Marina AS Daniele,a Rasmané Ganaba,b Sophie Sarrassat,a Simon Cousens,a Clémentine Rossier,c Seydou Drabo,d Djeneba Ouedraogob & Veronique Filippia
Objective
To determine whether an intervention to involve the male partners of pregnant women in maternity care influenced care-seeking, healthy breastfeeding and contraceptive practices after childbirth in urban Burkina Faso.
Methods
In a non-blinded, multicentre, parallel-group, superiority trial, 1144 women were assigned by simple randomization to two study arms: 583 entered the intervention arm and 561 entered the control arm. All women were cohabiting with a male partner and had a low-risk pregnancy. Recruitment took place at 20 to 36 weeks’ gestation at fve primary health centres in Bobo-Dioulasso. The intervention comprised three educational sessions: (i) an interactive group session during pregnancy with male partners only, to discuss their role; (ii) a counselling session during pregnancy for individual couples; and (iii) a postnatal couple counselling session. The control group received routine care only. We followed up participants at 3 and 8 months postpartum.
Findings
The follow-up rate was over 96% at both times. In the intervention arm, 74% (432/583) of couples or men attended at least two study sessions. Attendance at two or more outpatient postnatal care consultations was more frequent in the intervention than the control group (risk difference, RD: 11.7%; 95% confdence interval, CI: 6.0 to 17.5), as was exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2) and effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.5 to 12.3).
Conclusion Involving men as supportive partners in maternity care was associated with better adherence to recommended healthy practices after childbirth.
Introduction
Ending preventable maternal and perinatal mortality necessarily involves engaging with families and communities.
1Male partners, in particular, exert a considerable influence on women’s use of reproductive health services and participate in decisions that affect health outcomes.
2 Surveys from subSaharan Africa show that most women with a male partner would be willing for him to participate in maternity care, except where there is a concern about domestic violence, alcohol abuse or disclosing human immunodefciency virus (HIV) infection status.
3,4 However, few men join their pregnant partners during antenatal or postnatal appointments at healthcare facilities, ofen because of the perception that this is not their role.
5,6 Moreover, the clinic’s infrastructure may not be suitable for couples, there may be concerns about congestion or privacy and opening hours may be inconvenient.
7,8 Staff attitudes can also be a problem.9 Where policies to invite male partners to antenatal care appointments have been introduced, the focus has tended to be on HIV testing, afer which men may be told to leave.
10 In the last few decades, strategies promoting male involvement in reproductive health services have received increasing attention, such as endorsement by the World Health Organization.
11 Although systematic reviews conclude that these strategies can improve care-seeking throughout the childbearing period, most evidence comes from observational studies or evaluations of complex interventions that were not specifcally designed to investigate male involvement.
12–16 Consequently, the impact of these strategies is not clear. Few high-quality experimental studies have been conducted in sub-Saharan Africa and even fewer have assessed facility-based interventions,17,18 apart from those focusing on the prevention of mother-to-child HIV transmission.19
Burkina Faso has high maternal and infant mortality.20 Although the majority of women give birth in health-care facilities (the latest estimate was 66% in 2010), most do not have regular check-ups postpartum.20,21 Even in urban areas, fewer than half attend the recommended two outpatient postnatal consultations.22,23 Moreover, fewer than half of infants are exclusively breastfed 3 months postpartum.20 One quarter of women of reproductive age have an unmet need for family planning and few initiate contraception promptly following childbirth.23,24 Tese health vulnerabilities reflect women’s social and economic disadvantages in a country that is characterized by patriarchal family structures, polygyny and women marrying older men.20 Although childbearing and the care of young children are considered female domains, men are usually the ultimate decision-makers on care-seeking.25,26 However, male partners are rarely seen in health-care facilities and have scarcely any contact with health workers, which limits their exposure to health information.22,23 Older women, especially the male partner’s mother, are regarded as experts on infant care and feeding.27 Traditionally, in addition to breast milk, neonates in Burkina Faso receive water and herbal infusions.27 Opposition to contraception by the male partner is ofen cited as an obstacle and is associated with lower contraception use by women.28,29 Two community-based projects involving men have been initiated in the country but rigorous evaluations have not been published.30,31
Te aim of our study was to determine whether an intervention designed to involve the male partners of pregnant women in Burkina Faso in facility-based maternity care influences care-seeking and healthy practices afer childbirth.
Our hypothesis was that the intervention would increase postnatal care attendance, the duration of exclusive breastfeeding and the use of postpartum contraception.
