Doctoral thesis
Men‘s involvement in maternity care has been recognized as one of the key strategies
in improving maternal health and accelerating reduction of maternal mortality. Men
impact women‘s reproductive health through their role as partners, fathers and close
family providers in terms of financial power and decision control they have. Factors
that determine men‘s involvement in maternity care have been documented in other
parts of the globe, but very little research has been conducted in Tanzania to identify
the factors that determine men‘s involvement in maternity care. This study was
conducted in Dodoma Region in central Tanzania to explore the factors that
determine the involvement of men in maternity care. The study also looked at the
level of men‘s involvement in maternity care and the initiatives carried out by the
community to promote their involvement. A cross-sectional survey using
interviewer-administered structured questionnaire was conducted among randomly
selected 966 men aged 18 years and above. The survey was complemented by 32
focus group discussions (16 women‘s FGDs and 16 men‘s FGDs) and 34 in-depth
interviews (20 IDIs with community leaders and 14 IDIs with health care providers).
The involvement of men in maternity care was measured using a combined measure
of four (4) key points and then a factor analysis was used to obtain an overall men‘s
involvement index. Analyses were carried out using SPSS version 21.0 and NVivo 8
computer software packages. Pearson Chi-Square was used to test association
between the background characteristics of the respondents and the level of men‘s
involvement in maternity care. A multinomial logistic regression analysis was carried
out to determine the predictors for men‘s involvement in maternity care. Thematic
Content Analysis of the focus-group discussions and in-depth interviews was also
conducted. Overall, with regard to the level of men‘s involvement in maternity care
about 20.3% of men had high level of involvement, 52.6% had moderate level of
involvement and 27.1% had low level of involvement. With regard to the three
periods of maternity care, antenatal and postnatal periods had over half the
proportion of high men‘s involvement while the natal period had less than a quarter
proportion of high men‘s involvement. Results of bivariate analysis showed a
significant association with ethnicity (χ2=26.808, p<0.001), number of children
(χ2=11.360, p<0.05), occupation (χ2=9.558, p<0.01), religion ((χ2=14.220, p<0.001),
place of residence (χ2=8.290, p<0.05), distance to the health care unit (χ2=24.708,
p<0.001), information regarding the involvement of men in maternal health care
services (χ2=28.048, p<0.001) and spousal communication (χ2=69.621, p<0.001).
Results of multinomial logistic regression analysis showed that ethnicity, number of
children, place of residence, time spent to receive maternal health care service,
distance to the health care facility, information regarding the involvement of men in
maternal health care services and spousal communication were the predictors of
men‘s involvement in maternity care. Qualitative study revealed that traditional
gender role norms, beliefs and health care system issues were the barriers for men‘s
involvement in maternity care. The study also found that at the community level,
very few initiatives were taking place to encourage men‘s involvement in maternity
care in terms of economic, social and cultural measures. This study concludes that
the level of men‘s involvement in maternity care was moderate. Therefore, there is a
need to increase men‘s involvement through creating male-friendly health facilities,
increasing community awareness and sensitization on men‘s involvement in
maternity care in order to remove the cultural barriers for men‘s involvement.