Is Male Involvement in ANC and PMTCT Associated with Increased Facility-Based Obstetric Delivery in Pregnant Women?

Ensuring that pregnant women are delivering in a health facility and are attended to by skilled birth attendants is critical to reducing maternal and infant morbidity and mortality. This study sought to determine the associations between male involvement in antenatal care (ANC) services and pregnant women delivering at health facilities and being attended to by skilled birth attendants as well as attending postnatal care. This was a retrospective cohort study using secondary analysis of program data. We reviewed health records of all pregnant women who attended antenatal services irrespective of HIV status between March and December 2012 in 10 health facilities in three provinces of Zambia. An extraction questionnaire was used to collect socio-demographic and clinical information from registers used in services for maternal neonatal child health as well as delivery. Using logistic regression, we calculated the odds ratios (OR) and 95% confidence intervals (CI) of the association between (1) male involvement and delivery at a health facility by a skilled birth attendant and (2) male involvement and women’s attendance at postnatal services. We found that more women who had been accompanied by their male partner during ANC delivered at a health facility than those who had not been accompanied (88/220=40% vs. 543/1787=30.4%, respectively; OR 1.53, 95% CI: 1.15-2.04). Also, we noted that a greater proportion of the women who returned for postnatal visits had been accompanied by their partner at ANC visits, compared to those women who came to ANC without their partner (106/220=48.2% vs. 661/1787=37.0%, respectively; OR 1.58, 95% CI: 1.20-2.10). Male involvement seems to be a key factor in women's health-seeking behaviours and could have a positive impact on maternal and infant morbidity and mortality. Keywords: antenatal care, HIV, males, facility delivery, postnatal care, Zambia.RésuméS’assurer que les femmes enceintes accouchent dans un établissement de santé et qu’elles sont prises en charge par des accoucheuses qualifiées est essentiel pour réduire la morbidité et la mortalité maternelle et infantile. Cette étude visait à déterminer les associations entre la participation des hommes aux services de soins prénatals (SPrN) et des femmes enceintes qui accouchent dans des établissements de santé et d'être assistées par des accoucheuses qualifiées ainsi que la participation dans des soins postnatals (SPN). Il s’agissait d’une étude de cohorte rétrospective effectué à l’aide d’une analyse secondaire des données du programme. Nous avons examiné les dossiers de santé de toutes les femmes enceintes qui ont assisté à des services de soins prénatals indépendamment de leur statut du VIH entre mars et décembre 2012 dans 10 établissements de santé dans trois provinces de la Zambie. Un questionnaire d'extraction a été utilisé pour recueillir des informations socio-démographiques et cliniques à partir des registres utilisés dans les services de santé maternelle de l'enfant nouveau-né ainsi que l’accouchement. A l’aide de la régression logistique, nous avons calculé les odds ratios (OR) et 95% d’intervalles de confiance (IC) de l'association entre (1) la participation des hommes et de l’accouchement dans un établissement de santé par une accoucheuse qualifiée et (2) la participation des hommes et la présence des femmes aux services postnatals. Nous avons constaté que plus de femmes qui avaient été accompagnées de leurs partenaires masculins pendant SPrN ont accouché dans un établissement de santé que celles qui n’avaient pas été accompagnées (88/220 = 40% contre 543/1787 = 30,4%, respectivement; OR 1,53, 95% CI: 01/15 à 02/04). En outre, nous avons constaté qu'une plus grande proportion des femmes qui sont revenues pour des visites postnatales avaient été accompagnées par leurs partenaires lors des visites prénatales, par rapport à ces femmes-là qui venaient pour les SPrN sans leurs partenaires (106/220 = 48,2% contre 661/1787 = 37,0%, respectivement; OR 1,58, IC à 95%: 1.20 à 2.10). La participation des hommes semble être un facteur clé dans la recherche de comportement de santé des femmes et pourrait avoir un impact positif sur la morbidité et la mortalité maternelle et infantile. Mots-clés: soins prénatals, le VIH, les hommes, la prestation de service, les soins postnatals, Zambie

Developmental States: A Review of the Literature

This document is an output from a project funded by the UK Aid from the UK Department for International Development (DFID) for the benefit of developing countries. However, the views expressed and information contained in it are not necessarily those of or endorsed by DFID, which can accept no responsibility for such views or information or for any reliance placed on them. This paper conducts a review of the literature concerning developmental states, in order to identify gaps and suggest research questions which could be fruitful for the Effective States and Inclusive Development Research Consortium to explore, within the remit of their proposed research programme. This literature review attends to three key questions about developmental states and the answers proposed to them within the literature, namely; what worked? Why did it work? And would it work elsewhere? It also examines an emerging literature suggesting other models of a developmental state more suited to contemporary circumstances, which focus more explicitly on development as a social phenomenon rather than as a purely economic one. These are of particular interest given ESIDs focus on inclusive development. The conclusions of the paper examine some of the gaps in the literature and suggest an agenda for future research which includes addressing questions around: How does the consensus of conducting developmental roles come about – and how is it sustained? Patrimonialism, personal rule, development and stability Role of education, especially higher/further education Importance of rural/agriculture policie