An exploratory study of men’s companionship, perceptions and experiences during pregnancy and delivery in Uganda

Men’s support is an essential component for making women’s world better. There are increasing debates among policymakers and researchers on the role of men in maternal health programs, which is a big challenge in Uganda where society is male driven.

The failure to incorporate men in maternal health promotion, prevention and care programs by policy makers, program planners and implementers of maternal health services has had a serious impact on the health of women, and the success of programs [1].

Traditionally, in other African settings, women have been attended and supported by other women during labour and birth [2]. Being decision makers, men’s involvement is likely to improve maternal and child health outcomes [3].

The tendency to view maternal health as a woman’s issue has contributed to a narrow focus of targeting mostly women. Social relationships determine people’s ability to manage their sexual and reproductive health (SRH) lives, with important implications not only to their health but also for other life choices [1].

According to the ICPD ten year progress report, a major remaining challenge is “the promotion of greater men’s responsibility in family and reproductive decision-making” on of greater men’s responsibility in family and reproductive decision-making” [4]. Active men’s involvement and participation in maternal health services is necessary to increase utilization of maternal health services by the pregnant women and mothers.

These will deal with the research design, study population, the methods of data collection, processing, analysis and the limitations to the study.

An explorative qualitative design using in depth interviews was employed to explore the perceptions and experiences of male companionship during delivery [5] The study was carried out at a missionary private not for profit hospital providing quality care (St Francis Hospital Nsambya).

The study population comprised of all men of eighteen years and above who accompanied their spouses during labour and were willing to participate in the study. It is a missionary hospital located in the periurban area.

Its catchment population is approximately 250,000 with 7000 deliveries per year. Antenatal and maternity services at public health units in Uganda are provided free of charge. The Hospital, being a nongovernmental not- for- profit institution under Kampala Archdiocese, charges a fair user fee for these services.

Interviews were done for men who had accompanied their spouses during delivery until data saturation was reached. This was a point where no new information was gotten. Sixteen men were interviewed.

Purposive sampling was used to select participants who have characteristics with the potential of providing rich, relevant, and diverse data. The participants were approached in person, and none declined to participate.

Written consent was obtained from each of the men whose partner had normal vaginal delivery or caesarean section with a live birth in the hospital.

In depth interviews (IDIs) were the main data collection methods used in the study. Two (2) trained data collectors were used in the study. A pretested semi structured interview guide was used. I the principal researcher with the research assistant carried out the interviews. Interviews were conducted in English or Luganda, a local dialect in the periurban setting, depending on the language the respondent was comfortable with. Follow-up questions were asked and the clarification of points which arose was also sought.

One of the research assistants moderated and guided the interview while the other took notes and did the tape recording. The interviews were tape-recorded with the permission of the participants; in addition, the interviewer took notes. Codes were written on the interview guides and each recording was started by first mentioning the code on the interview guide to ensure data collected could be analyzed as belonging to that interviewee.

Notes were taken immediately after each interview. These notes covered the initial interviewee reactions, including the first analytical reflections from the interview content, and any useful observations that could not be captured by digital recording. Notes were taken on the demeanor of the respondent, his body language and mood, and any informal conversation that took place before or after the interview. Each interview ranged from 30 to 45 min.

The guide used covered the main areas on male companionship during labour. Questions were raised and participants were encouraged to express their opinion openly. Probes were made for clarification. Point of saturation was deemed to have been reached if no new information was obtained.

Validity in qualitative research is the extent to which observations reflect phenomenal of interest [6].

The principal researcher is a male doctor who conducted the interviews together with trained research assistance. The principal researcher was working at the Hospital while the research assistant in school of public health at a University. Data collection tools were pre tested and the semi structured interview guide was piloted to test the understanding of the questions.

Hence to improve credibility in data collection, clarification was sought during and after each interview. Triangulation was done to improve validity by interviewing women whose male partners participated in the study to collaborate their information.

Reliability in qualitative inquiry refers to the consistency of the research findings, through the interview process, the data transcription and analysis [6]. A semi structured interview guide was used to make sure that all participants answered the same questions. This improved consistency during interviews and build up of codes and themes. The data was transcribed and rechecked collaborating with the notes taken during interviews for gestures and motions, improving consistency.

Repeated listening to tapes of interviews was done however in absence of participants during analysis. Repeat interviews were done for 2 randomly selected participants to correlate with the initial interviews.

The taped interviews were transcribed verbatim after repeatedly listening to the recordings and the resulting texts analyzed by using Content Analysis technique. Broad themes were extracted from the transcripts and then progress to identifying coded themes. In establishing themes, consideration was given to statements of meaning that were present in most of the relevant data. In an attempt to ensure the credibility of the findings, an independent experienced coder was used to verify or corroborate the themes extracted from the data. The data was analyzed simultaneously with data collection. This allowed the researchers to progressively focus the interviews and observations, and to decide how to test the emerging conclusions. The transcripts were entered into ATLAS.ti for analysis. I developed a codebook based on the major themes of the study. The major themes were transformed in tree nodes and free nodes. Based on the codebook, I developed verified independently coded texts from the transcriptions.

The emergent themes and sub-themes are discussed below, supported and illuminated by respondents’ quotes. After exhaustive analysis of the interviews, it was possible to identify the following themes: feeling about attending child birth, responsibilities during child birth, positive experiences and negative experiences about child birth.

This research was approved by the Hospital’s Institutional Review Board (IRB) - IRC/PRJ/010/14/05. The data collection was carried out between October 2014 and January 2015, using semi-structured interviews, after being approved by the IRB of the fore mentioned institution and after the participants signed a Consent Form. To ensure confidentiality of participants who gave written consent, codes were used on the form instead of their names. In addition, only codes were written on interview transcripts.

The results cannot be generalized to all populations in and outside Uganda. We do not claim that these findings apply to all men who accompanied their partners during pregnancy and child birth.

The men who took part were married. Further exploration with men of different ethnicities, relationship status, and ages would be beneficial to expand on and compare with the findings in our study. The pre conception of the principal investigator from biomedical background training may affect the interpretation of information obtained from the interview.

Men’s involvement in the child birth process was associated with a more perceived bondage with the partner and the newborn. Their presence helped to promote a calm and successful child birth process. Four main themes were obtained: feelings about attending child birth, responsibilities during child birth, positive experiences and negative experiences about child birth. Men were willing to participate in child birth and should be encouraged as many are the decision makers in the family. Admission of a men into the delivery room, improves family togetherness. The women feel loved and treasured when a male companion was present during child birth.

This exploratory qualitative study provides an insight into the companionship during pregnancy and delivery, men’s experience during delivery in St, Francis Hospital Nsambya. The demographic data of the participants in this study showed that men who attended delivery were educated and profession men. These men could be likened to middle-class men in industrialized countries.

Regardless of the education, parenthood, age and mode of delivery, the participants wanted men’s involvement increased during pregnancy and delivery. This made decision making easier, being supportive and a learning moment as well. Although it is not a tradition for men to attend birth of their children, the participants demonstrated that men can be labour companions for their partners as women. Given the enabling environment, men can effectively assume the role of labour companions [7].

Men are willing to participate in labour and should be encouraged as many are decision makers in the family. This may have an impact on the three delays especially delay in seeking care, in recognising complications and asking for help and delay in reaching medical services. One male partner reported borrowing his neighbor’s car to bring his partner to hospital

The father in the labor room plays an essential role in the childbirth process by supporting and encouraging the mother to relax, which helps to promote a calm and successful labour and delivery process [8].

Male companions comfort their partners, massage their backs, prepare them tea, provide cotton and most of all, and learn how to take care of a pregnant mother in labor. This made decision making for emergency operation easier when the men were in the delivery room. The research shows hospital policies should advocate for men’s involvement especially provide space in theater where men can see the birth of their child, listen to the first cry as well.

Childbirth is the time when men are most receptive to getting involved with their families which makes men’s involvement critical for healthy pregnancy outcomes, infant survival and ideal child development [9].

The research has shown that the experience men go through during pregnancy and childbirth has a profound effect on planning their next child birth. Men expressed that they would not want their partner to go through child birth experience soon. One wanted 10 children but after seeing what his partner went through, he said he would stop at seven.

Admission of men into the delivery room, improves family togetherness, the women feel loved and treasured, the partners reported bondage to their partners and new borne. It was associated with high-level quality of intimate relationship between a man and a woman.

In agreement with prior research, the research demonstrated men’s attendance and active participation at labour and childbirth was associated with a belief of a ‘good’ partner, ‘good’ father [10] and a public statement of the strength of the father-infant bond [11].

The men stated that they were more knowledgeable about labour and appreciated the efforts of midwives and doctors in encouraging men’s attendance during labour. The men recognized the important role of partner’s presence played in promoting better care for their partners and new borne. One participant had to participate in translating for midwives what his wife was saying.

The participants expressed that they should have been told what to expect during antenatal visits. They expressed interest in attending antenatal with their partners to learn more about pregnancy and delivery. However due to commitments at their work places, majority are unable to attend antenatal visits but they made sure they attend delivery because they did not want second hand information about baby’s sex, time of delivery, condition of mother and baby. One participant cancelled a business trip to china to attend delivery of his child, an experience and decision he does not regret.

Participants reported that they decided when their partners would come for antenatal, when to come to hospital to deliver because it involved financial implications. The participants participated in choosing the hospital where partners would deliver from. This portrays the patriarch society where male companions during pregnancy and delivery are the decision makers.If male companionship is encouraged it could play a role in reduction in mortality and morbidity during pregnancy and delivery.

Male experience depended on various factors which included attitude of the health workers towards their partner during child birth, cost of services, preconceived traditional beliefs and lack of time off from their work places to attend child birth.

The factors that affect men’s involvement in maternal health care services may be categorized into Cultural factors, socio-economic, health facility factors, inter-spouse communication and perceptions men have on maternal health services.

Perceptions men have on maternal health services; perceptions that maternal health care services offered are poor and that services could be very expensive for both spouses to access [3].

Men expressed that they would have wanted to be present especially when main decisions were taken like being taken to theater.

This will deal with the conclusion and recommendations

Men involvement in the child birth process was associated with a more perceived bondage with the partner and the newborn. Their presence helped to promote a calm and successful child birth process.

This study is very important for operational direction and improvement in service delivery. As a society, if men were more involved in pregnancy and child birth, they would bond more to their partners and newly borne, help to promote a calm and successful child birth and delivery process. However hospitals should work on measures encouraging men’s involvement, encouraging antenatal and delivery attendance. Provide a place in theatre where men can view as their babies are born. Their partners and health workers have shown to accept this approach.