Professional Documents
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Introduction
The participation of the male partner in childbirth (family labour/delivery) has
evolved over time. In modern times, given the choice, many men are willing to attend
and support their partners (Leavitt, 2003). A survey on Salvadoran men (Carter &
Speizer, 2005) identified wanted pregnancies, couples living together, higher level of
male partners education/socioeconomic class and urban residence as associations of
male participation. Male participation ideally starts from pregnancy; involvement in
493
494 O. Olayemi et al.
antenatal visits and childbirth classes has been shown to increase their willingness to
attend the delivery (Wieglos et al., 2007). Male participants have dierent attitudes to
family birth, ranging from eagerness (Chan & Peterson-Brown, 2002; Carter Speizer,
2005), even actively protesting hospital policies that bar them from participating,
according to a mid-20th century history review in the US (Leavitt, 2003), to
acquiescing simply to please their partner (Rykowska-Pierzchala et al., 2001). Most
men claim that the decision to be at delivery was theirs, not their wives. An Indian
study concluded that men believed the health of a woman during pregnancy is her
husbands responsibility, but physical and moral support should be from other
women. Socio-cultural restrictions impeded them accompanying their wives to clinic
visits or being present at delivery (Khan et al., 1997). It appears that hospital policies
and stas hostile attitude to male intrusion in the labour room still contribute to
limit family delivery (Dragonas, 1992; Khan et al., 1997; de Carvalho, 2003). For their
own part, women often want their partners to attend labour. Some studies concluded
that both partners felt their relationships with each other had improved following
their shared experiences irrespective of mode of delivery (Dragonas, 1992; Chan &
Peterson-Brown, 2002). Yet, some of them prefer a traditional delivery. Reasons
proered include that men would be out of place in the labour ward and that the
experience may adversely aect their sexual relationship afterwards (Hung et al., 1997;
Wieglos, 2007).
One-to-one support in labour, according to the Cochrane Review, has been shown
to be beneficial, in that women who experienced continuous support during labour
were more likely to give birth without using analgesia or anaesthesia, less likely to
have a Caesarean or instrumental vaginal birth, and less likely to report dissatisfac-
tion with their childbirth experiences (Hodnett et al., 2006). The review looked at
female support in labour, though, and the place of male support has been less studied.
From a wider public health view, maternal mortality has remained a scourge of
the developing world; the current figure for Nigeria is 1100 per 100,000 live births
(WHO, 2007). Greater emphasis has been put on its non-medical causes and avenues
for stemming them. A great contributor to Phase I delay (that is, delay in making the
decision to seek medical care) is the fact that male partners make decisions in most
families, including those related to health and reproductive care. In many cases, the
woman (the partner at direct risk) is not empowered to make these decisions. Other
benefits include those demonstrated by a study on antenatal blood donation by
husbands (an option often explored where voluntary blood donation is low), which
showed that they were more likely to donate when they participated in antenatal
programmes (Obi, 2007).
This study aims to assess the level of pregnancy and birth participation in
Nigerian men, the possible associations, the attitude of the women and likely targets
for improved care delivery.
Methods
This was a descriptive hospital-based, cross-sectional study carried out on pregnant
women attending antenatal care in three government-owned health facilities in
Ibadan, in Yoruba-speaking south-western Nigeria: Idi-Ogungun Maternity Centre
Male participation in pregnancy and delivery in Nigeria 495
(IMC; a primary care facility), Adeoyo Maternity Hospital (AMH; secondary) and
University College Hospital (UCH; tertiary), catering for rural, semi-urban and urban
populations, respectively. A total sample of all consenting clients from 28th April to
9th May 2008 was taken. Nulliparous women were excluded, as information on their
previous experience with deliveries was sought. The instrument used was a 48-item
interviewer-administered questionnaire, which elicited information on the couples
biodata, the womens knowledge of and attitude towards male participation, and the
practice of their male partners in this respect.
The outcome variables were: husbands participation in household chores,
attendance at antenatal care and attendance at delivery. Explanatory variables were
age of respondents, educational attainments, ethnicity and occupations of both
husbands and wives.
Data was entered into Microsoft Excel spreadsheets and imported into Stata
software for analysis. Categorical variables were analysed using the 2 (Fishers exact)
test while continuous variables were analysed by t test for both equal and unequal
variance using the variance ratio function of the Stata software to determine the
appropriate use of the Satterthwaite correction for the degrees of freedom. Multi-
variate analyses were performed by multiple logistic regressions. Level of statistical
significance was at p<0.05 for all the analyses.
Results
Demographic data
Four hundred and sixty-two women were surveyed, with a mean age of 30.5 (95%
CI 30.031.0) years. Mean parity was 2. Table 1 shows the demographic character-
istics of the respondents and Table 2 shows that of their husbands.
Age group
%20 0 (0) 8 (4.2) 1 (1.3) 9 (2.0)
2125 16 (8.1) 51 (27.0) 11 (14.5) 78 (16.9)
2630 75 (38.1) 49 (25.9) 25 (32.9) 149 (32.2)
3135 71 (36.1) 61 (32.3) 30 (39.5) 162 (35.1)
3640 28 (36.1) 16 (8.5) 7 (9.2) 51 (11.0)
>40 7 (3.5) 4 (2.1) 2 (2.6) 13 (2.8)
Parity
1 75 (38.3) 64 (33.9) 28 (36.9) 167 (36.2)
2 75 (38.3) 73 (38.6) 27 (35.5) 175 (38.0)
3 25 (12.8) 27 (14.3) 14 (18.4) 66 (14.3)
R4 21 (10.7) 25 (13.2) 7 (9.2) 53 (11.5)
Wifes ethnicity
Yoruba 167 (84.8) 183 (96.9) 62 (81.6) 412 (89.2)
Hausa 2 (1.0) 1 (0.5) 1 (1.3) 4 (0.9)
Ibo 18 (9.1) 4 (2.1) 9 (11.8) 31 (6.7)
Other 10 (5.1) 1 (0.5) 4 (5.3) 15 (3.2)
Wifes education
None 1 (0.5) 7 (3.7) 1 (1.3) 9 (1.9)
Primary 6 (3.1) 31 (6.4) 11 (14.5) 48 (10.4)
Secondary 24 (12.2) 78 (41.3) 24 (31.6) 126 (27.3)
Undergraduate 16 (8.1) 30 (15.9) 7 (9.2) 53 (11.5)
Tertiary 150 (76.1) 43 (22.7) 33 (43.4) 226 (48.9)
Wifes occupation
Teacher 30 (15.2) 23 (12.2) 7 (9.2) 60 (13.0)
Artisan 6 (3.0) 28 (14.8) 15 (19.8) 49 (10.6)
Civil servant 36 (18.3) 24 (12.7) 14 (18.4) 74 (16.0)
Trader 36 (18.3) 14 (7.4) 9 (18.4) 59 (12.8)
Professional 48 (24.4) 86 (45.5) 20 (26.3) 154 (33.3)
Other 41 (20.8) 14 (7.4) 11 (14.5) 66 (14.3)
Total 197 (42.6) 189 (40.9) 76 (16.5) 462
IMC, Idi-Ogungun Maternity Centre; AMH, Adeoyo Maternity Hospital; UCH, University
College Hospital.
with higher education were more likely to share this experience (Table 3). Most of
these women admitted to benefiting from their partners presence (although there was
no statistically significant advantage), most citing emotional support as the main
benefit. Almost half of the respondents (45.9%) stated that the attending health
workers resisted their husbands presence at delivery.
Age group
%20 0 (0.0) 1 (0.5) 0 (0.0) 1 (0.2)
2125 0 (0.0) 12 (6.3) 1 (1.3) 13 (2.8)
2630 16 (8.1) 41 (21.7) 15 (19.7) 72 (15.6)
3135 72 (36.6) 55 (29.1) 23 (30.3) 150 (32.5)
3640 58 (29.4) 43 (22.8) 21 (27.6) 122 (26.4)
>40 51 (25.9) 37 (19.6) 16 (21.1) 104 (22.5)
Ethnicity
Yoruba 158 (80.2) 184 (97.3) 66 (86.9) 408 (88.3)
Hausa 2 (1.0) 2 (1.1) 1 (1.3) 5 (1.1)
Ibo 23 (11.7) 2 (1.1) 7 (9.2) 32 (6.9)
Other 14 (7.1) 1 (0.5) 2 (2.6) 17 (3.7)
Education
None 1 (0.5) 3 (1.6) 3 (4.0) 7 (1.5)
Primary 2 (1.0) 14 (7.4) 4 (5.3) 20 (4.3)
Secondary 13 (6.6) 79 (41.8) 21 (27.6) 113 (24.5)
Undergraduate 12 (6.1) 13 (6.9) 8 (10.5) 33 (7.1)
Tertiary 169 (85.8) 80 (42.3) 40 (52.6) 289 (62.6)
Occupation
Teacher 14 (7.1) 19 (10.1) 5 (6.6) 38 (8.2)
Artisan 12 (6.1) 53 (28.0) 13 (17.1) 78 (16.9)
Civil servant 50 (25.4) 36 (19.1) 26 (34.2) 112 (24.2)
Trader 28 (14.2) 43 (22.7) 10 (23.7) 89 (19.3)
Professional 73 (37.1) 29 (15.3) 9 (11.8) 111 (24.0)
Other 20 (10.1) 9 (4.8) 5 (6.6) 34 (7.4)
Total 197 (42.6) 189 (40.9) 76 (16.5) 462
clinic (48.3%) or the counselling sessions (56.7%). They did, however, expect them to
be responsible for paying the hospital bills, attend the delivery and to be involved in
decision-making as regard the pregnancy and childbirth. Most (93.7%) would discuss
their providers health advice with their husbands, and most (68.2%) would prefer
their husband to a female relative at delivery (p<0.01). Most women (65.9%) would
make a decision in their partners absence in an emergency (p<0.001); others (13.0%)
would allow another relative to make the decision, while 13.2% would wait for their
partners return. A few respondents (6.1%) felt they could not anticipate their
behaviour in this instance.
Centre
UCH 182 (92.4) 15 (7.6) 0.001 99 (50.2) 98 (49.8) 0.073 99 (50.2) 98 (49.8) 0.227
AMH 158 (83.60) 31 (16.4) 78 (41.3) 111 (58.7) 78 (41.3) 111 (58.7)
IMH 58 (76.3) 18 (23.7) 28 (36.8) 48 (63.2) 28 (36.8) 48 (63.2)
Age group
O. Olayemi et al.
%20 7 (77.8) 2 (22.2) 0.006 6 (66.7) 3 (33.3) 0.543 6 (66.7) 3 (33.3) 0.559
2125 57 (73.1) 21 (26.9) 38 (48.7) 40 (51.3) 38 (48.7) 40 (51.3)
2630 137 (92.0) 12 (8.0) 67 (45.0) 82 (55.0) 67 (45.0) 82 (55.0)
3135 141 (87.1) 21 (12.9) 70 (43.2) 92 (56.80) 70 (43.2) 92 (56.80)
3640 45 (88.2) 6 (11.8) 20 (39.2) 31 (60.8) 20 (39.2) 31 (60.8)
>40 11 (84.6) 2 (15.4) 4 (30.8) 9 (69.2) 4 (30.8) 9 (69.2)
Husbands ethnicity
Yoruba 347 (85.1) 61 (14.9) 0.213 173 (42.4) 235 (57.6) 0.011 173 (42.4) 235 (57.6) 0.149
Hausa 5 (100.0) 0 (0.0) 3 (60.0) 2 (40.0) 3 (60.0) 2 (40.0)
Ibo 29 (90.7) 3 (9.3) 15 (46.9) 17 (53.1) 15 (46.9) 17 (53.1)
Other 17 (100.0) 0 (0.0) 14 (82.4) 3 (17.6) 14 (82.4) 3 (17.6)
Wifes ethnicity
Yoruba 351 (85.2) 61 (14.8) 0.273 186 (45.2) 226 (54.8) 0.113 186 (45.2) 226 (54.8) 0.076
Hausa 4 (100.0) 0 (0.0) 2 (50.0) 2 (50.0) 2 (50.0) 2 (50.0)
Ibo 30 (96.8) 3 (3.2) 8 (25.8) 23 (74.2) 8 (25.8) 23 (74.2)
Other 13 (86.7) 0 (13.3) 9 (60.0) 6 (40.0) 9 (60.0) 6 (40.0)
Table 3. Continued
Household chores Attendance at antenatal clinic Attendance at delivery
Yes No p Yes No P Yes No p
Parity
1 148 (89.5) 19 (10.5) 0.115 81 (46.6) 86 (53.4) 0.025 81 (46.6) 86 (53.4) 0.257
2 153 (87.4) 22 (12.6) 81 (46.3) 94 (53.7) 81 (46.3) 94 (53.7)
3 56 (84.8) 10 (15.2) 21 (31.8) 45 (68.2) 21 (31.8) 45 (68.2)
R4 40 (76.1) 13 (23.9) 21 (39.1) 32 (60.9) 21 (39.1) 32 (60.9)
Husbands education
None 5 (66.7) 2 (33.3) 0.002 1 (16.7) 6 (83.3) 0.080 1 (16.7) 6 (83.3) 0.028
Primary 13 (65.0) 7 (35.0) 4 (20.0) 16 (80.0) 4 (20.0) 16 (80.0)
Secondary 89 (78.8) 24 (21.2) 46 (40.7) 67 (59.3) 46 (40.7) 67 (59.3)
Undergraduate 30 (91.0) 3 (9.0) 17 (51.5) 16 (48.5) 17 (51.5) 16 (48.5)
Tertiary 261 (90.3) 28 (9.7) 137 (47.4) 152 (52.6) 137 (47.4) 152 (52.6)
Wifes education
None 5 (55.6) 4 (44.4) 0.001 0 (0.0) 9 (100.0) 0.078 0 (0.0) 9 (100.0) 0.016
Primary 37 (77.1) 11 (22.9) 23 (48.2) 25 (52.0) 23 (48.2) 25 (52.0)
Secondary 102 (81.0) 24 (19.0) 59 (46.8) 67 (53.2) 59 (46.8) 67 (53.2)
Undergraduate 46 (86.8) 7 (13.2) 26 (49.1) 27 (50.9) 26 (49.1) 27 (50.9)
Tertiary 208 (92.0) 18 (8.0) 97 (42.9) 129 (57.1) 97 (42.9) 129 (57.1)
499
500 O. Olayemi et al.
Table 4. Attitude of respondents to male participation in pregnancy and delivery
Discussion
The awareness that husbands can participate in childbirth is high amongst the women
in this study. Health talks and counselling sessions are carried out by nurses in all the
centres, and is probably the source of most of their information. Women are well
supported during pregnancy, as evidenced by financial support, better nutrition (the
tradition usually is for the husband to have the best part of the meals, etc.) and
assistance with household chores. The latter is particularly welcome, as it is probably
seen as eeminate in a patriarchal society. In a similar study carried out in a Delhi
slum (Dutta et al., 2004), less than a tenth of husbands improved on their wives diet
during pregnancy. Respondents from the rural centre were less likely to be assisted at
home with chores, comparable to another study in rural India where household help
was low (Singh & Arora, 2008). More highely educated men were more likely to
attend antenatal clinic and delivery, in concord with Wieglos Polish study, and
contrary to the findings of a Taiwanese study (Hung et al., 1997).
Male participation in pregnancy and delivery in Nigeria 501
Table 5. Logistic regression analysis of male participation
Mens attendance at antenatal clinic was low. This may be partly due to the
discomfort of men to attend a female-oriented and dominated programme. Socio-
cultural restrictions may play a role, as shown in the Indian study discussed earlier
(Khan et al., 1997). Another study in Bangladesh showed that men did not feel
comfortable taking their wives to a health facility because they did not like to discuss
sexual reproductive health issues with the service providers (Shahjahan & Kabir,
2007), and poor couple interaction made it dicult for them to understand their
wives reproductive health issues. Most of the respondents, however, claim to discuss
the health advice given them with their husbands. With some education and
encouragement, there would probably be better attendance, given the high level of
participation of the husbands in other aspects of pregnancy in this study. It would be
advantageous for them to attend the counselling sessions at the clinic as this would
allow them to support their wives better, and to prepare them for labour. Wieglos
et al. (2007) demonstrated that men who attended childbirth classes were more likely
to attend labour. Our respondents own testimony confirmed the benefit of their
partner attending labour, preferring it to the presence of a doula.
The attitude of the women themselves is important in the actualization of male
participation: sometimes male partners only attend childbirth in response to their
wives desire (Rykowska-Pierzchala et al., 2001). While most women feel that the man
should bear the financial responsibility, it is gratifying that they feel empowered
502 O. Olayemi et al.
enough to make emergency decisions in his absence, reducing the delay that often
contributes to maternal morbidity and mortality. Findings from another Nigerian
study (Odimegwu, 2005) were similar: surveyed men corroborated their wives ability
to decide in their absence. Most of our respondents seemed to agree with the
traditional model of male financial and social support, without intruding into
antenatal care services.
In conclusion, it appears that male participation in pregnancy and delivery is
satisfactory in some respects in Ibadan, but more is desirable, especially for husbands
attendance at antenatal services and delivery. The importance of counselling sessions
by nurses is emphasized. Education at all levels is desirable, due to all its positive
associations, with specific education on family participation. Care-givers and hospital
policies need to refrain from hostile policies towards family delivery, given its known
benefits.
Acknowledgment
The authors acknowledge the medical students of Group D2005 of the College of
Medicine, University of Ibadan, for their invaluable contribution in administering the
questionnaires to the respondents.
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