Family inclusive care: how NOT to organise it! Rwanda

family inclusive

The practice of requiring husbands to come to an antenatal appointment for HIV testing may seem to be family inclusive, but when it starts to involve a degree of coercion, it has deeply problematic consequences, particularly for vulnerable women. A new study carried out in Rwanda with Uppsala University (Sweden) sheds new light on the pratice. The researchers interviewed 47 women who had nearly died during childbirth, 13 of their partners and 34 women and 26 men from the community.

If a woman cannot come to the first antenatal appoinment with their husband – if he is working or if he is unsupportive – then she has to get a letter from the Chief of her neighbourhood. The research also quotes mothers who take a man with them who pretends to be their husband, sometimes even having to pay for this.

“When I was [at the health center], a woman came for her medical check-up and she waited for her baby’s father for hours and he didn’t show up. People told her to just go outside and pay one of the guys who were idling on the street and ask him to come with her as the baby’s father. She went and paid the guy, and he came with her and they got the check-up over with.” (FGD8: 34-year-old man)

This delays women’s access to care and gives power over access to healthcare to unsupportive partners.

Typically, as soon as the HIV testing has been carried out, fathers are excluded from all further health consultations.

“Once the testing was completed, the men were not allowed to participate in the actual health consultation. This appeared to provoke low trust in the value of the ANC check-up altogether among the men, and, in a paradoxical way, appeared to keep them from becoming more involved and increasingly supportive. Participants felt further antagonised against embracing the ANC visit as a vehicle for increasing knowledge about the pregnancy or, for the men especially, about gaining more insight into the health of their pregnant partner. The men questioned why they were only included in the HIV testing at the ANC visit and not welcomed at the health consultation. Therefore, some perceived that the consultations were an entire waste of time. This negative attitude was confirmed by some women, who elaborated that their own partners felt uncomfortable and unwelcomed at the health centre. Several men openly expressed a wish to be more involved, and assumed a position of having limited trust in the ANC care provided.”

In common with other studies that have included interviews with husbands, the researchers found a strong desire for knowledge among the men, and also a desire by women that they should be well-informed so they can provide better support.

Any kind of requirement for family members to attend has no place in family inclusive care. Family inclusive care is about reaching out to family members, sharing knowledge and building a partnership of care around the pregnancy.

Family inclusive care is woman-centred.


Jessica Påfs et al. (2015), ‘They would never receive you without a husband’: Paradoxical barriers to antenatal care scale-up in Rwanda, Midwifery 31

Photo: Bread for the World. Creative Commons.