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.