Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

<p>Abstract</p> <p>Background</p> <p>Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi.</p> <p>Methods</p> <p>The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care.</p> <p>Results</p> <p>Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed.</p> <p>Conclusion</p> <p>Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at community level. There is need for creation of awareness in men so that they sustain their participation in maternal health care activities of their female partners even in the absence of incentives, coercion or invitation.</p

Malawian fathers’ views and experiences of attending the birth of their children: a qualitative study

Background Exploring the experiences and views of men who had attended the birth of their children is very vital, especially in a setting where traditionally only women accord women support during labour and childbirth. The insights drawn from the male partners’ views and experiences could enhance the current woman-centred midwifery model that encompasses the needs of the baby, the woman’s family and other people important to the woman, as defined and negotiated by the woman herself. This paper explored the views and experiences of men who attended the birth of their children from two private hospitals in an urban setting in southern Malawi. Methods This study used an exploratory descriptive qualitative approach. The data were collected through in-depth interviews from 20 men from Blantyre, a city in the southern part of Malawi, who consented to participate in the study. These men attended the birth of their children at Blantyre Adventist and Mlambe Mission Hospitals within the past two years prior to data collection in August 2010. A semi-structure interview guide was used to collect data. Qualitative content analysis was used to analyse the data set. Results Four themes were identified to explain the experiences and views of men about attending childbirth. The themes were motivation; positive experiences; negative experiences; reflection and resolutions. The negative experiences had four sub-themes namely shame and embarrassment, helplessness and unprepared, health care provider – male partner tension, and exclusion from decision-making process. Conclusions The findings showed that with proper motivational information, enabling environment, positive midwives’ attitude and spouse willingness, it is possible to involve male partners during childbirth in Malawi. Midwives, women and male peers are vital in the promotion of male involvement during childbirth. In addition, midwives have a duty to ensure that men are well prepared for the labour and childbirth processes for the experience to be a positive one

La Participation des hommes au soin de santé maternelle au Malawi

This study was conducted in Mwanza district in southern Malawi with the aim of investigating the individual’s, community’s and health workers’ perception of male involvement in maternal health care. In-depth interviews and focus group discussions were the methods used for data collection. The participants’ responses generated two main themes namely male involvement in health facility care and outside the health facility. The participants’ perception of male involvement in facility care concentrated around six sub-themes describing male involvement as; couple HIV counselling and testing; a government law; a strategy for fast services for women; unfair programme for women without partners; a foreign concept; an act of love. We conclude that male involvement in the health facility care was fragmented and associated mainly with first antenatal care; couple HIV counselling and testing; suggesting poor integration of male involvement into the existing maternal and child health programmes and that there is need to engender maternal health care services (Afr J Reprod Health 2012; 16[1]:145-157).L’étude exploratoire a été menée dans le district de Mwanza au Malawi en vue d’examiner la perception de l’individu, la communauté et du personnel de sante du rôle des hommes a l’égard du soin de sante maternelle. Pour collecter les données, nous nous sommes servis des interviews a profondeur, des discussions a groupe cible et de l’observation non participante. L’étude a révélé que l’on perçoit le rôle des males dans deux dimensions. D’abord, comme la participation des hommes dans le cadre du soin des établissements de santé et deuxièmement la participation de hommes en dehors du cadre des établissements de santé. Nous avons dégagé six sous-thèmes de l’étude : la participation comme les analyses et le conseil à l’égard du VIH chez des couples ; une loi gouvernementale ; une stratégie pour les services rapides pour femmes ; un programme injuste pour les femmes sans partenaires ; un concept étranger ; un acte d’amour. Nous concluons que la participation des hommes au soin des établissements de santé était fragmentée et liée principalement au premier soin prénatal ; le conseil et des analyses à l’égard du VIH chez des couples indiquent une mauvaise intégration de la participation des hommes dans les programmes actuels de la santé maternelle et infantile et qu’il y a la nécessité de créer des services de soins de santé maternelle (Afr J Reprod Health 2012; 16[1]:145-157)

Male Involvement in Maternity Health Care in Malawi

This study was conducted in Mwanza district in southern Malawi with the aim of investigating the individual&rsquo;s, community&rsquo;s and health workers&rsquo; perception of male involvement in maternal health care. In-depth interviews and focus group discussions were the methods used for data collection. The participants&rsquo; responses generated two main themes namely male involvement in health facility care and outside the health facility. The participants&rsquo; perception of male involvement in facility care concentrated around six sub-themes describing male involvement as; couple HIV counselling and testing; a government law; a strategy for fast services for women; unfair programme for women without partners; a foreign concept; an act of love. We conclude that male involvement in the health facility care was fragmented and associated mainly with first antenatal care; couple HIV counselling and testing; suggesting poor integration of male involvement into the existing maternal and child health programmes and that there is need to engender maternal health care services.Keywords: Gender roles, maternal health care, social norms, perceptionAfr J Reprod Health 2012; 16[1]:145-15

Using an innovative mixed method methodology to investigate the appropriateness of a quantitative instrument in an African context: Antiretroviral treatment and quality of life

The relationship between quality of life (QoL) and antiretroviral treatment (ART) has mainly been studied using quantitative scales often not appropriate for use in other contexts and without taking peoples\u27 lived experiences into consideration. Sub-Saharan Africa has the highest incidence of HIV and AIDS yet there is paucity in research done on QoL. This research report is intended to give an account of the use of a mixed method convergent parallel design as a novice approach to evaluate an instrument\u27s context specificity, appropriateness and usefulness in another context for which it was designed. Data were collected through a qualitative exploration of the experiences of QoL of people living with HIV or AIDS (PLHA) in Africa since being on ART, as well as the quantitative measurements obtained from the HIV/AIDS-targeted quality of life (HAT-QoL) instrument. This study was conducted in three African countries. Permission and ethical approval to conduct the study were obtained. Purposive voluntary sampling was used to recruit PLHA through mediators working in community-based HIV/AIDS organisations and health clinics. Interviews were analysed through open coding and the quantitative data through descriptive statistics and the Cronbach\u27s alpha coefficient. A much wider range and richness of experiences were expressed than measured by the HAT-QoL instrument. Although an effective instrument for use in the USA, it was found not to be sensitive, appropriate and useful in an African context in its present form. The recommendations focus on adapting the instrument using the data from the in-depth interviews or to develop a context-sensitive instrument that could measure QoL of PLHA in Africa