Contextualising men’s role and participation in PMTCT programmes in Malawi and Zambia: A hegemonic masculinity perspective

Mweemba, Oliver; Zimba, Chifundo; Benjamin, H.; Chibwe, Kasapo F; Dunda, Wezi; Freeborn, Kellie; Maman, Suzanne; Matenga, Tulani Francis L.; Phanga, Twambilile; Rosenberg, Nora E.

doi:10.1080/17441692.2021.1964559

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…As such, participants in our study proposed that the health system needs to go beyond the traditional ‘go and bring your husband’ agenda by extending a direct appeal to men through health and gender sensitive messaging. While this recommendation is consistent with recent study implications in Malawi and Zambia(53), it is in stark contrast to a study in Tanzania in where participants proposed that women should bear the emotional and intellectual burden of involving their partners in maternal and child health(54).…”

Section: Discussionsupporting

confidence: 80%

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“Go and bring your husband”: a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon

Foglabenchi,

Marchant,

Stöckl

2024

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Background Increasing access to and utilization of skilled care during pregnancy and child birth can significantly reduce maternal and infant morbidity and mortality. Male involvement can positively influence utilization but resource limited settings like Cameroon encounter obstacles in engaging men in maternal and child health services. The aim of our study was to identify contextually relevant barriers to male involvement in antenatal care attendance to inform the development of an intervention that is aimed at promoting male involvement in maternal and child health in Cameroon. Methods This study used a qualitative design with qualitative methods that draw on 68 semi-structured interviews and three focus group discussions with pregnant women, male partners and health workers. Both interviews and group discussions were audio-recorded, transcribed. Guided by the Capability, Opportunity and Motivation (COM-B) model of behaviour and Theoretical Domains Framework (TDF), we analyzed data using directed content analysis, followed by inductive thematic analysis. Results Our findings suggest that male involvement in antenatal attendance in Bamenda Health District is under the influence of six multidimensional factors: limited awareness on the need for male involvement, limited female agency to engage men on ANC, maternal extortion, restrictive gender and socio-cultural norms regarding male ANC attendance, limited engagement of men by ANC staff and intrapersonal fears that fuel the avoidance of antenatal clinics. These overlapped across all three COM-B constructs, and 9 TDF . Overall, we noted that the motivation of male partners to participate in antenatal attendance is strongly influenced by social opportunity factors categorised as restrictive gender, social and cultural norms on male ANC attendance and psychosocial capability underpinned by limited health system engagement and awareness of male role in antenatal care. Conclusions This study identified multi-dimensional barriers related to male partner capability, opportunity and motivation to participate in antenatal care services. There is a need for interventions that employ gender-transformative approaches to adapt the socio-cultural environment and the messaging on antenatal care for optimal male involvement and subsequently, better health outcomes for mothers and children in Cameroon.

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Section: Discussionsupporting

confidence: 80%

“…The corresponding author (LHF)— conducted the majority of SSIs (53) and co-facilitated all FGDs. LHF was assisted by a female Bachelor’s degree nurse midwife and a female master’s level sociologist who served as co-interviewers, observers and note-takers during group discussions.…”

Section: Methodsmentioning

confidence: 99%

“Go and bring your husband”: a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon

Foglabenchi,

Marchant,

Stöckl

2024

Preprint

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“…The level of male partner support may influence women's decision to take PrEP during pregnancy and breastfeeding. Evidence suggests that men are generally viewed as head of house and ultimate decision makers who are actively involved in health-related decision-making during pregnancy and breastfeeding ( 47 , 48 ). Our study found that women had divergent views about who would approve of their decision to take PrEP during pregnancy and breastfeeding.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings have been reported in similar settings. In a study that contextualized male roles and participation in PMTCT programs in Malawi and Zambia, for instance, both men and women reported that they had to consult and seek approval from their partners on decisions that related to their health ( 47 ). Other studies also reported that men were the primary advisors and key decision-makers on health-related decisions during pregnancy and breastfeeding ( 41 , 49 , 50 ).…”

Section: Discussionmentioning

confidence: 99%

“PrEP protects us”: Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Hamoonga

Mutale

Hill

et al. 2023

Front. Reprod. Health

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BackgroundAlthough pre-exposure prophylaxis (PrEP) is recommended for pregnant and breastfeeding women at elevated HIV risk, uptake has been low in Zambia.MethodsIn in-depth interviews, we explored beliefs about PrEP among 24 HIV-negative pregnant and breastfeeding Zambian women. Thematic analysis was used to identify behavioural, normative and control beliefs likely to influence PrEP uptake.ResultsMost women viewed PrEP as a good method of protecting themselves and their babies from HIV infection. Partners were cited as key referents in decision making about PrEP use. Many women felt that PrEP use was not entirely in their control. Most reported that they would not use PrEP if their partners did not approve. Health care providers with negative attitudes, long distance to clinics, and extended waiting times were cited as barriers to PrEP uptake.ConclusionHIV-negative pregnant and breastfeeding women had a positive attitude towards PrEP but barriers to uptake are multifaceted.

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“…We chose to focus on Malawi and Zambia due to their high HIV burdens and our ongoing HIV prevention work http://onlinelibrary.wiley.com/doi/10.1002/jia2.26128/full | https://doi.org/10.1002/jia2.26128 among ANC patients and their partners in these countries [10][11][12][13][14]. While specific quantitative results are most applicable to the populations of these countries, we expect that our findings are broadly generalizable to other eastern and southern African settings with similar patterns of sexual behaviour, HIV status awareness, viral suppression and ANC utilization.…”

Section: Discussionmentioning

confidence: 99%

Combination HIV prevention during pregnancy and the post‐partum period in Malawi and Zambia: a mathematical modelling analysis

et al. 2023

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Introduction: Despite widespread success in reducing vertical HIV transmission, most antenatal care (ANC) programmes in eastern and southern Africa have not emphasized primary prevention of maternal HIV acquisition during pregnancy and lactation/breastfeeding. We hypothesized that combination HIV prevention interventions initiated alongside ANC could substantially reduce maternal HIV incidence. Methods: We constructed a multi-state model describing male-to-female HIV transmission in steady heterosexual partnerships during pregnancy and lactation/breastfeeding, with initial conditions based on population distribution estimates for Malawi and Zambia in 2020. We modelled individual and joint increases in three HIV prevention strategies at or soon after ANC initiation: (1) HIV testing of male partners, resulting in HIV diagnosis and less condomless sex among those with previously undiagnosed HIV; (2) initiation (or re-initiation) of suppressive antiretroviral therapy (ART) for male partners with diagnosed but unsuppressed HIV; and (3) adherent pre-exposure prophylaxis (PrEP) for HIV-negative female ANC patients with HIV-diagnosed or unknown-status male partners. We estimated the percentage of within-couple, male-to-female HIV transmissions that could be averted during pregnancy and lactation/breastfeeding with these strategies, relative to base-case conditions in which 45% of undiagnosed male partners become newly HIV diagnosed via testing, 75% of male partners with diagnosed but unsuppressed HIV initiate/re-initiate ART and 0% of female ANC patients start PrEP. Results: Increasing uptake of any single strategy by 20 percentage points above base-case levels averted 10%−11% of maternal HIV acquisitions during pregnancy and lactation/breastfeeding in the model. Joint uptake increases of 20 percentage points in two interventions averted an estimated 19%−23% of transmissions, and with a 20-percentage-point increase in uptake of all three interventions, 29% were averted. Strategies achieving 95% male testing, 90% male ART initiation/reinitiation and 40% female PrEP use reduced incident infections by 45%. Conclusions: Combination HIV prevention strategies provided alongside ANC and sustained through the post-partum period could substantially reduce maternal HIV incidence during pregnancy and lactation/breastfeeding in eastern and southern Africa.

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Contextualising men’s role and participation in PMTCT programmes in Malawi and Zambia: A hegemonic masculinity perspective

Cited by 7 publications

References 34 publications

“Go and bring your husband”: a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon

“Go and bring your husband”: a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon

“PrEP protects us”: Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Combination HIV prevention during pregnancy and the post‐partum period in Malawi and Zambia: a mathematical modelling analysis

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