Husbands’ involvement and women’s utilization of maternal health care in Sidama zone,Southern Ethiopia.
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Date
2019-03
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Addis Abeba University
Abstract
Background: Husband involvement is an important intervention for improving maternal health,
and is considered as a crucial step in scaling up women’s use of prenatal care. The idea of men’s
involvement in reproductive health was first emerged at Cairo’s conference in 1994.
Nevertheless, to implement this idea into practice several challenges have been faced. Even
today, emphasis has not been given to the concept of men involvement in maternal health in
most developing countries. Until recently, there is limited evidence of husbands’ involvement
and its contribution for women’s use of skilled maternity care in Ethiopia, a country with low
coverage of maternal health care but with high maternal and neonatal mortality. Therefore, there
is a need to generate contextual evidence for policy formulation, designing and implementing
programs that remove barriers and to promote husbands’ involvement in maternal health care.
Objectives: The aims of this study were to assess the magnitude and determinants of husbands’
involvement in maternal health care, and to examine its association with women’s utilization of
skilled birth attendants and postnatal care services in Sidama zone, Southern Ethiopia.
Methods: The study used mixed research methods. The quantitative methods employed both
cross-sectional and follow-up study designs. Data were collected from sample of 1318 men and
709 antenatal women using interview questionnaires from December 2014 to January 2015 and
June 01 to November 30, 2015, respectively. The data were analyzed using SPSS ver.20. A
descriptive statistics: univariate and bivariate analyses, and inferential statistics: a chi-square test,
and binary logistic regression analyses with the corresponding odds ratios, 95% confidence
intervals (CI), and p-values were computed. The qualitative method was also employed to
explore contextual evidences on barriers to husbands’ involvement in maternal health care. The
data were collected using open-ended questions and analyzed thematically using ATLAS.ti
software. Before data collection, ethical clearance was assured at every steps of the data
collection process.
Results: Husbands’ involvement during antenatal care (ANC), skilled delivery care, and
postnatal care (PNC), in this study, were 19.9%, 42.7%, and 11.8%, respectively. In the
multivariate analysis, offering an invitation letter [adjusted odds ratio (aOR) 6.1, 95% CI: 4.0,
9.1], having <3 under five (U5) year children (aOR=3.3, 95% CI: 2.1, 5.1), and early initiation of
ANC visit (aOR 3.0, 95% CI: 1.3, 7.0) were significantly associated with husbands’ involvement
during ANC visits. In addition to early initiation of ANC visits and having <3 U5 year children,
place of residence (aOR 4.8, 95% CI: 2.4, 9.4) and husbands’ involvement in the preceded ANCvisit (aOR 2.1, 95% CI: 1.3, 3.4) were found to be a significant predictors of husbands
involvement during delivery care. Similarly, having <3 U5 year children (aOR 3.8, 95% CI: 1.5,
9.5), offering invitation letter to husbands (aOR 3.3, 95% CI: 1.3, 8.0), husbands’ involvement in
the preceded ANC visit and couples’ communication were also found to be a significant
predictors of husbands’ involvement during PNC services. Respondents in the qualitative study
further reported the existed social norms, men’s lack of awareness about when and how to
involve, health staffs’ and women’s attitudes towards men’s involvement, and absence of
guidelines were the main reasons for un-involvement of husbands in their wives’ maternal health
care. In the multivariate analysis of the cohort study, women whose husbands involved at least
for one ANC visit were 6.27 times and 7.45 times more likely to receive skilled birth attendants
and PNC services, respectively, compared to women attended ANC alone, [aOR: 6.27; 95% CI:
4.2, 9.3; and aOR 7.45; 95% CI: 4.18, 13.3].
Conclusions and recommendations: The proportion of husbands’ involvement in maternal
health care in the study areas was lower than the proportion reported from other African
countries. Offering an invitation letter to husbands, number of U5 year children alive during the
recent pregnancy, husbands’ involvement in the preceding ANC, couple’s communications,
initiation of ANC visit and place of residence were found to be significant predictors of
husbands’ involvement in maternity care. The observed associations between husbands’
involvement during ANC visit and women’s utilization of skilled birth attendants during birth
and PNC services were strong and significant. This implies that woman’s utilization of skilled
birth attendants’ and PNC services can be improved by involving their husbands in at least one
ANC visit. Therefore, to bring a behavioral change and communication at community and
facility levels, a contextual based awareness creation programs that focused on husbands’
involvement during maternal health care need to be launched; secondly, a national guideline on
husbands’ involvement in maternity care, at each level of health facilities, need to be prepared
and executed.
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Keywords
Maternal health care ,Husbands’ involvement ,women’s utilization