Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis

Abstract

BackgroundMale involvement in various health practices is recognized as an important factor in improving maternal and child health outcomes. Male involvement interventions involve men in a variety of ways, at varying levels of inclusion and use a range of outcome measures. There is little agreement on how male involvement should be measured and some authors contend that male involvement may actually be detrimental to women’s empowerment and autonomy. Few studies explore the realities, perceptions, determinants and efficacy of male involvement in newborn care, especially in African contexts.MethodsBirth narratives of recent mothers (n = 25), in-depth interviews with recent fathers (n = 12) and two focus group discussions with fathers (n = 22) were conducted during the formative research phase of a community-based newborn care trial. Secondary analysis of this qualitative data identified emergent themes and established overall associations related to male involvement, newborn care and household roles in a rural African setting.ResultsData revealed that gender dictates many of the perceptions and politics surrounding newborn care in this context. The influence of mother-in-laws and generational power dynamics were also identified as significant. Women alone perform almost all tasks related to newborn care whereas men take on the traditional responsibilities of economic providers and decision makers, especially concerning their wives’ and children’s health. Most men were interested in being more involved in newborn care but identified barriers to increased involvement, many of which related to gendered and generational divisions of labour and space.ConclusionsMen defined involvement in a variety of ways, even if they were not physically involved in carrying out newborn care tasks. Some participant comments revealed potential risks of increasing male involvement suggesting that male involvement alone should not be an outcome in future interventions. Rather, the effect of male involvement on women’s autonomy, the dynamics of senior women’s influence and power and the real impact on health outcomes should be considered in intervention design and implementation. Any male involvement intervention should integrate a detailed understanding of context and strategies to include men in maternal and child health should be mutually empowering for both women and men.

Roles and responsibilities in newborn care in four African sites

“…They otherwise play a limited role in direct care. Our findings confirm those from a study in Ghana that found that physical and social spaces related to newborn care were closed to men, that men were perceived to lack the ability to care for the newborn and had little physical contact with the baby, but as head of the family, they were often the symbolic decisionmaker and the financial provider [12]. As the head of the household, fathers in our study sites were viewed as having the ultimate decision-making power, although this was rarely exercised in relation to newborn care practices.…”

“…These family members often being present during the first days and weeks of the child's life to provide help and support to the mother [6,7,10,[12][13][14][15][16][17][18][19]. Several studies have noted the role of fathers in providing finances for birth preparedness and delivery, and their role in decision-making [7,11,12,20,21]; however, their role in the actual care of the newborn may be minimal and in some settings their role in decision-making is symbolic [7,12]. Only a few studies reported on the role of birth attendants, who are responsible for immediate newborn care in some settings, including giving the baby its first bath [15,22].…”

Parents’ experiences of caring for preterm infants after discharge with grandmothers as their main support

“…Family and friends use their previous experiences in child rearing to support new parents (Bazzano et al, 2008;Jansen, 2006). Older women and mothers-in-law in the community provide most of the support to younger and new parents (Dumbaugh et al, 2014). Their advice is perceived as very useful and cannot be disobeyed.…”

Newborns in crisis: An outline of neonatal ethical dilemmas in humanitarian medicine

“…75 Disabled children commonly experience significant individual and social neglect in Indian society, while female babies may also be stigmatised. 80 In other arenas, doctors may be expected to adopt complete responsibility for decision-making. 77 Cultural differences may also influence how ethically fraught decisions are approached.…”

“…79 Aid workers may also be required to navigate exclusionary gender roles when communicating with parents. 80 In other arenas, doctors may be expected to adopt complete responsibility for decision-making. Such approaches are common in some countries, in which it is typically considered unfair to impose responsibility on the parents of the child.…”