A recent study in Ghana has explored the involvement of fathers in improving women’s access to skilled maternal healthcare. The study explores the beliefs and actions of fathers, mothers and health workers and recommends ways of engaging men more effectively as partners in maternal health care.

The Family Included team would like to commend the article as the most interesting and informative single piece of research on family inclusive maternal healthcare that they have found during 2015.

The research, conducted by John Ganle and Isaac Dery, included 12 focus groups of fathers, each with between 7 and 12 men aged between 20 and 50. They are all from a low-income region mostly of small farms, with poor transport links and low levels of education.

The focus groups were followed up by 25 in-depth interviews with some of the participants along with their wives. The researchers also interviewed 30 further people – community leaders and health professionals.

Most of the men, particularly younger ones, understood the importance of using skilled maternal health services. Fewer than a quarter of them, however, had accompanied their wives to an ante- or postnatal clinic. What lies behind this? The researchers found a variety of reasons.

Gendered division of roles

Men in these communities tend to focus on work and small-holder farming is work intensive. There is a belief among both women and men in these communities that a division of roles is appropriate. Some men said work took precedence and some women noted that they would not want to be at a health facility with their husband.

Conversely, some of the couples repudiated this role division:

“I was with my wife during all her ANC visits and even during her delivery. My friends made fun of it but you know I did not mind them. My involvement gave my wife support and encouragement so that when she was pushing the child, she pushed it with happiness and comfort since she knew her husband was by her.” [Male participant]

“I followed my wife to the health centre where she was going to deliver. After all, she is carrying my pregnancy and the expected child belongs to both of us. I cannot share the pain of pregnancy but I have to support my wife during pregnancy, childbirth and even in child rearing and caring. It is the responsibility of both of us.” [Male participant]

Cultural beliefs

Some of the professionals and healthworkers are quoted in the research report as feeling that some men would be embarrassed to be seen to be going to an antenatal clinic. Some of the women interviewed said that their husbands and mothers believed that a pregnant woman going to an antenatal clinic was a sign of weakness.

Cost

Transport in these rural regions can be prohibitively expensive both in terms of cash and time.

Some health services illegally charge fees for antenatal care.

Waiting times at clinics can take a whole day, with higher opportunity cost if two family members are attending.

Poor quality of services

The strongest comments quoted in the research report relate to experiences of services. Some comments were very negative:

“I had a very bad experience three years ago when I went with my wife to see the midwife. The nurses were asking me what I wanted in the maternity ward…some even shouted at me to keep quiet when I wanted to tell the midwife how my wife behaved the night before our visit. Since that experience, I have told myself that I will not accompany my wife again to see the midwife.” [Male participant]

“One day, I followed my wife to a health facility. Upon entering the labour ward, the nurse ordered me to go out in a way as if I was not a human being. She continually shouted at me and pointed at the door for me to go and wait outside. After this experience, I have never escorted my wife again for maternal care.” [Male participant]

“Sometimes, the nurses are always so harsh and they don’t want to see a man (husband) inside the maternity ward. There is nothing you can do because you cannot see her (wife) although you wish to be near her, so it is better for you the husband to stay away (at home) and do some other things that can help her after delivery.” [Male participant]

But one father showed that this poor quality is not universal – it can be different.

“At one of the health centres there used to be one midwife…she was very nice to all the men and women who visited the health centre …she talked nicely to people especially men. Even when you make a mistake, she will not shout at you; she will take her time to talk to you. So a time came that all the pregnant women wanted only that midwife to attend to them. Men were also very willing to take their wives to see that midwife.”

Community support for better engagement with men

The researchers found strong support among both women and men for better engagement with men.

“My view is that if the healthcare providers want every woman in this community to attend antenatal clinic or deliver their babies at the hospital, then they need to talk to we the men too and involve us more to understand why it is important. I say this because we the men are often responsible for the pregnancy and therefore we have a lot of say in terms of how the pregnancy is cared for or how the baby should be born.” [Male participant]

“I believe one problem is the failure of the healthcare system to actively engage men on issues of maternal health. But you see, we still live in a country where men have more control over household decisions, including decisions like how many children to have and whether a woman should give birth in the hospital. So I think that if we want to ensure that all women have access to or use skilled maternal healthcare services, then we the healthcare providers must also engage the men in the process.” [Female participant]

Recommendations

The researchers conclude with a variety of recommendations, principally the introduction of services that are both patient and family centred, noting that, if there is harsh treatment, it tends to be delivered to both women and their husbands. One participant in the research put it well:

“I think the healthcare providers need to focus on improving the relationship between caregivers and women and their spouses. They need to provide more patient-centred care that is able to address the needs of women, accord the men who accompany them to the health facilities respect and assure dignity anytime they visit a health facility.” [Female participant]

The researchers recommend also:

• Tackling cost issues – transport, illegal fees, long waiting times (e.g. use mobile communications to implement booking system).
• Training for health workers in patient and family centred care.
• Strong leadership in services with incentives and penalties for healthcare workers to encourage good practice.
• Provide men and women with information about what men can do to support a pregnancy, to engender joint ownership of the responsibility.
• Community awareness programmes, perhaps fronted by fathers who have already defied tradition.

Ganle, JK & Dery I (2015), ‘What men don’t know can hurt women’s health’: a qualitative study of the barriers to and opportunities for men’s involvement in maternal healthcare in Ghana, Reproductive Health 12

Photo: Jason Finch. Creative Commons.