Interpretation
The 1994 United Nations Department of Public Information International
Conference on Population and Development (ICPD ’94) firmly emphasised
men’s active inclusion and shared responsibility in maternal and
reproductive health . Husband’s participation in BPCR appears to be
context-specific and widely varies globally. Previous studies
highlighted that a husband’s involvement in BPCR is influenced by
factors such as man’s age, literacy, socioeconomic status, ethnic
background, religion, and culture. Exploring these key correlates of a
husband’s involvement in BPCR would be of great use in fine-tuning
ongoing maternal and child health strategies.
In a recently published meta-analysis, husbands’ involvement in BPCR in
low- and middle-income countries (LMICs) varied from 6.6% to 86% . The
pooled estimate of husband’s involvement in BPCR from 37 studies (17,148
sample size) was 42.4% (95%CI: 33.0-51.8%) . It was relatively better
in Asian countries (55.7%, 95% CI: 22-89.4%) when compared to
sub-Saharan Africa (39.8%, 95% CI: 31.2-48.5%) . However, this
systematic review did not find any study from India. Husband’s
involvement in our study (50.2%, 95%CI:43.3-57.2%) was similar to the
pooled estimate from seven studies in Asia, i.e., Bangladesh, Indonesia,
Myanmar, and Nepal . However, this comparison is not straightforward due
to variations in the parameters considered to assess BPCR (husband’s
knowledge and behavioural practices of BPCR) and how the husband’s
optimal involvement in BPCR was defined. Our study focused on the
husband’s six key BPCR related behavioural practices and used relatively
stringent criteria to define optimal involvement in BPCR (practised at
least 4 of 6 practices).
In our study, the husband’s BPCR involvement in the following practices
was comparable with pooled estimates from 37 studies in LMICs:
identified the mode of transport (54.6% vs pooled 45.8%), arranged a
compatible blood donor (25.1% vs pooled 16.1%), saved money for the
delivery expenses (42% vs pooled 45.7%). On the contrary, the
husband’s involvement in identifying the place of delivery (84.1% vs
pooled 57.2%) and accompanying wife for ANC (91.8% vs pooled 45.7%)
was higher in our study. Husband’s dismal involvement in identifying a
compatible blood donor in this study and across LMICs requires attention
. Given that postpartum haemorrhage is the most common cause of maternal
mortality in India and LMICs, the ready availability of a blood donor
during emergency obstetric care could belief saving.
According to our and previous studies , husbands’ optimal involvement in
BPCR is associated with wives’ literacy. This could be attributed to the
overarching benefits of formal education in empowering women, enhancing
their autonomy, and shared decision-making for their health. Adequate
knowledge of danger signs aids in the early recognition of potentially
life-threatening complications and may avert the unnecessary delay in
deciding to seek health care . Although evidence was weak, our study
highlighted the positive effect of knowledge of key danger signs on
BPCR. Other studies have also reported an association between knowledge
of key danger signs and BPCR practice.
In our study, despite very high ANC service use by women and 91.8% of
husbands accompanying their wives for ANC at least once, only half of
the husbands were optimally involved in BPCR. Also, optimal BPCR
involvement seemed relatively better in husbands who sought ANC from the
private sector (weak evidence). These emphasise missed opportunities for
health education during ANC visits, particularly in the public health
sector. During pregnancy, the couple is sensitive and receptive to
suggestions. At the grassroots, ANM and ASHA should involve the husband
while explaining the key danger signs and BPCR practices.
Under NUHM, ANM and ASHA play a vital role in promoting the husband’s
involvement in BPCR. In previous studies, health workers’ efforts to
engage men in maternal health have shown positive results . Running
evening clinics is one of the core strategies of NUHM and has started in
Mangalore in 2016 . This strategy would further boost public healthcare
sector use for ANC and provide an opportunity to enhance the husband’s
involvement as he would be back home from work.
While designing strategies to improve the husband’s involvement in BPCR,
one must be sensitive to community perceptions and practices. In many
cultures in developing countries, the husband is not expected to be
directly involved in maternal and child health, and involvement is
regarded as a sign of weakness . A man accompanying wife for ANC is
unusual in many communities and often considered superfluous. In rural
Tanzania, perceived traditional gender roles and husbands’ lack of
knowledge and opportunities for involvement in obstetric care were
reported as barriers . Culture strongly influences women’s access to and
use of available healthcare services . Hence, considering its dynamism,
culture should be incorporated into maternal healthcare services.
Further qualitative research would be vital to understand community
perception, drivers, and barriers to the husband’s involvement in BPCR
and develop socio-culturally contextualised strategies in the study
setting.