A study of involvement of men in antenatal care in Southern Mozambique has been published by a Belgian-led team. Southern Mozambique, unlike the rest of the country, has a patrilineal system, which generates greater inequality between women and men than the matrilineal system in other parts of the country.

The researchers recommend more community activity focusing on existing positive role models, and a less reductionist/instrumentalist approach by health services to altering men’s behaviour, replacing this with gender-sensitive family-oriented care.

The research consisted of 10 interviews with key stakeholders, 11 days of observation in health centres, 3 couple interviews and, finally, 16 focus groups, some with health providers and some in the community (involving women, men, community leaders, health activists, community health workers and traditional birth attendants).

The research identified a series of issues and the researchers propose solutions, building on strengths and targeting weaknesses.

Problem 1: Lack of coherent national policy on involving men

• There is no written strategy at all in Mozambique. The training for Maternal and Child Health gives no attention to the issue of involvement of men and there is no supervisory support for professionals in this area. This despite an earlier national survey in Mozambique showing that lack of spousal support and fear of going to clinics together represent half of the reported barriers to attending antenatal care facilities.

Problem 2: Opposition of international NGOs to involving men

• Researchers learned that involvement of men is not a topic that attracts foreign donors. One NGO officer interviewed explained, “Personally I don’t think it’s a priority and there are many other problems in this country….I would rather do a mass HIV screening campaign for men at the border with South Africa than inviting them in the regular health system.”

Problem 3: Poor practices in health facilities

• There is a practice to distribute invitation cards for partner via women, but, when directly observed, only one third of women at their first appointment received one of these.
• Another common practice is to give priority to women if they come with their husband/partner. This exacerbates inequalities for those women who cannot come accompanied.
• The lack of privacy in crowded facilities, for example, more than one consultation going on at the same time in one room, is more serious if men are invited to be present.
• When couples are seen together, health professionals can make them the focus of attention and the men can dominate the discussion and decision-making.
• The mixing of maternal health care and HIV testing is a big problem. Many women do not want their partners to know if they are tested positive, for fear of stigma, even abandonment. Some health professionals only invite the partner into an antenatal consultation at the end for an HIV test. Women who test positive for HIV are much more likely to receive an invitation card for their partner, so associating the partner invitation card with HIV status. As a result of this and past HIV campaigns, antenatal care has become strongly associated with HIV testing.
• The researchers some up these problems thus: “Male involvement interventions commonly adopt a reductionist and instrumentalist approach that is focused on altering men’s behaviours, without addressing underlying gender roles that drive these behaviours.”

The researchers propose solutions to these deficits:

• Develop more “family-oriented care”, with a focus on engaging with gender inequalities.
• Focus on the care of mother and baby when engaging men, not on HIV testing.
• Provide training to healthcare providers about how to manage consultations so that men are not given a privileged position within them.

Problem 4: lack of community activity

• There are disincentives within the community, in particular social norms that result in a fear of ridicule on the part of men who publicly demonstrate active involvement. Many men describe their role as a provider and consider attending health clinics a waste of time. The researchers, however, uncovered some doubts about this concern with time, given that many men already spend a lot of time not working.
• The researchers found strengths in the community that could support more effective involvement of men in maternal healthcare. There is a widespread belief that men should participate actively and a general objection to existing social norms. A generational change is also observable: younger men are more interested in what happens in antenatal care. There are champions for active participation of men, not just among the young: one older male religious leader described participation as an “act of showing love”. Though in a minority, some men do go into antenatal clinics.
• Other social factors associated with low involvement of men are polygamous relationships and also the increase in pregnancies from informal relationships.

The researchers propose more action in the community to support involvement of men, focusing on the example of the champions and positive role models that already exist. Community meetings are mostly attended by men, as are workplaces, and so these are good places to communicate with them directly. Churches are also good places to engage men.

Another recommendation is to use mass communication and social media, where positive role models of men involved in family life have a high profile.

Galle A, Cossa H, Griffin S, Osman N, Roelens K & Degomme O (2019), Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: A qualitative study, BMC Pregnancy and Childbirth 19

Header photo: World Bank. Creative Commons.