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Table 1 Quantitative, qualitative and mixed-method studies included

From: Male partner involvement in birth preparedness, complication readiness and obstetric emergencies in Sub-Saharan Africa: a scoping review

Authors (date) Aim Inclusion criteria and sample (n) Recruitment strategy Data source & analysis Findings QA
Qualitative research 90 FGD and 393 IDI/SSI
 Burkina Faso
  Some, Sombie&Meda (2013) [16] To examine how decisions are made for maternal care in rural Burkina Faso Women aged 15–49 years who had recently given birth and had or had not used a facility
(8 FGD and 30 IDI)
Recruited using snowball technique - FGD, IDI
-Topic guide not reported
-Thematic analysis
-MP only involved in complications
-Men in control of money
-Women need permission to leave home
-MP decision influenced by women and women’s relatives
.60*
 Ghana
  Ganle & Dery (2015) [17] To describe men’s perceptions, attitudes and involvement in maternal healthcare and how women navigate maternal healthcare Men whose wives were pregnant or lactating, and community leaders
(12 FGD, 50 IDI with men and spouses, 30 IDI with community leaders)
Purposive sampling to capture diversity of social and health situations representative of region Recruitment via community and religious leaders - FGD, IDI
-Topic guides: 1) FGDs with men: SBA and barriers/enablers men’s involvement in MCH 2) IDI with women: women’s experiences with men’s involvement in MCH 3) IDI key informants: male involvement in MCH
-Thematic analysis
-MP only involved if complications occurred .80*
  Story, Barrington, Fordham, Sodzi-Tettey, Barker & Singh (2016) [18] To explore the various types of male involvement and health facility accommodation during obstetric emergencies Women who experienced severe birth complications and their partners
(8 FGD with 59 stakeholders, IDI with 21 women, 18 men and 6 key informants))
Purposive sampling for a range of health facilities and couples that had experienced complications - FGD, IDI
-Topic guide: personal experiences of childbirth and birth complications. Women explained the male partner’s role during the experience and male partners were asked about the woman’s crisis
-Inductive analytic approach, with comparison between men and women
-Women not involved in decisions about their healthcare
-If complications occur chain of discussion is: woman-man-his mother-man then decision is made.
− 25% MP not involved at all in complications.
−67% MP instrumentally involved (transport and fees) or emotionally involved (prayers) during complications
-MP often did not attend facility
-HW said it took vital time to contact MP for money/decisions
-HW mixed attitudes towards MP
.80*
  Aborigo, Reidpath, Oduro&Allotey (2018) [19] To explore men’s reluctance to be involved in MCH Opinion leaders (majority male): chiefs, elders, assemblymen, leaders of women’s groups
Healthcare workers
(10 FGD with 120 participants, 16 IDI)
Purposive selection where community chiefs asked 10–12 opinion leaders - FGD, IDI
-Topic guide: Opinions on the lack of support for women and delays in receiving care
-Thematic analysis
-MP save money
-Women wanted MP more involved in BPCR
-MP discuss pregnancy care with TBA
-Women not allowed to access care independently
.60*
 Kenya
  Brubaker, Nelson, McPherson, Ahn, Oguttu& Burke (2016) [20] To understand the role of men in MCH Men, women and community health workers
(18 FGD with 134 participants)
Purposive sampling for facility and home birth until saturation achieved Recruited by health workers - FGD
-Topic guide: birth experiences, preparations, individual and community expectations of male roles, obstacles to male involvement
-Thematic analysis, inductive/ set-list
-MP make MCH decisions because they make the money
-MP significant in complications
-Men have poor knowledge of MCH
.85*
 Malawi
  Manda-Taylor, Mwale, Phiri, Walsh, Matthews, Brugha& Byrne (2017) [21] To explore the role of men in MCH Women using/ not using MCH services, vulnerable women, household members such as husbands and women
(20 FGD, 85 IDI)
Purposive sampling based on socio-demographic characteristics for diversity. Snowball technique to recruit hard to reach participants - FGD, IDI
-Topic guide: formal and informal community system enablers and barriers to using MCH services
-Thematic analysis
-MP role to provide money .80*
  Aarnio, Kulmala& Olsson (2018) [22] To document husbands’ role in decision-making and healthcare seeking in cases of pregnancy complications Husbands and wives who had experienced complications within past 5 years
Key informants: Village chief and wife, mother and uncle head of clan, TBA
(SSI with 12 husbands, 12 wives, 6 key informants)
Purposive sampling with assistance of two village headmen - SSI
-Semi-structured interview guide: experiences of complications, perceptions of husband’s role in decision making and seeking care for complications
- Thematic analysis based on Bourdieu’s concepts of “capital” and “field”
-MPs economic and symbolic capital in healthcare decisions during complications
-Role attributed to their position as father, main income earner and head of the household
-Lack of money is only reason to deny women access to healthcare
-MPs have limited knowledge of MCH
.85*
 Tanzania
  Pembe, Urassa, Darf, Carlsted& Olsson (2008) [23] To describe perceptions of maternal referrals in a rural district in Tanzania Health workers: midwives, MCH aide, nurse assistants
Community groups: young men and women, old men and women
(10 FGD with 11 health workers and 85 community members)
Purposive sampling for representation of all hamlets Recruitment via village chairperson - FGD
-Topic guides: Where the community seeks care; what the danger signs are; referral decision processes; factors surrounding referrals
-Content analysis
-Women have limited influence on decisions during complications
-MP and relatives are the key decision makers
.65*
  Moshi &Nyamhang (2017) [9] To explore the socio-cultural barriers to health facility birth and SBA among parents choosing home birth in rural Tanzania Matched couples: partnered men and women whose youngest child had been delivered at home less than 12 months ago
(4 FGD, 32 IDI)
Purposive sampling for women who had experienced home birth via village head
The same participants were used for both FGD and IDI
- FGD, IDI
-Topic guides: 1) FGD: general socio-cultural barriers in the community 2) IDI: personal experiences with home childbirth
-Thematic analysis and triangulation FGD and IDI
-MP provide transport
-MP view pregnancy and childbirth as a natural and risk-free process
.85*
 Uganda
  Mbalinda et al. (2015) [24] To understand how obstetric complications are perceived by MPs MPs of women who experienced near-miss event
(25 IDI)
Purposive sampling - IDI
-Explored partners’ experiences and perceptions of women’s recovery from a near-miss event.
-Thematic analysis
-MPs experience intense fear and worry, financial loss, newborn death and loss of time while in hospital
-Excluded from healthcare discussions and decisions
-Support from social network
-Isolation and ongoing distress
.85*
  Nansubuga&Ayiga. (2015) [25] To examine the roles played by MP after near-miss obstetric complications MP of women who experienced a maternal near-miss
(10 IDI)
Purposive sampling from a large cross-sectional study sample (randomly selected) -IDIs
-Content analysis
- MP involved in managing household level response to life-threatening complications: intramuscular medication, oral medication and massage
-Decision making
-Financial support
-Social support
-Transport
.65*
  Kaye, Kakaire, Nakimuli, Osinde, ScoviaMbalinda&Kakande (2014) [26] To understand MP involvement in childbirth complications Male partners of women who developed obstetric complications and were admitted to hospital
(16 IDI)
Recruited via women admitted to hospital - IDI
-Thematic analysis
-Ideally fathers are involved and supportive
-MP willing to support partners but hampered by health system
-No clear roles in the hospital environment
-Excluded from decisions.
.80*
 Zambia
  Sialubanje Massar, Kirch, van der Pijl, Hamer & Ruiter (2016) [27] To explore men’s beliefs and experiences regarding maternity waiting homes Husbands or partners (aged 18–50 years) of women who attended a health centre with a waiting home. Wife reproductive age, given birth in last year
(24 IDI)
Purposive sampling for experience of waiting homes and range of districts, health centres and families
Health officers at waiting homes informed women of study, then women asked husbands to be involved
- IDI
-Topic guide: Husbands’ perceived benefits and barriers, decision making process and their roles in their wives’ use of waiting homes
-Short demographic questionnaire
-Thematic analysis and demographic statistics
-MP plan for birth finances
-MP main roles in pregnancy and birth: decision maker for waiting home; money for food and transport; clothes and items for newborn; finding someone to take care of children
-Decisions not unilateral, men and women discuss issues together
.80*
Quantitative research n = 5942
 Ethiopia
  Baraki et al. (2019) [28] To assess MP involvement in BPCR Men whose wives had an infant aged up to 12 months in a community household
(406)
Randomly selected lottery sample Cross-sectional observational study
-Interviewer administered standard JHPIEGO questionnaire
-Multivariate analysis
See Table 3 .72†
  GebrehiwotWeldearegay (2015) [29] To assess MP involvement in BPCR Men whose wives had an infant less than 12 months. Men separated or with critically ill children excluded
(398)
Randomly selected sample - Cross-sectional observational study
-Interviewer administered standard JHPIEGO questionnaire
-Multivariate analysis
See Table 3 .86†
  Mersha (2018) [30] To determine men’s level of knowledge about obstetric danger signs and level of BPCR Men whose wife gave birth within past 2 years
(824)
Multistage cluster sampling procedure
selected 4 districts from 19, all households within catchment areas with eligible men invited
- Cross-sectional observational study
- Standardised structured JHPIEGO questionnaire adapted for Ethiopia: Socio demographics, knowledge of danger signs, BPCR
- Frequencies and %. Bivariate logistic regression and multivariate regression.
See Table 3 1. †
  Tadesse, Boltena & Asamoah (2018) [31] To assess husbands’ level of participation in BPCR and associated factors Husbands of pregnant woman and nursing mothers
Husband age 20–50. Religion: majority versions of Christianity Occupation: largest groups merchant, labourer, government employed
(592)
Multistage sampling technique. Eight districts randomly selected from Wolaita town. Sampling frame of households in which a pregnant woman was living known from ANC registration. Systematic random sampling of 607 households with a woman registered for ANC. - Cross-sectional observational study
- Standardised structured BPCR questionnaire JHPIEGO. Translated into Amharic
Multiple regression with poor or good participation and other factors. Frequencies of husbands who participated in various BPCR activities.
See Table 3 1. †
 Ghana
  Atuahene, Arde-Acquah, Atuahene,  Adjuik&Ganle (2017) [32] To describe the level of male involvement in inner city safe motherhood projects Married men aged 18+ whose wife/partner was pregnant and in 3rd trimester or had children 5 or younger
Average age 37
(256)
Multistage sampling procedure to select: houses, households then respondents. Simple random sampling. - Cross-sectional observational study
-Interviewer administered study-designed questionnaire: socio demographic variables, ANC attendance, birth processes. Piloted in similar region.
-Descriptive statistics
See Table 3 .68†
 Kenya
  Dunn, Haque&Innes (2011) [33] To assess men’s awareness of danger signs of obstetric complications Men with wife or partner who had undergone childbirth in preceding 36 months
Average (SD) age 35 (8), 41% 0–2 children, 98% Christian
(167)
Purposively sampled for education diversity - Cross-sectional observational study
-Study specific questionnaire identifying dangers signs as true or false
- Descriptive statistics
See Table 3 .45†
 Nigeria
  Oguntunde et al. (2019) [34] To assess the determinants of MP knowledge of danger signs in pregnancy Married men with at least one wife younger than 25 years
(1627)
Multistage random selection - Cross-sectional observational study
-Interviewer administered standard JHPIEGO questionnaire
-Multivariate analysis
See Table 3 .90†
  Sekoni (2014) [35] To assess MP knowledge of obstetric danger signs Men aged 15–65 with at least one child < 3 years
(259)
Multistage random selection - Cross-sectional observational study
-Interviewer administrated structured questionnaire
-Descriptive statistics
See Table 3 .63†
 Rwanda
  Kalisa&Malande (2016) [36] To assess level of male partner involvement in birth plan, attitude of women towards BPCR Pregnant women and MP presenting as referrals to health service
59% completed primary education, 94% married, average age 27 (women) and 31 (MP)
(193 women + 203 MP)
Purposive sampling for referrals to health service.
Healthcare workers recruited participants
- Cross-sectional observational study
-Pre-tested structured interview questionnaire based on ‘Monitoring BPCR WHO’. Adapted for local conditions. Socio demographic characteristics, medical history, reason for referral, level of male partner’s involvement, women’s attitudes towards male involvement in BPCR, BPCR.
- Frequencies, chi-square test. Bivariate logistic regression. Multivariable logistic regression.
See Table 3 .82†
 Tanzania
  August, Pembe, Mpembeni, Axemo & Darj (2015) [37] To assess men’s knowledge of danger signs and BPCR Men with partners who gave birth within past 2 years
(756)
Two stage sampling procedure. All health facilities listed, then ballot to identify 14. Two villages within the catchment population for the facilities randomly selected - Cross-sectional observational study
-Standardised structured questionnaire by JHPIEGO adopted for Tanzania context. Socio demographic, attended ANC, experienced complications, knowledge of danger signs
-Descriptive statistics and logistic regression
See Table 3 1. †
  Shimpuku, Madeni, Horiuchi&Leshabari (2017) [38] To assess predicted birthplace intentions Pregnant women ≥16, (no psychological or physical illness), husbands and family members ≥16living with women
(121: 42 pregnant women, 35 husbands and 44 family members)
Non-probability sampling and purposive sampling via village leaders for pregnant women - Cross-sectional observational study
−38 item study-specific birth intention questionnaire
-Chi-square test, ANOVA, multiple regression, correlation
See Table 3 .59†
 Uganda
  Kakaire, Kaye & Osinde (2011) [39] To assess factors associated with BPCR & level of male participation in the birth plan among emergency obstetric referrals Pregnant women admitted as emergency obstetric referrals
Average for women and men: age 26, 32, 73 and 55% had no or primary education, 81% married
(140)
Purposive sampling for referrals
Healthcare workers recruited participants
- Cross-sectional observational study
-Questionnaire: Socio-demographic, medical history, Birth preparedness, roles of spouses in birth plan
-Medical records: obstetric complications, reasons for referral, obstetric care obtained at the referral and referring sites and availability of a birth plan
- Frequencies, Chi-square test. Bivariate logistic regression. Multivariable logistic regression.
-Men’s responsibility to save money for birth and organise transport. However results showed 44% of women used their own money for birth .77†
Mixed methods research n = 5603
 Ethiopia
  Andarge et al. (2017) [40]. To assess the factors influencing BPCR among pregnant women in Ethiopia Pregnant women and their partners
(707) women and 6 FGD with male partners
Multistage sampling - Cross-sectional observational study, FGD -Interviewer administered standardised JHPEIGO questionnaire Qualitative findings: Male FGD participants agreed that main BPCR practice was saving money and preparing special birth porridge
Quantitative data NR for men
.85*
 Malawi
  Aarnio, Chipeta&Kulmala (2013) [41] To explore husbands’ perception of birth care Ever married men whose wives had been pregnant in the last 5 years
- Median age 33, majority Islamic, 67% literate, 99.5% married, 10% polygamous, majority 1–3 children, 98% male breadwinner, majority access to health facility by walking, bicycle, or public transport.
(389)
Systematic random sampling, first eligible person in household interviewed - Cross-sectional observational studyincluding some open-ended questions
-Study-specific questionnaire. Closed- and open-ended questions about men’s perceptions of and involvement in antenatal care, birth preparedness, choice of birth place, obstetric complications, birth care and postpartum care. Picture cards of 5 danger signs; asked if they would go to hospital with these issues.
-Descriptive statistics
- Open-ended questions with narrative with content analysis.
MP make decisions about MCH decisions and BPCR
MP often seek help at a facility for danger signs (except convulsions)
.73*
 Nigeria
  Iliyasu, Abubakar, Galadanci&Aliyu (2010) [42] To assess BPCR and male involvement Ever married men whose wives had ever been pregnant, and their wives and community leaders
- Majority Muslim, aged 20–39, employed including government, farmers and private employees; 70% had some education.
(389)
Multistage systematic sampling of households - Cross-sectional observational study, IDI
-Standardised structured questionnaire by JHPIEGO: Demographic, perception of high risk pregnancy and danger signs during pregnancy, birth preparedness and complication readiness,) participation of men and spousal attitudes towards these issues.
IDI guide for community leaders: reasons for low participation of men in maternity care
Descriptive statistics. Chi-square test. Multivariate logistic regression
Thematic analysis, illustrative quotes
See Table 3 .95†
  Nwakwuo&Oshonwoh (2013) [43] To assess MP level of involvement in perinatal health events Men whose spouses had children or had maternal event last 1 year and local resident
- Average age 38, majority married, educated to secondary, Christians, public servants
(386, 20 IDI)
Multistage sampling technique for survey. Houses numbered then systematically selected. Ballot used to identify household if more than one in dwelling. All eligible men in household approached to be involved
Purposive sampling for antenatal woman or postnatal woman.
- Cross-sectional observational study, IDI
-Study-specific questionnaire including open and closed questions
Interview guide on topic of knowledge and attitudes of wives to husband involvement.
Descriptive statistics. Chi-square test and Fisher’s exact test. No further details given.
See Table 3 .68†
  Odimegwu, Adewuyi, Odebiyi, et al. (2005) [44] To examine the role of men in emergency obstetric care (1957 women and 1720 MP) Random selection from study drafted household list - Cross-sectional observational study, FGD,
-Topic guide on pregnancy complications and role of MP
-Thematic analysis
-Multivariate
-Men aware obstetric conditions particularly in relation to pregnancy signs and labour pains (53.2%).
-Men perform important tasks during obstetric conditions (89.2%).
.54†
 Uganda
  Singh, Lample& Earnest (2014) [45] To understand men’s participation in MCH, and’ men’s and women’s views on increased male partners’ involvement Women who were pregnant or gave birth in last 1–3 years and MP, and key informants
Religion Christian or Muslim depending on village, majority married, majority 18–28 years old, majority 1–2 or 3–7 children.
(35): 23 women and 12 men
Purposive and opportunistic sampling through key informants - Cross-sectional observational study, FGD
-Study specific self-report questionnaire for men and women
Topic guide for FGD: birth preparations, ANC, health services, involvement of men and factors impacting pregnancy and labour
Thematic analysis with triangulation between FGD and questionnaire data
MP involved in pregnancy decisions
Women said money was a challenge in birth preparation
Money for birth is responsibility of MP
Men and women agreed need to improve MP involvement
.60*
  1. MP Male partner, FGD Focus group discussions, IDI In-depth interview, SSI Semi-structured interview, SBA Skilled birth attendant, HW Health worker, TBA Traditional birth attendant, ANC Antenatal care, MCH Maternal child health, QA Quality assessment max score 1, JHPIEGO John Hopkins Program for International Education in Gynaecology and Obstetrics, MP Male partner, * Kmet qualitative checklist, † Kmet quantitative checklist