlike (100%) of those who did not. Chi squire tests of independence was (p=0.047). Majority (77.2%) of the respondents preferred traditional birth attendants for partner’s antenatal care compared to 15.6% for health care workers. On cross tabulation, (93.3%) of the participants who accompanied partners during the first ANC visit indicated that they preferred health care providers to traditional birth attendants while 81.8% of those who did not accompany the partners indicated preference for traditional birth attendants and 9.1% preferred care workers. Chi squire tests of (independence (p=0.001).Unique contribution to theory, practice and policy: Male partner involvement in maternal health is desirable at the study area and there is need of social supports such as informational, appraisal, instrumental and emotional supports to enhance physical, psychological well-being, social integration and social ties. Researcher highlights the need to address religion and traditional birth attendants’ reliance which were found significant and established as barriers of male partner participating in ANC and causes of low ANC attendances among pregnant women. Further, policy change is advocated so that the government can pass laws which oblige men to be responsible for pregnant partners by accompanying them to ANC, knowing ANC schedules, discussing interventions, supporting the ANC fees if applicable, and knowing what happens at the ANC during the current pregnancy.

\u201cHe lets me go although he does not go with me.\u201d: Rwandan women\u2019s perceptions of men\u2019s roles in maternal health

BackgroundIncreasing men’s involvement in their pregnant partners’ wellness has been reported as one of the ways to improve access to and utilization of maternal health services, including birth preparedness and complication readiness. Men can play meaningful roles in the support systems that pregnant women need to achieve better maternal health outcomes. In Rwanda, the roles that men take vary, resulting in diverse expectations and responsibilities to support the health of women during this critical time. In this study, we aimed to examine the views, perspectives, and experiences of women on men’s involvement in maternal health and how this impacts access and utilization of maternal health services.MethodsWe conducted 21 interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s involvement in facilitating their partners’ health during pregnancy. Interviews were conducted across five Rwandan districts in both rural and urban settings of the country. Data analysis was guided by a thematic analysis approach. This started with independent transcript review by the investigators, after which a meeting was held to discuss emergent themes and to identify potential codes. A coding scheme was created and transcripts were coded in NVIVO™ software according to conceptual and practical topics that formed an understanding of men’s involvement in maternal care.ResultsThree key themes emerged during the analytic process that categorize the specific roles that men play in maternal health: 1) facilitating access to maternal health services, which involves assisting women with getting and or attending appointments jointly with men; 2) supporting women’s decisions, wherein men can support the decisions women make with regard to their maternal healthcare in a number of ways; and 3) evaluating information, including gathering information from multiple sources, especially from community health workers, to assist women with making informed decisions.ConclusionRwandan men take on three types of roles in supporting women’s maternal health, and their responsibilities are experienced differently by women. Interventions involving men are encouraged to increase their understanding of the implications of their involvement in maternal health without compromising women’s autonomy in decision-making and to promote positive maternal health outcomes.

Pregnancy and childbirth in Mozambique: men as decision makers and women as caretakers?

Abstract Background Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique. Methods Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in maternal health, followed by 10 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. Results Results show a lack of strategy at policy level to stimulate male involvement in maternal health. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives and women accompanied by a husband are often put in a submissive position. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. Conclusions A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and health programs should step away from linking male involvement to HIV prevention. Key messages Linking the promotion of gender equality to male involvement is the key for success. Step away from linking HIV prevention to male involvement in maternal health.

Male involvement in reproductive, maternal, newborn, and child health: evaluating gaps between policy and practice in Uganda

IntroductionMale involvement in maternal and child health is a practice wherein fathers and male community members actively participate in caring for women and supporting their family to access better health services. There is positive association between male involvement and better maternal and child health outcomes. However, the practice is not always practiced optimally, especially in low- and middle-income countries, where women may not have access to economic resources and decision-making power.AimThis study investigates how key stakeholders within the health system in Uganda engage with the ‘male involvement’ agenda and implement related policies. We also analyzed men’s perceptions of male involvement initiatives, and how these are influenced by different political, economic, and organizational factors.MethodologyThis is a qualitative study utilizing data from 17 in-depth interviews and two focus group discussions conducted in Kasese and Kampala, Uganda. Study participants included men involved in a maternal health project, their wives, and individuals and organizations working to improve male involvement; all purposively selected.ResultThrough thematic analysis, four major themes were identified: ‘gaps between policy and practice’, ‘resources and skills’, ‘inadequate participation by key actors’, and ‘types of dissemination’. These themes represent the barriers to effective implementation of male involvement policies. Most health workers interviewed have not been adequately trained to provide male-friendly services or to mobilize men. Interventions are highly dependent on external aid and support, which in turn renders them unsustainable. Furthermore, community and religious leaders, and men themselves, are often left out of the design and management of male involvement interventions. Finally, communication and feedback mechanisms were found to be inadequate.ConclusionTo enable sustainable behavior change, we suggest a ‘bottom-up’ approach to male involvement that emphasizes solutions developed by or in tandem with community members, specifically, fathers and community leaders who are privy to the social norms, structures, and challenges of the community.

Community perspectives: An exploration of potential barriers to men's involvement in maternity care in a central Tanzanian community.

Male involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men's involvement in maternity care in central Tanzania. Qualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men's maternity care involvement indicators, benefits of men's involvement in maternity health care services and barriers to men's involvement in maternity health care services. Both men and women participants acknowledged the importance of men's involvement in maternity health care services, even though few men actually got involved. Identified benefits of men's involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men's involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services. Men's involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners' presence in the delivery room. Intervention to increase men's involvement in maternity care should address individual and systemic barriers to men's involvement.

Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico

BackgroundEffective health care requires services that are responsive to local needs and contexts. Achieving this in indigenous settings implies communication between traditional and conventional medicine perspectives. Adequate interaction is especially relevant for maternal health because cultural practices have a notable role during pregnancy, childbirth and the postpartum period. Our work with indigenous communities in the Mexican state of Guerrero used fuzzy cognitive mapping to identify actionable factors for maternal health from the perspective of traditional midwives.MethodsWe worked with twenty-nine indigenous women and men whose communities recognized them as traditional midwives. A group session for each ethnicity explored risks and protective factors for maternal health among the Me’phaa and Nancue ñomndaa midwives. Participants mapped factors associated with maternal health and weighted the influence of each factor on others. Transitive closure summarized the overall influence of each node with all other factors in the map. Using categories set in discussions with the midwives, the authors condensed the relationships with thematic analysis. The composite map combined categories in the Me’phaa and the Nancue ñomndaa maps.ResultsTraditional midwives in this setting attend to pregnant women’s physical, mental, and spiritual conditions and the corresponding conditions of their offspring and family. The maps described a complex web of cultural interpretations of disease – “frío” (cold or coldness of the womb), “espanto” (fright), and “coraje” (anger) – abandonment of traditional practices of self-care, women’s mental health, and gender violence as influential risk factors. Protective factors included increased male involvement in maternal health (having a caring, working, and loving husband), receiving support from traditional healers, following protective rituals, and better nutrition.ConclusionsThe maps offer a visual language to present and to discuss indigenous knowledge and to incorporate participant voices into research and decision making. Factors with higher perceived influence in the eyes of the indigenous groups could be a starting point for additional research. Contrasting these maps with other stakeholder views can inform theories of change and support co-design of culturally appropriate interventions.

Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study

BackgroundIncreasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men’s involvement in maternal health in southern Mozambique.MethodsTen key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis.ResultsResults show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity.ConclusionA clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.