FACTORS ASSOCIATED WITH MALE INVOLVEMENT IN
MATERNAL HEALTH CARE SERVICES IN JINJA DISTRICT,
UGANDA
BY
NANTAMU DYOGO PETER
MAKERERE UNIVERSITY SCHOOL OF PUBLIC HEALTH
SUPERVISORS
Dr CHRISTOPHER GARIMOI ORACH
Dr ROBINAH NAJJEMBA
DISSERTATION SUBMITTED IN PARTIAL FULFILMENT FOR THE
AWARD OF THE DEGREE OF MASTER OF PUBLIC HEALTH OF
MAKERERE UNIVERSITY
2011
i
DECLARATION
I, Dr Peter Dyogo Nantamu, hereby declare that this dissertation has not been presented to
any institution either partially or in total for any academic award, publication, or other use.
The works here in are original. Where the works of others are quoted, appropriate references
has been given.
I therefore wish to present it for the award of the Degree of Masters of Public Health of
Makerere University.
Author
………………………….
Dr. Peter Dyogo Nantamu
Supervisors
……………………………………….
………………………….
Dr. CHRISTOPHER GARIMOI ORACH
Dr. ROBINAH NAJJEMBA
Date ……………………….
Date ………………………..
ii
DEDICATION
This dissertation is dedicated to my parents the late William Dyogo and Ann Kako Dyogo,
who raised me and educated me. May their soul rest in peace
To my wife, Josephine Awor for all the encouragement and support she gave me during the
course. To my brothers and sisters especially Betty and Charles, for the company, love and
care they missed.
God bless them.
iii
ACKNOWLEDGEMENT
I am indebted to my supervisors Dr. Christopher Garimoi Orach and Dr Roginah Najjemba
for the guidance and support they accorded me with patience.
I wish to thank the staff of the School of Public Health for the dedication they showed while
teaching us. I extend appreciation to my employer Jinja Municipal Council who have enabled
me attend the course, Peri Peri U Makerere University project for the financial assistance
extended to me for this study. Without their contribution, I would have found it difficult to
complete the course.
I would like to extend appreciation to the District Health Officer and the entire District
Health Team of Jinja District for their co-operation and support. My interviewers, particularly
Sekiwano Samson, Naigaga Betty and Naku Ritah, the respondents and Menya our driver are
especially remembered. Their valuable time spent made it possible to collect the data.
Dr. Sarah Byakika is remembered for having spared her valuable time to make comments on
the proposal and also being my mentor.
I am greatly indebted to Micheal Kalungu for his input during data analysis and Drs. Nyolia,
Stephen Banonya, Muki Musa for support they extended to me during the course. Lastly, I
would like to thank my colleagues, the Master of Public Health (DE) class, for the valuable
contribution, support and team spirit they exhibited throughout the course.
iv
TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................... v
LIST OF FIGURES ............................................................................................................ VII
LIST OF TABLES ............................................................................................................. VII
ABSTRACT .............................................................................................................................. X
CHAPTER ONE ........................................................................................................................ 1
1.0 INTRODUCTION AND BACKGROUND .................................................................................. 1
CHAPTER TWO ....................................................................................................................... 5
LITERATURE REVIEW .............................................................................................................. 5
2.1 ACCESSIBILITY AND UTILIZATION OF MATERNAL HEALTH SERVICES BY WOMEN............... 5
2.2 MALE INVOLVEMENT IN MATERNAL HEALTH CARE SERVICES......................................... 6
2.2.1 ANTENATAL CARE .......................................................................................................... 7
2.2.2 DELIVERY CARE ............................................................................................................. 9
2.2.3 POSTNATAL CARE......................................................................................................... 10
2.3 FACTORS AFFECTING MALE INVOLVEMENT IN MATERNAL HEALTH CARE SERVICES ..... 10
CHAPTER THREE ................................................................................................................. 14
3.0 PROBLEM STATEMENT, JUSTIFICATION AND CONCEPTUAL FRAMEWORK ........................ 14
3.1 PROBLEM STATEMENT .................................................................................................... 14
3.2 JUSTIFICATION OF THE STUDY ......................................................................................... 15
3.3 CONCEPTUAL FRAMEWORK FACTORS AFFECTING MALE INVOLVEMENT IN MATERNAL
HEALTH CARE SERVICES ........................................................................................................ 16
CHAPTER FOUR .................................................................................................................... 18
4.0 STUDY OBJECTIVES ......................................................................................................... 18
4.1 GENERAL OBJECTIVE ....................................................................................................... 18
4.2 SPECIFIC OBJECTIVE ........................................................................................................ 18
CHAPTER FIVE ..................................................................................................................... 19
5.0 METHODOLOGY .............................................................................................................. 19
5.1 STUDY AREA ................................................................................................................... 19
5.3 STUDY DESIGN ................................................................................................................ 20
5.5.0 SAMPLING PROCEDURE ................................................................................................ 21
5.5.1 HOUSEHOLD SURVEY ................................................................................................... 21
5.5.2 INTERVIEWS OF COMMUNITY RESOURCE PERSONS........................................................ 23
5.6.1 SELECTION CRITERIA .................................................................................................... 23
5.6.1.2 EXCLUSION CRITERIA ................................................................................................ 24
5.8 DATA COLLECTION. ......................................................................................................... 25
5.8.2 QUALITATIVE DATA ..................................................................................................... 25
5.8.3 QUANTITATIVE DATA ................................................................................................... 26
5.9.0 QUALITY CONTROL ...................................................................................................... 26
5.9.3 FIELD EDITING OF THE DATA ........................................................................................ 27
5.10 DATA MANAGEMENT AND DATA ANALYSIS .................................................................. 28
5.10.2 DATA ANALYSIS ........................................................................................................ 28
5.10.2.2 QUALITATIVE DATA ANALYSIS ............................................................................... 30
5.11 ETHICAL CONSIDERATION ............................................................................................. 31
5.12 STUDY LIMITATIONS...................................................................................................... 31
v
CHAPTER SIX ........................................................................................................................ 33
6.0 RESULTS ......................................................................................................................... 33
6.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS........................................................................ 33
6.2 LEVEL OF MALE INVOLVEMENT IN MATERNAL HEALTH CARE SERVICES. ......................... 35
6.3 EFFECTS OF MEN ATTENDING ANC ON THEIR LEVEL OF KNOWLEDGE ABOUT MATERNAL
HEALTH SERVICES. ................................................................................................................ 37
CHAPTER SEVEN ................................................................................................................. 47
7.0 DISCUSSION .................................................................................................................... 47
7.1 MALE INVOLVEMENT IN ANC, DELIVERY AND POSTNATAL CARE SERVICES. .................. 47
7.2 EFFECTS OF MEN ATTENDING ANC ON THEIR LEVEL OF KNOWLEDGE ............................ 48
7.3 FACTORS ASSOCIATED MALE INVOLVEMENT IN ANC, DELIVERY AND POSTNATAL CARE 49
CHAPTER EIGHT .................................................................................................................. 56
8.0 CONCLUSIONS AND RECOMMENDATIONS ........................................................................ 56
8.1 CONCLUSIONS ................................................................................................................. 56
8.2 RECOMMENDATIONS ....................................................................................................... 57
10.0 REFERENCE ............................................................................................................... 58
QUESTIONNAIRE FOR MEN ..................................................................................................... 68
ANNEX 4
FOCUS GROUP GUIDE FOR MEN .................................................................. 76
INFORMED CONSENT FORM-LUSOGA .................................................................................... 85
EBIBUUZO BY’ABASAADHA (QUESTIONNAIRE FOR MEN-LUSOGA)........................................ 87
JINJA MAP SHOWING HEALTH FACILITY COVERAGE BY SUB-COUNTY.................................... 96
6
LIST OF FIGURES
Figure 1.Males who accompanied their partners for maternal care services………………...35
Figure 2.Males who made a joint decision with partner on maternal health…………………36
LIST OF TABLES
Table 6.1.1 Socio demographic characteristic factors male involvement in maternal health.34
Table 6.3.1 Effect of men attending ANC on their knowledge……………………………..37
Table 6.4.1 Bivariate analysis, Factors affecting male accompanying their partners to the
health unit for ANC…………………………………………………………………..............38
Table 6.4.2 Bivariate analysis, Factors affecting male accompanying their partners to the
health unit during labour..................................................................................................…....41
.
Table 6.4.3 Bivariate analysis, Factors affecting male accompanying their partners to the
health unit for postnatal……………….………………………….………………………….43
Table 6.4.4 Multivariate models for escorting wife for ANC, delivery and postnatal…...….45
VII
LIST OF ABBREVIATIONS
AOR
Adjusted odds ratio
ANC
Antenatal Care
DHO
District Health Officer
FGD
Focus Group Discussion
HSSP
Health Sector Strategic Plan
ICPD
International Conference on Population and Development
IEC
Information Education and Communication
LC
Local Council
MCH
Maternal and Child Health
MDGs
Millennium Development Goals
MOH
Ministry of Health
OR
Odds ratio
PPASA
Planned Parenthood Association
SRH
Sexual and Reproductive Health
UDHS
Uganda Demographic Health Survey
UNICEF
United Nations Children’s Fund
UNFPA
United Nations Population Fund
WHA
World Health Assembly
WHO
World Health Organization
VIII
OPERATIONAL DEFINITIONS
ANC: Ante-natal care services is health care given to a mother and partner during pregnancy
Delivery care services: Delivery care services is health care given to the pregnant mother
after onset of labour until complete expulsion of the baby, placenta and membranes
Involvement: Involvement is to make a matter of concern or affect somebody or to make
somebody to participate
Male: Male refers to a man of the age eighteen years and above, having a right to marry and
to start a family (Constitution of Uganda 1995).
Maternal health services: Maternal health services for purposes of the study refer to
antenatal care, delivery and postnatal care
Male involvement in maternal health services: Male involvement in maternal health
service is when a man discusses maternal health issues with the spouse and they make a joint
decision as a couple, accompany the partner to seek maternal health services.
Postnatal care: Postnatal care is health care given to the mother and baby after childbirth up
to six weeks.
IX
ABSTRACT
Introduction
Globally, male involvement in maternal health services remains a challenge to effective
health care accessibility in general and maternal health care service utilization by the
pregnant women and mothers in particular.
Objective
The general objective of the study was to determine factors associated with male involvement
in antenatal, delivery and postnatal care services in Jinja district.
Methodology
This was a cross sectional household survey. A total of 469 men were randomly selected to
participate in the study. Twenty-four Key Informant interviews (KI), 4 Focus Group
Discussion (FGD) were held. Qualitative data were analyzed using SPSS version 10 and
STATA version 10, multivariate logistic regression was done to assess factors associated
with male involvement in maternal health care services. Qualitative data were analyzed using
a Manifest-Content analysis.
Results
About 43% of the men in Jinja accompanied their partners to the health facility during ANC,
43% accompanied their partners during delivery and nearly 32% accompanied partners for
postnatal care. Majority of the men (62.7%) reported joint couple decision-making with the
wife on where to attend ANC, 32.5% on delivery and 66.6% for postnatal care.
Factors that predicted male involvement in maternal health care services included; providing
invitation letter (AOR 4.46, 95% CI: 2.72-7.31), and communication with the partner
concerning place of delivery (AOR 2.47, 95% CI: 1.12-5.46). Factors associated with low
male involvement included; low education level of the husband (AOR 0.53, 95% CI: 0.33X
0.85), male perception of maternal health services being accessible (AOR 0.60, 95% CI:
0.38-0.92) and health workers demanding for more money.
Conclusion and Recommendations
Although a high proportion of males in Jinja district discuss and make join couple decision
on ANC and postnatal care, the number of males who discuss and make joint couple decision
on where the wife is to deliver from or those who accompany their partners for ANC,
delivery and postnatal care is low.
Strategies for improvement of male involvement in maternal health care services should
include, providing invitation letters for the husbands, encouraging couple communication on
matters concerning maternal health care services.
XI
CHAPTER ONE
1.0 Introduction and Background
1.1 Introduction
The behavior of men, their beliefs and attitudes affect the maternal health outcomes of women
and their babies. The exclusion of men from maternal health care services could lead to few
women seeking maternal health services and as a result worsening the negative maternal health
outcomes for women and children. Increasingly, recognition is growing on a global scale that
involvement of men in reproductive health policy and service delivery offers both men and
women important benefits (Naomi, 2005).
In order for African countries to achieve the Millennium Development Goal 5 of reducing
maternal mortality by three quarters (MDG 5) by 2015 requires a 5.5% annual average reduction
of maternal mortality. However the actual reduction in Sub Saharan Africa between 1990 and
2005 was only 0.1 % (WHO, 2008).
This slow progress in reducing maternal mortality is as a result of a number of factors including
lack of maternal health services and in some cases where services exist some husbands have
been reported to refuse their wives to seek maternal health services.
Globally, low male involvement in maternal health care services remains a problem to health
care providers and policy makers. Since the Cairo international conference on population and
development (ICPD) 1994, and the Beijing world conference for women 1995 a lot of emphasis
has been to encourage male involvement in reproductive health including maternal health. The
Beijing conference emphasized that man’s attitudes, knowledge base and ways of reacting
influences not only men’s health but also women’s reproductive health (WHO, 2007).
1
At the 1994 ICPD in Cairo the participating (179 nations) nations agreed on the action plan,
which stated that” Changes in both men’s and women’s knowledge, attitudes, and behavior are
necessary conditions for achieving a harmonious partnership between men and women. This
would open doors to gender equality in all spheres of life, including improving communication
between men and women on issues of sexuality and reproductive health, and improving
understanding of their joint responsibilities….’’ (UNFPA, 2004:29)
Following that action plan there is a positive trend globally of increasing male involvement in
reproductive health including maternal health services though not without challenges.
Where health services exist there are many reasons why men do not use them particularly in
relation to reproductive health. Studies done in several countries globally have reported cultural,
social economic, program factors, policy issues and communication issues as the factors
influencing male involvement. Identifying and overcoming these obstacles requires working with
women, young people and men to understand better their needs analyze their problems and to
propose acceptable solutions (WHO, 2004). Understanding the factors affecting male
involvement in antenatal, delivery and postnatal care services in Jinja district is important in
order for health service managers and health workers to design interventions that will encourage
and maintain male involvement. Increased male involvement in maternal health care services is
likely to improve maternal and child health outcomes.
1.2 Background
The failure to incorporate men in maternal health promotion, prevention and care programs by
policy makers, program planners and implementers of maternal health services has had a serious
impact on the health of women, and the success of programmes (Greene et al, 2002). Yet the
huge majority of African women are still unaware of their fundamental rights to health and they
2
continue to suffer from socioeconomic discrimination and unwanted pregnancies which are
harmful to their health (WHO, 2008).
The United nations expert group on women and finance estimated that 70 percent of the world’s
population living on less than a dollar a day are women (Were, 2009) Women tend to have less
education and have fewer job opportunities, this influence their maternal health seeking behavior
and maternal health outcomes. Greater male involvements in maternal health programmes may
help reduce un-intended pregnancies and transmissions of sexually transmitted infections as well
as improve child survival.
The tendency to view maternal health as a woman’s issue has contributed to a narrow focus of
targeting mostly women. Yet we know that the social relationships determine people’s ability to
manage their sexual and reproductive health (SRH) lives, with important implications not only to
their health but also for other life choices (Greene et al, 2002).
According to the ICPD ten year progress report, a major remaining challenge is “the promotion
of greater male responsibility in family and reproductive decision-making’’ (UNFPA, 2004:32).
In Jinja district maternal health care services especially Antenatal, Delivery and Postnatal care
services are available from health center II (HC II), HCIII, HCIV and regional referral Hospital.
A high number (106%) of mothers attend antenatal for at least one visit in Jinja district, however
only 47% women actually attend the recommended minimum of four visit while only 63% of the
pregnant women deliver in a health facility with the help of a trained health service provider and
only 77% of those who deliver in the health facility seeking postnatal care services at least once
in the six weeks following delivery (HMIS, 2008/9).
3
The decline in ANC 4th visit attendance by the pregnant women and low health facility delivery
and postnatal care attendance could be as a result of low male involvement in these services.
Active male involvement and participation in maternal health services is necessary to increase
utilization of maternal health services by the pregnant women and mothers. The aim of study was
to examine the factors associated with male involvement in antenatal care, delivery and postnatal
care service.
4
CHAPTER TWO
Literature Review
The safe motherhood initiative, launched in 1987 by WHO, UNICEF, UNFPA, the World Bank
and other organizations placed maternal health at the forefront of international public health
(Family care international, 1997)
Maternal health is a state of complete physical, mental and social well being of the mother; it is a
resource for everyday life of the mother.
Maternal health care services comprise of a wide range of health services given to the mother
before pregnancy, during pregnancy, labour and after delivery. Maternal health services include
the following, preconception care, antenatal care (ANC), Prevention of Mother to Child
Transmission of HIV (PMTCT), safe delivery (intra-partum care); post natal care (PNC) and
emergency obstetric care/management of obstetric complications. However for this study
maternal health services refers to antenatal care, delivery and postnatal care.
2.1 Accessibility and utilization of maternal health services by women
The goal of maternal health care services is to ensure that no woman or newborn dies or incurs
injuries due to pregnancy and or childbirth. However to achieve this goal, maternal health service
planners, service managers and providers need to view maternal health services in the context
that women’s potential to control and improve their wealth as well as their health is more limited
than men’s in most parts of the world (EngenderHealth, 2008). This prevents women from
accessing critical health information and services and can lead to poor reproductive, maternal
and child health outcomes, including unwanted infections and unwanted pregnancies.
Because men have a strong influence on women’s health and their access to care, the need for
male involvement in maternal health services is clear and male involvement is becoming even
5
more critical in the delivery and uptake of maternal health care service. According to Adamehak
and Adebyao (1997), in order to encourage improved reproductive health, emphasis needs to be
focused on the understanding of men’s reproductive behavior and the influence to their wives.
2.2 Male Involvement in Maternal Health Care Services
It is important to note that to increase male involvement in maternal health care services requires
the providers to gain in-depth knowledge and understanding of the men’s health perspectives,
behavior and practices.
Although pregnancy is not an illness, it creates a lot of physical and emotional demands on the
mother. The husbands as well as other family members need to understand and appreciate the
discomfort and tiredness that pregnancy may cause to the pregnant woman. The awareness about
the demands of pregnancy on the part of the husband and other family members could result into
the necessary support the pregnant woman needs from the family members including the
husband.
The husband is often the primary decision maker, and wife’s economic dependence on her
husband gives him greater influence on major household decisions, as was reported in Nepal by
Britta and others (2004) where 50% of the women had the final decisions about their own health
care made by their husbands (Nepal Demographic and Health Survey, 2001). Because of the role
men play in decision making in the family, some researchers suggest that male involvement is a
very significant factor to consider in finding a solution to the three main factors responsible for
many of the maternal death: 1) the delay in decision-making to refer the patients to the
appropriate health facility where proper treatment could be taken; 2) lack of a system for
emergency transport to ensure that women who experience obstetric complications receive
6
timely treatment; and 3) delay in receiving treatment within the health care facility, which is
sometimes related to covering the costs associated to such emergencies.
Studies have suggested that male involvement in maternal health results into positive outcome
for not only the pregnant woman but also for the unborn child. Reporting findings of their studies
Pagel et al (1990) and Mutale et al (1991) concluded that lack of social support; especially from
the husbands or family has negative effects on fetal growth.
In much poorer countries many of which have a patriarchal society, increase in male
involvement during pregnancy has been seen as a possible factor in reducing the number of
children born with low birth weight (Mira and UNICEF, 2000). However despite these benefits
of male involvement in maternal health care services, the majority of interventions and services
to promote SRH including care during pregnancy and childbirth in most countries have been
exclusively focused on women (Ntabona, 2002). Yet it is important to assume that for all the
steps leading to maternal survival there is always a man standing by the side of every woman
knocking at the gate, before, during and after each pregnancy (WHO, 1995).
2.2.1 Antenatal care
Societal allocation of roles to the men and women especially decision making influences
utilization of ANC. It is therefore important for men to understand and appreciate the importance
of attendance of ANC, delivery at a health facility and postnatal care services.
A study done by Britta et al (2004) in Nepal revealed that husbands accompanied only 40% of
their women attending ANC for the first time and that greater decision-making power for women
was associated with lower husband accompaniment to ANC and lower overall male involvement.
Other reasons reported for low male involvement in maternal health care is that many men feel
marginalized and left outside in their contact with the mother and child care services (Plantin,
7
2007,Lester and Moorsesom, 1997, quoted by Britta, 2004). In effect men’s involvement in the
maternal health care system often stops at the doors to the clinic, yet to exclude men from the
information on the benefits of antenatal care, counseling and services is to ignore the important
role men’s behaviors and attitudes may play in a woman’s maternal health choices.
It is not uncommon in most African societies for men to decide as to when and how a woman
should seek care. For example in Kano Nigeria, 17.2 % of women did not attend regular ANC
because of husband denial (Adamu and Salihu, 2002).
In Uganda, despite of health facilities being in walk able distances in many districts, women
having income and improvement in the quality of care, women continue to report late for ANC
and deliver outside the health facilities (Kasolo and Ampaire, 2000). Previous studies in Uganda
have shown that most women attend ANC only once instead of the recommended minimum of
four times, and never return for delivery. This has been attributed to a number of factors, the
notable one among many is husbands deciding when and where a woman is to get ANC and
delivery care.
This fact of male’s affecting utilization of ANC and delivery care in Uganda is supported by the
findings of the study done by Nyane (2007) in Tororo in which she observed that some pregnant
women when asked to come with their partners during the next ANC visit dropped out and also
the study by Kasolo and Ampaire (2000) in which they argued that poor knowledge of what is
done at the health facility coupled with poor communication among spouses and the low status
of women in the community greatly affect women’s utilization of ANC services in Uganda.
Traditional beliefs have also contributed to low utilization of ANC, for example in some
communities in Uganda there is a general belief that pregnant women have sexual intercourse
with other men who are not their husbands, and that men have sex with pregnant women who are
8
not their wives (Kasolo and Ampaire, 2000). This belief has resulted in some men to refuse their
wives to attend ANC.
In order for women to be able to access and utilize ANC services, male involvement needs to be
emphasized at all levels of ANC delivery.
2.2.2 Delivery care
A number of studies have also shown that the presence of husbands in the labour room shortens
the labour, reduces pain, panic and exhaustion of the women (Somer-Smith, 1999, Kennel et al,
1991, WHO, 2001)
However, it is widely recognized that men are often marginalized by the maternal health care
provided with limited access to basic information and knowledge to help them make informed
choices and decisions in order to promote their own health as well as that of their families
(Ntabona, 2002). Koisa (2002) reported that most men do not actually accompany their partners
to antenatal care consultations or during labour or delivery.
In Uganda, 41 percent of the women who deliver in the health facilities are accompanied by their
husbands / partner (UDHS, 2006). The eastern region where Jinja district is located and central
region having 58 percent and 55 percent of women accompanied by their husbands/partner to
deliver which is slightly higher than the national average (UDHS, 2006).
Part of the reason for the low male involvement have come a long way with the traditional
attitude of health workers, coupled with notices in the health care premises, for example “men
are not allowed in the labor ward” which discourage men from giving support to their wives in
ANC and labor (Muwa et al, 2008)
9
2.2.3 Postnatal care
Although the Uganda SRH guidelines (2006), recommend that a mother should attend
postpartum care during puerperium, only 23% of mothers in Uganda receive postnatal care
within the first two days and overall, 74 percent of the women who deliver in Uganda receive no
postpartum care at all (UDHS, 2006). If men are well sensitized about postnatal care services and
their concerns addressed, the number of mothers seeking post natal care is likely to increase
It is important therefore for all stakeholders to realize that maternal health is not just a woman’s
issue because a mother’s health has a direct bearing on the health of her newborn. Men if
properly sensitized could serve as agents to bring more women to accept and utilize maternal
health care services. Increased male involvement and participation in maternal health can be
achieved in the way men accept and support their partner’s needs, choices and rights.
2.3 Factors affecting Male Involvement in Maternal Health Care Services
A number of factors have been reported by several researchers as being responsible for
influencing male involvement in maternal health care services. Some of which are noted in the
paragraphs that follow in this segment.
Traditionally, health providers and researchers in the field of reproductive health have focused
almost exclusively on women when planning programmes and services, especially with regard to
FP, prevention of unwanted pregnancies and of unsafe abortions, and promotion of safe
motherhood (WHO, 2001).
However for purposes of this discussion, factors affecting male involvement in maternal health
services will be considered under the following categories
Cultural factors: Men do not seek health information and services due to traditional notions of
masculinity, where asking for help from a nurse or doctor is viewed as a sign of weakness. Many
10
men feel it is their right to refuse contraception, to allow their partners or even discuss FP
(EngenderHealth, 2008). These refusals can lead to unwanted pregnancies, unsafe abortion and
maternal death or disability. Reporting their findings from the study on women’s autonomy and
male involvement in Nepal, Britta at el, concluded that higher women autonomy was associated
with lower male involvement in pregnancy health.
Socio –economic: Some men feel it is a duty to facilitate their wives in terms of transport and if
they do not have means of transport they see no point in escorting them while both are walking.
Yet in many situations in Africa where the man is economically in position to provide the basic
necessities of life he tends to have more than one wife, which also negatively affects his
willingness and ability to escort the wife to seek care. Multiple partner relationships promotes
different interests for the man and his partners and this will hamper possibilities for transparent
decision making on maternal health service issues in addition to involvement in maternal health
services of all his wives when needed. Reporting his findings Ratcliffe (2001) noted that men are
often involved in multiple sexual relationships that present a considerable challenge to fertility
awareness and reproductive health programmes.
Alcohol consumption by the men has also been noted to plays an important role in keeping men
away from involvement in maternal health care services as most of the time they may be drunk,
leaving them with no money or time to facilitate the needed care.
Health service factors: Generally research shows that service related factors are more important
than user related factors in affecting male involvement in maternal health care services. The most
important ones pointed out include, long physical distance from the health unit, lack of
transportation, inconvenient clinic hours, long waiting time at the clinic, poor technical and
11
interpersonal skills. The situation is worsened by the fact that information received from health
workers on maternal health care is primarily aimed at women as was reported by UNFPA (1999)
in several developing countries that women not men were the targets of reproductive health
programmes yet most of them are not financially or culturally positioned to make decisions about
these issues without consulting their husbands. This may actively discourage men from
participating in maternal health care services by the structure of services or by attitudes of health
care workers.
In Turkey, it was observed that health care workers were not supporting men who wanted to join
in maternal health services, the same study noted that a lot of men come to the clinic with their
wives ‘but it stops at the door (Cigdem et al, 1999).
In their study Bulut and Molzan (1995) reported that societal definitions of gender roles, lack of
information, and significant barriers within the health care system itself as some of the issues
cited by clients as impediments to father’s participation in postpartum care. Long working hours
and difficult in taking time off work to attend services were also cited as reasons why many men
would be unable to participate in ANC care services. While Mboizvo and Bassett (1996) stated
that, failure to target men in programmes has weakened the impact of reproductive health
programmes, since men can significantly influence their partner’s reproductive health decisionmaking and use of health resources.
In Uganda, Maternal and Child Health (MCH) services implementers and providers largely
ignored the role of men. However since the onset of HIV/AIDS pandemic, many efforts are now
being made to reach men, especially regarding HIV/AIDS (UNFPA, 1999).
12
Policy issues: Greene et al (2002) noted that researchers and reproductive health service
providers have tended to describe women’s disadvantaged positions without men’s roles. This
has resulted in some reproductive health programs designed to improve women reproductive
health to consider men as part of the problem and not part of the solution.
Communication issues: Studies show that there is a general lack of interest on the part of men
in some countries Africa in their partners’ reproductive health (WHO, 2005). Men often do not
have access to information on maternal health issues and on their role in promoting maternal
health resulting into majority of the men not to have sufficient information and knowledge with
regard to maternal health.
Communicating with men has been reported by some researchers to pose challenges for
programmes, which historically have focused on serving women (Young & Kol, 1999). It is not
easy to design messages and materials that men find persuasive, but that also promote gender
equality and women empowerment. In Zimbabwe, most men misinterpreted campaign messages
promoting male involvement to mean that decisions should solely be left to men (Young and
Kols, 1999). Sometimes couple dialogue may be the problem, once there is a communication
breakdown for one reason or the other, the whole family function fails. Kasolo and Ampaire
(2000), highlighted an example of a breakdown in communication among couples was when they
reported that some men did not want to discuss ANC attendance with pregnant women because
they considered pregnant women to nag a lot.
13
CHAPTER THREE
3.0 Problem statement, Justification and Conceptual framework
3.1 Problem Statement
Low level of male involvement in maternal health care services in Jinja district has persisted
despite several interventions by the district health office aimed at encouraging male involvement
in maternal health care services. However the proportion of males who discuss, support or
accompany their wives to seek maternal health care services in Jinja district has not been
documented.
In 2008/9 financial year, only 47% of the women in Jinja attended ANC the recommended four
times, supervised deliveries were 63% while only 77% of the women who delivered in the
health facility attended postnatal care at least once 6 weeks following delivery(Jinja district
HMIS,2008/9)
The low male involvement in maternal health care services may be partly contributing to the low
utilization of maternal health care services by the pregnant women and mothers with in the
district because of the significant role men have on the health seeking behavior of their family.
Currently Jinja district issues an invitation letter to every pregnant woman inviting the
partner/husband to attend ANC and discuss issues regarding the pregnancy, childbirth and
postnatal care. Secondly village health teams (VHT) are functional in some of the sub-counties
in the district and the VHTs have been used to disseminate messages on maternal health services.
Despite these efforts by the health managers the low male involvement in ANC, delivery and
postnatal care services still persists and perceived barriers to male involvement in maternal
health care services in the district are not well understood.
14
3.2 Justification of the study
Worldwide, every pregnancy faces an element of risk. Men, as partners and decision makers,
need to be involved in maternal health services, Low male involvement in maternal health care
services results in low utilization of ANC, health facility delivery and postnatal care leading to
high maternal morbidity and mortality. Men’s accompanying their wives in routine ANC and
other maternal health services is an important factor in contributing to the reduction of maternal
morbidity and mortality. According to Thaddeus and Maine (1994) men can positively affect the
prevention of maternal and child mortality by being able to recognize an obstetric emergency,
take a decision to seek care and being able to transport the pregnant women to obtain health
services. Men accompanying women for antenatal care presents an opportunity to the health
workers to health educate them and empowering men to be able to recognize an obstetric
emergency early in order to make appropriate decisions and actions that may influence the
outcome of the pregnancy.
This aim study is to contribute to better understanding of the factors that make men get involved
in ANC, delivery and postnatal care. Information generated will be used to provide decisionmaking and actions that will lead to increased male involvement in maternal health care services.
Increased male involvement in maternal health care services will subsequently, lead to increased
utilization of maternal health services by the pregnant women, mothers and their children. This
will contribute to reduction in maternal and infant mortality in Jinja district.
15
3.3 Conceptual framework Factors affecting male involvement in maternal health care
services
Socio- economic factors
Perceptions /Attitudes
Age
Negative Attitude of men and women
Education
Most service providers are women
Financial difficulties
Lack of information
Myths and misconception
Low male involvement
in maternal health care
services
Cultural factors
Poor communication among
spouses
Traditional beliefs
Polygamy
Health facility factors
Attitude of health workers
Quality of care
Waiting time
Availability of health workers
Availability of services
Affordable services/cost
Accessibility of services
16
Low female
utilization of
maternal health
services
The factors that affect male involvement in maternal health care services may be categorized into
Cultural factors, socio-economic, health facility factors, inter-spouse communication and
perceptions men have on maternal health services in the district.
Cultural Factors include; Polygamy, this has been associated with family wrangles that may
hinder the man from treating his wives equally. Health facility factors included; Lack of privacy,
comfort and lack of confidentiality, Poor attitude of health workers adversely affect men’s
capacity to be involved in maternal health services.
Inter spouse communication; absence of inter-spousal communication and discussion can inhibit
male involvement in maternal health care services. This prevents men from taking appropriate
maternal health decisions.
Perceptions men have on maternal health services perceptions that maternal health care services
offered is poor and that services could be very expensive for both spouses to access. Low male
involvement in maternal health care services will lead to low utilization of these services by the
pregnant women, mothers and their children, which will lead to high maternal and infant
morbidity/mortality.
3.4 Research questions
1. What is the level of male involvement in maternal health care services in Jinja district?
2. What factors determine male involvement in maternal health care services?
17
CHAPTER FOUR
4.0 Study objectives
4.1 General objective
To investigate factors associated with male involvement in antenatal, delivery and postnatal care
in Jinja district, in order to assist the district health team design appropriate strategies to improve
male involvement in maternal health care service.
4.2 Specific objective
1) To determine the proportion of males who accompany the wife/partner to the health unit for
ANC, delivery and postnatal care, make a joint decision with the partner on these services in
Jinja district
2) To assess the effects of men’s attending ANC with their wives on male partner’s level of
knowledge on maternal health care services
3) To identify factors associated with the males accompanying their wives and making joint
couple decision with their partners on ANC, delivery and postnatal care services.
18
CHAPTER FIVE
5.0 Methodology
5.1 Study area
The study was carried out in Jinja district which is located in the Eastern part of Uganda at the
shores of Lake Victoria about 80 kilometers (Km) from the capital city Kampala, bordered by
Mayuge, Kamuli and Mukono districts in the east, north and the west respectively and on its
southern border is lake Victoria. The study was carried out in both rural and urban sub counties.
Jinja district covers a surface area of 734 sq Km with a projected population of 433, 600 people
(UBOS, 2007). The district has both a rural and urban population; the majority, 342,700 (79.1%)
being in the rural area. The district has a population density of 640 people per square meter and a
male to female ratio of 96:100. Apart from the islands the population of Jinja is within 5kilometer distance to a health center.
Maternal health care services in the district are delivered through a network of a total of 63
health units some of which are owned by Non Governmental organization and the other are
government owned. The district has 41 health center II, 14 center III, 5 health center IVs, 2
private hospitals and one regional referral hospital, five health sub districts two being in Jinja
Municipal Council and the other three are in the rural areas of the district. Administratively Jinja
district has 7 rural sub counties, 3 municipal council divisions, 3 town council (Kakira, Bugembe
and Buwenge), 50 parishes, 11 of these parishes are in Jinja municipal council and 392 villages
(UBOS, 2005).
19
In Jinja district maternal health care services especially ANC, delivery and postnatal care
services are available from health center two and above. The maternal health indicators for the
2009/10 were, ANC 4th was at 51%,health facility deliveries were at 59%,while only 32 % of
the women who delivered in the health facilities come back to attend postnatal care.
5.2 Study population
The study population comprised of all men of 18 years of age and above in the study area, who
were married or had ever been married or had fathered a child in the last two years preceding the
study or whose spouses were pregnant and met the inclusion criteria and the mothers and
pregnant women attending maternal health services during the period of the study who consented
to participate in the study were interviewed.
5.3 Study design
This was a cross sectional community based household survey. The study employed both
quantitative and qualitative techniques of data collection.
5.4 Sample size
The sample size was calculated using Kish Leslie formula (1996).
n = z2 x p x q
= (1.96)2X (0.58) (0.42) = 375
d2
0.052
z =1.96= z value for 95% confidence limits
p=0 .58 = expected proportion of men involved in maternal health in Jinja district. This is the
proportion of men in Jinja who are expected to accompany their women to a health unit to
deliver (UDHS, 2006)
20
q = 1-p = 1-0.58 = 0.42
d = 0.05 is the acceptable error of the estimator at 95% confidence interval.
Adjustment for possible non-response or not participating in the final analysis
I estimated that 20% of the respondents would not contribute to the final analysis. Face- to- Face
administered interviews have response rate of 80% and above (Weisberg and Bowen, 1977). The
adjustment factor 100/(100-20) = 1.25 was used to give the final sample size.
The required sample size adjusted to account for non-response was = 375 x1.25 = 469.
Out of the 469 respondents who consented to participate in the study 434 respondents completed
the interview giving a non-response rate of about 8%.
5.5.0 Sampling procedure
The study population comprised of all men of 18 years of age and above in the study area, who
were married or had ever been married or had fathered a child in the last two years preceding the
study or whose spouses were pregnant and met the inclusion criteria and the mothers and
pregnant women attending maternal health services during the period of the study who consented
to participate in the study were selected to participate in the Focused Group
Discussion(FGD).The FGDs for women were used to generate women's opinion about male
involvement in maternal health care services.
5.5.1 Household survey
Out of the 12 sub counties in the district we decided to sample only 6 (50%) of the sub county.
The decision to sample 6 Sub County was guided by the assumption that information generated
21
from the 6 sub counties was representative of the whole district. The Sub-Counties of Budondo,
Buwenge rural, Buwenge Town Council, Mafubira, Kakira Town council and Mpumudde
Kimaka division were selected to participate in the study.
The process involved writing the names of the sub counties on pieces of paper, folding papers
putting them in a container and vigorously shaking the container after which one piece of paper
was picked without replacement until six sub counties were selected. Two parishes were selected
from each sub county using lottery type of simple random sampling mechanism. Names of
parishes by Sub County were written on small pieces of paper, the paper were folded and put in a
container by Sub County and we shook vigorously and randomly picked one paper at a time
without replacement.
The parishes that were selected to participate by sub county are; Budondo sub county we
selected Buwagi and Namizi parish, Kagoma and Magamaga parish were selected for Buwenge,
and Buwenge Town Council, Buwenge north and west wards were selected and from Mafubira
sub county Buwekula and Buwenda parishes were selected while from Kakira Town Council and
Mpumudde Kimaka Division, Karongo, Wairaka, Lubaga and Mpumudde parish were selected
respectively. Households served as the sampling frame from which the study unit (participants)
who met the study criteria were interviewed. A household was eligible to be selected if there
was a woman who is pregnant, had given birth in the last two years preceding the study.
Households served as the sampling frame from which the study unit (participants) who met the
study criteria were interviewed.
The first household was identified by spinning a pen on a flat surface while at the front door of
the LC I chairperson and facing the road. Taking the direction of the pointing of the nib of a pen
22
we obtained the first respondent from an eligible household close to the residence of the Local
Council (LCI) chairperson. The subsequent respondents were identified by conducting a door to
door search for the eligible respondents. In order to interview the required respondents, from
each parish 40 households were selected. We therefore set to select 80 households from each sub
county, a total of 480 households in the whole district.
5.5.2 Interviews of community resource persons
The local council two (LC II), chairperson and secretary for women affairs at local council two
of the parishes selected to participate in the study were considered to be the community resource
persons. We assumed that as local leaders they were more aware of the behaviour of the male
residents of the village concerning maternal health care services in their area. In a parish where
the chairperson was a woman then the vice chairperson if a male was interviewed.
The in-charges of health centres and in-charge of maternity units of the health facilities a part
from Jinja hospital, participating in the study were interviewed (key informants) about the
behaviour of men and the factors that could be responsible for the low male involvement in
ANC, delivery and postnatal care services
5.6.1 Selection criteria
5.6.1.1 Inclusion criteria
Male of 18 years of age and above who consented to participate in the study and had fathered at
least one child or whose spouses had been pregnant at least once in the last two years preceding
23
the study to cater for recall period, and residents for three months or more to cater for familiarity
and knowledge of the services provided were requested to participate in the study
Pregnant women and mothers 18 years or older in second trimester attending ANC who were
accompanied by their partners or had received an invitation letter from the health workers to
their partners, had delivered or attending postnatal care services during the time of the study and
consented to participate in the study.
5.6.1.2 Exclusion criteria
Study participant who were sick and were unable to sustain an interview
5.7 Study variables
5.7.1 Dependent variables
The dependent variables were; man accompanied the wife to the health unit for ANC, delivery,
postnatal during the most recent pregnancy or a joint couple decision was made on where the
wife is to attend ANC, delivery and postnatal care during the most recent/current pregnancy
5.7.2 Independent variables
The independent variables included socio-economic and demographic characteristics of male
respondents; these were age of the man, education level of the man and wife, employment status,
marriage relationship, availability of means of transport, number of children a man has, having a
radio in the homestead and the distance to the health unit from the man’s homestead.
24
Man’s knowledge on maternal health services. This was the man’s awareness of the
recommended ANC visit for the pregnant woman during the course of pregnancy, services
offered at health unit during ANC, delivery and postnatal care.
Attitude men have towards maternal health services, especially health workers behavior, quality
of services offered and accessibility of maternal health services.
Cultural factors, these were cultural factors that could be prohibiting male involvement in ANC,
delivery or postnatal care and inter spouse communication.
5.8 Data collection.
5.8.1 Tools
The study instruments included, individual semi structured questionnaires were used to
quantitative data while for qualitative data FGD and KI interview methods of data collection
were employed.
5.8.2 Qualitative data
Focus group discussion (FGD) and key informant interviews were conducted with married men
and women. We conducted two FGD with the men and two women. Four FGD were conducted,
two from each sub-county. The composition of the focus group for the male was of 8-12 who had
fathered a child in the last two years or whose spouses were pregnant and residents in the area for
at least three months while the composition of FGD with females was 8-12 women who had
delivered children in the last two years or were pregnant at the time of the study.
25
A moderator using a discussion guide and eliciting details through probes facilitated the FGD.
Two Research Assistants took notes during the FGD. Proceedings of FGDs were tape-recorded
and the tapes transcribed by the interviewers. The Principal Investigator and team leader
administered the key informant guide. Individual interviews with key informants helped to
explore the knowledge; attitude and behavior related to male involvement in ANC, delivery and
postnatal care services.
5.8.3 Quantitative data
Research Assistants administered the structured individual questionnaires while the principal
investigator and the team leaders interviewed the key informants. The Principal Investigator
supervised the Research Assistant. As a further quality control check interviewer’s name or code
was recorded on the questionnaire so that it was possible to ask for clarification if certain
information was found not to be clear.
5.9.0 Quality control
5.9.1 Training of Research Assistants
The Principal Investigator selected Research Assistants (RA) from health Assistants and other
health workers in the district who had previously taken part in survey data collection but not
working in the sampled parishes.
Research Assistants were trained such that they became familiar with the statement of the
problem, objectives of the study, sampling procedure, data collection tools and plan for data
collection. They were also taught interview techniques such as asking questions in a neutral
26
manner, not showing by word or actions what answer they were expecting and how to record
answer especially from the open ended questions without interpreting them.
The Research Assistants participated in pre testing of the study tools. This served two purposes:
the training of the interviewers and a test for clarity of the questionnaires, FGD and KI guides
5.9.2 Pre testing of Data Collection Tools
The data collection tools were pre tested at Mafubira trading center zone C. The questionnaires
were administered to males and females; this was done to assess how effective the tools met the
collection of the required information from the respondents. The field test of the data collection
tools was carried out in three groups of 3 persons, with each team having the principle
investigator and two RAs. The village selected for pre testing the data collecting tools was not
selected for the final data collection.
5.9.3 Field editing of the data
Questionnaires were checked at the point of data collection for completeness and those found
incomplete were completed before the respondent was discharged.
Issues that were not clear to the interviewer clarifications were obtained from the respondents.
The data was cleaned and edited by the research assistants and the Principal Investigator before
closing the day’s activities. In case of any missing data research assistant who interviewed the
respondent whose data was missing were responsible to go back to the respondent to fill the
missing information
27
5.10 Data Management and Data analysis
5.10.1 Data Management
Quantitative data
The villages were given a code and each questionnaire had the village code and the respondent’s
number written on it for proper identification and storage.
Qualitative data
Immediately after each key informant interview or the FGD the raw field notes were transformed
into well organized notes reflecting as close as possible what was discussed and the observations
of the interviewer during the meeting. Data from FGD, key informants and Data from openended questions was categorized, transcribed and coded; the responses were listed into categories
that best describe them. The data were analyzed using a manifest-content analysis. The data was
ordered in relation to the objectives of the study and there after analyzed and separated into
themes. It was triangulated with the quantitative data findings to gain deeper understanding of
the information obtained.
5.10.2 Data Analysis
5.10.2.1 Quantitative Data Analysis
The data entry clerk entered the data in the SPSS version 10.0 and later STATA version 10.A
print out of the file details, variable names, and details of coding was made and this was used to
clean the data, the print output was then stored. The Principal Investigator was responsible for
storing the data. The questionnaires were stored in the order of the village from which the
28
respondents were interviewed and the questionnaires were numbered. Data was kept both as hard
copies and the soft copies were stored on CD-ROM as back up.
Univariate analysis was conducted, frequency and percentage analyses was done for the
categorical variables Cross tabulations have been used to describe the data in terms of a
combination of background variables (age, occupation, level of education, residence and
marriage relationship) Data are presented in frequency counts, descriptive and analytical tables.
In order to address the specific objective 1, determining the proportion of males who discussed
and made a joint decision with their partners, accompanied their partners for ANC, delivery and
postnatal care services, univariate analysis was done and presented as a proportion of husbands
who participated in the study, who discussed and made a joint decisions as couples on ANC,
delivery and postnatal care services or accompanied their wives to seek these services. All the
male study participants served as the denominator.
To address specific objective 2, of assessing the effect of men’s attending ANC with the wife on
male partner’s level of knowledge on maternal health care services. The proportion men who
were knowledgeable about maternal health care services for the group of men who attended
ANC with the wife was compared with that of men who did not attend ANC with their partner.
The data was summarized using cross tabulation in a 2x2 table. The chi-square test was used to
assess whether the proportion of men who attended ANC with the wife and were knowledge
about maternal health care service was significantly different from the level of knowledge men
who did not attend ANC have about maternal health care services. The Standard Error (SE) was
computed SE= √ (p (1-p)/n) where p is the proportion expressed as a decimal number of men in a
group from which the proportion is calculated. The 95% confidence interval around frequency
statistics was determined by multiplying standard error by 1.96 (95%CI p∓ (SE x1.96).
29
The specific objective 3 was addressed by carrying out a bivariate and multivariate analysis.
Relationships between male involvement behavior and background characteristics, couple
characteristics were assessed using logistic regression. Bivariate analysis was performed to
identify variables that were suggestive of a significant association between background
characteristics, couple characteristics and male involvement in maternal health care services.
The logistic regression model below was used
Logit (y) = 0 + 1 X1 Logit (y) = the logarithm of the probability of a male accompanying wife
for ANC, delivery or Postnatal care or discussing and making a joint decision
0 = the Y intercept
1 = Coefficient for the independent variable for example age
X1 = independent variable for example age
The odds ratio and ‘p’ value was calculated and chi-square test used to test significance of the
contribution of the various independent variables in affecting male involvement. The
independent variables that had significant values in Bivariate analysis and those that were
suspicious with odds ratio of two or more were entered into multivariate logistic regression
analysis model Logit (y) = 0 + 1 X1+…+5 X5.
The dependent and independent variables were converted into binary for further analysis using
the model of logistic regression. The logistic regression model was used to control for
confounding and to predict the factors that affect male involvement in maternal health care
services.
5.10.2.2 Qualitative Data Analysis
Data from FGD and key informants was transcribed, coded and summarized in matrices it was
then separated into themes. The data was analyzed for content. The information was triangulated
30
with the quantitative data findings to gain deeper understanding of the behavior of men
concerning male involvement in maternal health care services.
5.11 Ethical Consideration
The study was approved by the Makerere University Higher Degrees Research and Ethics
committee. At the district level, permission to conduct the study was obtained from the local
leaders and the District Health Office before conducting the study. The free and informed
consent of each individual participant was obtained at the start of the study. Respondents were
read an informed consent form that explained the following 1) the purpose of the study, 2) what
participation in the study would involve, 3) How confidentiality and anonymity was to be
maintained, 4) The right to refuse to participate in the study or to withdraw from the study
without any penalty, 5) the benefits and risks of participating in the study. Study participants
were not required to undergo any invasive procedures. Personal / sensitive issues were explored
when a good relationship had been established with the informant. The research team was urged
and required to respect the culture of the respondents during the data collection process.
Confidentiality and anonymity was maintained by the use of code numbers on the questionnaire
other than names. Information obtained was only used for the purposes of this study. The data
collected was accessible only to the people involved in the study and the principal investigator
stored the questionnaires and other study tools in a lockable filing cabinet.
5.12 Study limitations
The data were collected during the weekdays (Monday –Saturday) from 8.00am to 6.00pm for
household survey while for the health units’ data were collected during working days (Monday-
31
Friday). Therefore the men who are working far from home or shift workers who were presumed
to be available at home late in the evening and on Sundays were missed out. This was minimized
by communicating to the local leaders of the parishes we were to visit a day prior to when we
planned to visit such that they guide us on the timing of our data collection an appropriate time
when most of the men are likely to be home.
The economically able women prefer to deliver and utilize the services of the private health
facilities. Since the private health facilities were not included in the study, these women were
missed out.
The respondents who participated in the focus group discussion were from only two sub counties
out of the ten sub counties and 3 town councils; the findings from FGD may not be transferable
to other sub counties.
The selection of an equal number of participants from all the participating sub-counties does not
offer equal chances of all eligible respondents to participate because of the difference population
per Sub County.
5.13 Dissemination of the study findings
The final report of this study will be presented to the Makerere University School of Post
Graduates and Makerere University School of Public Health in partial fulfillment for the award
of Masters of Public Health of Makerere University. The findings of the study will be presented
to the office of the District Health Office Jinja.
32
CHAPTER SIX
6.0 Results
The results are presented in 4 sections. Section 6.1 deals with socio-demographic characteristics,
section 6.2 focuses on the level of male involvement in maternal health care services, section 6.3
shows the effects of men attending ANC with their wives on their level of knowledge regarding
maternal health services and section 6.4 focuses on the factors associated with male involvement
in maternal health care services
6.1 Socio-demographic characteristics
Majority of the respondents (72.4%) were from the rural areas of the district. Most respondents
(79.7%) were above the age of 25 years. Nearly 51% had education level of primary and below,
most of them (55.1%) reporting having spouses with education level of primary and below. Most
respondents (90.3%) were living with their spouses. Most of the respondents among the men
(97.7%) reported having culture that does not prohibit male involvement in maternal health care
of their spouses.
33
Table 6.1.1 Socio demographic characteristics for the male respondents (N = 434)
Characteristics
Residence
Rural
Urban
Age
Below 25 years
25 yrs & Above
Frequency
Percentage
(N)
(%)
314
120
72.4
27.6
88
346
20.3
79.7
348
86
80.2
19.8
220
214
50.7
49.3
239
195
55.1
44.9
302
132
69.6
30.4
366
68
84.3
15.7
392
42
90.3
9.7
73
361
16.8
83.2
231
203
53.2
46.8
77
357
17.7
82.3
280
154
64.5
35.5
Employment status
Employed
Not employed
Education level
Primary and below
Post primary
Wife education
Primary and below
Post primary
Alcohol consumption
Does not consume
Consumes
Marriage relationship
Monogamous
Polygamous
Couple living together
Yes
No
Wife living together with mother in-law
Yes
No
Number of children
3 and above
Less than 3
Distance to health facility (H/F)
5 kilometers and more
Less than 5
Transport to H/F
Available
Not available
Key H/F = Health facility
34
6.2 Level of male involvement in maternal health care services.
Figure 1. Percentage of Males who accompanied their partners for maternal health services
The study shows that 42.7% (185/433) of the men accompanied the partner to the health unit for
ANC, 43.4 % (184/424) accompanied the wife during labour, and 32 % (135/426) accompanied
the wife for postnatal care (Figure 1).
35
Figure 2.Percentage of Males who made joint couple decision on maternal health services
Joint couple decision-making was relatively high at 62.7% (271/432) for ANC, 66.6 % (289/434)
for postnatal care and only 32.5 % (139/328) for delivery care (Figure 2).
36
6.3 Effects of men attending ANC on their level of knowledge about maternal health
services.
Men who mentioned three or more correct responses of the services offered were considered to
be knowledgeable. The list of services offered was obtained from Uganda National policy
guidelines and service standards for sexual and reproductive health and rights (2006)
Table 6.3.1 Effects of men attending ANC on their Level of knowledge
Proportion of males who
Maternal health services
were knowledgeable
Attended ANC
(%, 95%CI)
Did not attend ANC
(%, 95%CI)
P-value
Number of ANC visit
29.7 (26.1-33)
25.7 (20.2-31.2)
0.35
Services offered during ANC
35.1 (31.6-38.6)
28.5 (27.0-30.0)
0.14
Services offered during delivery
10.8 (6.4-15.2)
7.2 (4.0-10.4)
0.19
Services offered during postnatal care
8.6 (4.6-12.6)
7.2 (3.5-10.9)
0.56
The percentage of males who attended ANC and found to be knowledgeable about services
offered during ANC was 35.1% (95% CI: 31.6-38.6%). This was not significantly higher than for
men who did not attend ANC that was at 28.5 % (95% CI: 27.0 - 30.0%) p = 0.14.
The percentage of males found to be knowledgeable about services offered during postnatal for
men who attended ANC was 8.6 % (95% CI: 4.6 -12.6%). This was not significantly higher than
for men who did not attend ANC that was at 7.2 % (95% CI: 3.5 - 10.9%) p = 0.56.
37
6.4. Factors associated with male involvement in ANC, delivery and postnatal care
Table 6.4.1.Bivariate analysis of factors affecting male accompanying wife during ANC (N
=434)
Accompanied wife for ANC
Frequency (%)
Variable
Residence
Urban
Rural
Age
Below 18-25 years
25 yrs & Above
Employment status
Employed
Not employed
Male education level
Primary and below
Post primary
Wife education
Primary and below
Post primary
Alcohol consumption
Does not consume
Consumes
Marriage relationship
Polygamous
Monogamous
Couple living together
Yes
No
Yes
Significance Test
No
Total
47 (39)
138 (44)
73 (61)
178 (56)
120
314
0.82 (0.53-1.26)
1.0
0.36
33 (38)
152 (44)
55 (62)
194 (56)
88
346
0.76 (0.47-1.23)
1.0
0.27
161(46)
24 (28)
187 (54)
62(72)
348
86
2.22 (1.32-3.72)
1.0
0.002
76 (36)
109 (51)
144 (66)
105 (49)
220
214
0.50 (0.34-0.74)
1.0
0.001
84 (35)
101(52)
155(65)
94 (48)
239
195
0.50 (0.34-0.74)
1.0
0.001
130 (43)
55 (42)
172 (57)
77(58)
302
132
0.95 (0.63-1.43)
1.0
0.79
38 (56)
147(40)
30 (44)
219 (60)
68
366
0.52 (0.31-0.39)
1.0
0.01
165 (42)
20 (48)
227 (58)
22 (52)
392
42
0.79 (0.42-1.51)
1.0
0.49
15 (30)
234(61)
50
384
3.64 (1.92-6.89)
1.0
0.000
247(58)
8 (80)
424
10
5.58 (1.17-26.6)
1.0
0.03
207 (58)
42 (55)
357
77
0.86 (0.52-1.42)
1.0
0.58
146 (54)
103 (63)
271
163
1.73 (1.06-2.81)
1.0
0.02
189 (55)
59 (67)
345
88
0.59 (0.36-0.97)
1.0
0.03
97(48)
152(65)
200
234
0.50 (0.34-0.74)
1.0
0.001
Man received invitation letter
Yes
35 (70)
No
150 (39)
Cultures
Non-prohibitive
177 (42)
Prohibitive
2 (20)
Distance to health facility
Less than 5
150 (42)
5 kilometers and more
35 (45)
Joint decision making on ANC
Yes
125 (46)
No
60 (37)
Waiting time
More than 30
156 (45)
Less than 30 minutes
29 (33)
Male perception on maternal health
Easily accessible
108(52)
Not easily accessible
82(35)
The P value <0.05 is statistically significant
38
OR 95% CI
P-value
Male partner receiving an invitation letter (OR 3.64, 95% CI: 1.92-6.89, p=0.000) and being
employed (OR 2.22, 95% CI: 1.32-3.72, p=0.002) were the factors associated with increased
likelihood of the man escorting the wife for ANC.
Education level of the man of primary and below (OR 0.50, 95% CI: 0.34-0.74, p=0.001), low
wife’s education level (OR 0.50, 95% CI: 0.31-0.74, p=0.001), men in polygamous relationship
(OR 0.52-95% CI: 0.31-0.89, p=0.01) were predictive of few men escorting their partners for
maternity care services (Table 6.4.1).
From qualitative data, lack of knowledge of the benefits and need of male involvement in
maternal health care were reported to contribute to low male involvement in maternal health care
services. This is emphasized by some of the responses from focus group discussion and KI
interviews.
“Most men in this area are just reluctant to discuss or accompany their wives to the
health unit for ANC, delivery or postnatal care services because they think it is not a big
issue that may need their attention or participation.” (KI Buwenge Town Council).
“I have had ten children but I have always gone for ANC, delivery and PNC without my
husband, I wonder why these days you want women to come with their partners yet ANC
and delivery is intended for the pregnant women alone”,! (Mother Buwenda).
Another factor that was mentioned to inhibit male involvement was health workers demand for
payment for services
“We are told services are free but sometimes health workers ask for money for gloves and
medicines from mothers. That is why men fear to go to the health unit and they leave the
women to go alone. They even think that if the woman goes alone she will be charged less
compared to when she is with the husband.” (Key informant Kalebera East, ).
39
Long waiting time at the health unit coupled with concurrent job demand were the other factors
mentioned in FGD as contributing to low male involvement in ANC
“Sometimes the woman goes to the health unit for ANC and she ends up spending the
whole day at the health facility that is why I cannot attend ANC or accompany her for
postnatal care. (KI Wairaka).
Health workers attitude, being rude to mothers and their partners, absenteeism
“ In our health unit health workers some times are very rude, one wonders why the same
health worker handling mothers in a very rude way in the government health unit is very
good when you pay some money, Is it because of money?” Young man Kimaka.
“Sometimes when we go the health unit for ANC, delivery or postnatal care we do not
find any health workers to attend to us and they always come late” (FGD Mpumudde).
Lack of drugs and supplies in the health facilities was mentioned as a problem.
Stock out of drugs and requiring mothers to buy gloves plastic sheets was cited as one of the
reasons for the men not to escort the wife during labour.
“Health workers burden us a lot, when you escort the wife to the health unit they ask to
buy almost everything from gloves, syringes, yet some times we do not have the money.
That is why I have stopped escorting my wife to avoid embarrassment”
(KI Magamaga, Kalongo).
The health workers not allowing men into the delivery room also featured prominently as an
example of the health system not accommodating men who accompany their partners during
labour
‘Even when we escort our wives during labour we are not allowed into the delivery room
and we are made to wait from outside’. (FGD Kimaka).
40
Table 6.4.2 Factors associated with male accompanying wife during labour (N =425)
Accompanied during labour
Frequency (%)
Variable
Employment status
Employed
Not employed
Education level
Primary and below
Post primary
Wife education
Primary and below
Post primary
Alcohol consumption
Does not consume
Consumes
Marriage relationship
Polygamous
Monogamous
Couple living together
No
Yes
Yes
n(%)
No
n(%)
145 (43)
39 (46)
196(57)
45(54)
341
84
0.76 (0.41-1.42)
1.0
0.55
84 (39)
100 (48)
131(61)
110 (52)
215
210
0.50 (0.29-0.86)
1.0
0.01
94 (40)
90(47)
141(60)
100 (53)
235
190
0.55 (0.32-0.92)
1.0
0.02
128 (44)
56 (42)
165(56)
76(58)
293
132
1.27 (0.68-2.39)
1.0
0.44
34 (51)
150(42)
33 (49)
208 (58)
67
358
0.59 (0.31-1.13)
1.0
0.11
40
385
0.41(0.20-0.86)
1.0
0.01
18 (45)
166 (43)
22 (55)
219(57)
Total
N
Significance Test
OR 95% CI
P-value
Man received invitation letter
Yes
33 (66)
No
151(40)
Distance to health facility
Less than 5
147 (42)
5 kilometers and more
37 (49)
Joint decision making on delivery
Yes
77 (56)
No
180 (63)
Escorted wife for ANC
Yes
111(61)
No
73 (30)
Prior arrangement where wife is to deliver
17 (34)
224 (60)
50
375
2.37(1.20-4.09)
1.0
0.01
202(58)
39 (51)
349
76
0.48 (0.26-0.88)
1.0
0.01
61 (44)
107 (37)
138
287
2.99(1.51-5.90)
1.0
0.000
70 (39)
171(70)
181
244
4.75(2.66-8.48)
1.0
0.000
Yes
No
131(46)
110 (79)
284
140
3.85(1.85-8.02)
1.0
0.000
153 (54)
30 (21)
The P value <0.05 is statistically significant
The table 6.4.2 on the previous page illustrates the factors associated with the male partner
accompanying the wife for delivery. Education level for both the male and the wife being of
primary level and below was associated with few men accompanying their partner during
41
delivery (OR 0.50, 95% CI: 029-086, p=0.01 and OR 0.55, 95% CI: 0.32-0.92, p=0.02
respectively).
Men who accompanied their partners during ANC (OR 4.75, 95% CI: 2.66-8-48, p=0.000),
received male partner invitation letter (OR 2.37, 95% CI: 1.20-4.09, p=0.01) and made joint
couple decision on where the wife was to deliver (OR 2.99, 95% CI: 1.55-5.90, p=0.000) were
factors found to be predictive of more men accompanying their partners during delivery
42
Table 6.4.3.Bivariate analysis of factors associated with male accompanying wife during
postnatal
Accompanied during PNC
Variable
Education level
Primary and below
Post primary
Wife education
Primary and below
Post primary
Escorted wife for ANC
Yes
No
Man received invitation letter
Yes
No
Distance to health facility
Less than 5
5 kilometers and more
Joint decision making on PNC
Yes
No
Waiting time
Less than 30 minutes
More than 30
Yes
n (%)
No
n (%)
Significance Test
Total
(N)
OR 95% CI
P-value
54 (25)
79 (37)
166 (75)
139 (63)
220
214
0.55 (0.34-0.84)
1.0
0.005
66 (28)
67 (34)
173 (72)
128 (66)
239
195
0.72(0.48-1.09)
1.0
0.13
4.77(3.07-7.40)
1.0
0.000
94 (51)
42 (17)
91 (49)
207(83)
185
49
32 (64)
101 (26)
18 (46)
283 (74)
50
384
4.98(2.69-9.26)
1.0
0.000
101 (28)
32 (41)
256 (72)
45 (59)
357
77
0.55(0.33-0.92)
1.0
0.02
107 (37)
26 (18)
182 (63)
119 (82)
289
145
2.77(1.06-3.81)
1.0
0.02
38 (39)
94 (27)
50 (61)
251 (73)
88
345
2.02 (1.25-3.29)
1.0
0.004
The P value <0.05 is statistically significant,
The table 6.4.3 above indicates that men who received male partner invitation letter (OR 4.98,
95% CI: 2.69-9.26, p=0.00), waiting time at the health facility being less than 30 minutes
(OR 2.02, 95% CI: 1.25-3.29, p=0.004) and men who attended ANC with the wife
(OR 4.77, 95% CI: 3.07-7.40, p=0.00), were predictive of more men accompanying their wives
during postnatal.
Men’s education being below secondary level (OR 0.55, 95% CI: 0.34-0.84, p=0.005) and
distance of less than 5 Km to the health facility were associated with less likelihood of men
escorting their wives and children for postnatal care.
43
Key Informants and participants in FGDs also reported poor knowledge of what is done at the
health facility, coupled with poor communication among couples and paying money to some
health workers before rendering services as the reasons that greatly affect male involvement
postnatal care.
“I have seen few men escort their wives for ANC and delivery but not postnatal care”. (KI
Wairaka)
44
Table 6.4.4.Multivariate analysis of factors associated with men accompanying wife for
ANC, delivery and postnatal care
Variable
Crude OR
Adjusted OR (95% CI) P-value)
A) Accompanied wife for ANC
Employed vs. unemployed
2.22
1.05 (0.55-2.03)
0.86
Primary education vs. Post primary
0.50
0.53 (0.33-0.85)
0.009
Wife education primary vs. post primary
0.50
0.68 (0.42-1.08)
0.10
Polygamous vs. monogamous
0.52
0.47 (0.06-0.96)
0.01
Received vs. not received letter
3.64
2.98 (1.49-5.96)
0.002
Maternal health services accessible vs. not accessible
0.50
0.60 (0.38-0.92)
0.02
Waiting time >30 vs. less than 30 minutes
0.59
0.59 (0.33-1.02)
0.06
Culture not prohibitive vs. prohibitive to escort wife
5.58
6.67 (1.25-35.4)
0.02
B) Accompanied wife during labour
Wife education primary vs. post primary
0.50
0.85 (0.46-1.59)
0.06
Not living vs. living together with wife
0.41
0.31 (0.14-0.72)
0.006
Received vs. not received letter
2.37
1.44 (0.69-3.01)
0.32
Made vs. no joint decision on delivery
2.99
0.80 (0.85-3.79)
0.12
Attended vs. did not attend ANC with wife
4.75
3.44 (1.83-6.46)
0.000
Arrangement vs. no arrangement on delivery
3.85
2.47 (1.12-5.46)
0.02
Primary education vs. Post primary
0.55
0.72 (0.45-1.16)
0.18
Received vs. not received letter
4.95
3.48 (1.76-6.91)
0.000
Waiting time less vs. more than 30 minutes
2.02
3.28 (1.83-5.87)
0.000
Attended vs. did not attend ANC with wife
4.77
4.46 (2.72-7.31)
0.000
C) Accompanied wife and child for postnatal care
The logistic regression analysis revealed that a man who attended ANC with the wife
(AOR 3.44, 95% CI: 1.83-6.46, p=0.000) and a couple having an arrangement of where the wife
should deliver (AOR 2.47, 95% CI: 1.12-5.46, p=0.02) were the factors associated with
increased male accompanying the wife during labour.
45
The factor associated with increased male accompanying the wife during labour was a man
attending ANC with the wife (AOR 3.44, 95% CI: 1.83-6.46, p=0.000).
While low education level of the man (AOR 0.53, 95% CI: 0.33-0.85, p=0.009), polygamous
relationship (AOR 0.47, 95% CI: 0.06-0.96, p=0.01), and men who perceived maternal health
services as being accessible (AOR 0.60, 95% CI: 0.38-0.92, p=0.02) were factors responsible for
few men escorting the wife during ANC.
Joint decision-making on ANC (AOR 4.46, 95% CI: 2.89-6.86, p=0.000) is predictive of joint
decision making on postnatal care.
46
CHAPTER SEVEN
7.0 Discussion
7.1 Male involvement in ANC, delivery and postnatal care services.
The study revealed that the proportion of males who accompanied their spouses for ANC,
delivery and postnatal care was relatively low at 42.7% for ANC, 43.4% for delivery and 31.7%
for postnatal care.
Our study is consistent with the recent studies that have shown low male involvement in
maternal health care services. The study done in Omoro county Gulu district revealed that 48%
of the males accompanied wife during delivery (Tweheyo, 2009), but male who accompanied the
wife for ANC in our study is relatively low compared to 65.4% reported in Omoro (Tweheyo,
2009) and 63% reported in Nigeria (Olayemi et al.; 2009). However the proportion of males who
accompanied the wife for ANC in this study was higher than in northern Tanzania where male
participation was reported to be only 12.5% (Nsuya et al, 2008).
The implications of our finding at individual level all health workers need to put more effort to
encourage male involvement while as the health system especially the health education we need
to design messages to encourage male involvement in maternal health care services in order to
achieve increased utilization of maternal health care services by women.
According to this study, joint couple decision-making is high for postnatal care (66.6%) and
ANC (62.7%), while low for delivery at 32.5%. The findings of our study differ from findings of
studies done in Kooki, Nepal and India. In the study conducted in Kooki county Rakai district,
reported a 71.3% joint decision-making on delivery (Bua, 2008), while in Nepal 75% of the
sampled women reported discussing with their husbands on health issues during pregnancy
47
(Britta and others, 2004) and in India a 71% joint couple decision-making on maternal health
issues was reported (Frontier, 2004).
The comparatively lower level of male involvement in decision-making on maternal health care
services in Jinja district contrasts with that in Nepal and India. This is probably because majority
of the respondents were from the rural areas that may hold on to the traditional belief that do not
encourage joint couple decision on maternal health. In addition, the low level of women
education in Jinja might also explain the low level of male involvement in decision-making in
this study compared to that in Nepal and India. Studies have shown (Britta et al, 2004) that
educated women are more likely to discuss and make joint decisions with their spouses on
pregnancy health issues than the uneducated.
The low level of male involvement in decision-making on matters related to labour and postnatal
care if not addressed will continue to delay referral of the mothers in labour from home to the
health facility because they may need to consult their husbands late when labour begins. The
health workers therefore need to encourage inter-spousal communication during sensitization of
the community on the importance of male involvement in maternal health care services.
7.2 Effects of men attending ANC on their Level of knowledge
This study revealed that men attending ANC with the wife did not lead to a significant increase
in the level of knowledge men had on the recommended minimum number of ANC visit,
Services offered to the women during ANC, delivery and postnatal visits to the health units on
the part on men who attended ANC with their partners compared to those who did not attend
ANC. Our study findings is similar to reports of other studies that have shown that even when
men attend reproductive health services, they are not directly addressed by the service providers
48
and they end up generally receiving less information on reproductive health and are less prepared
in parenting (Finnbogadottir et al, 2003).
Lack of uniform messages and guidelines on the package of care men should receive when they
accompany their partners for maternal health care services could be the reason for the low level
of knowledge men have about maternal health care services in Jinja.
The finding of the study could further imply that the health workers in the district do not fully
exploit the opportunity provided by the men attending ANC with their partners to health educate
women together with their husbands. The implication of the findings is that the ministry of health
and the district need to clearly identify and provide standard messages to address men who
accompany their partners for maternal health care services.
However the reasons for no
difference in level of knowledge identified in this study will probably be a subject of
investigation by future researchers.
7.3 Factors associated male involvement in ANC, delivery and postnatal care
The study revealed several factors to be associated with men accompanying their partners for
maternal health care services. Men who received an invitation letter were more likely to escort
the wife for ANC and about three and a half time likely to accompany the wife during postnatal
compared to men who did not receive an invitation letter. It is possible that the letter provided an
opportunity to encourage couple communication and negotiation, which has been reported to be
positively associated with male involvement (Britta et al 2006).
This finding of our study suggests the invitation letter for the husband to attend ANC with the
wife should be made part and parcel of the package that a pregnant woman must receive on the
first contact with maternal health care services.
49
Men who perceived their culture not being prohibitive of the man escorting the wife during ANC
were more likely to accompany the wife for ANC compared to men whose culture was
prohibitive. The finding of our study is consistent with findings of other studies carried out in
South Africa in 2005. In South Africa, service providers had a concern that men hold on to
traditional beliefs for example that a man may lose strength when he sees a naked woman
(Mullick et al 2005). This was noted to contribute to some men’s not escorting the women for
maternal health services. Health service providers need to sensitize the community and dispel
some of these retrogressive culturally held beliefs that discourage male involvement in maternal
health care services.
This study also revealed that men who accompanied the wife for ANC were more likely to
accompany the wife for delivery and also more likely to accompany the wife for postnatal care
compared to those who did not attend ANC with the wife. A similar finding was reported in a
study by Alka and others (2002) done in rural India, they reported that husbands who accompany
their wives for routine care in one phase of maternity care are likely to accompany them in the
other phases of maternity care. The implication of this finding is that we need to design
messages and package them in simple terms such that all what we would the couple to provide in
during ANC and delivery is prepared in time and the couple comes well prepared to avoid
surprises that keep men away from maternal health care services.
In this study, having a prior arrangement where the wife should deliver was found to be strongly
associated with increased likelihood of male accompanying the partner during labour (AOR 2.47,
95%CI 1.12-5.46). Having prior arrangement on where the wife is to deliver reflects that better
communication exist between couples. Although it did not reach significant levels in this study,
50
we found an increased likely hood of a man escorting the wife during labour among couples who
indicated making a joint decision on delivery issues. This finding is consistent with other studies
that have shown strong associations between inter partner communication and male involvement
(Mbizvo and Basset, 1996, Fapohunda & Rutenberg, 1999).
In the study, short waiting time at the health facility was predictive of increased male
accompanying the wife for postnatal care (AOR 3.28, 95%CI 1.83-5.87). The findings of our
study is in agreement with findings from several studies that have reported long waiting time at
the health facility as being one of the reasons for low male accompanying their partners for
maternal health services (Mullick et al, 2005).
It is possible that if waiting time at the health facility were reduced it will result in increased
male accompanying the wife and child for postnatal care. This is because many men have long
working hours and long waiting time makes it difficult to find time off to attend maternal health
services. The implication of the finding is that we need to increase on the number of midwives in
the health facilities if we are to achieve the waiting time at the health facilities of less than 30
minutes when women are attending maternal health care services at our facilities.
From quantitative data analysis, only low education level for the man or wife was found to be
significant in contributing too few men escorting the wife for ANC. The finding of our study is
similar to findings in the studies carried out in Omoro County (Uganda) and in Kenya .In Kenya,
un-educated men were found to be less likely to participate in reproductive health. The study in
Omoro County revealed that educated men were positively associated with male participation in
ANC (Tweheho, 2009). Studies suggest that uneducated men tend to hold on to traditional belief
51
which greatly impair inter spousal communication leading to low male involvement in
reproductive health (Nzioka, 2001).
According to this study, men who perceived maternal health services as accessible were less
likely to accompany the wife for ANC. The finding of this study differs from other studies that
have shown that distances traveled are indirectly associated with utilization of health services
(Eijk et al, 2006, Muki, 2009). However the finding in our study is in agreement with the finding
of a study done in Budondo sub county Jinja district that revealed that when services are near,
men stop accompanying their wives to seek care (MFPED, 2002). This is most likely because
most men view the provision of transport (which in most cases require riding a bicycle) for the
wife to the health facility as the major reason for escorting the wife to the health unit yet this
ceases to be the case when the health facility is within a walking distance. This finding of our
study suggests that if we do not sensitize the community on the benefits of the man
accompanying the wife during ANC then the intended benefit of bring services near to the
people will not achieve all its intended objective of reducing maternal morbidity and mortality.
In this study, men in a polygamous relationship were less likely to escort the wife for ANC. This
finding is consistent with findings from other studies that have suggested that men in polygamy
relationships are always detached from their wives because they are supposed to remain
impartial across their marriages (Draper, 1989, Mullick et al, 2005).
According to this study, waiting time at the health facility of more than 30 minutes was
associated with 49% chances of the man not escorting the wife for ANC. This finding is higher
than that in Gulu where long waiting time at the health facility was cited by 23.8% of the male
respondents as the challenges they faced in accompanying their spouses for maternal health
52
services (Tweheyo, 2009). Jinja being more urban than Omoro means most of the men are likely
to work away from home most of the time, therefore are likely to take more time away from
home and as a result not being able to escort the wife during ANC
According to this study, demand for money by some health workers before rendering services
and lack of drugs and supplies in the government health facilities, were the reasons other given
by men for not escorting the wife during labour. Ruhweza and others (2009) reported similar
findings of household paying for health care in Jinja district. The same study also reported that
health workers told their clients who came for care in the government health facilities that there
were no drugs at the health facility but on making payment, drugs suddenly became available
(Ruhweza et al 2009). Poverty could be a major bottleneck to men accompanying their partner
for fear of being embarrassed in case they fail to pay the health workers or not being able to pay
for supplies like gloves that the health workers demand during delivery.
According to this study, poor attitude of health workers and fear of being harassed by health
workers were some of the reasons contributing to low male involvement. The finding of our
study is consistent with other studies in Kenya where poor behavior of service providers has
been found to adversely affect male partner’s capacity to use reproductive health services
(Nzioka 1997, Fapohunda and Rutenberg 1999, Alka et al, 2005). This is probably because men
fear being the subject of verbal and emotional, sometimes physical abuse and this prevent men
from being involved (Breiding-Buss, 2002).
According to this study, the fact that health workers don’t allow men entry into the delivery
room may be responsible for some men not accompanying their partners for maternal health
care. Similar findings were reported in the study carried out in South Africa. In South Africa,
53
some men indicated that even when men accompanied their partners to the clinic, they generally
waited from outside (Mullick, 2005). These finding imply that much as we are advocating for
increased male involvement in maternal health, the health system has not yet been prepared to
accommodate men who escort the women during labour.
This study revealed lack of knowledge of what roles the man is to play during postnatal care,
belief that the man’s role is to provide transport and checking on child health card were cited as
the reason why some men do not escort the wife and child for postnatal care. The findings of our
study is consistent with several other studies that have reported that even when men encourage
their partners to seek care and get involved there is still lack of information on postnatal care.
This study revealed that men who reported making a joint decision on ANC were more likely to
make a joint decision on delivery and also likely to make a joint decision on postnatal care.
The finding of our study is consistent with finding in India that reported that men who were
involved in one phase of maternal health care were likely to be involved in other phases of
maternal health (Alka et al, 2002)
In this study, men who shared problems with their partner were twice more likely to make a joint
decision on where the wife is to deliver. Similar findings were reported in the study carried out in
Nepal in 2003. In Nepal, women who shared with the husbands were more likely to experience
several male involvement behaviors (Britta, 2004). The finding from FGD confirm the above in
that majority of the male participants considered postnatal care as a woman’s issue and
considered checking on the child health card as the only responsibility to confirm if the wife
actually went to the health facility for postnatal care.
54
The finding of this study suggests that the level of male awareness of the services offered during
postnatal care in Jinja district is still very low. This is could be the reason why men with 3
children or less are less likely to make joint couple decisions on this service.
55
CHAPTER EIGHT
8.0 Conclusions and Recommendations
8.1 Conclusions
Although a high proportion of males in Jinja district discuss and make join couple decision on
ANC and postnatal care, the number of males who discuss and make joint couple decision on
where the wife is to deliver from or those who accompany their partners for ANC, delivery and
postnatal care was low.
Men who attended ANC with their partners did not have a significantly higher level of
knowledge on maternal health care services compared to men who did not attend ANC with their
partners. However, establishing the contributing factors to this finding need to further be
investigated to establish the messages health workers give to the men who attend ANC with their
partners.
Factors that were found to be associated with increased male accompanying the wife for ANC,
delivery and postnatal care services included; higher education status of the husband and men
receiving an invitation letter.
The factors associated with low male involvement in maternal health care services Jinja district
included; poor couple communication; maternal health services being perceived as easily
accessible, men in a polygamous relationship, and couple not living together.
56
8.2 Recommendations
1. The District together with the Ministry of Health should take steps to raise awareness on
the importance and benefits of male involvement in maternal health care services. This
could be achieved through the issuing of invitation letters for men to attend maternal
health care services with their partners, designing messages that specifically target men
who accompany their spouses for maternal health care services and the involvement of
the village health teams and community leaders in reaching out to men and encouraging
their involvement in maternal health care services.
2. To increase male involvement in maternal health care services, the district health
managers have to ensure the availability of medicines as supplies at the health facilities,
improve the health workers attitude towards men who accompany their partners for
maternal health care services and stop illegal charges for services by health workers.
3. Both girls and boys in school should be encouraged to stay in school beyond the primary
level for sustainability of increased male involvement in maternal health care services
4. A study to establish factors that motivate male involvement in maternal health care
services would further strengthen strategies for improving male involvement in maternal
health care services.
57
10.0 REFERENCE
Adamu Y .M and Salihu H.M (2002), Barriers to the use antenatal and obstetric care services
in rural Kano, Nageria; journal of obstetrics and gyaenacology. 22(6): 600-603
Ademchak DJ, Adebyao A (1997), Male fertility attitudes: neglected dimension of Nigeria
fertility research. Social Biology, 34:57-67
Alka Barua (2005), Husbands involvement in maternal care: Young couples in
Maharashtra.How much do husbands participate in their adolescent and young wives’ pregnancy
and maternity care?
Alka Barua, Rohini P.Pande, Kerry Mac Quarrie and Sunayana Walia (2005), Caring Men?
Husbands’ involvement in maternal care among young couples in India, International center for
research and women
Amy Ratcliffe (2002), Men’s roles with multiple partners: challenges and opportunities Report
of the meeting of W.H.O. Paper presented in the meeting of Regional adviser in Reproductive
Health WHO/PAHO, Washington DC, USA 5-7 September 2001,World Health Organization.
Birungi.S, Odaga.J, Lochoro J.P, Santini. S, Owiny E (2009), The quality and use of maternal
health services care in Oyam district, Uganda. Baseline survey for an intervention, Health policy
and development Vol 7, No1 Faculty of Health sciences Uganda martyrs University
Breiding-Buss, Marg Bigsby and Evelyn Trischler (2002), Men and women in Postnatal
Family Health services. Report presented to PHA conference Dunedin, 26 June 2002.
58
Britta C Mullany (2006), Barriers to and attitudes towards promoting husbands involvement in
maternal health in Kathmandu, Nepal. Social science and medicine, 62(11): 2798-809
Britta C Mullany (2004), Women’s autonomy and male involvement in antenatal care in Napal:
associations and tensions. John Hopkins Bloomberg School of public Health Baltimore USA
Britta C Mullany, Becker, S and Hindin M.J (2007), The impact of including husbands in
antenatal health education services on maternal health practices in urban Nepal: results from a
ramdomised controlled trial. Health education and research, 22(2): 166-76
Bua John (2008), Barriers and supportive factors to men’s participation in perinatal care in
Kooki County Rakai district. MPH dissertation Makerere University School of Public Health
Bulut and Molzan Turan (1995), Bringing fathers into the picture; postpartum family planning
available at www.avsc.org. Accessed January 2009
Carter.M (2000a), Husbands and maternal health in Guatemala. Wives reports on spouses
involvement in pregnancy and birth. Social Science & medicine 55(3), 437-50
Carter.M (2000b), Because he loves me’: husbands involvement in maternal health in
Guatemala. Culture, Health, & Sexuality, 4(3), 259-279
Chege J (2005), Interventions Linking gender relations and violence with Reproductive Health
and HIV: rationale, effectiveness and gaps. Available at
November 2008
59
www.who.int,
accessed 10th
Cigdem .B, John M .P, Arzum G, Ayse Kin (1999). Involving Men as partners in reproductive
health lessons learned in Turkey. Available at www.who.int, accessed 10th November 2008
Draper.P (1989), African marriage systems; perspectives from evolutionary biology, Ethology
and sociobiology, 10:145-169
Drennan M (1998), Reproductive health .New perspectives on men’s Participation. Population
Reports, Series J No.46.Baltimore John Hopkins School of Public Health, Population
Information program.
Eijk A.M.V, Bless H.M, Odhimbo.F, Ayisi J.G, Blockland I.E, Rosen D.H, Adazu K,
Slutster L, Lindblade K.M (2006) Use of Ante-natal services and delivery care services in
Rural western Kenya: Community based survey. Reproductive Health Journal, 3:2.
EngenderHealth (2001), Men as partners Johannesburg available at www.engender.org /our
work gender/men-as-partners-php; accessed 20th October 2008
Family Care International (1997), The safe motherhood Action Agenda; priorities for the next
decade, report on safe motherhood technical consultation, Colombo, Sri Lanka 18-23 October
1992.FCI New York
Fapohunda B M, Rutenberg N (1999), Expanding men’s participation in reproductive health in
Nairobi, Kenya.The African population research center.
Finnbagadottir H, Crang Svalenieus E, Persson.E (2003), Expectant first time fathers’
experience of pregnancy, midwifrey
60
Ghorayeb F (1998), Male involvement in sexual and reproductive health programmes and
services available at www.who.org accessed 20th October 2008
Kasolo.J and Ampaire C (2000), Knowledge, Attitudes and Practices of women and men
towards safe motherhood in rural settings. A qualitative study done on behalf of Delivery of
Improved Service for Health (DISH II) project
Khan M.E (2002), Male involvements in reproductive health programme: where we stand today.
Paper presented in the meeting of Regional adviser in Reproductive Health WHO/PAHO,
Washington DC, USA 5-7 September 2001, World Health Organization.
Koisa A (2002), Opportunities and Challenges for men’s involvement: the regional reproductive
strategy, Paper presented in the meeting of Regional adviser in Reproductive Health
WHO/PAHO, Washington DC, USA 5-7 September 2001,World Health Organization.
Kunene B, Beksinska M, Zondi S, Mthembo N (2005), Involving men in maternity care in
South Africa, Agenda special focus Reproductive health research unit of the University of
Witwatesrand & FRONTIERS in reproductive program of the population council population
health international
Greene M (2002), Lessons and future programmatic directions for Involving men in
reproductive health. Paper presented in the meeting of Regional adviser in Reproductive Health
WHO/PAHO, Washington DC, USA 5-7 September 2001, World Health Organization.
Greene M, Manisha M, Puherwitz, Deirdre W, Akinrinola and Susheela (2003), Involving
men in Reproductive Health: Contributions to Development Background paper to report Public
61
choices, Private Decisions: Sexual and Reproductive Health and Millennium Development
Goals. Mellinnium Project
Lundgren Rebecka (2000), Research protocol to study sexual reproductive health of
adolescents in Latin America, Division of health promotion and protection family health and
population program.
Manisha M (2002), Communicating with men to promote family planning, Paper presented in
the meeting of Regional adviser in Reproductive Health WHO/PAHO, Washington DC, USA 57 September 2001,World Health Organization.
Mbizvo M T and Basset (1996), Reproductive health and AIDS prevention in sub-Saharan
Africa: the case for increased male participation. Health policy and planning 11(1): 84-92
MEDiCAM (2004), Male involvement is key to Reproductive Health. Reproductive health
working group report available at www.who.int accessed January 2010
Ministry of Finance Planning and Economic Development (2002), Uganda Population,
Reproductive Health & economic development November 2001
Ministry of Health Uganda (2005), Health sector strategic plans II Volume I.
Ministry of Health Uganda (2006), Uganda Demographic Health Survey
Ministry of Health Uganda (2006), The National policy guidelines and service standards for
sexual and reproductive health and rights
62
Mira/UNIEF (2000), Report: LBW prevention and associated factors in 4 regions of Nepal a
mult-hospital based study. Katmandu, Nepal
Muki M (2009) Factors affecting utilization of Natal services by HIV positive pregnant women
in Jinja district.
Mullick Saiga,Busi Kunene and Monica Wanjiru (2005),Involving men in maternity
care;Health service delivery issues: available at www.who.int accessed 20 October 2008
Muwa .B, Mugume A, Buzaalirwa, Nsabagasani, Kintu.P, Nkwake (2008), The role of
family support groups in improving male involvement in PMTCT programs. Uganda Programme
for Human and Holistic Development (UPHOLD) project evaluation report
Naomi W (2005), Challenges and opportunities for male involvement in reproductive health in
Cambodia, Policy Project Paper presented for review by the United Agency for International
Development (USAID).
Nepal Demographic and Health Survey (2001), Family Health Division, Ministry of Health,
His Majesty’s Government, Katmandu, Nepal &New ERA, Katmandu, Nepal & ORC Macro,
Calverton, MD
Ntabona Alexis (2002), Involving men in safe motherhood: the issues. Paper presented in the
meeting of Regional adviser in Reproductive Health WHO/PAHO, Washington DC, USA 5-7
September 2001, World Health Organization.
Nyane L (2007), Factors associated with Antenatal care dropout among pregnant women in
Tororo district. MPH dissertation Makerere University School of Public Health
63
Olayemi, O, Bello, F.A., Aimakhu.C.O.Obajimi, G.O and Adekunle A.O (2009), Male
participation in pregnancy and delivery in Nigeria. A survey of antenatal attendees. Journal of
Biosocial Sciences, 2:1-11
Reproductive health outlook (2004), Men and reproductive health. Available at
www.rho.org accessed 20th October 2008
Ruhweza M, Baine S O, Onama V, Pario G (2009), Financial risks associated with health care
consumption in Jinja Uganda. African Health Sciences 2009,9(S2):586-589
Shahfahan M and M Kabir (2006), why males in Bangladesh do not participate in reproductive
health: Lessons learned from focus group discussion. International quality community health
education, 26(1): 45-59
Shefner-Rogers C and Sood S (2004), Involving husbands in safe motherhood: Effects of suami
siaga campaign in Indonesia. Journal of Health communication 3:233-58
Sternberg, P and Hubley (2004), Evaluating men’s involvement as a strategy in sexual and
reproductive health promotion. Health promotion international, 19(3): 389-96
Thaddeus S and Maine D (1994), Too far to walk; maternal mortality in context, Social
sciences and medicine, 38:1091-1110
Tweheyo.R (2009), Determinants of male participation in skilled antenatal and delivery care in
Amoro County Gulu district. MPH dissertation Makerere University School of Public Health
64
Uganda Bureau of statistics (2005), 2002 Uganda population and housing census Jinja district
report
United Nations Children’s Fund (2008), The state of the world’s children 2009, maternal and
newborn health
UNFPA, Cohen, Burger. M (2000), Partnering: anew approach to sexual and reproductive
health. Technical Paper No.3.
UNFPA. (2004), Investing in people: National progress in implementing the ICPD Program of
action 1994-2004
United Nations Population Fund (1999), implementing the reproductive health vision; progress
and future challenges for UNFPA, available at www.unfpa.org accessed 20th October 2008
Were Nathan, (2009), Rural finance should target women The New Vision newspaper (2009),
Tuesday December 2009 Pg 13
World Health Organization (2001), Programme for male involvement in reproductive health
available at www.who.org accessed 20th October 2008
World Health Organization (2004-2005), Overview of activities Gender, Women and Health in
Headquarters and Regional offices available at www.who.org accessed 20th October 2008
65
World Health Organization (2004), Reproductive health strategy to accelerate progress
towards the attainment of international development goals and targets available at
www.who.org accessed 20th October 2008
World Health Organization (2006), Accelerating progress towards the attainment of
international reproductive health, available at www.who.org accessed 20th October 2008
World Health Organization (2008), Women ‘s Health in the WHO Africa Region: A call for
action. Report of Regional Director. Fifth-eighth session Yaunde, Cameroon 1-5 September 2008
WHO, UNICEF and UNFPA (2001), Maternal mortality in 1998 estimates, available at
www.who.int accessed 29th March 2010
Young M Kim and Andreine Kols (2002), Counseling and communicating with men to
promote family planning in Kenya and Zimbabwe. Paper presented in the meeting of Regional
adviser in Reproductive Health WHO/PAHO, Washington DC, USA 5-7 September 2001, World
Health Organization.
66
Annexes
Annex 1
Consent Form
Title of the study: Factors Affecting Male Involvement in Maternal Health Services in Jinja
District
I am----------------------------------. Coming from the office of the medical officer of health Jinja
Municipal Council. We are carrying out a study on male involvement in Maternal Health in Jinja
Reason for the study. We would like to find out the reasons why most men in the district are not
actively involved in maternal health services especially regarding accompanying their partners to
the health unit to seek antenatal care, delivery and postnatal care services. The study will provide
an opportunity to obtain a comprehensive picture on male involvement in maternal health care
services and the factors that hinder or promote male involvement in maternal health.
Benefits of the study. The Findings of the study will provide information on how best to involve
men in maternal health and to improve the health of both men and women as a whole. Study
participants who may have any medical illness will receive free consultation services from the
research team and where it requires referral they will be referred to the health facilities for the
management of their conditions
Risks of the study. No invasive procedures that will be performed on you during this study.
However some of the questions I will ask are sensitive and are of a private nature, and may make
you feel uncomfortable. Please be assured that this discussion is strictly confidential, and names
will not be recorded. The findings of the study will be generalized and not linked to the
individual
Participation in the study. Participation in the study is voluntary, if you do not want to answer
particular questions that is okay. There are no right or wrong answers to the questions that we
will be asking you. Please feel free to answer exactly as you feel. You are free to withdraw from
the interview at any time without the need to justify your decision
I would like to seek your consent before I proceed. Are you willing to allow me continue with
the interview?
1. Yes
2. No
If the Respondent agrees to continue, ask if he has any questions. Respond to the questions as
appropriate, and then start discussion.
If the Respondent does not agree to continue, thank him/her and go to the next interview.
For further information about this study please contact Dr Nantamu Dyogo Peter
Tel 0712858539
67
Annex 2
Questionnaire for men
Factors Affecting Male involvement in maternal health care services in Jinja district
Household Number_________
Name of Village____________ Parish_________________ Parish Number_______
Sub county_____________ Sub county Number___ Interview Number_______________
Place of Usual residence (1) Urban (2) Rural
Name of interviewer__________ Signature of Team Leader_____________
Q1 How old were you at your last birth day
a) 18-25years
1
b) Above 25years
2
Qn 2 What is your employment status?
a) Employed
1
b) Unemployed
2
Q.3 What is your highest level of education?
a) Primary level and below
1
b) Secondary level and above
2
Q.4 What is the highest level of education of your wife?
a) Primary level and below
1
b) Secondary level and above
2
Q.5 What is your religion?
a) Catholic
1
b) Anglican
2
68
c) Born again Christian
3
d) Moslem
4
Man’s status
Q.6 Who is the income earner in your family? (Working for pay)
a) Only husband working for pay
1
b) Only wife working for pay
2
c) Both husband and wife working for pay
3
d) Neither husband nor wife working for pay
4
Q.7 Do you consume alcohol?
a) Yes
1
b) No
2
Q.8 How many children do you have?
a) Less than 3
1
b) 3 and above
2
Couple Characteristic
Q.9 What is your marriage relationship?
a) Monogamous Relationship
1
b) Polygamous relationship
2
Qn10 Do you live together with your wife?
Yes
1
No
2
Q.11 Does your wife reside in the same homestead with your mother?
a) Yes
1
b) No
2
69
Qn 12 Do you have means of transport?
a) Have at least bicycle and more
1
b) Do not have means of transport
2
Qn 13 Do you have a radio?
a) Yes
1
b) No
2
Communication
Q.14 When you have a problem who do you share it with first?
a) My wife
1
b) b) My relatives (Brothers, Sisters or your parents) / Friend
2
Qn 15 Who has the final say about the health of your wife?
a) Woman has final say
b) Husband has final say
c) We discuss and decide as husband and wife
Qn 16 Have you ever received an invitation letter from a health worker inviting you to discuss
pregnancy issues of your wife?
a) Yes
1
b) b) No
2
18
Qn 17 If your answer in 16 above did you go to the health unit to discuss with the health
workers?
a) Yes
1
b) No
2
Health Services
Qn 18 How far is the health unit offering ANC, delivery and postnatal care services from your
home?
70
a) Less than 5km
1
b) More than 5km
2
Q.19 How do you rate the over accessibility of the available maternal health services?
a) Not easily accessible
1
b) Easily accessible
2
Q.20 What is the condition of maternal health services provided in the health unit nearest to your
home?
a. Very good
1
b.
2
Not very good
22
Qn
21
Why
do
you
say
Response………………………………………………………………………………….
so?
Qn22 How do you find the attitude of health workers towards men who accompany their wives
to hospital to seek care?
a) They attend to us very well and friendly
1
b) They are unfriendly
2
Qn 23 How long does the woman on average spend in the health facility when she goes for ANC
or postnatal care.
a) Less than 30 minutes
1
b) More than 30 minutes
2
Qn24 Have you had of bad practices going on in the health facilities?
a) Yes
1
b) No
2
26
Qn25 Why do you say so?
Response……………………………………………………………
Qn26 What do people talk about men who escort their wives to the health unit for ANC, delivery
and postnatal care?
71
a) Good and encouraging
1
b) Bad and discouraging
2
28
Qn27 Why do you say so?
Response ………………………………………………………..
Qn28 Are men allowed entry into the labour room at the health facilities?
a) Restricted to men
1
b) Not restricted to men
2
Knowledge about maternal health services
Qn 29What is the recommended minimum number of times a pregnant woman is to attend ANC?
a) Twice
b) Three times
c) Four times
Qn30 What services are offered to pregnant woman and her husband during ANC? (Mention at
least four)
a) ……………………………..
b) ………………………………
c) ……………………………….
d) ………………………………..
Qn 31 Which services are offered to pregnant women during labor and delivery at the health
unit? (Mention at least four)
a) ……………………………..
b) ………………………………
c) ……………………………….
d) ………………………………..
72
Qn 32 What are some of the services offered to the mother and her baby during the first 6 week
after delivery? (Mention at least four)
a) ……………………………..
b) ………………………………
c) ……………………………….
d) ………………………………..
Male involvement outcomes
Qn 33 Have you discussed and made a joint plan with your wife where she is to attend ANC
during the most resent pregnancy?
a) Yes
1
b) No
2
Qn 34 Did you attend ANC at least once with your wife during the last pregnancy?
a) Yes
1
b) No
2
36
Qn 35 Why did you not attend?
Response……………………………………………………………………………………
Qn 36 Did you escort your wife to the health unit during labour for the most resent delivery?
a) Yes
1
b) No
2
38
Qn 37 Were you present the labor room together with your wife during delivery?
a) Yes
1
b) No
2
39
Qn 38 What could have prevented you to be with her in the labour room?
c)
Social stigma
1
73
d)
Cultural taboo
2
e)
Health workers do not allow you into the labour room
f) Fear of outcome of mother/baby
3
4
Qn 39 Have you made any fixed arrangement where your wife is to deliver?
a) Yes
1
b) No
2
Qn40 Did you discuss and made a joint decision on postnatal care services with your wife for the
last pregnancy?
a) Yes
1
b) No
2
Qn 41 Did you accompany your wife to seek care in health unit within 6 weeks after delivery of
your youngest child?
a) Yes
b) No
1
2
Qn 42 Who makes the final decision of where your wife should attend ANC?
a) The woman decides
1
b) The husband
2
c) Make a decision as a couple
3
Qn43 Who makes the final decision of where your wife is to deliver?
a) Make a decision as a couple
1
b) Wife decides
2
c) Husband decides
3
Qn 44 Are you as a man supposed to be involved in maternal health care services?
a) Yes
1
b) No
2
46
Qn 45 If yes in question 44 above, in what way are you supposed to be involved?
………………………………………………………………………………………………………
………………………………………………………………………………………
Qn46 What challenges do you face in escorting your wife to the health facility for ANC, delivery
and postnatal care?
a) Lack of transport
1
74
b) Long waiting time at the health facility
2
c) Concurrent job demand
3
d) Long distance to the health facility
4
e) It is a cultural taboo
5
f) Other (specify)………………………………..
Qn 47 What do you recommend the health managers to do to encourage men to be more
involved in the material health services?………………………………………………
Thanks very much for your time
75
Annex 4
Focus Group Guide for men
Factors Affecting Male Involvement in Maternal Health Services in Jinja District
Subcounty………………………………..Parish…………………..Village……………….
Date of discussion………………………….Number of participants………………………
Name FGD chair…………………………Other Reaseach Assistant………………………
Introduction –Welcome
The office of the medical officer of health Jinja municipal council is carrying out a study on male
involvement in maternal health services. We wants to know how women are working together
with their male partners in maternal health services, so as to improve utilization of maternal
health services by the pregnant mothers in the district.
The information got from this study will be used in planning and designing intervention to
encourage male involvement in maternal health. I am requesting you to participate in this
research by giving us the information that we need. You are free to withdraw from the study at
any time. But am urging you to take part to the end to make the study successful.
I have been told of this study and I understand the objectives of the study as the eventual
participation in this study is by choice not coercion. I have understood that I am allowed to
withdraw from the study any time I feel like and my withdrawal will not affect my right to access
to information and health services in the district.
…………………………………. ……………………………………
Witness’s signature Participants signature
(Research Assistant) (Thumb print)
Research………………………………………. Date……./…...2009
Introduction of moderators and observers
Objectives of the focus group
We are going to talk about topics related to your maternal health services. The purpose of this
discussion is for you to share your ideas and experiences with us so that we can understand your
views that will help in improving the maternal health services for women as well as increase
male involvement in maternal health.
Participation
76
There are no right or wrong answers to the questions that we will be asking you. Please feel free
to answer exactly as you feel.
Confidentiality, respect for others. Anything you say here will be kept confidential. We will
never mention your name outside this room. If you do not want to answer particular questions
that is okay. If you need to leave at any time that is fine
I request you to allow us tape the proceedings/ note taking of this meeting.
Introduction of particulars (name, work, etc)
Introduction of particulars (name, work, etc)
Qn 1 What do you know about ANC, delivery and postnatal care services?
Probes Who is the intended user?
Who should attend?
What are the services offered?
Q2) Do men in this area accompany their wife for ANC, labour and delivery and postnatal?
Probes What are the benefits of men attending these with their spouses?
To the mother?
To unborn baby and the newborn?
To the father?
Qn 3 What could be the reasons that prevent men to accompany the wife for ANC, labour
and delivery and postnatal?
Probes, Culture issues? Any social economic issue?
Health unit related factors?
Knowledge gaps of what is done at the health facilities?
Qn4 What do you suggest that the health service managers and the health workers need to
do to encourage male involvement in maternal health care services?
Qn 5 What about you as the men and community members what are you going to do to
improve male involvement in maternal health services?
77
Qn 6 Why is it that some pregnant women do not attend ANC; postnatal care services and
delivery in health facilities?
Probes Any influence from the husbands?
Any power /social economic issues?
Any community issues?
Any health facility issues?
Qn7 What should be done to improve health facility deliveries and attendence of postnatal
care services?
Probes Any issues on male involvement?
Any health facility issues?
Any community issues?
Thank you very much for your time and information
Do you have any questions or comments on the above issues we have been discussing?
(Answer any questions raised and thank the participants before closure of the session)
78
Annex 5
Focus Group Guide for women
Factors Affecting Male Involvement in Maternal Health Services in Jinja District
Subcounty………………………………..Parish…………………..Village……………….
Date of discussion………………………….Number of participants………………………
Name FGD chair………………………..Other research assistant…………………………
Introduction –Welcome
The office of the medical officer of health Jinja municipal council is carrying out a study on male
involvement in maternal health services. We wants to know how women are working together
with their male partners in maternal health services, so as to improve utilization of maternal
health services by the pregnant mothers in the district.
The information got from this study will be used in planning and designing intervention to
encourage male involvement in maternal health. I am requesting you to participate in this
research by giving us the information that we need. You are free to withdraw from the study at
any time. But am urguing you to take part to the end to make the study successful.
I have been told of this study and I understand the objectives of the study as the eventual
participation in this study is by choice not coercion. I have understood that I am allowed to
withdraw from the study any time I feel like and my withdrawal will not affect my right to access
to information and health services in the district.
…………………………………. ……………………………………
Witness’s signature Participants signature
(Research Assistant) (Thumb print)
Research………………………………………. Date……./…...2009
Introduction of moderators and observers
Objectives of the focus group
We are going to talk today about topics related to your maternal health services. The purpose of
this discussion is for you to share your ideas and experiences with us so that we can understand
your views that will help in improving the maternal health services for women as well as
increase male involvement in maternal health.
Participation
79
There are no right or wrong answers to the questions that we will be asking you. Please feel free
to answer exactly as you feel.
Confidentiality, respect for others. Anything you say here will be kept confidential. We will
never mention your name outside this room. If you do not want to answer particular questions
that is okay. If you need to leave at any time that is fine
I request you to allow us tape the proceedings/ note taking of this meeting.
Introduction of particulars (name, work, etc)
Qn 1 What do you know about ANC, delivery and postnatal care services?
Probes Who is the intended user?
Who should attend?
What are the services offered?
Qn2 Do you think it is important for you partner/husband to attend ANC,delivery and
postnatal care services?
Probes Any benefits to your social/psychological well being during pregnancy and delivery?
What services directly benefit men?
Would their involvement affect ANC, delivery and postnatal care?
Q3) Do men in this area accompany their wife for ANC, labour and delivery and postnatal?
Probes What are the benefits of men attending these with their spouses?
To the mother?
To unborn baby and the newborn?
To the father?
Qn 4 What could be the reasons that prevent men to accompany the wife for ANC, labour
and delivery and postnatal?
Probes, Culture issues? Any social economic issue?
Health unit related factors?
Knowledge gaps of what is done at the health facilities?
80
Qn5 What do you suggest that the health service managers and the health workers need to do to
encourage male involvement in maternal health care services?
Qn 6 Why is it that some pregnant women do not attend ANC; postnatal care services and
delivery in health facilities?
Probes Any influence from the husbands?
Any power /social economic issues?
Any community issues?
Any health facility issues?
Qn7 What should be done to improve health facility deliveries and attendence of postnatal
care services?
Probes Any issues on male involvement?
Any health facility issues?
Any community issues?
Thank you very much for your time and information
81
Annex 6
Key Informant Guide
Factors Affecting Male Involvement in Maternal Health Services in Jinja District
Subcounty………………………………..Parish…………………..Village……………….
Date of discussion………………………….Name of Interviewer………………………
Introduction –Welcome
The office of the medical officer of health Jinja municipal council is carrying out a study on male
involvement in maternal health services. We wants to know how women are working together
with their male partners in maternal health services, so as to improve utilization of maternal
health services by the pregnant mothers in the district.
The information got from this study will be used in planning and designing intervention to
encourage male involvement in maternal health. I am requesting you to participate in this
research by giving us the information that we need. You are free to withdraw from the study at
any time. But am urguing you to take part to the end to make the study successful.
I have been told of this study and I understand the objectives of the study as the eventual
participation in this study is by choice not coercion. I have understood that I am allowed to
withdraw from the study any time I feel like and my withdrawal will not affect my right to access
to information and health services in the district.
…………………………………. ……………………………………
Witness’s signature Participants signature
(Research Assistant) (Thumb print)
Research………………………………………. Date……./…...2009
Introduction of moderators and observers
Objectives of the study
We are going to talk today about topics related to your maternal health services. The purpose of
this discussion is for you to share your ideas and experiences with us so that we can understand
your views that will help in improving the maternal health services for women as well as
increase male involvement in maternal health.
Participation
There are no right or wrong answers to the questions that we will be asking you. Please feel free
to answer exactly as you feel.
82
Confidentiality, respect for others. Anything you say here will be kept confidential. We will
never mention your name outside this room. If you do not want to answer particular questions
that is okay. If you need to leave at any time that is fine
I request you to allow us tape the proceedings/ note taking of this meeting.
Introduction of particulars (name, work, etc)
Qn 1 What is you opinion about the level of men accompanying their wives for ANC,
delivery and postnatal care services?
Qn2 Do you think it is important for the husbands/partners to discuss with their wives and
attend ANC, delivery and postnatal care?
Probes What are the benefits of this action to the woman, unborn baby and the man?
How does male involvement improve the quality ANC, delivery and postnatal
care and utilization of these services by pregnant women and mothers
would their involvement ANC,delivery and postnatal care services?
Q3) Do men in this area accompany their wife for ANC, labour and delivery and postnatal?
Probes What are the benefits of men attending these with their spouses?
To the mother?
To unborn baby and the newborn?
To the father?
Qn 4) What are the possible reasons why few men in the district discuss and make ajoint
decision with their wives on ANC, delivery and postnatal care?
Probes Any health facility issues?
Any culture issues?
Any policy issues?
Any social ecoconmic issues?
Any information gap?
83
Qn5 In your opinion what should be done to improve male involvement in ANC,delivery
and postnatal care services?
Probes Any community issues?
Any health facility issues?
Any policy issues?
Qn 6 What about you as leaders and community members what are you going to do to
improve male involvement in maternal health services?
Qn 7 What should be done to improve utilization of ANC, delivery and postnatal care
services?
Probes Any issues of male involvement
Any health facility issues?
Any community issues?
Do you have any questions or comments on the above issues we have been discussing?
Thank you very much for your time and information
(Answer any questions raised and thank the participants before closure of the session)
84
Annex 7
Informed Consent Form-Lusoga
Title of the study: Factors Affecting Male Involvement in Maternal Health Services in Jinja
District
Enhandhula (introduction)
Ninze……………………………Nva mu yafeesi y’omukulu w’ebyobulamu Municipaali
y’eidhindha (Jinja Municipal Council).Tuli kukola okonoonenkeza ku ngeri abasaadha
yebeenhigira mu bwidhandhabi obuheebwa abakazi abali amabuundha,abali okulumwa akuzala
oba abaazaire.
Ensonga y’okunoonenkereza kuno (Reason for the study)
Tuli kwenda okuzuula ensonga lwaki abasaadha abawula obungi mu disitulikiti tibafaayo inho
kwenhigira mu bwudhadhabi obuheebwa abakazi abali amabuundha, abali okulumwa akuzala
oba abaazaire obuli ku kigema ku kugheerekeraku bakazi baibwe ku malwaliro nga bagya
okunhya obulezi nga bali mabunda, mukuzaala n’kufuna obwidhandabi oluvainhuma
lwo’kumala okuzaala.
Omuganhulo ogusubirwa mukunoonenkerza kuno (Benefits of the study)
Ebinaava mu kunoonekereza kuno biidha kutumanhisa ensambo ewula kuba nkalamu
gyetughanga okwingiza abasaadha mu nhidhandhaba y’abakazi abali amabunda n’okulongoosa
embeera dhobulamu bwonabwona obw’abakazi nabasaadha. Abantu abaneenhigira oba
abaneebuzibwaku mu kunoonenkereza kuno bwe banaaba n’bulwaire obw’ensambo yoonayoona
baidha kufuna okugalagirwa kwa bwereere okuva mu Bantu bano abagya okukola
okunoonenkereza kuno era ghekinaaba nga kyenda kwongerwayo mu malwaliro agasingawo,
kiidha kokolebwa olw’okubafunisa obwidhandhabi ku mbeera eyo.
Obuzibu obughanga okubaawo munoonenkereza kuno(Risks of the study)
85
Ezira kukakibwa kwa nsambo yoonayoona okunakolebwa mu kunoonenkereza kuno.Aye ebiindi
kubibuzo bye ngya okubuuza birimuku eigumba olw’okuba byakyama kale bighanga
obutakuletera idembe na kweyagala mu mutima gwo.Nkweghembye nga okukubagania ebidhubo
kuno kwidha kukumibwa nga kwa kyama,n’amaina tigaidha kughanaikibwa.Okunoonenkereza
kuno kwidha kutwalirwa ghalala awo tikwiddha kunhomorlamu muntu oba abantu
Okwenhigira mu kunoonenkeereza kuno(Participation in the study)
Okwenighira mu kunoonenkereza kuno kwa kyeyendere,bwe ghabaawo ebibuzo byotasiimye
kwiramu,
oli
wa
idembe
obutabiiramu.Ezira
ansa
ntuufu
oba
enfu
kubibuuzo
ebinakubuuzibwa.kale wulira nga oli wa idembe okwiramu nga bw’olowooza.Oli n’eiddembe
okuba ni w’okanga okwiramu ekiseera kyonakyona nga ghazira kwewozaku.
Nandyenze okusooka okwisania n’we nga nkaali. kweyongerayo
Oganha ngye mu maiso n’okukubuuza bino?
1. Nganhie
2. Ndobye
Agya okubuuzibwa bwaba aganhie,mubuuze oba ali n’e ekibuuzo era omwiremu bukalamu male
ogye mu maiso n’okumubuuza.
Bw’aba alobye,omwebaza male wagya kuwundi.
Bwe ghaba ghaliwo ebindi bye wandyenze okumanha ku kunoonenkereza` kuno kubira eisimu
Dr Nantamu Dyogo Peter ku eisimu naamba 0712858539
86
Annex 8
Ebibuuzo by’abasaadha (Questionnaire for men-Lusoga)
Factors Affecting Male involvement in maternal health care services in Jinja district
Namba Y’Amaka_________Ekyalo____________ Omuluka_________________
Namba y’omuluka_______Eigoloza_____________ Namba y’eigoloza___
Ekifo y’osula (1) Tawuni (2) Kyalo
Enaku dh’omwezi________/______/2010
Namba_______________
Eriina ly’oyo ali kubuuza__________ Omukono gw’omukulu w’ekikunsu____________
Q1 Wali n’emyaka emeka lw’amazaalibwa go olwakabita?
a) 18-25emyaka
1
b) Okuwula emyaka 25
2
Qn 2 Oli n’omulimo gw’okola nga bakusasula enkembe/omusala?
c) Ndi n’omulimo/ndi mukozi
1
d) Nzira mulimo/tikola
2
Q.3 Wasomaku kukanga gha?
a) Tinasomaku / Nakanga mu pulayimaale
b) Natuka mu siniya n’okuwulawo
Q.4 Mukazi wo yasomaku ku kanga gha?
a) Tiyasomaku / Pulayimaale
87
1
Siniya n’okuwulawo
b)
2
Q.5 Oli wa idiini ki?
a) Mukatuliki
1
b) Mupolositanti
2
c) Mulokole
3
d) Musisamu
4
Embeera dh’omusaadha mumaka(Man’s status)
Q.6 N’ani ayemerezawo amaka go? (akola n’gabana)
a) Musadha yenka n’akola
1
b) Omukazi yenka n’akola
2
c) Bombi omwami n’omukazi bakola
3
d) Bombi omwami n’omukazi ghazira akola
Q.7 Onhwa omwenge?
a) Nhwaku
1
b) Tinhwa
2
Qn8 Olina abaana bameka?
a)Tibaghera basatu
1
b)Basatu no kuwulawo 2
Ebeerabdh’obufumbo(Couple Characteristic)
88
4
Q.9 obufumbo bwaimwe bwa nsambo ki?
a) Nina omukazi mulala
b) Nina omukazi okuwula kumulala
Qn10 Muba gharara ni mukaziwo?
a)Yii
1
b)Mbe
2
Q.11 Mukazi wo ali mu maka malala ni mukaire wo akuzala?
a) Bali ghalala
b) Tibali ghalala
1
2
Qn12 Olina Egali,pikipiki oba motoka?
a) Yii
1
b) Mbe
2
Qn13 Olina radio ghaka?
a) Yii
1
b) Mbe
2
Okwisania(Communication)
Q.14 Bw’oba no buzibu,nani gw’osooka okughayiraku?
a) Mukazi wange
1
b) Ab’ekika kyange oba mikwano gyange
2
Qn 15 N’ani asalawo ekyensembo kubigema ku bulamu bwa mukazi wo?
89
a) Omukazi mwene
1
b) Omusadha(iba)
2
c) Tuteesa twembi ni mukazi wange male twasalawo twembi
Qn 16 Wali ofunieku embaluwa ekweta okuva eri omusawo nga akweta okwogera ku
mbeeray’omukazi wo nga ali mabunda?
a)Nafunaku
1
b)Mbe/ Busa
2
18
Qn 17 Bwe kiba nga kitufu baakwetaku,wagyayo okuteesa ku nsonga eyo n’abasawo?
a)Nagya
1
b) Mbe/ Busa
2
Empeereza mu mirimo gy’ebyobulamu (Health Services)
Qn18 Okuva ghaka wo okutuka mwi’rwaliro ghaliwo bughavu ki?
a)Tighawera kilomita itanu(5km)
1
b)Kilomita itanu no kuwula wo
2
Q.19 Oyogera ki kunfuna y’obwidhandhabi obughebwa abakazi abali amabunda n’ensambo
yebufunikamu?
a) Tibwangu bwa kufuna
1
b) Bufunika mangu
2
Q.20Oyogera ki kubulungi bw’empeereza eno mu irwaliro erikuli okumpi?
a) Nungi inho
1
22
90
b) Tiinungi
2
Qn21 Lwaki tiinungi?
………………………………………………………………………………………………
Qn22 Oyogera ki ku nebiisa y’abasawo eri abasadha abaidha ni bakazi baibwe mw’irwaliro
okufuna obwidhandhabi?
a) Nungi inho era balaga okusiima
b) Tibakisanikira
1
2
Qn 23 Omukazi amala kiseera kyags kitya mw’irwaliro bwa gya okwidhandhawa nga ali
amabunda oba nga yakamala okuzaala.
a) Tagheza waire daakika 30
1
b) Ekiseera kiwula ni mudaakika 30 2
Qn24 Wawuliku ekikolwa mw’irwaliro abakazi ghe banwera obuleezi ebitali bilungi?
a)Yii
1
b)Mbe
2
26
Qn25 Bikhi ebitiitali bilungi?
………………………………………………………………………………………………
Qn26 Abasadha abagherekera bakazi babwe okugya mw’rwaliro babogeraku batya ku kyalo?
a) Bulungi era ba ghagirwa okukola ekyo
1
b)Tibulungi
2
28
Qn27 Babogera ku ki ekitali kilungi? ……………………………………………………
91
Qn28 Abasadha bakirizibwa okungira muleeba nga abaki baibwe bali kulumwa?
a)Yii
1
b)Mbe
2
Okumanhaku ebigema ku bwidhandhabi obugheebwa abakazi abazaire
Qn
29
Mirundi
emeka
omukazi
ali
amabunda
gya
saine
okugya
okufuna
obwidhandhabi(okunhwa obulezi) ?
a) Mirundi/mikuzi ebiri
b) Mikuzi esatu
c) Mikuzi ena
Qn30 Bw’idhandhabi bwa nsambo ki omukazi ali amabunda bw’afuna nga agiire mw’irwaliro?
(Tukobere ku bwa nsambo inna)
a) ……………………………..
b) ………………………………
c) ……………………………….
d) ………………………………..
Qn 31 Bw’idhandhabi bwa nsambo ki omukazi ali amabunda bw’afuna nga agiire mu leeba ni
mu zaala mw’irwaliro ? (Tukobere ku bwa nsambo inna)
a) ……………………………..
b) ………………………………
c) ……………………………….
92
d) ………………………………..
Qn 32 Bw’idhandhabi bwa nsambo ki obugheebwa omwana ni inhina mutangama eya
saasira/wiiki mukaga edhisooka okuva kukuzaala n’okuzaalibwa? (Tukobere ku bwa nsambo
inna)
a) ……………………………..
b) ………………………………
c) ……………………………….
d) ………………………………..
Ebivaamu nga abasadha beenhigiremu (Male involvement outcomes)
Qn 33 Wateesaku ni mukazi wo mwakola n’esngeka ey’aghalala ku kifo mukazi wo gye afunira
obwidhandhabi nga ali amabunda kuluzaalo lwe yakamala oba amabunda galina go ?
a)Twateesa
1
b)Titwateesa
2
Qn 34 Waliwo ku nga mukazi wo agya okunhwa obulezi kulazaalo lwalina oba lwe yaakamala
oba lwalinalwo?
a) Naliwo
1
b) Tinabaawo
2
36
Qn35 Nsoga ki lwaki tiwasobola kubawo?
………………………………………………………………………………………………
Qn36 Wa gherekera mukazi wo mw’irwaliro nga ajaa okuzala kumukuzi oguweire?
93
a) Yii
1
b) Mbe
2
38
Qn 37 Waliyo mu leeba nga mukazi wo azaala omukuzi oguweire?
a) Nabaawo
1
b) Tinabaawo
2
39
Qn38 Lwaki tiwaliwo?
c) Kutya baino kukwogeraku
d) Bughangwa tibukwikiriza
e) A basowo tiba kwikiriza
f) Kutya ebiyinza okubawo ku mukazi wo/omwana
Qn 39 Oli n’ensengeka eyolubeerera mukazi wo y’ali n’okuzaalira?
Qn40
a) Ndi nayo
1
b) Mbe
2
Mwateesa
ni
mukazii
ku
bigemagana
no
bwidhandhabi
obuyebwa
abakazi
abakazala(muwiki edhisoka omukaga) ku mukuzi oguweire ?
a)Yii
1
b)Mbe
2
Qn 41Wagherekeraku mukazi wo ngo agya okufuna obwidhandhabi mw’irwaliro mu ntagama
eya wiiki 6 nga yakamala okuzaala
a) Namugherekera ku
1
94
b) Mbe
2
Qn 42 N’ani asalawo mukazi wo gh’ananhwera obulzi nga ali amabunda?
a) Mukazi n’asalawo
b) Iba n’salawo
c) Tusalawo twembi nga abafumbo
Qn43 N’ani asalawo mukaziwo gh’anazaalira?
a) Mukazi mwene n’asalawo
b Bombi nga abafumbo
c)Mwami n’asalawo
Qn 44 Olowoza iwe nga omusadha osaine okwenigira mu byo bwidhandabi bwa mukaziwo nga
ali mabunda oba okuzaala?
a) Yii
1
b) Mbe
2
46
Qn 45 Osaine kwenigiramu otya?
………………………………………………………………………………………………
Qn 46 Nsonga ki kudhino gy’olowooza nga n’ebairenga okulobera okugheerekeraku mukazi wo
ali amabunda ng’agya okunha obulezi?
2.0 Kubula ntabula
3.0 Kitwala ekisera kinene nga oli mw’rwaliro
4.0 Kubula biseera olwemirimo
5.0 Obughanwa tibundikiliza
Qn 47 Magezi g’owa abakulira eby’obulamu basobole okuyamba abasadha baidhumbire
okwenhigira
mu
bwidhandhabi
obufunibwa
abakzi
baibwe
nga
bali
mabunda
………………………………………………………………………………………………
Webaale inho okutuwa ku biseera okwiramu abibuzo ebyo
95
?
Annex 10
Jinja Map showing health facility coverage by sub-county
N
96
Jinja Map showing parishes and study area
Key
Study Area
97