Men’s involvement in birth preparation and couples’ communication linked to greater use of health facilities for childbirth in poorer families (Mozambique)

birth preparation

A new study from Mozambique recommends that strategies to promote couple’s communication should be included in reproductive, maternal and newborn healthcare, particularly among less wealthy families.

The study, involving a household survey of 1422 mothers of 0-23 month olds, found that when male partners were involved in arranging transport or in choosing a place of delivery (two of the four elements of the “birth preparedness and complication readiness” approach that were studied), the birth was more likely to take place in a health facility than if the mother made these arrangements alone.

These correlations were stronger in lower income families. In the highest wealth category, among women who arranged transport or chose a place of delivery with their male partner, 99% delivered in a facility. But in the lowest wealth category, only 72% of women who did not arrange transport gave birth in a facility. When male partners helped arrange transport, the percent of facility births rose to 94%, nearly eliminating the gap between wealth groups.

Similarly for choosing delivery location, nearly all wealthier women delivered in a facility (98%), whether or not they conducted BPCR. However, only 74% of women in the lowest wealth category choosing a delivery location alone gave birth in a facility, compared to 92% when male partners helped choose a location.

Saving money and choosing a birth companion, two of the other four BPCR elements studied, were not correlated with institutional delivery.

The research also found correlations between a woman reporting discussion with her partner about family planning and three things: delivery in a health facility (46% more likely), the women engaging in birth planning (34% more likely), and partner participation in this birth planning (2x higher). These correlations were visible across differences in wealth, education and rural/urban residence.

The research took place in the Nampula and Sofala provinces of Mozambique. Mozambique has one of the

maternal mortality ratios in the world (489 maternal deaths for every 100,000 live births, in 2015). In the sample of 1422 women, 34% had not completed any schooling, 66% lived in rural areas, 90% had attended at least one antenatal clinic visit, 50% had attended at least one visit with their partner, and 84% delivered in a health facility. 59% reported shared money saving with their partner and 47% reporting arranging transport with their partner.

Both men and women were questioned; however, the study found that women reported less involvement by men than men did. The men’s evidence was considered less reliable due to “likely stronger social desirability bias on the part of men”. The study team therefore decided to include only women’s responses.

This research did not measure the impact of an intervention with control groups, but rather existing practices at one particular moment in time. Therefore all the results are correlational, and causation cannot be assumed. Nevertheless, together with a body of other research from across the world, the study provides strongly suggestive evidence of the benefit of partner participation in reproductive, maternal and newborn health decision-making.


Sitefane GG, Banerjee J, Mohan D, Lee CS, Ricca J, Betron ML & Cuco RMM (2020), Do male engagement and couples’ communication influence maternal health care-seeking? Findings from a household survey in Mozambique, BMC Pregnancy and Childbirth 20

Header photo: Global Financing Facility. Creative Commons.