An inquiry among men, women and health workers in Papua New Guinea has identified a series of measures to engage expectant fathers more effectively in antenatal healthcare. The study spanned four provinces of the country and involved 28 focus groups of men and women, some expecting a child, some already with one. 14 health workers were also interviewed.
The researchers made the following recommendations on the basis of this qualitative enquiry.
- Ensure that the pregnant woman’s autonomy is not compromised.
At the same time as encouraging men to attend antenatal clinics, women should be able to attend alone, or to have parts of the consultation where they are alone if they want to be, for example, physical examinations. One possibility is to specify certain antenatal appointments during the pregnancy when fathers are invited, and keep other appointments for women only.
The researchers reject the proposal of some of those consulted to make the attendance of men compulsory. Any such approach disadvantages women who cannot come with a husband or partner.
- If the man is present outside, invite him in.
In response to the finding that some men come, but stay outside, the researchers propose that women should be routinely asked if their partner is waiting outside and if she would like him to be brought in for part of the consultation.
- Routinely invite men, not only if there is a problem.
A practice identified in this study is to invite men only if there is a health problem or if HIV or STIs are detected. This has the effect of stigmatizing the attendance of fathers.
- Make clinics family/couple-friendly.
In Papua New Guinea, many men feel uncomfortable in the presence of big group of women – this is not in line with cultural norms. Clinics can consider specific waiting areas for men or for couples, separate entrances for women and men, and/or separate times of day for women-only and couple visits. This latter recommendation would tackle the problem faced by some men of long waiting times when they have work responsibilities.
Settings can be made welcoming to men by providing posters and information materials targeted at them. Game-based educational materials may be interested for men who are waiting significant lengths of time.
Finally, and most importantly, staff should be trained in engaging men and working with couples.
- Engage with communities and engage male champions to promote new norms.
Raising awareness within communities of the benefits of expectant fathers participating in antenatal care can do much to address social stigma. Men can also be engaged in the settings where they meet socially already. Individual invitations to fathers can be effective.
The study in Papua New Guinea found a diversity of views about whether men belong in antenatal clinics – some mock men who attend and others approve of it. One way to tackle disapproval is to work with male champions to make the case for the involvement of expectant fathers.
- Provide opportunities for men-only engagement.
This could be in the form of groups or one-to-one peer education. It could be part of the solution for engaging more with polygamous men; 13% of the women in this study were in polygamous families. Such men are less likely to engaged in antenatal care.
The research found that men are more likely to attend antenatal clinics if:
- They feel a shared responsibility and concern for the health of mother and baby;
- It is the first pregnancy of their partner;
- The antenatal clinics are men-friendly;
- There are male workers at the health clinics.
The barriers to involvement included social norms specifying antenatal care as a women’s activity, fear of being tested for HIV and STI, rude staff, lack of separate waiting areas for men, and being in a polygamous relationship.
Davis J, Vaughan C, Nankinga J, Davidson L, Kigodi H, Alalo E, Comrie-Thomson L & Luchters S (2018), Expectant fathers’ participation in antenatal care services in Papua New Guinea: a qualitative inquiry, BMC Pregnancy and Childbirth, 18
Photo: Mohd Fazlin Mohd Effendy Ooi. Creative Commons.