Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

Abstract

Background Greater paternal engagement is positively associated with improved access to and utilization of maternal services. Despite evidence that male involvement increased uptake of maternal and child services, studies show that few men are participating in MNCH programs. Community leaders have long been engaged in public health promotion in rural settings and have been shown to mobilize communities to enhance changes in cultural practices related to public health. With the ultimate goal of increasing men’s involvement in maternal health, this study seeks to understand men’s perceptions of community and health systems barriers to maternal access and usage of skilled care in rural Edo, Nigeria. Methods This qualitative study involved the analysis of data collected from community conversations with male elders in Etsako East and Esan South East Local Government Areas of Edo State, Nigeria. Community conversations participants ( n = 128) comprised of elders between the ages of 50–101. A total of 9 community conversations were conducted. Discussions were audio recorded, transcribed and imported into Atlas.ti 6.2 for content analysis. Results Men’s perceptions of barriers to maternal use of skilled care are presented in two overarching themes: community systems and health systems. Three sub themes were generated as community systems barriers to maternal healthcare use, they include: gender roles, traditional treatment and policy changes. Three sub themes emerged under health system barriers and they include: cost of health facilities, dissatisfaction with facilities and distance from facilities. Conclusion Findings suggest that community elders are not only in a good position to influence men’s behavior, they are also a source of information to policy makers on strategies to overcome barriers to maternal health, especially at the community level. Furthermore, community elders need support to enact regulations that will promote men’s involvement in maternal health, thereby increasing maternal use of skilled care.

Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective

“…Our results support studies from Nigeria [ 18 , 34 , 60 , 61 ] and other African countries [ 7 , 21 , 62 , 63 ]. However, it is evident from our findings and others that these roles are often entrenched in patriarchal mores reinforced by tradition and religion [ 21 , 30 , 31 , 35 ].…”

“…Beyond impacting on patterns of marriage, factors such as education and age impact on male partners’ health decision-making. Furthermore, patriarchal norms often entrenched in, or reinforced by tradition and religion, tend to assign men sole/overriding financier, provider and decision-making roles, and this affects access to, and utilization of maternal-child health services by women [ 1 – 3 , 5 , 18 , 33 , 34 ]. These demographic, traditional, religious and interpersonal relationship factors synergistically interact to influence male partners’ decisions regarding maternal-child health [ 3 , 5 , 7 , 34 – 36 ].…”

Knowledge and Attitude of Men towards Factors influencing Childhood Mortality in a Semi-Urban Community in Northwestern Nigeria

“…The questionnaire was drafted after a review of the literature on knowledge and attitude of men toward risk factors influencing maternal and child mortality. 6,7,9,10,20,23 (87.2%) had a positive attitude and this was statistically significant, p=0.001 (Table 5).…”

“…These include gender stereotyping, lack of a definitive role for men in maternal and child health, time constraints, health facility environment and women's reservations about men's involvement. 8,9 Studies have shown that men (especially in resource poor settings) have poor knowledge on child health as well as the basic preventive measures of common causes of childhood mortality. 10,11,12 A study among men in Ekiti State showed that almost half of the respondents had a negative attitude towards childhood immunisation which is one of the major preventive measure against the common childhood killer diseases.…”

“He lets me go although he does not go with me.”: Rwandan women’s perceptions of men’s roles in maternal health

“…Beyond this requirement, the initiative offers no guidelines to advise on potential roles for men in promoting maternal health or caring for pregnant partners. It has been suggested elsewhere that the patriarchal nature of Rwandan society leads to expectations that men make key household decisions on their own, and in some instances men’s decision-making extends into the realm of maternal care, such as by choosing where and when care will be accessed [ 29 ]. Existing research on maternal care in Rwanda has not fully explored men’s involvement in this form of care from women’s perspectives, nor considered the expectations that women have regarding the involvement of their partners during this period.…”