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Table of Contents
ORIGINAL ARTICLES
Year : 2022  |  Volume : 18  |  Issue : 2  |  Page : 45-49

Involvement of husbands in birth preparedness of their partner: A cross-sectional survey from a rural area of Ernakulam, Kerala


Department of Community Medicine, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission21-Jan-2022
Date of Acceptance16-Mar-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Sreelakshmi Mohandas
Department of Community Medicine, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMJM.AMJM_9_22

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  Abstract 

Background: In India, a country driven by a patriarchal society, the involvement of men in their wife’s pregnancy and childbirth has been considerably low. This remained static until the International Conference on Population and Development held in Cairo in 1994 which prompted the equal responsibility of men and women in reproductive health. Objective: The aim of this article is to assess the involvement of husbands in birth preparedness and to determine factors associated with their involvement in the birth preparedness of their partner. Materials and Methods: A community-based cross-sectional study was done in the rural field practice area of Amrita Community Health Training Center at Njarackal, Ernakulam. The minimum calculated sample size was 103; three wards from the panchayath were selected and women who were currently pregnant or had a child less than 2 years of age were interviewed using a semi-structured pre-tested questionnaire. Data were tabulated using Microsoft Excel and analyzed using SPSS version 20. Results: Of the 102 respondents, good involvement of husbands in birth preparedness was found to be 50%. A significant association was seen between husbands’ involvement and age of respondent (>27 years) as well as with the presence of an older child in the couple. Conclusion: As 50% of husbands had only poor involvement, sessions need to be planned under MCH for sensitizing husbands to their role in ensuring a healthy pregnancy, especially in primigravida, as it is seen that there is an association between higher-order births and involvement.

Keywords: Childbirth, husband, involvement, pregnancy


How to cite this article:
Mohandas S, Francis PT, Paul N. Involvement of husbands in birth preparedness of their partner: A cross-sectional survey from a rural area of Ernakulam, Kerala. Amrita J Med 2022;18:45-9

How to cite this URL:
Mohandas S, Francis PT, Paul N. Involvement of husbands in birth preparedness of their partner: A cross-sectional survey from a rural area of Ernakulam, Kerala. Amrita J Med [serial online] 2022 [cited 2022 Aug 11];18:45-9. Available from: https://ajmonline.org.in/text.asp?2022/18/2/45/349265




  Introduction Top


India, the second-most populous country on the globe, is a land of varied customs and beliefs ranging from the northern tip to the southern tip of the country. However, the one solid belief held with conviction is the patriarchal nature of the society in India. This has largely influenced the role of a husband in his wife’s pregnancy and childbirth. A revolutionary change to this view was brought in by the International Conference on Population and Development held in Cairo in 1994. The conference addressed the need for equal responsibility in reproductive health-related decision-making between partners in a relationship.[1] Since then, the United Nations Population Fund (UNFPA) has also dynamically endorsed the participation of men in the achievement of improved maternal health.[2]

Men play a crucial role through the allocation of household resources for seeking medical care and for transportation during pregnancy and childbirth.[3],[4] Several research works have indicated that ensuring the involvement of men in reproductive and maternal health matters can have a positive impact through added social support.[5],[6] The primary cause for maternal deaths is the result of the three delays associated with pregnancy and childbirth: delay in seeking care, delay in reaching the healthcare facility, and a delay in the appropriate care provided at the institutional level.[7],[8] Men play a crucial and significant role in addressing the first two delays associated with maternal death.

In India, a lot of thrust was initially given to family planning services alone until 1977, when the policymakers realized the potential role of men in the promotion of maternal and child health and also in availing reproductive healthcare services.[6] However, there is a paucity of literature regarding husbands’ involvement in pregnancy and childbirth in India even in states with high Human Development Index such as Kerala. The few that are done mainly look at their knowledge and attitude and there are very few looking at it from a woman’s perspective. Hence, the objective of this study was to assess the involvement of husbands in birth preparedness and to determine factors associated with their involvement in the birth preparedness of their partner.


  Materials and Methods Top


A community-based cross-sectional survey was carried out in Njarackal Panchayath of Ernakulam District, Kerala between April and June 2017. The research population comprised women who were currently pregnant or had a child less than 2 years of age. The minimum calculated sample size was 103, based on the percentage of men accompanying women for their antenatal care visit (81%) in a similar study done by Singh and Ram[6] in rural Ahmadnagar. The sample size was calculated with a 10% allowable error and after accounting for a probable 10% non-response rate. By simple random sampling, 3 wards (7, 13, and 14) were selected from a total of 15 wards in the panchayath. One ward was visited in a day, and starting from the central point, the houses were visited consecutively till the end of the session. A total of 105 subjects were interviewed over a period of 3 days. The questionnaire had three parts: questions relating to sociodemographic profile, questions relating to pregnancy, and questions relating to childbirth. The questionnaire was pre-tested in the OBGYN Department at Amrita School of Medicine. A total of 18 questions were scored as zero and one based on a positive reply to assess the involvement of husbands in birth preparedness. A mean score of 14 was taken to classify the outcome variable into good and poor involvement of husbands.

A verbal informed consent was taken prior to the face-to-face interview. Data were entered in MS Excel and analyzed using SPSS v. 20. Prevalence is expressed in percentage with 95% confidence interval. The χ2 analysis with odds ratio was done to look for association between dependent and independent variables.


  Results Top


A total of 105 participants were interviewed for the research. Due to the incompleteness of data, the information relating to three participants was excluded. The age of the participants ranged from 19 to 40 years. A majority of the respondents belonged to an age <27 years (63.7%). Most of the participants had either a graduate (32.44%) or postgraduate degree (33.3%). However, a majority of the respondents were homemakers (63%) and they belonged to three generation families (50%). A greater proportion of the respondents belonged to the Hindu religion (59%).

The sociodemographic characteristics of the partner (husband) and the characteristics of the respondents based on factors related to pregnancy have been described in [Table 1] and [Table 2], respectively.
Table 1: Distribution of partners based on the sociodemographic profile

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Table 2: Distribution of respondents based on characteristics relating to pregnancy (n = 102)

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Of the 86 women, who had a child less than 2 years of age, 60% of them underwent a cesarean section and 80% of the deliveries took place in a private hospital. The place of delivery was most often decided by the couple together (38%) or by other family members (25%). Except for three respondents (2.9%), all women were satisfied with the support provided to them by their husbands during the course of their pregnancy and childbirth.

The mean score attained was 14 ± 2.8, and good involvement of husbands was found to be only 50%. On the univariate analysis, although not significant, poor involvement of husbands was observed for women with the education of higher secondary and above, age less than 33 years, employment in a skilled occupation and above, and belonging to nuclear families. The factors significantly associated with involvement of husbands have been described in [Table 3].
Table 3: Univariate analysis*

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  Discussion Top


The involvement of husbands in birth preparedness of currently pregnant women or women with a child less than 2 years of age was found to be good among 50% of the study participants from a rural area of Ernakulam District, Kerala, India.

Majority of the male partners were less than 32 years of age (58.8%), which is similar to the age structure of male partners from rural Ahmadnagar and in contrast to the study done in England, probably due to the differences in age at marriage.[6],[9] Majority of the husbands (97%) were happy in response to their partner’s pregnancy. This is similar to the findings from England, where 80% of the partners were “overjoyed.”[9]

A majority, 90%, of the husbands accompanied their wife, once or more, during their antenatal care visits. This finding is comparable to the finding of 81% in rural Ahmadnagar and higher than the findings reported from New Delhi (20%), Nigeria (59%), Ethiopia (54%), and Myanmar (64.8%).[6],[8],[10],[11],[12]

In rural India, only 75% of the births are institutional deliveries compared with 100% in Kerala and in our study.[13] Only 38% of the couples took decision on the place of delivery together, and this finding is similar to the findings of 28% reported from rural Mumbai and lower than the findings from New Delhi (69.5%). This may be due to the better educational qualification of the women in this study.[6],[8] While in a study done in Uttar Pradesh, the primary decision-maker in place of delivery was the mother-in-law.[14]

Around 72% of the husbands were aware of vaccinations to be taken during pregnancy, and our findings are lower than those of the study reported from New Delhi (84.5%).[8] Nearly 50% of the husbands helped in household chores during partner’s pregnancy in the Ahmadnagar study, and this finding is lower than the findings from our study (78.2%).[6] However, in Nigeria, 82.5% of the husbands helped with household chores. In a research done by Sokoya et al.,[15] 97% of the husbands provided financial support during pregnancy and this is comparable to the findings of our study. In the study from Nigeria, 19% reported emotional disturbances during pregnancy when compared with 44% in our study.

The factors significantly associated with good involvement of husbands were the respondent age >27 years and being a multiparous woman. Similar findings were reported from the study done in England and rural Ahmadnagar.[6],[9]


  Conclusion Top


The study shows that only 50% of husbands had been involved adequately in the birth preparedness of their partner. With increasing evidence on improved maternal health outcomes with good involvement of husbands, there is a need to involve husbands more in the birth preparedness of their partner. The maternal and child health programs in the region need to organize sessions for sensitizing husbands to their role in ensuring a healthy pregnancy. The awareness has to start early so that they involve from the first pregnancy rather than with higher-order births as shown in the study.

Acknowledgments

We acknowledge the efforts put in by the 2014 MBBS undergraduate students of R2 A1 Batch who were a part of the preliminary research work. The students include R. P. Rahul, Gadipalli Sahithya, G. Anitha, G. Sibi, Roshni Stanley, Deepthy Gopalakrishnan, Anirban Chakrabarthy, Sathvik Vinoo, Anushka Anil, Vishnu Sasindran, Meenakshy J. Nair, Jishnu Raj, P. Karthika, Anju S. Ganesh, and Vaishnavi Sujathan. We also acknowledge the effort put in by our field staff of Amrita Community Health Training Centre and Department of Community Medicine, AIMS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical approval

Not required.



 
  References Top

1.
International Conference on Population and Development. Available from: https://www.unfpa.org/icpd [Last accessed on 24 Aug 2020].  Back to cited text no. 1
    
2.
Male involvement in maternal health critical to saving women’s lives, say UN Leaders. Available from: /press/male-involvement-maternal-health-critical-saving-womenslives-say-un-leaders. [Last accessed on 24 Aug 2020].  Back to cited text no. 2
    
3.
Lewis S, Lee A, Simkhada P The role of husbands in maternal health and safe childbirth in rural Nepal: A qualitative study. BMC Pregn Childb 2015;15:162.  Back to cited text no. 3
    
4.
Kashaija DK, Mselle LT, Mkoka DA Husbands’ experience and perception of supporting their wives during childbirth in Tanzania. BMC Pregn Childb 2020;20:85.  Back to cited text no. 4
    
5.
Carter M Husbands and maternal health matters in rural Guatemala: Wives’ reports on their spouses’ involvement in pregnancy and birth. Soc Sci Med 2002;55:437-50.  Back to cited text no. 5
    
6.
Singh A, Ram F Men’s involvement during pregnancy and childbirth: Evidence from rural Ahmadnagar, India. Popul Rev 2009;48:83-102.  Back to cited text no. 6
    
7.
Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Med Int Health 2010;15:964-72.  Back to cited text no. 7
    
8.
Knowledge, attitude and practice regarding antenatal care among husbands attending antenatal clinic in a tertiary care hospital [Internet]. ResearchGate. Available from: https://www.researchgate.net/publication/304610811_Knowledge_attitude_and_practice_regarding_antenatal_care_among_husbands_attending_antenatal_clinic_in_a_tertiary_care_hospital. [Last accessed on 24 Aug 2020].  Back to cited text no. 8
    
9.
Redshaw M, Henderson J Fathers’ engagement in pregnancy and childbirth: Evidence from a national survey. BMC Pregn Childb 2013;13:70.  Back to cited text no. 9
    
10.
Adeniran AS, Aboyeji AP, Fawole AA, Balogun OR, Adesina KT, Adeniran PI Male partner’s role during pregnancy, labour and delivery: Expectations of pregnant women in Nigeria. Int J Health Sci (Qassim) 2015;9:305-13.  Back to cited text no. 10
    
11.
Teklesilasie W, Deressa W Husbands’ involvement in antenatal care and its association with women’s utilization of skilled birth attendants in Sidama zone, Ethiopia: A prospective cohort study. BMC Pregn Childb 2018;18:315.  Back to cited text no. 11
    
12.
Wai KM, Shibanuma A, Oo NN, Fillman TJ, Saw YM, Jimba M Are husbands involving in their spouses’ utilization of maternal care services?: A cross-sectional study in Yangon, Myanmar. PLoS One 2015;10:e0144135.  Back to cited text no. 12
    
13.
Ministry of Health and Family Welfare, GOI. National Family Health Survey-4 2015-16-Kerala State Factsheet [Internet] [cited January 4, 2019]. Available from: http://rchiips.org/nfhs/pdf/NFHS4/KL_FactSheet.pdf. [Last accessed on 9 Mar 2020].  Back to cited text no. 13
    
14.
Sudhinaraset M, Beyeler N, Barge S, Diamond-Smith N Decision-making for delivery location and quality of care among slum-dwellers: A qualitative study in Uttar Pradesh, India. BMC Pregn Childb 2016;16:148.  Back to cited text no. 14
    
15.
Sokoya MR, Farotimi AR, Ojewole FR Women’s perception of husbands’ support during pregnancy, labour and delivery. IOSR J Nurs Health Sci 2014;3:45-50.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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