Male involvement in reproductive and maternal healthcare: Why are men still missing?

There is increasing recognition that preventing maternal deaths not only requires improvements in the coverage and quality of comprehensive and basic emergency obstetric care. Recent research has shown that the mobilisation and engagement of men in reproductive and maternal healthcare is also key. Men’s engagement can increase the use of emergency obstetric care services, eliminate delays in accessing care, and promote timely referral when problems arise.

The realization of the importance and need for a gender-inclusive approach to reproductive care stems from the International Conference on Population Development (ICPD) in Cairo in 1994. This conference laid the ground for a transformative agenda by calling for men’s “shared responsibility”, promoting partnership in reproductive health matters, and encouraging men’s ownership of sexual and reproductive health matters. In most low-resource settings, and particularly in patriarchal societies, where the burden of maternal mortality is high, men are often major decision-makers for their families. Therefore, decisions around when, where, and even if, a woman should have access to healthcare are often made by men. As a result, there is growing recognition of the importance of men's involvement in facilitating women’s access to maternal healthcare. Additionally, the Centre for Maternal and Newborn Health’s research on maternal morbidity illustrated the need for more social and psychological support for women and their babies postnatally. Therefore, encouraging male engagement with maternal healthcare services needs to be a priority.   

However, progress toward engaging men in maternal and reproductive healthcare has stagnated in low-resource settings. There are many barriers, and the definition of male involvement varies in different healthcare facilities. The term explicitly goes beyond merely the physical presence of a husband or male partner. It also includes other psychosocial behaviours that positively impact maternal and reproductive health outcomes, such as shared responsibility in reproductive health, and improved communication and decision making. Some healthcare facilities and non-governmental organisations make it mandatory for a woman to bring her husband if she wants access to maternal services. This is to demonstrate desirable outputs for targets such as couples testing for HIV, condom use, family planning and prevention of mother-to-child transmission of HIV. However, the result is that some women are denied the right to access care because they have failed to convince their partners to attend maternal services. The question is “Should someone’s right to healthcare be premised on the availability of another (over whom they wield no power)?

In addition, several maternal and child health programmes are constrained by or fail to address the negative social notion associated with men’s involvement. Others lack innovative and replicable models to target community norms and individual beliefs. It is also evident that eliciting behaviour change takes time, and improvement of men’s knowledge of maternal health might not necessarily result in their actual involvement. Even with the existence of a conducive political environment and policies in favour of male-involvement, research has shown that men found most of the healthcare facilities hostile and felt excluded from decisions on type of care provided. Issues include a lack of sufficient knowledge about the social, economic, and health benefits of becoming involved in sexual and reproductive health and rights (SRHR); health services factors such as unfavourable opening hours of services and poor attitudes of healthcare providers. Some women have incurred additional costs by “hiring” husbands for maternal services in order to access care.

The healthcare system in most low-resource settings is still characterized by a discord between the policy and practice on male involvement in pregnancy and childbirth. Achieving the Sustainable Development Goal 3 targets for ending preventable mortality and provision of universal health coverage requires a renewed focus that will require large-scale approaches to improving quality of care. Health system factors that are critical to preventing access to quality maternal health care such as male involvement in women’s health issues during pregnancy and childbirth need to be addressed.

The Centre for Maternal and Newborn Health’s approach to implementation research and training of healthcare providers is to ensure there is sharing of expertise and discussion with partners and colleagues in low- and middle-income countries of how we can all provide better care. We have developed a new competency-based workshop package to increase the capacity of healthcare providers working in low- and middle-income countries, to address the identified health needs of mothers and babies during and after pregnancy with integration of care. This package has taken on board health system factors that are critical to promoting access to quality care, including male involvement in women’s health issues during pregnancy and childbirth, through respectful and patient-centred care training for healthcare providers. Together, with healthcare providers, we can ensure that male involvement increases, enabling more women to access life-saving care. Many of the healthcare providers we work with are fathers themselves. This Father’s Day, we congratulate them, thank them for their commitment to improve care for women worldwide, and encourage all men to get involved and share the responsibility to improve maternal health.  

About the author
Florence Mgawadere
is Senior Research Associate at CMNH. She is a nurse and midwifery expert in maternal health with over 15 years international clinical and research experience low- and middle-income settings. She has a Master in Public Health from the University of Malawi and PhD from the University of Liverpool. She joined the Centre for Maternal and Newborn Health after several years of clinical, teaching, research and programme experience in the University of Malawi and MoH-Malawi. She is passionate regarding improving the quality of care for women and their newborn babies in developing countries through evidence based practice.