AMBO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

MALE PARTNER INVOLVEMENT AND ASSOCIATED FACTORS INFLUENCING

ON ANC SERVICES UTILIZATION AMBO TOWN 01 AND 02 KEBELE SHOWA
ZONE, OROMIA REGION, ETHIOPIA, 2018

Group Name ID No

1. GEMECHU CHIMDESA…………………………..Eve/0153/06
2. GEMECHIS ABEBE………………………………..Eve/0136/06
3. BARSISE KENEA…………………………………..Eve/0119/06
4. FIRAOL GEDEFA………………………………….Eve/0142/06

Advisor: Mr. DelelegnYilma ( MPH, MSC) .

March, 2018

Ambo, Ethiopia
 AMBO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

MALE PARTNER INVOLVEMENT AND ASSOCIATED FACTORS INFLUENCING

ON ANC SERVICES UTILIZATION AMBO TOWN 01 AND 02 KEBELE SHOWA
ZONE, OROMIA REGION, ETHIOPIA, 2018

BY

Group Name ID No

1. GEMECHU CHIMDESA…………………………..Eve/0153/06
2. GEMECHIS ABEBE………………………………..Eve/0136/06
3. BARSISE KENEA…………………………………..Eve/0119/06
4. FIRAOL GEDEFA………………………………….Eve/0142/06

Approved by:

Advisor: Mr. DelelegnYilma ( MPH, MSC) .

Signature________________ Date_____________________

Department head Name___________________________________

Signature_______________ Date________________

March, 2018

Ambo, Ethiopia
ACKNOWLEDGEMENT
First of all, we would like to acknowledge almighty God for giving us the strength, power and
courage to complete our research.

Secondly, we wish to express our sincere gratitude and positive reception to the following bodies

 Ambo University, College of medicine and Health science, Department of Public Health
Officer for giving this golden and educative practical opportunity.
 Our advisor Mr. DelelegnYilma for his unreserved encouragement and provision of
constructive comments and guidance while doing this research and
 Our Senior Students b/c of sharing their experiences and encouragement
 TABLE of CONENT

Contents Page
ACKNOWLEDGEMENT..................................................................................................................................I
TABLE of CONENT........................................................................................................................................II
Lists of Tables.............................................................................................................................................IV
List of Figure...............................................................................................................................................IV
ABBREVIATIONS..........................................................................................................................................V
ABSTRACT...................................................................................................................................................VI
1. INTRODUCTION...................................................................................................................................1
1.1 Background of the study....................................................................................................................1
1.2. Statement of the problem..................................................................................................................3
1.3. Significant of the study.....................................................................................................................4
2 OBJECTIVES..........................................................................................................................................5
2.1General objective................................................................................................................................5
2.2 Specific objective..............................................................................................................................5
3 Literature Review.....................................................................................................................................6
3.1 Male Involvement in Maternal Health Care Services........................................................................6
3.1.1 Male Involvement in Antenatal Care..........................................................................................7
3.1.2 Predisposing Factors...................................................................................................................8
3.1.3 Enabling factors..........................................................................................................................8
3.1.4 Reinforcing factors.....................................................................................................................9
3.2 Conceptual framework.....................................................................................................................11
4 Methods and Materials...........................................................................................................................12
4.1. Description of the study area and periods.......................................................................................12
4.2 Study design....................................................................................................................................12
4.3 Source and study population............................................................................................................12
4.4 Sample Size determination..............................................................................................................12
4.5 Sampling Technique........................................................................................................................13
 4.6 Data collection Instrument...............................................................................................................13
4.7 Study Variables...............................................................................................................................14
4.8 Operational definition......................................................................................................................15
4.9 Data Analysis Plan...........................................................................................................................15
4.10 Data Quality Management.............................................................................................................15
4.11 Ethical Consideration.....................................................................................................................15
4.12 Dissemination plan........................................................................................................................15
5. RESULTS..............................................................................................................................................16
5.1 Socio demographic characteristics of respondents:..........................................................................16
5.2 Enabling factors in attending ANC among men..............................................................................18
5.3 Reinforcing factors in ANC attendance among men........................................................................18
5.4 Men Involvement in ANC...............................................................................................................19
6. Discussion.............................................................................................................................................22
7. CONCLUSIONS AND RECOMMENDATIONS.................................................................................25
7.1 Conclusion.......................................................................................................................................25
7.2 Recommendations...........................................................................................................................26
8. REFERENCES......................................................................................................................................27
Appendix B: QUESTIONNAIRE.............................................................................................................30
 Lists of Tables
List Page

Table 1: Socio-demographic characteristics of respondents Ambo town 01 and 02 kebele, 2018

……………………………………………………………………………………………………17

Table2: Summary of enabling factors in attending ANC……………………………………….18

Table 3: Summary of reinforcing factors in ANC attendance…………………………………..19

Table 4: Responses on men participation in ANC ……………………………………………..21

List of Figure
Figure 1: Responses on source of information about ANC, Ambo town 01 and 02 kebele,
2018………………………………………………………………………………………………19
Figure 2: Male Involvements in ANC…………………………………………………………..20
Figure 3: Recommendations to improve male Involvement in ANC……………….…………. 22
ABBREVIATIONS
AIDS: Acquired Immunodeficiency Syndrome

ANC: Antenatal Care

FP: Family planning

ICPD: International Conference on Population and Development

IPPF: International Planned Parenthood Federation

MCH: Mother and Child Hospital

MMR: Maternal Mortality Ratio

NGO: Non-governmental Organization

PNC: Post- natal Care

RH: Reproductive Health

UNFPA: United Nations Population Fund

UNICEF: United Nations Children’s Fund

WHO: World Health Organization

ABSTRACT
Background: Men are not only act as decision-makers for women and children’s access to
health services, but also through abuse or neglect, men’s actions can have a direct bearing on the
health of their female partners and children. This study sought to investigate the factors
influencing male involvement in the ANTENATAL care of their pregnant partners.

The researcher was guided by the objectives of the study which included: To assess how the
socio-cultural factors influence male involvement; To evaluate the economic factors affecting
male involvement, To explore how the health related services influence male participation and,
to assess the clients’ level of awareness on the services offered in the antenatal clinic.

Objective: This study was conducted to assess factors influencing male participation in ANC in
Ambo town 01 and 02 kebele of Oromia region. The study was a cross-sectional study involving
253 men of 18 years and above who are partners of women and who attend or have ever attended
ANC in the study area.

Methods: cross sectional study design was employed to access the factors influencing male
involvement among a total of 253.The study participants were selected by using simple random
sampling technique. Data was collected by using questionnaire and interview guides. The data
collected was processed and analyzed by using scientific calculator and using tally sheet and
frequency count cross tabulation. The results were presented by using word explanation, tables,
data frequency, counts and figures.

Result: Results from this study however indicate that, male participation in ANC is very low at
34.4% whiles 65.6% of the men involved in the study had poorly attended ANC with their wives
or partners. Results from this study indicate that the educational level of men influence their
ANC attendance respondents who had some form of education had increases numbers of
accompanying wives or partners to ANC as compared to those with no formal education.
Conclusion and recommendation: Personal recommendations to improve male participation in
ANC included frequent advertisement on the TV or radio, reducing waiting time at ANC, giving
men priority at the ANC and increasing male staff at the ANC. There should be improved efforts
by stakeholders to ensure increased participation of men in their spousal participation in ANC
1. INTRODUCTION

1.1 Background of the study

Antenatal care (also known as prenatal care) refers to the regular medical and nursing care
recommended for women during pregnancy. Prenatal care is a type of preventative care with the
goal of providing regular check-ups that allow doctors or midwives to treat and prevent potential
health problems throughout the course of the pregnancy while promoting healthy lifestyles that
benefit both mother and child.(1)

Prenatal care generally consists of: monthly visits during the first two trimesters (from week 1–
28); fortnightly visits from 28th week to 36th week of pregnancy; weekly visits after 36th week
until delivery (delivery at week 38–42) and assessment of parental needs and family dynamic. At
the initial antenatal care visit and with the aid of a special booking checklist the pregnant women
become classified into either normal risk or high risk (1)

The behavior of men, their beliefs and attitudes affect the maternal health outcomes of women
and their babies. The exclusion of men from maternal health care services could lead to few
women seeking maternal health services and as a result worsening the negative maternal health
outcomes for women and children. Increasingly, recognition is growing on a global scale that
involvement of men in reproductive health policy and service delivery offers both men and
women important benefits (1,2)

Male involvement in reproductive health is a complex process of social and behavioral change
that requires men to play a more responsible role in reproductive health. It not only implies
contraceptive acceptance but also refers to the need to change men’s attitude and behavior
towards women’s health, to make them more supportive of women using health care services and
sharing child-bearing activities. Participation of men in Antenatal care leads to better
understanding between husband and wife, it reduces not only unwanted pregnancies but also
reduces maternal and child mortality in connection with pregnancy and labor by being prepared
in obstetric emergencies (2)

Male involvement in the antenatal care (ANC) clearly goes against prevailing gender norms in
many places in Sub-Saharan Africa (SSA). Reproductive health seeking was seen by men as
“women’s work”. Men saw the antenatal clinic as women’s space, and the definition and
organization of the program as fundamentally female oriented (2)

Predictably, men thought that antenatal clinic activities fell outside their area of responsibility.
Consequently, men perceived that attending the antenatal clinic would be “unmanly”. There are
different factors which have been identified in other studies as barriers to male involvement in
the ANC and they include: Health-facility factors, Cultural factors and Socio-Economic factors
(2, 4).

The failure to incorporate men in Antenatal care and other health promotion, prevention and care
programs by policy makers, program planners and implementers of maternal health services has
had a serious impact on the health of women, and the success of programs (3)

Yet the huge majority of African women are still unaware of their fundamental rights to health
and they continue to suffer from socio-economic discrimination and unwanted pregnancies
which are harmful to their health. The United Nations expert group on women and finance
estimated that 70 percent of the world’s population living on less than a dollar a day is women
(3,5)

Further, the role of men in ANC was to be elaborated in three different levels: Men as
clients, men as partners and men as agents of positive change. Following the efforts by the
ICPD, there have been a number of attempts to further buttress the need to actively involve men
in ANC. A male accompanying to attend ANC is rare and in many African communities
it is unthinkable to find male partners accompanying the pregnant woman to the labour room
(4,11)

The situation in Ethiopia is similar to what pertains in other African countries. A

cursory look at ANC attendance in any government health facility shows mostly women
in attendance. The men seen at the ANC tend to be health workers and very few men brave the
odds to accompany their partners for ANC (4).
1.2. Statement of the problem
Good care during pregnancy is important for the health of the mother and the development of the
unborn baby. Pregnancy is a crucial time to promote healthy behavior and parenting skills. Good
antenatal care links the woman and her family with the formal health system, increases the
chance of using a skilled attendant at birth and contributes to good health through the life cycle.
Inadequate care during this time breaks a critical link in the continuum of care, and affects both
women and babies. Men have traditionally not been involved in the reproductive health care of
their partners. Therefore, there has been a low and declining rate of male involvement in the
antenatal clinic in the whole country which has been a worrying trend in the reproductive health
department (4,12).

The men are mostly absent during labour and delivery yet, there are evidences suggesting that
men’s presence in the labor room shortens the period of labor and reduce the number of children
ever born with low birth weight(5). Thus, participation of men in antenatal care leads to better
understanding between husband and wife, it not only reduces unwanted pregnancies but also
reduces maternal and child mortality in connection with pregnancy and labor by being prepared
in obstetric emergencies (5,8)

The attempts at involving men in antenatal care are yet to be fully accepted by the
Ethiopian society. This is reflected in the rare participation of men in ANC, labor, post natal care
(PNC) and management of infertility. For the very few men who would want to be involved in
ANC care, existing situations (congestion in hospitals, attitude of health workers, socioeconomic
restraints) militate against their full participation. Although, research in the area of male
involvement in ANC is gaining attention recently to provide basis for appropriate
interventions to incorporate men into this very import aspect of healthcare, there is little of
such in Ethiopia. Therefore, the study seeks to investigate the factors influencing male
participation in the antenatal clinic so as to improve the antenatal care services for the family
(6,10).
1.3. Significant of the study
The behavior of men, their beliefs and attitudes affect the maternal health outcomes of women
and their babies. The exclusion of men from antenatal care services could lead to few women
seeking services and as a result worsening the negative health outcomes for women and children.
Increasingly, recognition is growing on a global scale that involvement of men in reproductive
health policy and service delivery offers both men and women important benefits (6,2)

Their involvement in the program can increase the utilization of the service by women
through encouraging their partners to visit antenatal clinic. In this regard, male partner should
be involved meaningfully for the success of the program. However, until now very little success
has been reported in the study area with regard to men’s involvement. Understanding the factors
affecting male involvement in antenatal care services in the study area is important in order for
health service managers and health workers to design interventions that will encourage and
maintain male involvement which is likely to improve maternal and child health outcomes
furthermore, information obtained from the study could serve as a base line data for further
research (7)
2 OBJECTIVES

2.1General objective
The general objective of this study is to identify prevalence and factors influencing male
involvement in ANC in Ambo town 01 and 02 kebele, 2018.

2.2 Specific objective

 To assess the prevalence of male involvement in ANC in Ambo town 01 and 02
kebele.
 To identify factors influencing male involvement in ANC in Ambo town 01 and 02
kebele
3 Literature Review

3.1 Male Involvement in Maternal Health Care Services.

The International Conference on Population and Development 1994, defined Reproductive
health as "a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system and to its
functions and process. Reproductive health therefore implies that people are able to have a
satisfying and safe sex life and that they have the capability to reproduce and the freedom to
decide if, when, and how often to do so. Implicit to this last condition are the right of men and
women to be informed and to have access to safe, effective, affordable and acceptable
methods of their choice, as well as other methods of their choice for regulation of fertility which
are not against the law, and the right of access to appropriate health care services that will enable
women to go safety through pregnancy and childbirth and provide couples with the best
chance for having healthy infant" (7,8).

Changes in both men’s and women’s knowledge, attitudes, and behavior are necessary
conditions for achieving a harmonious partnership of men and women. The role of men in
Reproductive Health will be elaborated in three different levels

Men as clients: To extend the same range of RH services to both men and women and to employ
more male Family Planning personnel.

Men as partners: To recruit men as allies and resources in improving maternal health
and

Men as agents of positive change: To work with men as sexual partners, fathers and
community leaders. It seeks to move towards gender equity by looking at the way service is
delivered to serve the interest of both men and women (8, 15)

In her report on "The role of WHO in addressing inequities between women and men", the WHO
Director General in 2005 stated the need "to involve the fathers and other male decision-
makers as well" in attempts at Reducing child mortality and improving maternal health.
Unfortunately, the role of male partners is still largely unknown and untapped in many regions
around the globe (9, 16, and 11).
With global efforts aimed at attaining the Millennium Development Goals 4 and 5, there have
been some attempts aimed at involving men on the continent in Sexual and Reproductive
Health. Studies conducted in Lesotho and Uganda identified barriers such as traditional gender
roles, fear of losing respect from their peers, lack of communication skills, lack of
knowledge and strong perceptions about masculinity (9,16)

The husband is often the primary decision maker, and wife’s economic dependence on her
husband gives him greater influence on major household decisions, as was reported in
Nepal by Britta and others where 50% of the women had the final decisions about their own
health care made by their husbands (10,15).

Studies have suggested that male involvement in maternal health results into positive
outcome for not only the pregnant woman but also for the unborn child. Social support;
especially from the husbands or family has positive effects on foetal growth. In much poorer
countries many of which have a patriarchal society, increase in male involvement during
pregnancy has been seen as a possible factor in reducing the number of children born with low
birth weight (10,8).

However despite these benefits of male involvement in maternal health care services, the
majority of interventions and services to promote SRH including care during pregnancy
and childbirth in most countries have been exclusively focused on women (11,12). Yet it is
important to assume that for all the steps leading to maternal survival there is always a man
standing by to support the spouse before, during and after each pregnancy (11, 3).

3.1.1 Male Involvement in Antenatal Care

Societal allocation of roles to the men and women especially decision making influences
utilization of ANC. It is therefore important for men to understand and appreciate the
importance of attendance of ANC, delivery at a health facility and postnatal care services
(12,15).

Only 40% of husbands accompanied their women attending ANC for the first time and
that greater decision-making power for women was associated with lower husband
accompaniment to ANC and lower overall male involvement. Other reasons reported for
low male involvement in maternal health care are that many men feel marginalized and left
outside in their contact with the mother and child care services (12,14).

In effect men’s involvement in the maternal health care system often stops at the doors to the
clinic; yet to exclude men from the information on the benefits of antenatal care,
counseling and services is to ignore the important role men’s behaviors and attitudes may
play in a woman’s maternal health choices. Male involvement in women’s decision to attend
ANC has been reported in some studies from Africa. For example according to a study
conducted in Kano Nigeria, 17.2 % of women did not attend regular ANC because of
husband denial (13).

3.1.2 Predisposing Factors

Predisposing factors are those characteristics that make an individual likely to adopt a
particular lifestyle or behavior. These are antecedents in a person’s life that motivates
behavior; his values, knowledge, attitudes and beliefs. Although general knowledge on
pregnancy related issues and available services were low among men, it was noted that
knowledge increased with age, higher educational levels and being married (13,3).

Yet in many situations in Africa where the man is economically in position to provide the basic
necessities of life he tends to have more than one wife, which also negatively affects his
willingness and ability to escort the wife to seek care. Multiple partner relationships
promotes different interests for the man and his partners and this hamper possibilities for
transparent decision making on maternal health service issues in addition to involvement in
maternal health services of all his wives when needed (14,16).

Men are often involved in multiple sexual relationships that present a considerable
challenge to fertility awareness and reproductive health programmers. Long working hours
and difficulty in taking time off work to attend services were also cited as reasons why many
men would be unable to participate in ANC care services in the study by (14,16).

3.1.3 Enabling factors

Enabling factors are the logistics aspect of obtaining healthcare. They refer to conditions that are
outside a person, but help him to either adopt or maintain a healthy lifestyle/ behavior, or
not. Anderson used enabling factors to describe factors that determine use of health services (15,
6).

The 2011 Health Survey in Malawi questioned men as to what enabling factors discouraged them
from attending ANC. Almost half of all fathers interviewed said the only available ANC was too
far, 44% thought it was not necessary, whilst 12% said it was too costly. Not surprisingly though,
27% of men interviewed denied knowledge of ANC care and thus will not use the service. In
Kenya, it was found that only 13% of women attending ANC were ever accompanied by their
partners (15, 17).

On interview, both men and women in the study identified structural and attitudinal
health service factors as well as socio cultural constraints playing a major role in „keeping
men away‟ from ANC. Women autonomy in the relationship or family have also been reported
to influence men’s participation in ANC. women autonomy was associated with lower male
involvement in pregnancy health(15)

Generally research also shows that service related factors are more important than user related
factors in affecting male involvement in maternal health care services. The most important
ones pointed out include, long physical distance from the health unit, inconvenient clinic
hours, long waiting time at the clinic, poor technical and interpersonal skills. These factors may
actively discourage men from participating in maternal health care services. In Turkey, it was
observed that health care workers were not supporting men who wanted to join in
maternal health services. The same study noted that a lot of men come to the clinic with their
wives but stop at the door to avoid interactions with health staffs. In Uganda also argued that
poor knowledge of what is done at the health facility coupled with poor communication among
spouses and the low status of women in the community greatly affect men’s utilization of ANC
services(16,17).

3.1.4 Reinforcing factors

Reinforcing factors are the positive or negative influences or feedback from others that
encourage or discourage health-related behavior change (16,6). These factors come from
the influential people around us- family, friends, peers, service providers, politicians etc.
sand they can encourage or discourage certain health related behavior. Some authorities
refer to this as social influence. For example, a man who wants to accompany his pregnant wife
to the ANC might be discouraged from doing so if no other man in the community attends ANC
(17).

Education by health workers can also be seen as reinforcing factors. Unfortunately a lot of the
education in pregnancy tends to over-concentrate on the woman leading to limited male
partner knowledge on pregnancy. The 2004Malawian Health Survey (MHS) in Malawi asked
male respondents about their knowledge on pregnancy complications. The data show that two in
three men (65%) had no knowledge of any signs or symptoms that indicate that the pregnancy
may be in danger. The most often cited sign of pregnancy complication is vaginal bleeding
(11%). Abdominal pain and swelling of hands and feet are mentioned by 8 percent each of men,
while high fever and difficult labor are mentioned by 7% and 6% of men, respectively. Studies
show that there is a general lack of interest on the part of men in some countries in Africa in their
partners‟ reproductive health (WHO, 2005). Men often do not have access to information on
maternal health issues and on their role in promoting maternal health resulting into
majority of the men having insufficient information and knowledge with regard to
maternal health.(17,16)

A study in Zimbabwe reported that, most men misinterpreted campaign messages

promoting male involvement to mean that decisions should solely be left to men. Sometimes
couple dialogue may be the problem, once there is a communication breakdown for one
reason or the other, the whole family function fails (17).
3.2 Conceptual framework

PREDISPOSING FACTORS
(Socio demographic ENABLING FACTORS
factors)
REINFORCING FACTORS  Means of accessing
 Age
 Discuss ANC with ANC
 Education level
partner  Marital status  Distance to ANC
 Knowledge of ANC  Employment  Time spent to ANC
 Knows a man who  Job status  Acceptability in
attends ANC with wife  Number of community
children  Time spent at ANC
 Religion
 Staff attitude
 ANC setting

MALE PARTNER
PARTICIPATION AT ANC
Source: Authors construct, modified from Green (2005)
4 Methods and Materials

4.1. Description of the study area and periods

Ambo is located in the western part of Oromia State, and has a latitude and longitude of
8°59′N, 37°51′E respectively. It is 114 km away from Addis Ababa and the city is also serves
as a gateway connecting Addis Ababa and the western region of Ethiopia. The total area of
Ambo is 3025Km2.

The town has 6 kebeles, 6 urban areas and 42 rural areas. As of 2018, there are 2 health
centers, 3 health posts, one general and one referral Hospital and 31 health clinics and 23
pharmacies. Number of Population Ambo town 01 and 02 kebele is64366 and 9869 households
in both kebeles. Totally, mothers had delivery before one year and mothers have pregnant up to
this data is collected 603.

4.2 Study design

Community based cross sectional study design was used

4.3 Source and study population

The study population involves men 18 years and above who are partners of women and all
mothers had birth before one year and pregnant mothers up to this data is collected Ambo town
01and 02 kebele.The study populations were all male partners who are either sexual
partners or husbands of pregnant women and mothers had birth before one year

4.4 Sample Size determination

The sample size for this study was calculated using single population proportion calculation
formula considering the following assumption.

n= [(Z α/2)2x p (1-p)]/d2, where:

n = the sample size for the study,

Zα/2= the value of Z at the 95%CI,

p = the proportion of male partner involvement in ANC which is estimated to be 20 %
(0.2),which is taken from research done at Holota town 2017

d = the margin of error.

Taking the following statistical assumption:

Zα/2= 1.96

p = 20 %,

d = 0.05,

N=number of pregnant mother and mothers had birth before one year

Non-response rate = 5%

no=245

Since our source of population is less than 10,000 correctional formula is used

(nf=no/1+no/N),nf=(245/1+245/603)=175

Accordingly, the final sample size will be calculated to be 175x5% NR+245 =253.

4.5 Sampling Technique

Systematic random sampling technique was used to select the study participants. The sampling
frame was obtained from Ambo town 01 kebele and 02 kebele of women those are pregnant up
to this data is collected and number of mothers had birth before one year, totally 603. Sampling
interval was obtained by dividing total number of source of population (603) by the sample size
(253), accordingly, every 2 households with a random start were selected from Ambo town 01
and 02 kebele until the required number is reached.

4.6 Data collection Instrument

Data was collected by interviewer by using structured questionnaires prepared in English and
translated to Afaan Oromoo by administering face to face interview and observation. The data
collection tools was adapted from the survey tools developed by JHPIEGO Maternal and
Neonatal Health Program (11) and from reviews of different relevant literatures and variables
identified to be measured. A structured, interviewer-administered questionnaire containing both
open and closed-ended questions was used to collect the data. Data was collected through face to
face interview method using structured questionnaire. Data collectors was trained for one day
on the objective, relevance and benefits of the study, confidentiality of information,
respondent’s right, informed consent and technique of interview supported with demonstration.
Data collectors were selected based on their ability to speak the local language and their
exposure to the subject under study.

4.7 Study Variables

a) Dependent variable: Male involvement (composite measure)

Male involvement were measured as a composite measure using the following 5 points
which were equally weighted:

1) The man accompany partner to health facility

2) The man discusses ANC health issues with partner

3) The man discusses ANC issues with her health care providers

4) The man provides financial and physical support to his partner

5) The man is involved in planning for ANC

b) Independent variables:

• Means of accessing ANC

 Distance to ANC
 Time spent to ANC
 Acceptability in community
 Staff attitude

• ANC setting

The independent variables were grouped as:

 Socio demographic characteristics

  Cultural factors
 Health facility factors

4.8 Operational definition

Each of the above five points were allotted a score of one (1) when a male participant
performed the activity and zero (0) when the activity is not performed. A total score was
computed for each participant and the level of involvement was categorized as good, or poor as
follows: a score of 3 - 5 was considered good level of involvement, and a score of 0 - 2 was
considered poor level of involvement. An overall level of involvement in the ANC of their
partners was also assessed by combining their scores for the two aspects of ANC care. For the
overall score, a score of 8 -15 were considered good level of involvement, and a score of 0
-7 was considered poor level of involvement.

Male involvement: In this study refers to engaging men to participate in ANC health service
together with their partners, especially in ANC settings and counseling

4.9 Data Analysis Plan

The collected data was checked for completeness and consistency. Data was entered and
analyzed using SPSS version 22 software and by manual. Factors influencing male involvement
was assessed using X2-test. The results were presented using word explanation, tables, data
frequency, counts and figures.

4.10 Data Quality Management

Questionnaires and interview guides were pre-tested for clarity, consistency and acceptability of
the questions to respondents. Following this, the necessary corrections were made and
questionnaires were finalized for the actual field work.

4.11 Ethical Consideration

Ethical clearance for the study was obtained initially from the department of public health,
college of medicine and health sciences, Ambo University. Once all these approvals granted,
informed consent were obtained from the respondents of the study. The purpose of the
study was explained to the participants, their privacy and Confidentiality was maintained.
4.12 Dissemination plan
Based on the findings, after conclusion and recommendation will be made, one copy of the
Research paper will be submitted to Ambo University department of public health ,AU library,
Ambo health Center and other responsible bodies and stakeholders who are working on the issue
of ANC around Ambo health center

5. RESULTS

5.1 Socio demographic characteristics of respondents:

The mean age of respondents was 35(SD+/- 6.29) years. Majority of the respondents were
between 24 and 35 years of age with only 11.8% being above 44 years of age. About 46.6% of
the respondents had attained primary education whereas 35.6% had had secondary school
education. 15.4% of them have attended tertiary education while five of the respondents (1.97%)
had no formal education. Religiously 50.2%, 5.1% and 39.1 of the respondents are Orthodox
Muslim and protestant respectively and about 5.5% of them were other. Most of the respondents
(91.7%) were employed and 44.2%, 52.5% of these were daily labor and Merchants respectively.
Among the respondents, majority of them (41.8%) earned less than 500 birr with 34.7 % earning
from 500 up to 1000.birr. Majority of them had<3 children and also 88.1 are married (Table 1).
Table1. Socio-demographic characteristics of respondents Ambo town 01 and 02 kebele,
2018
Variable Number Percent
Age 18-25 14 5.5
25-34 109 43
35-44 100 39.5
>44 30 11.8
Educational level Illiterates 5 1.97
Primary 118 46.6
secondary 90 35.6
Tertiary 39 15.4
Religion Orthodox 127 50.2
Muslim 13 5.1
Protestant 99 39.1
Other 14 5.5
Employment status Employed 232 91.7
unemployed 21 8.3
Main occupation Daily labor 112 44.2
Farmer 7 2.7
Merchant 133 52.5
Monthly income <500 106 41.8
500-1000 88 34.7
>1000 60 23.7
Number of Children <3 193 76.3
>3 61 24.1
Marital status Married 223 88.1
 Divorced 30 11.8

5.2 Enabling factors in attending ANC among men.

Majority of the respondents would visit the facility by means of commercial vehicle (taxi)
whereas 46.2% would walk to the facility. Majority of the respondents disclosed that they were
not aware of it was acceptable in the community to accompany their wives to ANC whereas
85.3% were of the opinion that it was acceptable.

It was also observed that, 87.7% indicated that it was acceptable among friends and family to
accompany their wives to ANC whereas 12.2% did not share that opinion. Most of the
respondents perceived programs organized at ANC as helpful (Table 2)

Table2 Summary of enabling factors in attending ANC

Variables Number Percentage
Means of going to ANC Walking 117 46.2
By taxi 124 49
Private car 12 4.7
Acceptable for man to accompany wife to Yes 216 85.3
ANC in community No 37 14.6
Acceptable among family and friends to Yes 222 87.7
accompany wife to ANC No 31 12.2
Rating of distance to the facility Far 78 30.8
Near 111 43.8
Very near 64 25.2
Perception about programs organized at Helpful 123 48.6
ANC Very helpful 124 49
Complete waste of 6 2.4
 time

5.3 Reinforcing factors in ANC attendance among men.

As shown in table below, majority of the respondents had their wives or partners ever discussing
ANC with them. About 20.5% also indicated that their wives had never discussed ANC with
them. However, on discussion of ANC with health workers and friends, majority of the men
responded no (52.9% and 17.4% respectively). Majority of the respondents had not heard about
ANC from any source whereas 33.2% said they had heard about ANC from other sources
(Table3) and (Fig1).

Table 3 Summary of reinforcing factors in ANC attendance

yes N0
Numbe
Variable Number % r %
Wife/partner 201 79.4 52 20.5
Health worker 140 55.3 103 40.7
Friend 62 24.5 191 75.5

Heard or read about ANC from any source? 100 39.5 153 60.5

Know man who attends ANC with wife/ Partners 95 37.5 158 62.5
Sources of information on ANC cited among respondents included hospital (26%), radio (28%),
and television (25%) and friends (13%) as detailed in (figure 1)

Figure 1: Responses on source of information about ANC

30%
25%
20%
15% 28%
26% 25%
10%
13%
5% 8%
0%
5.4 Men Involvement in ANC
As shown in Figure below, majority 166 (65.6%) of the respondents had poorly accompanied
their partners to antenatal clinic whereas 87(34.4%) had done so. Personal reasons for
accompanying wife to the ANC included being motivated by other men, a desire to know what
happens at ANC, as a help and support to wife, wife being sick or weak, wanted wife and baby to
be safe, being her first pregnancy and being happy with wife’s pregnancy. Among those who had
ever been to ANC, most accompanied their partners on less than three occasions during the entire
pregnancy period and majority of them spent less than 2hours at the facility. About 48.6% of the
men viewed the time spent at ANC as short. Majority of the men described the attitude of ANC
and the entire ANC setting as friendly and about 94.5% were of the opinion that accompanying
their wives or partners to ANC will motivate them to attend in timely manner as detailed
in(Table4)
Figure 2 Male Involvements in ANC

(34.4%)

(65.6%)
Table 4 Responses on men participation in ANC

Variables Frequency Percentage

Number of times during pregnancy period 1 49 19.3
2 38 15
3 57 22.5
>3 80 31.6
Time spent at ANC < one hour 123 48.6
1-2 hour 80 31.6
2-3 hour 50 19.8
Rate of time spent at the facility Long 88 34.9
Normal 120 12.2
Short 45 17.8
Perception of attitude of staff Friendly 220 86.9
Normal 29 11.4
Unfriendly 4 1.5
Perception about entire ANC setting during Friendly 68 26.8
visit Normal 177 69.9
Unfriendly 8 3.1
Pregnancy planed Yes 165 65.2
No 88 34.8
Discussing health issue relating to the Yes 155 61.3
pregnancy No 98 38.7
Believe accompanying your wife to facility Yes 235 94.5
 motivate her to attend ANC in timely manner No 18 7.1

On personal recommendations to improve male participation in ANC, some respondents cited

frequent advertisement on the TV or radio as their source of information. Other
recommendations included reducing waiting time at ANC, giving men priority at the ANC
And increasing male staff at the ANC as shown in (Figure 3)

Figure 3: Recommendations to improve male Involvement in ANC

100
80
60
40
20 52
33 25
0 12 9
en t e en ff
m en tim m sta
e sm g r la e
th rti n fo
g ive aiti ir ty gm
elin d w io in
nc ta cin
g
pr as
u en u g cr
e
Co qu d vin In
Fr
e Re Gi

6. Discussion
Factors considered under study were predisposing or socio-demographic factors, enabling factors
and reinforcing factors.
Male involvement in antenatal care services has received remarkable attention in recent years.
This is as a result of the recognition of the importance in contributing to reducing mother and
child mortalities (9). This study was done to assess the factors affecting male involvement in
ANC and identify the factors contributing to male participation in ANC.
The result in this study shows that high proportion of the women was not accompanied by their
male partners. Moreover, being out of information on ANC,lack of education, lack of discussion
about the possible pregnancy problem with their male partners.

The finding in this study show that 65.6% of the women were poorly accompanied to any of their
ANC visited and only 34.4% were accompanied by their male partners during their current visit.
The reason why they were not accompanied to the visit were identified to be a pre text of being
pre occupied with work, lack of knowledge that pregnancy could result in different
complications, a believe that the ANC is the issue of women’s only, males feeling shame to
accompany and lack of responsibility. The finding of this study is consistency with other studies
in relevant similar reason for males not to accompany their female partners during ANC visited
(13, 15-18).
Study conducted in Nepal showed that about 40% male partners accompany their partners at
ANC follow up (14). Similarly, a study conducted in Uganda revealed that 42.7% of males
accompanied their partner for ANC (16).A study from India, however indicates that only 18.33%
of male partners were reported to present during antenatal checkups (15).

It was possible to identify this study that significant numbers of current pregnancies are
unintended. The odds of partners who were not accompanied in their ANC visit were higher for
unintended pregnancy than the intended ones. If the pregnancy is unintended it leads even to
lower utilization of ANC. In supporting this studies also show that women who wanted their
pregnancy are 1.5 time more likely to have used prenatal care than wanted pregnancy (19) and
the risk of dealing ANC initiation is hearth for unwanted pregnancy than intended pregnancies
(12) accordingly lower interest of husband for unintended pregnancy and poor communication of
couple about this unintended pregnancy could explain the unaccompanied.

With regarded to women’s having discussion about health issue during pregnancy with their
male partners about 38.7% of women were reported to do so; this is very similar to a study done
in Nepal, which is 75% of women reported to discuss with their spouse(15)
Majority of the respondents believed education was inadequate, and proposed improving the
educational momentum through public education, using the mass media. Other recommendations
included reducing waiting time at ANC, giving men priority at the ANC and increasing male
staff at the ANC.
The socio-demographic and cultural characteristics of individuals are antecedents in a person's
life that motivates behavior; his values, knowledge, attitudes and beliefs. These have been
described as predisposing factors and influence health seeking behavior (13,3).
Results from this study indicate that the educational level of men influence their ANC
attendance. Whereas about 46.6% of the respondents had attained primary education 35.6% had
had secondary school education. Respondents who had some form of education had increases
numbers of accompanying wives or partners to ANC as compared to those with no formal
education. The study revealed that there was appositive association between male educated and
participation in ANC. Studies suggest that uneducated men tend to hold on to traditional beliefs
which greatly impair interposal communication leading to low male involvement in reproductive
health (13).
This could be due the fact that respondents with higher education have much access to
information about ANC and have better understanding of the importance of ANC and are able to
make positive decisions including accompanying wives or partners to ANC. According to Cutler
(15), for many health outcomes, there are positive health consequences related to increased
education and an almost linear negative relationship exists between mortality and years of
schooling and between self-reported fair/poor health status and years of schooling. An increased
level of education among husbands has the potential of not only increasing antenatal care
utilization among men but also supporting and encouraging their wives and partners. This
indicates the importance of knowledge and awareness in the utilization of health care.

Enabling factors involve the logistics aspect of obtaining healthcare and could describe factors
that determine the use of health services (15, 6). They help one to either adopt or maintain a
healthy lifestyle/ behavior, or not. Negative perceptions about programs organized at the facility
decreased the likelihood of accompanying wife or partner to the facility.
Women who have ANC follow-up for the latest pregnancy are less likely to be unaccompanied.
One study from southern Ethiopia reported that women who had used prenatal care during prior
pregnancy were 50% more likely to use prenatal care during the most recent pregnancy than
women with no prior prenatal care experience (18)

Reinforcing factors involves factors relating to the influential people around us: family, friends,
peers, and service providers etc. and provide a feedback that encourages or discourage
behavioral change (16, 6). In this study, having ever discussed ANC with a health worker or
friend and being aware of a man who attends ANC with the wife or partner significantly
influenced the decision to attend ANC.

7. CONCLUSIONS AND RECOMMENDATIONS

7.1 Conclusion

It can be concluded from the results that there is a low level of ANC attendance among men in
the study area. Men’s reasons to accompanying wives or partners to the ANC included being
motivated by other men to do so and a desire to know what happens at ANC and regard for the
safety of their wives and baby.

Male involvement in ANC was influenced by the level of education. Increased educational level
increased the likelihood of male involvement in ANC.
The study further revealed the influence of enabling factors on male participation in ANC.
Further, improving the knowledge and awareness of men on the programs organized at ANC is
an important way of improving male Involvement as men who had negative perception about
programs organized at ANC were less likely to accompany wives or partners to ANC.

Finally, It can be concluded that positive discussions about ANC with wives, friends or health
workers have positive influence on male attendance to ANC. Prior awareness of a man who has
accompanied his wife to ANC also might motivate other men to participate in ANC. Efforts to
improve male participation in ANC should revolve around improving awareness and
understanding of husbands and partners of their contribution to ensuring a positive pregnancy
outcome and reducing maternal and child mortality.
7.2 Recommendations
The following are recommendations for future health education and policy interventions to
improve male involvement in ANC;

 There should be increased efforts to improve the knowledge and understanding of men about
ANC through the use of mass media and other effective mass communication means.

 At the household level, pregnant mothers should be educated by the family head and parents
on adopting more positive inter-Spousal attitudes to enhance positive communication with
husbands and partners

 Pregnant mothers should be counseled by care providers during ANC programs to

communicate effectively on maternal health issues to their husbands to improve their
participation in ANC
 At the community level, educational programs that seek to demystify negative perceptions
about male involvement in ANC and improve understanding of the benefits of male
participation in ANC should be instituted by district and municipal public health sectors
 Men should have interest in their pregnant wives/partners and should play an active role in
ensuring positive pregnancy outcomes.
 Further studies need to explore specific societal norms and beliefs that undermine male
participation in ANC
8. REFERENCES

1. United Nations (UN): The Millennium Development Goals Report. New York: United
Nations; 2013
2. Ostllin P, Eckiman E, Marsha US, and Nkowne M, Wallstam E: General health promotion: a
multisectoral policy approach Health promotion international 2007, 21(1)...
3. Reproductive Health Promotion Working Group (RHPWG): Male involvement is key to
reproductive health MEDiCAM; 2004.
4. Reece, M.et al. (2010).Assessing male spousal engagement with prevention of mother-to-
child transmission programs in western Kenya.AIDScare, 22(6):743-50.
5. Byamugisha, R.et al. (2010).Male partner antenatal attendance and HIV testing eastern
Uganda: randomized facility based intervention trial.JIntAIDSoc 2011, 14(1):43.
6. Dudgeon MR, Inhorn MC: Men’s influence on women’s reproductive health: medical
anthropological perspectives. Social Science & Medicine 2004 59:1379-1395.
7. Farquhar, C.et al. (2004).antenatal couple counseling increases uptake of interventions to
prevent HIV .tranismision.Journal of AIDS, 37:1620-1626 Were, N. (2009).Rural finance
should target women: The new vision newspaper, Tuesday December, pg. 13.
8. Farquhar, C.et al. (2004).antenatal couple counseling increases uptake of interventions to
prevent HIV .tranismision.Journal of AIDS, 37:1620-1626 Were, N. (2009).
9. WHO, UNICEF, UNFPA and The World Bank estimates. Geneva: World Health
Organization; 2012.
10. United Nations (UN): The Millennium Development Goals Report. New York: United
Nations; 2013.
11. Dudgeon, M. &Inhorn, M. (2004).Men’s influences on women’s reproductive health:
Medical anthropological perespectives.Social science and Medicine, 59:1379-1395.
12. Drennan, M. (2007).Reproductive health: new perspectives on men’s participation
population.
13. Kakaire T, Kaye DK, Osinde MO: Male involvement in birth preparedness and complication
readiness for emergency obstetric referrals in rural Uganda. Reproductive Health 2011,
8(12): 1-7.
14. Bhatta DN: Involvement of males in antenatal care, birth preparedness, exclusive breast
feeding and immunizations for children in Kathmandu, Nepal. BMC Pregnancy and
Childbirth; 2013, 13(14):1-7.
15. VMullany BC, Hindin MJ, and Becker S: Women’s autonomy and male involvement in
antenatal care in Napal: associations and tensions. John Hopkins Bloomberg School of public
Health Baltimore USA 2004.
16. Nantamu DP: Factors associated with male involvement in maternal health care services in
jinja district, Uganda. Makerereuniversity, school of public health; 2011.
17. Lucy IK, Johanne S, Ellen C, and Address M, Alfred M: Barriers to husbands’ involvement
in maternal health care in a rural setting in Malawi: a qualitative study. Journal of Research
in Nursing and Midwifery; 2012, 1(1):1-10.
18. Biratu BT, Lindstrom DP: The influence of husbands approval on women’s use of prenatal
care: R results from Yirgalem and Jima town south west Ethiopia Etiop J HealthDev
2006,20(2):84-92.
APPENDIX A: Participant informed consent forms

Good morning, my name is ……I am a student Ambo University college of health science and I
am a data collector about male involvement in AN service utilization in Ambo town 01 and 02
kebele. The purpose of the study will provide baseline information for those interested groups or
individuals about the case. In this study the role of your active participation is important. The
interview will take only 20 minutes. Your name and identification will not be documented
because the result of the study is important for the whole community not for individual person.
Your participation in the study will be on your interest and will not have any type of payment.

Are you willing to participate?

If the answer yes continue No stop

Thank you very much!!

Appendix B: QUESTIONNAIRE
MALE PARTNER INVOLVEMENT IN ANC IN AMBO TOWN OROMIYA REGION,
ETHIOPIA

STUDY ID: ………………………… HOUSE NUMBER: …………………….

INTERVIEWER: ………………….. DATE: …………………………………..

SOCIODEMOGRAPHIC CHARACTERISTICS

1. Age: ......................................

2. Sex: 1, male 2, female

3. Marital status: Married Single =1 Separated/Divorced =2 Cohabiting =3 Other (Specify) =4

4. Educational level housewife: Illiterates =1 Primary =2 Junior Secondary =3 Senior Secondary

=4 Tertiary and above =5

5. Educational level househusband: Illiterates =1 Primary =2 Junior Secondary =3 Senior

Secondary =4 Tertiary and above =5

6. Occupation house wife = 1 Unemployed =2 Private sector =3 Government sector =4,

merchant = 5 other

7. Occupation househusband = 1 Unemployed =2 Private sector =3 Government sector =4,

merchant 5 other

8 .Monthly income in birr……..

9. Do you have a communication service? 1. TV 2. Radio 3.New paper 4. No one

10. Religion: Christianity =1 Islam =2 Protestant =3 other= 4

11. Number of children: ……………………………….

12. Age of last child (years) :< 1=1 1=2 2=3 3 =4 4 =5 5 =6

13. Family relation. 1 .parents. 2 related communities. 3. No other relation

14. Period marriages …………….

15. Did your culture influence ANC follow up? 1 yes 2 no

ANTENATAL CARE

16. Were you living together with your partner at the time of her pregnancy? Yes =1 No =2

(If no, skip to question 20)

17. Are other family members living with you? Yes =1 No =2

18. If yes, whose family member was living with you? Her mother =1 my mother =2 Siblings =3
others (specify) =4

19. Who influences male partners’ decision to get involved in ANC 1. Mother of the wife?

2 .Male partners’ mother 3 Siblings

20. Was the pregnancy planned? Yes =1 No =2

21. Did she attend antenatal clinic? Yes =1 No =2 don’t know=3

22. Did she attend antenatal clinic you are interested? 1= yes 2= no.

23 You peers can influence male partner’s involvement in ANC? 1= yes 2= no.

24. Where did she attend antenatal clinic? …………………… =1 Don’t know =2

25. Were you involved in the decision on where she had antenatal care? Yes =1 No =2

26. Did you make any joint plans for emergency situations during the pregnancy? Yes =1 No =2
(if no, skip to question 27)
27. If yes, please specify the preparation made: Put money aside for emergency =1 Made
transport arrangement=2 Decided on where to go in case of emergency =3 others (specify) =4

28. Did you ever accompany your partner to the antenatal clinic? Yes =1 No =2 (if no, skip to
question 32)

29. If yes, how many times did you accompany her? Once =1 Two – three times =2 4 or more
times =3

30. How would you describe the attitude of the staff? Friendly =1 Unfriendly =2 Indifferent =3

31. How would you assess the time you had to spend at the health facility? Reasonable =1 Too
long =2

32. If no, why were you never present? …………………………

33. What support did you provide your partner during her pregnancy? Provided funds for ANC
visits =1

Reminded her of her ANC visits =2 Helped with household chores =3 others (specify) =4

34. Did you discuss health issues relating to the pregnancy with your partner? . Yes =1 No
=2

35. Did you discuss health issues relating to the pregnancy with her health care
providers? Yes =1 No =2

36. What are the community attitudes regardless to antenatal follow up? Good=1, fair=2,
unknown=3

37. What the distance of health clinic facilities from your home? too long=1,medium=2,near=3

THANK YOU!!,