A study in Kigali Rwanda interviewed 32 men about their attitudes to childbearing and their encounter with maternal health services. It revealed a tension between more progressive gender attitudes on the part of the men and the lack of response of maternal health services. The researchers regard this as a lost opportunity to promote gender equality in Rwanda.

The study, organised jointly between the University of Rwanda and Uppsala University in Sweden, and led by Jessica Påfs, involved semi-structured interviews with the 32 men. The men were aged 23-35 except for two over 50. They all had primary or secondary education and one was a university student. 13 had experienced the near death of their wife or baby. The interviews took place in 2013-2014.

The following are some of the things the men said.

The role of men in pregnancy and childcare:

• The main task of the man is to provide financially for the family.
• The man should be strong and engaged, not allowing anxieties to affect his wife.
• The man should be caring and kind.
• The man should not pressure the mother for sex – this is selfish and disrespectful, something associated with old times.
• The man should stop thinking of himself as the ‘king of the home’.
• A man not attending to the needs of his pregnant wife will be considered negligent and cowardly.
• It is the responsibility of men to bring the women to health facilities.

“[During pregnancy] you should listen to whatever your wife tells you, and stop thinking that accepting her ideas or the advice she gives you is some sort of unmanly attitude. You also have to avoid being rude towards her or frightening toward her, because if she gets angry it will affect the baby, too. And then you risk losing both of them because you were a jerk.”

“If you cannot cope with your wife’s troubles, then you do not love her.”

On getting information:

• The lack of extended family creates challenges for those who had moved from afar to Kigali for employment or who had lost relatives in the 1994 Genocide.
• Getting information second-hand from the pregnant woman is not satisfactory.

“When she comes home and tells you what they have told her, you just listen [to her] but do not care, because you were not there.”

This quotation corresponds to what the women in Bwari Hospital in Nigeria told the Family Inclusive team during a visit by the Family Included team.

The interviews revealed a number of obstacles within the maternal health services.

• Only a few had been included in a group information session conducted at the care facility, covering pregnancy and health risks.
• None of the men were welcomed during the actual pregnancy consultation and wondered why they could not participate and receive direct, first-hand information from the care provider.
• Their exposure to the health services had led to more awareness of and concern about poor quality service, particularly service that is not respectful to their wife. But their ability to negotiate is compromised by lack of definition of their acceptable role.

“[Health care workers] are more interested in talking to the women, but they do not consider informing the men, as well. It would be better if we all could understand more about those symptoms.”

It is compulsory for men to attend the first antenatal clinic in Rwanda, part of the HIV system. (We published earlier research by the same team on the problems this creates for women – Family inclusive care: how NOT to organise it! Rwanda.) Some of the men raised questions about this compulsion, complaining about the impact of very long waiting times on their role as breadwinner. In some cases the limited availability of the father delayed the partner’s attendance at a clinic.

In public facilities, men are not allowed to attend the birth itself. This rule was discussed by the men:

“There are some women who do not like to scream when they are in pain, which the doctor will interpret as if she is not suffering. But if you, who is closest to her, are there, then she can tell you to advise the doctor.”

“They ask you to give your ID number and sign that you are there to make sure she is safe. But, then, after you sign, they turn around and lock you out of the delivery room. So, how am I supposed to ensure that my wife and kid are safe if am locked out of that room?”

“In our culture, they say that if the husband sees his wife giving birth, he is never going feel attracted to her again sexually. We are saying that we should be there, but in the Rwandan culture, it is taboo to see your wife giving birth. Some women would not even accept to have their husbands there. So we are kind of on the fence.”

“I think the decision should come from her. If she is comfortable with it, then [the health care workers] should accept her choice to allow whoever she came with to be there and to watch the entire procedure.”

The researchers interpret the findings in relation to the promotion of gender equality. According to Rwanda’s National Gender Policy, more involvement of men in reproductive health matters is an objective. The authors consider the already high attendance of fathers at antenatal clinics as an “opportunity to embrace men’s presence” and see this as “a cornerstone in promoting gender-equitable attitudes” in Rwanda.

Påfs J, Rulisa S, Musafili A, Essén B & Binder-Finnema B (2016), ‘You try to play a role in her pregnancy’ – a qualitative study on recent fathers’ perspectives about childbearing and encounter with the maternal health system in Kigali, Rwanda, Global Health Action

Photo: Ayoze O’Shanahan. Creative Commons.