Determinants and perceived benefits of male partner involvement in antenatal and postnatal care in Bumula sub-county, Kenya

Abstract

Current global efforts as embodied in the Sustainable Development Goals (SDGs) state the need to reduce Maternal Mortality Ratio (MMR) to less than 70 per 100,000 live births by 2030. In 2015, MMR in Kenya was 510 per 100,000 live births. Increased utilization of antenatal care (ANC) service is an essential strategy in reducing risks associated with pregnancy and child bearing while post-natal period is particularly important for women, since during this period they may develop life-threatening complications thus post-natal care (PNC) visit is an ideal time to educate a mother on how to care for herself and her new-born. Men play significant roles in health seeking behaviours of their families. Existing evidence suggest that increasing male participation in maternal and new-born health care improves maternal and new-born health outcomes. However, ANC male involvement rates in Kenya are estimated at 5%. While determinants of men’s involvement in reproductive health matters are known, they are likely to vary by social context. This study therefore sought to assess the determinants of male partner involvement in ANC and PNC in Bumula sub-County, Kenya. The specific objectives were to determine socio-demographic, cultural and health facility factors influencing male partner involvement in ANC and PNC and to determine perceived benefits of male involvement in ANC and PNC services. This was a cross sectional household survey. Simple random sampling was used to select 398 men and women participants out of 1,716 households within functional community health in Bumula subcounty. Questionnaires were administered to participants within households by face-to-face interviewing to collect data on their socio-demographic, cultural, health related factors and perceived benefits of male involvement in ANC and PNC. Key informant interviews (KII) were conducted among 14 health workers. KII data were analysed under themes of cultural and perceived benefits of ANC and PNC involvement by men. Questionnaire data were analysed using logistic regression to determine relationships between socio-demographic, cultural factors and male involvement in PNC and ANC. Variables that had p< 0.05 were included in the final multivariate logistic model. Fishers exact test was used to determine whether there was significant difference between perceived benefits and male involvement. The study found 41.88% of males and 34.30% of females had attended ANC and PNC with their partners. Logistic regression showed that male and female participants having college education were more likely to report male involvement (aOR = 3.25, 95%CI [1.03-10.25], p=0.044) compared to those with no education. Fishers exact test showed that participants who made joint decisions (p<0.0001) and who viewed PNC as necessary (p=0.021) had a significant association with male involvement. Education had a favorable influence on male involvement. Cultural practices were a major impediment to male involvement due to its portrayal of male dominance in roles of financial support and inferiority if male accompanies spouse to PNC and ANC. The study recommends intensified health education messaging to increase support for male involvement and a further study to explore specific societal norms and beliefs that undermine male partner participation in ANC and PNC.