Background

Worldwide, male presence in Antenatal care (ANC) and during delivery remains a challenge to safe motherhood(1) Each year 210 million women become pregnant, 15% of these develop complications and over half a million die due to reasons related to pregnancy or birth . Statistics of World Health Organization (WHO) indicate that 99% of all maternal deaths occurs in low and middle-income countries; almost half of these occur in sub-Saharan Africa, (2). Socioeconomic, cultural, religious and ethnic disparities continue to inhibit women’s ability to make decisions regarding their own health (3)(4) because of men’s control of allocation of family income, transportation and time, and access to health services. Male involvement in maternal health services remains a challenge to safe motherhood (5), despite its essential roles in providing financial, emotional and physical support to women (6). Efforts to engage male partners in maternity care not only prevent delays in receiving appropriate care but also facilitate adequate treatment at the appropriately-equipped health facility level(7). Male participation in antenatal care is thought to be an essential step leading to positive maternal and new born health outcomes(8) Also Male involvement in child-bearing decisions is important and also has a positive impact on the suitability of Prevention of Mother To Child Transmission of HIV (PMTCT) interventions (9)(10).

In Tanzania, Reproductive and Child Health (RCH) services cut across a health-system pyramid where primary health care is at the base and specialized tertiary care at the apex. As a developing country at a low middle income level, the average male involvement in RCH services ranges from 60 to 70% (10)(11) despite a mandate under national RCH policies and guidelines for male participation(12). Similar rates of male involvement in RCH services were evident in other African settings including Kenya (13), Ethiopia(14) and Ghana (15). Maternal and child health care has been perceived as women’s rather than men’s affair Promotion of maternal and child health is perceived as women’s role and men do not feel that they are responsible and see no reason to accompany their partners to ANC visits (16)(17) Apart from the misconceived gender role, other inhibitions of male partners’ attendance to antenatal clinic included unfriendly structure of services (18), fear of testing for Human Immunodeficiency Virus (HIV) for self-suspected or confirmed HIV infection, and ill-perceived process of care, including waste of time and loss of earnings while waiting for service (19). Engaging male partners in maternal health care require in-depth understanding of social cultural impact of each intervention. Further, persistent gender inequality especially in Sub-Saharan Africa, including Tanzania, where men are decision makers and gatekeepers for families (20)(21). A study done on acceptability and preferences among men and women for male involvement in Antenatal Care revealed that socio-cultural factors are the main barrier to antenatal male partner HIV testing (19). necessitates a new approach that harmonizes incorporation of men in a culturally-perceived female domain. However, in some settings, interventions to encourage male partners unintentionally discriminated against unaccompanied women that may either be single or in a bad relationship(22). Thus, interventions to solicit male involvement in antenatal care require adequate buy-in from both couples and health care providers, and continuous updating of context-specific cultural influences.

The Tanzanian Ministry of Health, as well as WHO emphasizes the particular value of male involvement in ANC. According to Tanzania one plan II 2016 PMTCT program, the data shows only 30% of women come for couple counseling with their partners (23)(24). It has been suggested that, maternal health interventions, aiming to emphasize health care seeking behavior during ANC and birth, should reconsider male partner involvement and increase their opportunity on attending with their partners for the ANC services(25) . Improving facility and health provider attitudes toward male involvement has the potential to get better service delivery to all pregnant women; on the other hand, care must be taken to avoid discriminating against unaccompanied women who are either single or in unstable relationships(26). Therefore, Determination of barriers of male participation in maternal health care is an important step in meeting men’s needs for supporting women’s health, and subsequently improving family health. As a quality-improvement measure, interventions to improve male participation in maternal health requires continuous inquiry and feedback using locally-defined quality indicators and qualitative interviews that provide men’s and women’s experience in each setting. However, there is ongoing studies on barriers of male participation in antenatal care but until now, there has been no published study of male attendance at Mbulu district. This study aimed to assess prevalence and barriers of male participation in antenatal care at Mbulu district.


METHODS

Study area and design

This study was conducted in Mbulu District in Manyara region, one of the six districts of the Manyara Region of Tanzania. It is bordered to the north by the Arusha Region and Lake Eyasi, to the east by the Babati Rural District, to the south by the Hanang District, and to the west by the Singida Region. According to the 2012 Tanzania National Census, the population of Mbulu District was 380,865 male population, 192,223 (50.5%) and female population, 188,641 (49.5%). The district 2015 divided into mbulu town council and mbulu vijijini which total consists of 32 wards, this study was focused on mbulu vijijini which had total of 15 wards. And nine wards were selected randomly to participate in the study which were hydom, dogombeshi, bashay, hayderer, geterer, maretadu, masqaroda, yaeda, and dinamu.

The District is inhabited by people of different ethnic affiliations, especially the Iraqw people who are some of the earliest agro-pastoralists to migrate to what is now the Republic of Tanzania and people engage mainly in agriculture, keeping livestock and farming activities. Also is known for one of biggest hospitals in northern Tanzania is found in Mbulu, the Haydom Lutheran Hospital (HLH). The Community based descriptive cross-sectional study was conducted at mbulu district. Three hundred and twenty-four married males were recruited and involved in study which was conducted for three weeks from June to July 2023.

Data collection

Semi-structured questionnaire was used to collect data on social demographic characteristics including age, educational level, occupation, marital status, religion and parity, knowledge, factors that hinder men’s participation to the ANC services, future willingness to participate as well as services provided to the couple attending were collected.

Data analysis procedure

Collected data was entered and analyzed using SPSS version 20 Chicago, IL: SPSS Inc. version 20. Sociodemographic data were summarized in the form of proportions. Univariate logistic regression was carried out to determine factors associated with male involvement in ANC visits. Factors with P values of < 0.05 were included in a multivariable logistic regression model to determine predictor variables that were independently associated with the outcome. Significant difference was defined as P- value less than 0.05 and Odds Ratio (OR) that did not include 1.0

Ethical consideration

Ethical approval was sought from the joint CUHAS and Bugando Medical Center Research Ethics Committee with ethical clearance No.2687/2023. Permission was obtained from regional administrative secretary and ward secretaries to implement the study. The respondents were adequately informed using the participant’s informed written consent statement about all the relevant aspects of the study, including its aim, interview procedures, confidentiality, anticipated benefits and potential hazards.