Prevalence of male attending ANC services with their partners
Male participation in antenatal care is thought to be important in improving positive maternal and new born health outcomes . In this study, the prevalence of men attending ANC visits with their partners was found to be 56.9%. This prevalence is higher than those reported from other studies done in Mbeya, Tanzania . The former study reported that, only 39% of the facility have been receiving male partners for both ANC/PMTCT and that reported by government of Tanzania in one plan II of 2016 which was only 30% . This can be explained with vast of improvement in national reproductive policies, infrastructures as well different modalities of reproductive health promotions. For examples pregnant women would not receive ANC services if they would not attend with their partners and those who attended with their partners will get priority services.
In contrast to our study which was conducted in rural areas, most studies done in either urban setting or referral health facilities in Africa had low prevalence of male attendance to the ANC services. Study done in Mwanza city, north western Tanzania reported that only 24.7% of mothers had their male partners involved in PMTCT which is a crucial component of ANC services . Another study done in northern Tanzania had reported that few men attended the ANC-VCT services during prenatal compare to those attended during post natal care (12.5% vs. 40%) which also is lower than the findings from this study . A study by Byanmugisha et al. in Uganda reported that, 26% of men whose wives were attending ANC at Mbale Regional Referral hospital reported to have full male involvement in ANC services . In most urban areas there is large number of people with occasional jobs so have less habit for seeking health services. Men who had occasional job were less likely to participate in ANC than peasants in Kenya .
However, apart from attending to the ANC services, majority of men provided financial support to their partners for the attendance to the ANC services. This can be through paying for transport, accompanying their partner to ANC, joining inside the rooms as well as participating in different ANC services . Most men support women’s attendance to the ANC even though their own attendance at the services is low . This may be due to cultural system in most of Sub-Saharan Africa, men are the main decision makers in the family including for economic affairs as well as health issues [17,18,19,20,21]. This system can be used to motivate men to attend to the ANC services with their partners.
Services provided in ANC services
In this study, men who attended ANC services did not only accompany their partners but about 97% of those who attended reported that they availed of all the ANC services in the particular clinics, this included voluntary counselling and HIV testing for the prevention of maternal to child transmission of HIV/AIDS and STIs/STDs. From other studies, poor male participation of male in ANC services were due to poor access, stigma and confidentiality of services that were unfriendly to men . As reported in studies done in Tanzania, there is minimal health education and counselling during ANC visits. This is due to either high number of the clients in the clinics and long-time of waiting. Also, some of the clinics reported to have male unfriendly facility environment and poor health workers attitudes towards men. These discourages male partner participation in ANC services [23, 24]. In Uganda reported that the number of the educated men attending to the ANC were twice as much as those who were less educated . However, in other studies financial constraint such as cost of travel to ANC were reported as the setback to the male attendance to the ANC [25, 26].
This study has found the significant association between couple communication with male partner attendance to the ANC services. This findings is similar to the findings reported in other studies in aspect that women were likely to bring their partners to ANC services especially after bringing their feedback of the services they obtained during previous ANC visit [13, 25, 27]. Verbal communication seems to lighten the mind of the male partners on the advantages of attending to the ANC with their partners. As reported in study done by Chibwae et al in Shinyanga 2014, couple communication about ANC helps men to increase male partner awareness about ANC services . And hence, they were able to know about what happened on previous ANC visit and next ANC visiting dates which were all significant associated with their attendance in this study.
Reported factors hindering male partners attendance to the ANC by pregnant women
For the women whose partners did not attend, different reasons were given out but majority were due to the fearing HIV testing. This reason was also reported in the study done in Uganda that male partners were concerned with stigma and confidentiality of services that were unfriendly to men after knowing their status [22, 28, 29]. Other studies also done in Tanzania reported to fear of HIV testing as a barrier for the male partner attendance to ANC services [13, 30]. So there is a need to improve campaigns for HIV counselling and testing for men in Tanzania and other parts of the world.
Another reason reported by women whose husbands did not attend at ANC was polygamy or partners are not living together. Similar data findings were reported in other different studies that reduces number of male attendance in ANC services [31, 32].
Health facility factors also have being implicated in this study such as long queue and long waiting time. Long waiting time and long duration of ANC clinics were also common barrier for male attendance to the ANC services reported in other studies [4, 33].