Kabanga et al.

BMC Pregnancy and Childbirth (2019) 19:321

https://doi.org/10.1186/s12884-019-2475-4

RESEARCH ARTICLE Open Access

Prevalence of male partners involvement in

antenatal care visits – in Kyela district,
Mbeya
Elizabeth Kabanga1, Alfred Chibwae1* , Namanya Basinda2 and Domenica Morona2

Abstract
Background: In most countries in the world, promotion of maternal and child health is perceived as women’s role
and men do not feel that they are responsible and see no reason to accompany their partners to Antenatal Care
(ANC) clinics [Vermeulen, E., et al., BMC Pregnancy Childbirth 16:66, 2016]. Male involvement in Reproductive,
Maternal, Neonates and Child and Adolescent Health (RMNCAH) programs in Tanzania is low. In Prevention of
Mother to Child Transmission (PMTCT) program, the data shows only 30% attend couple counseling and only 8%
for HIV counseling with their partners. There is limited data on prevalence of male involvement in ANC visits in
Kyela. The purpose of this study was to determine prevalence of male involvement in ANC services and assess
factors influencing male partners’ involvement in ANC visits in Kyela district in Mbeya. The findings from this study
will serve as a baseline in efforts to increase male involvement in ANC care in Kyela.
Methods: Hospital based cross-sectional study was undertaken in Kyela district, Mbeya from October 2017 to
November 2017. Data was collected using structured questionnaire and analyzed using SPSS version 20. Factors
with P values of < 0.05 in univariate logistic regression were included in a multivariable logistic regression model to
determine predictor variables that are independently associated with the outcome. Significant difference was
defined as a P- value less than 0.05 and Odds Ratio (OR) that did not include 1.0.
Results: About 174 pregnant women who were visiting the ANC in their second to fourth visits or higher. About,
56.9% (99) attended with their male partners and 51% (52) of these reported to be accompanied by male partners to
ANC because the women had requested their partners to accompany them. Attendance of male partners to ANC was
significantly associated with male partner awareness of ANC visiting dates OR 24.1, 95% CI 6.8, 86.5, and P < 0.0001.
Conclusion: Prevalence of male attendance to the ANC in Kyela district is not adequate as fearing of HIV testing
seemed to decrease male attendance to ANC services. So, there is high need to improve ANC health services with a
focus on male friendly services.
Keywords: Antenatal care, Maternal and child health, Male partner involvement

Background that 99% of all maternal deaths occurs in low and mid-
Worldwide, male presence in Antenatal care (ANC) and dle-income countries; almost half of these occur in sub-
during delivery remains a challenge to safe motherhood Saharan Africa, [1, 2].
[1]. Each year 210 million women become pregnant, Promotion of maternal and child health is perceived as
15% of these develop complications and over half a mil- women’s role and men do not feel that they are respon-
lion die due to reasons related to pregnancy or birth [2]. sible and see no reason to accompany their partners to
Statistics of World Health Organization (WHO) indicate ANC visits [3]. Male participation in antenatal care is
thought to be an essential step leading to positive mater-
nal and new born health outcomes [4]. Although there is
* Correspondence: achibwae@gmail.com
1
Catholic University of Health and Allied Sciences-Bugando, P.O Box 1464,
active promotion of male involvement during antenatal
Mwanza, Tanzania care, a small number of men in Tanzania with their
Full list of author information is available at the end of the article

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Kabanga et al. BMC Pregnancy and Childbirth (2019) 19:321 Page 2 of 6

wives during antenatal care visits. In Sub-Saharan Africa, there has been no study of male attendance in ANC in
the non-attendance of male partners to ANC services is Kyela district of Tanzania. The aim of this study is deter-
due to; health care staff treatments of male partners, mine the prevalence of male involvement in ANC and to
prolonged waiting time during ANC visits and a loss of understand why men do not accompany their partners
income if men accompany their partners in ANC [5, 6]. during ANC visits in Kyela districts.
A fear of HIV/AIDS as reported in Rwanda as a barrier
to scaling up the provision of antenatal care, men who
recognize or believe that they are HIV positive are less Methods
willing to go together with their partners to antenatal Study area and design
clinics for testing [3, 6]. A study done on acceptability This study was conducted in Kyela district in Mbeya re-
and preferences among men and women for male in- gion. The district has for population of 221,490, among
volvement in Antenatal Care revealed that socio-cultural these, females were 115,478 and males were 106,
factors are the main barrier to antenatal male partner 012.Agriculture is the major economic activity in the
HIV testing [5]. district where 88% of the population is involved in food
Regardless of men’s positive attitudes; lack of male- and cash crop production. The district has 29 govern-
friendly health infrastructure and inadequate under- ment dispensaries, 11 private dispensaries, 1 private
standing, by both community members and health hospital and 1 Government Hospital located at the dis-
facility providers in relation to the role of men during trict headquarters which serves as the main referral
pregnancy impede their attendance [4]. point for the whole district [9]. In the year 2016, there
Male involvement in child-bearing decisions is import- were 23,268 women aged 15 to 45 years and maternal
ant and also has a positive impact on the suitability of mortality rate was 76/100,000(District Health Informa-
Prevention of Mother To Child Transmission of HIV tion System DHIS2). Also in the year 2016, of the 8547
(PMTCT) interventions [7, 8]. Appropriate medical women who became pregnant, those who attended ANC
information to men is very important with regards to services were 52% for the first visit, 30% for second or
PMTCT interventions. First, well-informed men will be third visit and only 17% visited ANC clinics four times
more likely to participate positively in the decision mak- (District Health Information System DHIS2). A hospital-
ing for the well-being of the couple [7]. Next, women in based cross-sectional study was conducted at Kyela dis-
the company of supportive partners will be more moti- trict. One hundred six pregnant women were recruited
vated to undergo HIV testing, to return for the HIV test from Njisi Health centre and the remaining 64 pregnant
result and to reveal the HIV result to their partners. women were recruited from Kyela district hospital from
Third, well-informed couples may be more likely to October 2017 to November 2017.
accept a low risk behaviour and increase shared support,
regardless of the test results [7, 8].
The Tanzanian Ministry of Health, as well as WHO em- Data collection
phasizes the particular value of male involvement in ANC Semi-structured questionnaire was used to collect data
[4]. According to Tanzania one plan II 2016 PMTCT pro- on social demographic characteristics including age,
gram, the data shows only 30% of women come for couple educational level, occupation, marital status, religion and
counseling with their partners [9, 10]. And a study done parity. Also, data on factors that hinder men’s participa-
in Sub-Sahara Africa revealed that, men in low and middle tion to the ANC services as well as services provided to
income countries are the main decision-makers, decide the couple attending were collected Additional file 1.
women’s access to maternal health services and thus influ-
ence their health outcomes [11]. It has been suggested
that, maternal health interventions, aiming to emphasize Data analysis procedure
health care seeking behavior during ANC and birth, Collected data was entered and analysed using SPSS
should reconsider male partner involvement and increase version 20 Chicago, IL: SPSS Inc. version 20. Sociode-
their opportunity on attending with their partners for the mographic data were summarised in the form of propor-
ANC services [4]. Improving facility and health providers tions. Univariate logistic regression was carried out to
attitudes toward male involvement has the potential to get determine factors associated with male involvement in
better service delivery to all pregnant women; on the other ANC visits. Factors with P values of < 0.05 were included
hand, care must be taken to avoid discriminating against in a multivariable logistic regression model to determine
unaccompanied women who are either single or in predictor variables that were independently associated
unstable relationships [5]. with the outcome. Significant difference was defined as
While the barriers and challenges to male involvement P- value less than 0.05 and Odds Ratio (OR) that did not
in ANC services has previously been studied, until now, include 1.0.
Kabanga et al. BMC Pregnancy and Childbirth (2019) 19:321 Page 3 of 6

Ethical consideration Table 1 Social demographic characteristics of included

Ethical approval was sought from the joint CUHAS and participants
Bugando Medical Center Research Ethics Committee Response Frequency (n) Percentage (%)
with ethical clearance number CREC/250/2017. Permis- Residence
sion was obtained from Kyela District Executive Director Urban 67 38.5
and health facility administration to implement the
Rural 107 61.5
study. The respondents were adequately informed using
Religion
the participant’s informed written consent statement
about all the relevant aspects of the study, including its Christian 141 81.0
aim, interview procedures, anticipated benefits and Islam 33 19.0
potential hazards. Education
Non-educated 12 6.9
Results Primary 105 60.3
Sociodemographic characteristics of included participants
Secondary education 45 25.9
About 174 pregnant women who were visiting the ANC
in their second to fourth visits or higher with Mean age College education 12 6.9
of 27.0 (sd ±6.4) years and mean number of 1.8 children Occupation
(SD ±1.4) participated in the study. 61.5% (107/174) Small scale farmers 112 62.1
were coming from rural areas, 81.0% (141/174) were Business 41 23.6
Christians, 60.3% (105/174) had primary education, and
civil servant 21 12.0
62% (102/174) were small scale farmers (Table 1).

Male partners’ attendance to antenatal care clinics multivariate analysis the only significant factor found
According to women who completed questionnaire, 56.9% was if the partner know ANC visiting dates (OR 24.1,
(99) of male partners attended to the ANC services with 95% CI 6.8, 86.5, and P < 0.0001), Table 3.
their partners. Though 99 men were reported to have ac-
companied their partners to ANC services, only 90.9% Discussion
(90) were confirmed from the ANC cards. About 51% (52/ Prevalence of male attending ANC services with their
99) of all partners accompanying pregnant women were partners
invited by their female partners to go together to ANC Male participation in antenatal care is thought to be im-
clinics. Of the participant 40.2% (41/99) of attended male portant in improving positive maternal and new born
partners attended as it was a requirement of the govern- health outcomes [4]. In this study, the prevalence of
ment to attend. However, 73.0%(127/174) of the partici- men attending ANC visits with their partners was found
pant reported that their male partners were aware of the to be 56.9%. This prevalence is higher than those re-
female partner schedule and the ANC visiting dates and ported from other studies done in Mbeya, Tanzania [12].
86.8%(151/174) provided financial support for the ANC The former study reported that, only 39% of the facility
visit. Most of the respondents 94.4% (165/174) reported to have been receiving male partners for both ANC/
believe that, their partners heard about ANC services. PMTCT and that reported by government of Tanzania
Among of them, about 64.4% (105/174) heard from their in one plan II of 2016 which was only 30% [12]. This
partners. can be explained with vast of improvement in national
reproductive policies, infrastructures as well different
Reasons why men did not attend to the ANC services modalities of reproductive health promotions. For exam-
In this study, the most common reasons why male part- ples pregnant women would not receive ANC services if
ners did not attend with their partners in the ANC they would not attend with their partners and those who
clinics included fearing of HIV testing (18.7%), polygamy attended with their partners will get priority services.
(14.7%), long queues (12.2%), and their partners not In contrast to our study which was conducted in rural
living together (10.7%). areas, most studies done in either urban setting or refer-
This study found a significant association between ral health facilities in Africa had low prevalence of male
male attendance to the ANC and knowing the dates for attendance to the ANC services. Study done in Mwanza
the ANC visits (OR: 18.7 95% CI: 7.2 to 48.0 P = < city, north western Tanzania reported that only 24.7% of
0.0001), couple communication (OR 4.295% CI: 1.6 to mothers had their male partners involved in PMTCT
10.6,P = 0.003), hearing about ANC (OR 11.7,95% CI: 1.4 which is a crucial component of ANC services [13].
to 95.7 P = 0.02), and knowing about ANC services (OR: Another study done in northern Tanzania had reported
3.6 95% CI: 1.5 to 8.8 P = 0.06,) Table 2. However in that few men attended the ANC-VCT services during
Kabanga et al. BMC Pregnancy and Childbirth (2019) 19:321 Page 4 of 6

Table 2 Univariate logistic regression of factors associated with Table 3 Multivariable logistic regression of factors associated
male attending ANC services with male attendance to ANC services
Responses OR (95% C.I.) P value OR (95% C.I.) P value Overall P value
Residence Occupation
Urban Reference 0.72 Peasants Reference 0.27
Rural 0.9 (0.5,1.7) Business 0.9 (0.4, 2.1) 0.79
Religion Civil servant 0.3 (0.1, 1.3). 0.11
Christians Reference 0.28 Partner know ANC visiting date
Moslems 1.5 (0.7,3.3) Yes Reference < 0.0001
Education level No 24.1 (6.8, 86.5)
Informal Reference Couple Communication
Primary 0.6 (0.2,2.1) 0.45 Yes Reference 0.13
Secondary education 0.4 (0.1,1.3) 0.12 No 0.24 (−0.04, 1.5)
College or higher education 0.4 (0.1, 1.9) 0.22 Partner know About ANC care services
Occupation Yes Reference 0.45
Peasants Reference No 1.7 (0.4,6.9)
Business 0.6 (0.3, 1.2) 0.14 Partner heard aboutANC services
Civil servant 0.2 (0.1, 0.7). 0.01 Yes Reference 0.49
Partner know ANC visiting date No 2.4 (0.2, 28.6)
Yes Reference < 0.0001
No 18.7 (7.2, 48.0) attendance at the services is low [4]. This may be due to
Couple Communication cultural system in most of Sub-Saharan Africa, men are
Yes Reference 0.003 the main decision makers in the family including for
economic affairs as well as health issues [17–21]. This
No 4.2 (1.6, 10.6)
system can be used to motivate men to attend to the
Partner know About ANC care services
ANC services with their partners.
Yes Reference 0.005
No 3.6 (1.5,8.8)
Partner heard about ANC services Services provided in ANC services
Yes Reference 0.02 In this study, men who attended ANC services did not
only accompany their partners but about 97% of those
No 11.7 (1.4, 95.7)
who attended reported that they availed of all the ANC
services in the particular clinics, this included voluntary
counselling and HIV testing for the prevention of mater-
prenatal compare to those attended during post natal nal to child transmission of HIV/AIDS and STIs/STDs.
care (12.5% vs. 40%) which also is lower than the find- From other studies, poor male participation of male in
ings from this study [14]. A study by Byanmugisha et al. ANC services were due to poor access, stigma and confi-
in Uganda reported that, 26% of men whose wives were dentiality of services that were unfriendly to men [22].
attending ANC at Mbale Regional Referral hospital As reported in studies done in Tanzania, there is
reported to have full male involvement in ANC services minimal health education and counselling during ANC
[15]. In most urban areas there is large number of visits. This is due to either high number of the clients in
people with occasional jobs so have less habit for seeking the clinics and long-time of waiting. Also, some of the
health services. Men who had occasional job were less clinics reported to have male unfriendly facility environ-
likely to participate in ANC than peasants in Kenya [16]. ment and poor health workers attitudes towards men.
However, apart from attending to the ANC services, These discourages male partner participation in ANC
majority of men provided financial support to their part- services [23, 24]. In Uganda reported that the number of
ners for the attendance to the ANC services. This can be the educated men attending to the ANC were twice as
through paying for transport, accompanying their part- much as those who were less educated [15]. However, in
ner to ANC, joining inside the rooms as well as partici- other studies financial constraint such as cost of travel
pating in different ANC services [4]. Most men support to ANC were reported as the setback to the male attend-
women’s attendance to the ANC even though their own ance to the ANC [25, 26].
Kabanga et al. BMC Pregnancy and Childbirth (2019) 19:321 Page 5 of 6

This study has found the significant association be- Additional file
tween couple communication with male partner attend-
ance to the ANC services. This findings is similar to the Additional file 1: English version questionnaire. Ethical clearance latter
(DOCX 16 kb)
findings reported in other studies in aspect that women
were likely to bring their partners to ANC services espe-
Abbreviations
cially after bringing their feedback of the services they
ANC: Antenatal care; BMC: Bugando Medical Centre; CUHAS: Catholic
obtained during previous ANC visit [13, 25, 27]. Verbal University of Health and Allied Sciences-Bugando; DHSI2: District Health
communication seems to lighten the mind of the male Information System; FP: Family Planning; PMTCT: Prevention of Mother to
Child Transmission; VCT: Voluntary Counseling and Testing; WHO: World
partners on the advantages of attending to the ANC with
Health Organization
their partners. As reported in study done by Chibwae et
al in Shinyanga 2014, couple communication about Acknowledgements
ANC helps men to increase male partner awareness Authors are grateful to all pregnant women in Kyela district who participated
in this study for their time, patience and cooperation. We also thank the
about ANC services [3]. And hence, they were able to support from the Kyela District Council, the District Medical Office, and
know about what happened on previous ANC visit and Medical officer in charge of Kyela district hospital as well as Njisi Health
next ANC visiting dates which were all significant centre. Also we are thankful to School of Public Health-Catholic University of
Health and Allied Sciences-Bugando.
associated with their attendance in this study.
Authors’ contributions
EK participated in study designing and data collection, data analysis and
Reported factors hindering male partners attendance to interpretation, preparation and writing a Manuscript. AC participated data
the ANC by pregnant women analysis and interpretation, preparation and writing Manuscript. DM
For the women whose partners did not attend, different interpretation of the data and manuscript preparation, and NB supervised
the study and participated in designing the study, data analysis, manuscript
reasons were given out but majority were due to the fear- writing & final editing of the study. All authors have read and approved the
ing HIV testing. This reason was also reported in the final manuscript.
study done in Uganda that male partners were concerned
Funding
with stigma and confidentiality of services that were un- This study was authors self funded.
friendly to men after knowing their status [22, 28, 29].
Other studies also done in Tanzania reported to fear of Availability of data and materials
HIV testing as a barrier for the male partner attendance to The datasets used and/or analyzed during the current study are available
from the corresponding author on request.
ANC services [13, 30]. So there is a need to improve
campaigns for HIV counselling and testing for men in Ethics approval and consent to participate
Tanzania and other parts of the world. Ethical approval was sought from the joint Catholic University of Health and
Allied Sciences-Bugando and Bugando Medical Center Research Ethics Com-
Another reason reported by women whose husbands mittee with ethical clearance number CREC/250/2017. Permission was ob-
did not attend at ANC was polygamy or partners are not tained from Kyela district executive director and health facility administration
living together. Similar data findings were reported in to implement the study. The respondents were adequately informed using
the participant’s informed written consent statement about all the relevant
other different studies that reduces number of male aspects of the study, including its aim, interview procedures, anticipated ben-
attendance in ANC services [31, 32]. efits and potential hazards.
Health facility factors also have being implicated in
this study such as long queue and long waiting time. Consent for publication
Not applicable.
Long waiting time and long duration of ANC clinics
were also common barrier for male attendance to the Competing interests
ANC services reported in other studies [4, 33]. The authors declare that they have no competing interests.

Author details
1
Catholic University of Health and Allied Sciences-Bugando, P.O Box 1464,
Conclusions Mwanza, Tanzania. 2School of public health, Catholic University of Health and
This study has found that more than a half of the preg- Allied Sciences P. O BOX 1464, Mwanza, Tanzania.
nant women who attended to the health facility attended
Received: 21 November 2018 Accepted: 26 August 2019
with their male partners. Women played a great role in
influencing their partners to participate in the ANC ser-
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