A study of respectful care during childbirth in Tanzania breaks with tradition by including fathers. The study is different in three ways: (1) it includes fathers in the questioning about the quality of the care; (2) it considers fathers as recipients of certain aspects of maternal healthcare, for example, being informed; and (3) it includes a strong focus on the problem of denial of birth companions to mothers.
The study, like an earlier study from Tanzania in 2014, engaged both mothers and fathers. Fathers were equally involved: six interviews with fathers and six with mothers, and two focus groups with fathers and two with mothers. The mothers and fathers in the study were not necessarily related.
Fathers, like mothers, reported the use of harsh or rude language by providers, towards mothers and also towards fathers. Unlike fathers, mothers also reported positive experiences of encouragement received from providers. This is probably because the exclusion of fathers means that positive interactions with providers are not possible.
Both mothers and fathers reported the negative impacts of long waiting times, for example, a feeling of abandonment. Both mothers and fathers experienced being left uninformed when separated from the baby or from each other. Both mothers and fathers raised concerns about the physical condition of the facilities, and about a negative culture surrounding payments, particularly bribery and extortion.
The researchers consider the denial of the woman’s right to have a birth companion. One mother put it thus:
“I would love my husband to be present at the time of delivery. I would love for him to witness the kind of turmoil we ladies go through during delivery so that he can be more cooperative. Because you may find that some men don’t offer full support to their wives during pregnancy and even delivery because they don’t understand how difficult it is. But if he is present and sees how tough it gets, maybe he will be more supportive. This might change his attitudes a little bit and understand that his wife endures a rough time during pregnancy and labour. This might instil a sense of solidarity and supportiveness towards me. I would really like him to be present during delivery time.”
Fathers too expressed concern about this exclusion, for example:
“Sometimes you face problems. If you want to know about what is going on with your wife….if you do not see your wife during visiting time, you have to go back home and wait for another visitation time. You are not given any information neither can you call your wife because at the time, she is told not to use her phone to communicate unless there is an emergency.”
There is in Tanzania a clash between the desire of mothers and fathers to have fathers present at the birth and the cultural and physical constraints in health services. Another earlier study by the same team in 2018, found that women typically expressed a desire for the father to be involved in the delivery process, sometimes more so than the man himself.
“It is really encouraging when your husband escorts you. In my case, in all my previous deliveries, my husband didn’t escort me. I was hoping he would escort me in the last pregnancy. Some people tried to help me to persuade him but his reply was that he had given me money so I should just hire a taxi. Some old women stood up against him and made sure he came with us. It really felt great to have him there, even though he stayed at the hospital entrance.”
The researchers recommend that “the rights and desires of both the mother and father are taken into account and respected”.
Another study from Tanzania in 2016 found concerns among fathers about quality of care. “The one aspect of quality that men focused on more than women was disrespectful care and health worker attitude.”
Mselle LT, Kohi TW & Dol J (2019), Humanizing birth in Tanzania: A qualitative study on the (mis) treatment of women during childbirth from the perspective of mothers and fathers, BMC Pregnancy and Childbirth 19
Kohi TW, Mselle LT, Dol J & Aston M (2018), When, where and who? Accessing health facility delivery care from the perspective of women and men in Tanzania: A qualitative study, BMC Health Services Research 18
Kimweri A, Hermosilla S, Larson E, Mbaruku G & Kruk ME (2016), Service quality influences delivery decisions: A qualitative study on maternity care in rural Tanzania, Journal of Reproductive Health and Medicine 2.1
McMahon S, George AS, Chebet JJ, Mosha IH, Mpembeni RN & Winch PJ (2014), Experiences of and responses to disrespectful maternity care and abuse during childbirth: A qualitative study with women and men in Morogoro region, Tanzania, BMC Pregnancy and Childbirth 14
Photo: Ericsson. Creative Commons.