FACTORS INFLUENCING MALE INVOLVEMENT IN CARE FOR THEIR SPOUSES DURING LABOR IN KAPCHORWA HOSPITAL,
KAPCHORWA DISTRICT
ABSTRACT
The study sought to investigate the factors influencing male involvement in care for their spouses during labor and was guided by the following objectives; to assess the individual factors influencing male involvement in care for their spouses during labor, to identify the social cultural factors that influence male involvement in care for their spouses during labor and to assess health facility based factors that influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district.
A cross-sectional descriptive study design was adopted for this study, using both qualitative and quantitative methods of data collection. The study design was chosen because it helped the researcher gather key determinant factors from the sample population within a limited period of time.
The study concludes that that majority of respondents 21 (70%) had never received maternal health education, majority of respondents 17 (56.7%) said that there are cultural barriers that prevent men from accompanying their wives for delivery and another majority of the respondents 21 (70%) said that it’s not important for men to be involved in care during child birth The study further concludes that majority 27 (90%) said that they are not a aware of any policies or regulations regarding male involvement in child birth and another majority of respondents 21 (70%) said that they have never been invited by midwives while 25 (83.3%) said that they didn’t feel welcome in the labor ward and majority of respondents 16 (53.3%) said that they were told to wait outside.
In conclusion, it’s very important for men to get involved in the care of their spouses during child birth but due to social economic and cultural factors, men being the bread winners of the family, polygamy, unfriendly delivery ward environment constrains their involvement.
COPY RIGHT
This research report must not be coped either printed or reprinted without written permission from the author or public health nurse’s college kyambogo
Copyright © (2017) by (Cherotich Immaculate)
AUTHORIZATION
RULES GOVERNING USE OF STUDENT’S WRITTEN WORK FROM PUBLIC HEALTH NURSES COLLEGE
Unpublished research report submitted to Public Health Nurses College, Kyambogo are deposited in the library, are open to inspection but are to be used with regard to the rights of the authors. The author and the school of nursing grant privilege of loan or purchase of microfilm or photocopy to accredited borrowers provided credit is given in subsequent written or published work.
Author Signature………………. Date……………………..
Cherotich Immaculate
Kapchorwa District
Supervisor Signature……………… Date: ……………………
Mrs Consolata Iyogil
Public Health Nurses College
Principal’s Signature……………… Date: ……………………
Kasujja Lwanga Gertrude (Mrs)
Public Health Nurses College, Kyambogo
DEDICATION
This report is dedicated to my husband Mr Chemonges Rashid, my Mom Joina Cherop My daughter Chebet Gift Grace and to my brothers and sisters who have sacrificed so much for my education and gave me support in all ways with lots of love and my supervisor Ms Iyogil Consolata who has dedicated herself for my success.
ACKNOWLEDGEMENT
I appreciate the almighty God for enabling me to accomplish this research report
I would also like to recognize my supervisor Ms Iyogil Consolata for guidance and direction.
My sincere gratitude goes to Kapchorwa Hospital for accepting me to carry out my study at their facility and the men who accepted to respond positively during data collection I will forever be great full.
I would also like to recognize principal, teaching and nonteaching staff of PHNC for all that they did to equip me with knowledge in order to attain a diploma in midwifery.
My sincere thanks goes to my discussion group together we were able to help each other in order to archive our goal.
Finally I would also like to recognize the combined efforts of my parents and everyone whose support deserves mentioning for tireless efforts accorded to me during this course may the almighty God reword you abundantly.
TABLE OF CONTENTS
TITLE PAGE:
TABLE OF CONTENTS…………………………………………………………….vi
1.2 Statement of the Problem.. 3
1.6 Justification for the Study. 5
CHAPTER TWO: LITERATURE REVIEW… 7
2.2 Individual factors that influence male involvement in care of their spouses in labor 7
2.3 Socio- cultural factors that influence male involvement in care of their spouses in labor 9
CHAPTER THREE: METHODOLOGY.. 13
3.2 Study Design and Rationale. 13
3.3 Study Setting and Rationale. 13
3.4.1 Sample Size Determination. 14
3.5 Definition of Variables. 15
3.7 Data collection procedures. 16
3.9 Anticipated limitations of the Study. 18
4.2 Demographic data of respondents. 20
4.3 Individual factors that influence male involvement in care of their spouses in labor 22
4.4 Socio-cultural factors that influence male involvement in care of their spouses in labor 28
DISCUSSIONS, CONCLUSIONS, RECOMMENDATION AND IMPLICATIONS TO NURSING PRACTICE.. 34
5.2.1 Demographic Characteristics. 34
5.2.2 Individual factors that influence male involvement in care of their spouses in labor 35
5.2.3 Socio-cultural factors that influence male involvement in care of their spouses in labor 39
The study made the following recommendations. 42
5.4.3 To the health workers. 43
5.5 Implication to the nursing practice. 43
APPENDIX III: INTRODUCTION LETTER.. 54
APPENDIX V: MAP OF UGANDA SHOWING KAPCHORWA DISTRICT. 55
APPENDIX VI: MAP OF KAPCHORWA DISTRICT SHOWING KAPCHORWA HOSPITAL 55
Table 1 Table 1 Shows demographic data 20
Table 2 Showing where respondents were educated on maternal health. 23
Table 3 Showing respondents’ experience at the labor ward. 24
Table 4 Showing whether it’s the duty of females to escort a woman for delivery 28
Table 10 Whether respondents feel welcomed to the labor ward ……… 31
LIST OF FIGURES
Figure 1 Showing whether respondents have received any maternal health education. 22
Figure 2 Showing whether respondents had ever accompanied their spouse for child birth. 23
Figure 3 Showing whether respondents knew what ‘a mama kit’ is. 24
Figure 4 Showing what respondents understand by birth preparedness. 25
Figure 5 whether it’s acceptable for men to escort their wives for delivery. 26
Figure 6 showing what respondent’s friends say about who should escort their wives to delivery 27
LIST OF ABBREVIATIONS
CME: Continuous Medical Education
HCWs: Healthcare Workers
MCH: Maternal and Child Health
MoH: Ministry of Health
PHNC: Public Health Nurses College
SDG: Sustainable Development Goal
SSA: Sub Saharan African
UNMEB: Uganda Nurses and Midwives Examinations Board
WHO: World Health Organization
DEFINITION OF KEY TERMS
Factors: These are predisposing issues or conditions which make it very
hard for an individual to utilize something.
Involvement: Is to make sure a matter of concern or affect somebody or to
Make some body participate.
Labor: This is the process of expulsion of the fetus, placenta and it’s
Membranes through the birth canal after 28 weeks of gestation
Male involvement: The participation of male in health initiatives such as caring for
mothers in labor
Male: Is a man of the age 18 years and above having a right to
marry and start a family.
CHAPTER ONE
1.0 Introduction
This chapter presents the background of the study, problem statement, purpose of the study, specific objectives, research questions and justification for the study.
1.1 Background
Male partner involvement in care during labor is a process of bringing males into parental care of their spouses from prenatal care to the time when the child is born, particularly logistically. emotionally and financially, (Davis, Luchters & Holmes, 2013). It also has many potential benefits for both partners as it is associated with reduced maternal stress, better health outcomes for the mother and baby and ensures that men engage in future parental roles from an early stage, (Carter, 2012).
Pregnancy and childbirth could threaten a woman’s life. It is estimated that more than half a million maternal deaths occur worldwide annually, and of these, 90% occur in developing countries, hence a husbands’ role is critical in pregnancy and childbirth of women, especially in making a decision about seeking and supporting appropriate health care services, (Hogan et.al. 2010)
According to the World Health Organization. (WHO), developing countries account for 286,000 of maternal deaths as a result of preventable causes in 2015 alone, (WHO, 2015). It was noted that only 30% of every 100 mothers who attended focused antenatal care services with their spouses presented with them in labour suites. Therefore, incorporation of males into reproductive health programs is one of the initiatives to achieve safe motherhood, since this initiative could reduce maternal morbidity and mortality. (Yargawa & Leonardi-Bee, 2015).
In Sub Saharan African (SSA) countries like South Africa, male involvement in care for their spouses during labor and child birth is estimated at 23%, in Nigeria 18%, Ghana 24% and Mali 19% (Ditekemena et.al, 2012). The main barriers to participation in care were lack of knowledge on the mama kit (41.7%), lack of transport means (35.8%), and delays in seeking health facility skilled delivery, (Mullany, 2012). Other barriers included non-invitation by midwives, attaching no importance to their attendance and having a concurrent task or job demand at the same time as the spouses’ expected delivery time, (Kululanga et.al, 2012).
Tanzania continues to record the highest hospital based skilled delivery rates in East Africa with approximately 78% of pregnant women delivering at a health facility, although the opposite was true for male involvement as figures revealed that only 14% of the pregnant women presented with their partners for delivery services. (Mbekenga et.al, 201 1). In another study, many factors hindered male partner involvement in care for their spouses during labor such as lack of knowledge about delivery services, perceptions that pregnancy and child birth are the women’s exclusive concern, non-accommodative health facilities, poor reception from midwives and socio economic status of the family, (Alio et.al, 2013).
Uganda is steadily progressing towards meeting the fifth Sustainable Development Goal (SDG. 5) of abolishing all maternal deaths, but, continues to record rates at over 300 deaths per 100.000 live births with low male involvement of 18.4% during child birth, (MOH, 2010). A lot has been invested in improving maternal health services, but only a few studies have examined the importance of male involvement in care during labour, which critically influences maternal health. Little has been explored about the factors influencing male involvement in care for their spouses in labor, which calls for this study to identify these factors in Kapchorwa hospital. Kapchorwa district.
1.2 Statement of the Problem
Male partner involvement in childbirth has remained a serious challenge for safe motherhood globally,(Safe Motherhood, 2015). Despite concerted efforts by several health organisations charged with Maternal and Child Health (MCH), men’s unsupportive attitudes towards care for their spouses during labor has caused a negative impact on their spouses’ and children’s health and further complicated maternal and child mortality and morbidity, (Misra et.al, 2010).
It is estimated that although about 240 million women become pregnant each year globally, only about 12 million men get involved in care of their wives during labor and child birth. In Uganda. the Ministry of Health (MOH) has designed a strategic plan to accelerate reduction of maternal and newborn deaths in Uganda, by the year 2020. one of which is improving male involvement in care for their spouses during labour. However, the MOH (2010), report indicates that only a few (18.4%) males care, support and escort their wives during child birth, (MOH, 2010)
However, Hogan et.al, (201 1), documented that male involvement in care for their spouses during labor has many potential benefits including emotional, physical and psychological support for their partners, establish an earlier relationship between a father and his infant and could help the man to measure up and accept his responsibility as a father.
1.3 Purpose of the Study
To identify factors influencing male involvement in care for their spouses during labor in Kapchorwa hospital. Kapchorwa district so as to devise interventions to increase upon the involvement of male partners in labour and child birth.
1.4 Specific Objectives
- To assess the individual factors influencing male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district.
- To identify the social cultural factors that influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district
- To assess health facility based factors that influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district.
1.5 Research Questions
What individual factors influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district?
What are the social cultural factors that influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district?
What health facility based factors influence male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district?
1.6 Justification for the Study
The study would be useful in the following ways;
To Ministry of Health:
Recommendations from this study could be used by the ministry to improve upon sensitization programs targeted at male partners to elaborate more on the importance of their involvement in care for their partners during labour and child birth. This will be achieved by presenting a copy of the final report to the administration of Kapchorwa hospital.
To the health workers in Kapchorwa Hospital:
The study findings could greatly assist health workers in the hospital to organize and disseminate vital information during health education talks with males seeking health services on ways of improving male partner involvement in maternal health care services. This will be ensured by conducting 30 minute sessions of health education at Kapchorwa hospital.
To the administration of Kapchorwa Hospital:
The result from the study would grant sophisticated indicators for health service improvement to the board managers, decision makers and planners to fund and facilitate health education outreaches by health workers aimed at increasing male partners in maternal health care services
To the future researchers:
The study would also make important contribution to future research by providing source of literature on a similar topic. This would be ensured by disseminating a copy of the research report to the school library.
To the researcher:
The study is a partial requirement for the researcher to attain a Diploma in Midwifery by submitting a copy of the research report to Uganda Nurses and Midwives Examinations Board.
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter presents the views of other authors written about the related study and presented under subheadings derived from the research objectives that include; individual and health facility related factors influencing patients’ referrals.
2.2 Individual factors that influence male involvement in care of their spouses in labor
A study was conducted in Turkey by Gungor & Beji, (2010), to examine the effects of fathers” attendance to labor and experiences of childbirth among 142 fathers who escorted their wives to labour suites and exposed that attempts at being involved during child birth predisposed men to psychological or mental scarring. In their study majority (92.8%) male spouses were alienated from the birth process, ignored or mistreated by healthcare providers in unsupportive hospital environments, (Gungor & Beji, 2010)
A study carried out in rural Guatemala by Carter, (2012), exposed that, the level of husbands” involvement in maternal health was found to be off-balanced. Their level of financial support was high (95.8 % for antenatal care and postnatal care) but very low on the direct involvement as accompaniment for child birth (35.6%). The variations in male involvement was due to exposure to maternal health education and their maternal health knowledge, which were the main predictors of their involvement in maternal care.
Mullany, (2012), evaluated the barriers to and attitudes towards promoting husbands’ involvement in maternal health in Nepal and discovered that most (76.3%) husbands did not -» accompany their spouses to labor wards because they were not knowledgeable on the birth process, requirements for delivery kits and were often harassed by harsh and rude health workers. when they failed to provide necessary support to their spouses. The study concluded that ensuring positive healthcare provider attitudes, and providing educational support and a friendly environment to men are potential interventions to increase male involvement in pregnancy and childbirth.
Ditekemena et.al, (2012), reviewed the determinants of male involvement in maternal and child health services in 5 African countries (Malawi, Congo Brazaville, Mozambique, Ethiopia and Guinea Bissau), where they found out that, the major barrier to men’s involvement in pregnancy and child birth was the lack of knowledge on the health implications to the woman and the newborn baby. Majority of men in their study expressed that their duty was only to make the woman pregnant and issues to deal with pregnancy and child birth are purely for the woman.
Kululanga et.al, (2012), evaluated the barriers to husbands’ involvement in maternal health care in a rural setting in Malawi and found out that most (46.7%) husbands had a positive perception towards attending maternal health services with their wives but had unreceptive attitudes towards their own involvement, attributed mostly to external factors such as men’s perspectives of pregnancy as a socially constructed ‘female domain’, their lack of awareness of the importance of their involvement and perceived low accessibility to labour wards.
A study done in South-Western Uganda regarding birth preparedness by Mugisha et.al. (2013). showed that, husband’s involvement was notably low (37.6%) for some characteristics. For example, less husbands’ involvement was found in planning for transportation to the delivery place (52.1%), purchasing a safe delivery kit (21.1%), and arranging for a potential blood donor (15.5%). Most husbands in this stucfy expected that, health centers were liable for providing necessary delivery materials.
2.3 Socio- cultural factors that influence male involvement in care of their spouses in labor
Abushaikha & Massah, (20)2), evaluated the roles of the fathers during childbirth in Syria and discovered that social stigma and traditional gender roles negatively influence male involvement in care during labor. It was reported by most (56.9%) husbands in this study that even though they wanted to be more involved in taking their wives to deliver and help them with household activities during the time of labour, they feel they can not publicly present themselves in such a way because of the fear of scolding from community members and fellow men.
It was discovered in Peru that, having more than one child and polygamous marriage were negatively associated with husband’s involvement in child birth issues because husbands pay more care to their spouses’ maternal issues when the newborn is their first child or in a monogamous marriage. In a polygamous society, husbands have rigid perceptions as they do not need to be involved in maternal issues. Moreover, both having more than one child and polygamous marriage were known to be associated with lower utilization of maternal care services, (Kainz, Eliasson & Von Post, 2010).
Misra et.al, (2010), evaluated paternal contributions to birth outcomes and explained that women’s utilization of safe delivery care was considerably influenced by their husbands” concern about pregnancy and childbirth in physical, psychological, or social context. Therefore, to achieve safe motherhood, one of the critical factors is to encourage husbands to be involved in maternal health.
A qualitative study conducted in rural western Kenya on perspectives of men on delivery care service utilisation revealed that traditional gender roles and family structures remain important in Kenya, and greatly influence household practices during child birth. Moreover, husbands perceived that wives should be taken care by the female family members in the delivery period.
They explained that such roles need to be taken into account, otherwise male involvement will remain focussed on financial support and decision-making, (Kwambai et.al, 2013).
A cross-sectional pilot study by Singh et.al, (2014), to assess the factors for male involvement in maternal health care in Maligita and Kibibi districts in Uganda revealed that despite existence of a supportive policy for male involvement in child birth from Ministry of Health (MOH). men often experienced stressful situations in their attempts to be involved during pregnancy because the society viewed pregnancy and child birth as ‘a woman’s role’ which created a conflict between the policy for male involvement and the practice in the health systems.
2.4 Health facility based factors that influence male involvement in care of their spouses in labor
Alio, et.al, (2011), evaluated the policy barriers to paternal involvement during pregnancy and child birth in 48 government owned hospitals in New Zealand and discovered that most (67.9%) of these facilities had unwelcoming hospital environment characterized by lack of privacy, absence of facilities in which men would be comfortable, apparent neglect by healthcare providers, lack of communication and near-total exclusion of men from healthcare issues of their spouses at this critical time.
A longitudinal survey done by Kunene et.al, (2009), among 338 randomly selected males in South Africa revealed that on the overall men had positive attitudes towards escorting their wives for hospital delivery, but, health system factors including poor attitude of HCWs towards men escorting their wives to the labour ward was a hindering factor in male involvement and this appeared to contribute to the perception that men were not welcome at labour wards. Long waiting time and excessive costs were reported as well.
In a Nigerian study to establish the birth preparedness, complication readiness and fathers’ participation in maternity care among 148 fathers found in Ibadan General Hospital labour ward, it was exposed that they had a high level of involvement in women activities related to child birth including; escorting their wives to the health facility for delivery, arranging for where their women would deliver, and responding to the invitation to the health centre for delivery services. They noted a moderate positive correlation between Involvement of men in child delivery and health system factors, (Iliyasu et.al, 2010).
Kiwanuka, (2015), notes that nevertheless, for male involvement to be possible in the Ugandan perspective, health facilities need to be more receptive and positive about the involvement of men. Appropriate hospital policies, enough space and staffing inviting men to get involved in births would, increase the quality of care. He noted that there is need to recruit more midwives to reduce on long queues in labour wards and health education of males could be also considered to increase their knowledge on delivery matters.
CHAPTER THREE
METHODOLOGY
3.1 Introduction
This chapter presents the study design, study setting and rationale, study population, sample size determination, Sampling procedure, inclusion criteria, definitions of variables, data collection procedures, Data management and analysis, Ethical Issues, limitations of the study and dissemination of results.
3.2 Study Design and Rationale
A cross-sectional descriptive study design was adopted for this study, using both qualitative and quantitative methods of data collection. The study design was chosen because it helped the researcher gather key determinant factors from the sample population within a limited period of time.
3.3 Study Setting and Rationale
The study was carried out in Kapchorwa Hospital, Kapchorwa district located approximately 287 Kilometres to North East of Kampala. The district is bordered by Kween district to the North-east, Sironko district to the West, Bulambuli district to the East and Nakapiripirit district to the South.
Kapchorwa Hospital is a referral hospital that serves the general population. It has 14 wards, 12 out-patient clinics, 1 theatre. It offers maternal health care services such as skilled delivery, antenatal care, HIV testing and counseling, family planning among others . The hospital hosts in its wards between 1500 and 2000 patients on any given day cared for by 132 health workers and support staff, ( Kapchorwa Hospital Records, 2017).
The study setting was chosen because it was easily accessible and the researcher is well conversant with it, which would make data collection easy at the grounds of the Hospital
3.4 Study Population
For this study, the target population was males aged 18 years and above seeking health services with their wives at Kapchorwa hospital who consented to participate in the study.
3.4.1 Sample Size Determination
To compute sample size, 30 males aged 18 years and above seen in the maternal health departments at the hospital were included in the study. This particular number is the requirement as per the UNMEB guideline for the Diploma level of study.
3.4.2 Sampling Procedure
The respondents for the study were selected by the use of simple random sampling technique whereby the researcher wrote the words ‘YES’ and ‘NO’ on different pieces of paper, folded them and put in an enclosed box.
To avoid any biasness in selecting respondents, the researcher shook the box and then opened it up and gave potential respondents an opportunity to pick a paper.
Any respondent who picked a paper with the word ‘YES’ written on it was requested to participate in the study after giving voluntary consent. This continued until the total of 30 respondents is achieved.
3.4.3 Inclusion Criteria
All males aged 18 years and above in the company of their wives found in the maternal health care department of Kapchorwa hospital, who were in position to give written or verbal consent were included in the study
3.4.4 Exclusion criteria
The study excluded males above 18 years who did not consent to participate in the study or those who were less than 18 years of age (minors).
3.5 Definition of Variables
A variable refers to an attribute of interest that a researcher intends to measure, observe or control in the study.
Dependent variable:
Male involvement in the care of their spouses during labour
Independent variable:
These will include;
Individual factors that influence male involvement in care for their spouses during labor.
Social-cultural factors that influence male involvement in care for their spouses during labor Health facility based factors that influence male involvement in care for their spouses during labor
3.6 Research Instruments
The researcher used a structured questionnaire to collect data from the respondents. This type of questionnaire contained both closed and open-ended questions drafted in English. The questionnaire was pre-tested among males above 18 years found in the maternal health care ward of Chemosong health centre III, Kapchorwa district as this assisted the researcher to verify the accuracy and reliability of the tool before applying it in the area.
3.7 Data collection procedures
The researcher obtained a letter of introduction from the Principal Public Health Nurses College addressed to the Medical Superintendent, Kapchorwa Hospital, explaining the intention of the study while requesting for permission to conduct the study.
After permission was granted, the medical superintendent introduced the researcher to the departmental head from where she introduced herself and show a copy of the introductory letter from the Principal PHNC before proceeding to interview males who were the inclusion criteria.
An interview guide administered by the researcher was used to collect data from 5. males per day and covered a period of six (6) days to gather information from 30 respondents.
3.7.1 Data Management
At the end of data collection, the researcher processed the raw data for analysis and presentation. The period of data processing included data editing to reduce errors due to inaccuracies; this was done by cross checking all the questionnaires to ensure that they are properly filled in accordance to the instructions given. Those found with errors were followed up and corrected to avoid any misrepresentation of data. All questionnaires were locked away in a drawer to avoid any data loss.
3.7.2 Data Analysis
The data was first coded manually, using a pencil, rubber and paper to tally items with similar responses and finally be entered into the computer by the assistance of a data entrant, putting into concern all the variables for easy analysis using Excel 2016.
3.8 Ethical Consideration-
Respondents’ confidentiality and privacy was maintained in this study. The researcher obtained approval and authorization to conduct the study from the authorities of Kapchorwa hospital after presenting an introductory letter from the Principal PHNC. Voluntary participation of respondents was ensured as none was coerced to participate. Signed consent of participants sought before proceeding with the interviews. Refusal to participate in this study attracted no penalty neither denial of services in the hospital. The findings of the study were disseminated to the relevant authorities of Kapchorwa hospital as well as Public Health Nurses College.
3.9 Anticipated limitations of the Study
The study was carried out in a very busy hospital setting; therefore some of the males accompanying their wives to receive care might be hesitant to participate. This was overcome by carefully explaining the study purpose and benefits. The researcher sought appropriate times when the study can be carried out without inconvenience to either party.
The researcher is likely to face financial inadequacy due to excessive costs like printing study materials, transportation, and facilitation during the field study. This was resolved by working within the budget and soliciting for financial help from relatives and friends.
Language barrier proved a challenge since not all respondents understood English that was used to construct the questionnaire. The researcher sought the services of a local interpreter to relay the questions in the local language understood by respondents.
Limited time; was overcome by strictly using the work plan and adhering to study schedules.
3.10 Dissemination of Results
On completion of the study, original copies of the research report would be disseminated to: UNMEB for the award of a Diploma in Midwifery
Public Health Nurses College library
The Administration of Kapchorwa Hospital
The researcher for future reference.
CHAPTER FOUR
RESULTS
4:1 Introduction
This chapter presents results data collected from the field which is in four sections that include; demographic data, socio economic, cultural and health facility related factors
4.2 Demographic data of respondents
Table 1 Table 1 Shows demographic data
| Respondents | Frequency (n=30) | Percentage (%) |
| Age 18-25 26-35 36-45 Above 45 | 00 14 12 04 | 00 46.7 40.0 13.3 |
| Religion Catholics Protestants Moslems Others | 12 13 02 03 | 40 43.3 6.7 10 |
| Marital status Married Single Divorced Widowed | 25 03 02 00 | 83.3 10 6.7 00 |
| Level of Education No formal education Primary Level Secondary Level Tertiary/ University | 07 14 06 03 | 23.3 46.7 20 10 |
| Type of Marriage Monogamous Polygamous | 25 05 | 83.3 16.7 |
| Number of wives 2 3 ≥4 Other | 3 2 0 25 | 10 6.7 0 83.3 |
| Number of children 1-3 4-6 7 and above | 16 9 5 | 53.3 30 16.7 |
Regarding the age of the respondents, the majority14 (46.7%) were between 18 -25 years while the minority 4 (13.3%) were above 34 years.
On religion, majority of respondents 13 (43.3%) were protestants while the least 2 (6.7%) were Muslims.
According to research findings, majority of the respondents 25 (83.3%) were married while 2 (6.7%) had Divorced.
According to the findings of the study majority of respondents 14 (46.7%) had attended primary level education while minority 3 (10%) had attended tertiary and university level education.
The table above further indicates that majority of the respondents 25 (83.3%) were monogamous while minority 5 (16.7%) had polygamous families.
The results in the table above indicate that majority 25 (83.3%) were not polygamous while minority 2 (6.7%) had two wives.
The results in the study also reveal that majority of respondent 16 (53.3%) had 1-3 children while minority 5 (16.7%) had 7 and above children.
4.3 Individual factors that influence male involvement in care of their spouses in labor
Figure 1 Showing whether respondents have received any maternal health education
(n=30)
In the figure 1 above shows that majority of respondents 21 (70%) had never received maternal health education while minority 9/30 (30%) said they have received it
Table 2 Showing where respondents were educated on maternal health
(n=30)
| Response | Frequency | Percentage (%) |
| During antenatal care | 2 | 6.7 |
| Community health workshop | 3 | 10 |
| Mass media | 1 | 3.3 |
| Family and friends | 3 | 10 |
| Any other | 21 | 70 |
In the table 2 above majority of respondents 21 (70%) gave other sources of of maternal health information while minority 1 (3.3%) said mass media.
Figure 2 Showing whether respondents had ever accompanied their spouse for child birth.
(n=30)
In the figure 2 majority of respondents 24 (80) revealed that they have ever accompanied their spouses for child birth while minority 6 (20%) said they had never.
Table 3 Showing respondents’ experience at the labor ward
(n=30)
| Response | Frequency | Percentage (%) |
| Neglected from the birth process | 6 | 30 |
| Harassed and scolded by health workers | 1 | 3.3 |
| Welcomed by friendly health workers | 18 | 60 |
| Just ignored by midwives | 3 | 10 |
In the table 3 above, majority of the respondents 18 (60%) said that they were welcomed by friebdly halth workers when they accompnied their spouses for child birth while minority 1 (3.3%) said they were harassed and scolded by health by health workers.
Figure 3 Showing whether respondents knew what ‘a mama kit’ is
(n=30)
In figure 3 above majority of respondents 18 (60%) had ever heard of mama kit while 12 (40%) said they had never.
Figure 4 Showing what respondents understand by birth preparedness
(n=30)
According to figure 4 above majority of the respondents 16 (53.3%) said that birth preparedness is Availability of delivery kits, funds and transport to health facility while minority 3 (10%) said it’s Money for drugs and blood in case of Emergency conditions and bleeding
Figure 5 whether it’s acceptable for men to escort their wives for delivery
(n=30)
In figure 5 above majority of the respondents 16 (53.3%) said its not acceptable for men to escort their wives for delivery while minority 14 (46.7%) said that its not acceptable.
Figure 6 showing what respondent’s friends say about who should escort their wives to delivery
(n=30)
In figure 6 above indicate that majority of respondents 18 (60%) said that their friends think escorting their wives to delivery is a task for women while minority 2 (7%) said that those who do are charmed by their wives
4.4 Socio-cultural factors that influence male involvement in care of their spouses in labor
Table 4 Showing whether it’s the duty of females to escort a woman for delivery (n=30)
| Response | Frequency | Percentage |
| Yes | 18 | 60 |
| No | 12 | 40 |
| Total | 30 | 100 |
According to table 4 above, most of the respondents 18 (60%) said that it’s the duty of females to escort their fellow women for delivery while the least 12 (40%) said it’s not.
Table 5 whether respondents believe that it is important for men to be involved in care during child birth. (n=30)
| .Response | Frequency | Percentage |
| Yes | 21 | 70 |
| No | 9 | 30 |
| Total | 30 | 100 |
In table above majority of the respondents 21 (70%) said that it’s not important for men to be involved in care during child birth while minority 9 (30%) said it’s important.
Table 6 Showing whether there are social or cultural barriers that prevent them from accompanying their wives for delivery. (n=30)
| .Response | Frequency | Percentage |
| Yes | 17 | 56.7 |
| No | 13 | 43.3 |
| Total | 30 | 100 |
In table 6 above majority of respondents 17 (56.7%) said that there are cultural barriers that prevent men from accompanying their wives for delivery while minority 13 (43.3%) said that there are no such limitations in their culture.
Table 7 Showing whether respondents know of any benefits of accompanying your spouse to the labor ward. (n=30)
| .Response | Frequency | Percentage |
| Yes | 3 | 10 |
| No | 27 | 90 |
| Total | 30 | 100 |
In table 7 above majority of the respondents 27 (90%) of the respondents said that there are no befits of accompanying their spouses to the labor ward while minority 3 (19%) said that there are benefits in accompanying their spouses to the labor ward.
4.5 Health facility based factors that influence male involvement in care of their spouses in labor
Table 8 showing whether respondents are aware of any policies or regulations accepting them to accompany your spouse for delivery services. (n=30)
| .Response | Frequency | Percentage |
| Yes | 3 | 10 |
| No | 27 | 90 |
| Total | 30 | 100 |
In table 8 above majority 27 (90%) said that they are not aware of any policies or regulations accepting them to accompany their spouses for delivery services while minority 3 (10%) said they are aware.
Table 9 Showing whether respondents have ever been personally invited by midwives to attend the delivery of your spouse. (n=30)
| .Response | Frequency | Percentage |
| Yes | 9 | 30 |
| No | 21 | 70 |
| Total | 30 | 100 |
In table 9 above majority of respondents 21 (70%) said that they have never been invited by midwives to attend the delivery of their spouse while minority 9 (30%) said they had ever been invited.
Table 10 Whether respondents feel welcomed to the labor ward (n=30)
| .Response | Frequency | Percentage |
| Yes | 5 | 16.7 |
| No | 25 | 83.3 |
| Total | 30 | 100 |
In table 10 above majority of respondents 25 (83.3%) said that they didn’t feel welcome in the labor ward while minority 5 (16%) said that they felt welcomed
Table 11 showing how respondents would describe the facility where their spouse gave birth (n=30)
| .Response | Frequency | Percentage |
| Spacious with enough waiting rooms for men | 2 | 6.7 |
| Congested and filthy | 3 | 10 |
| No sitting space | 6 | 20 |
| Told to wait outside | 16 | 53.3 |
| Other | 3 | 10 |
| Total | 30 | 100 |
The results in the table above indicate that majority of respondents 16 (53.3%) said that they were told to wait outside while minority 2 (6.7%) said there was enough space with waiting rooms for men.
Table 12 showing the time respondents waited while their spouses were delivering before getting discharged. (n=30)
| .Response | Frequency | Percentage |
| 1-2 days | 18 | 60 |
| 3-5 days | 9 | 30 |
| 6 or more days | 3 | 10 |
| Total | 30 | 100 |
In table 12 above majority of respondents 18 (60%) said they waited for 1-2 days while minority 3 (10%) said they waited for more than 6 days.
CHAPTER FIVE
DISCUSSIONS, CONCLUSIONS, RECOMMENDATION AND IMPLICATIONS TO NURSING PRACTICE
5.1 Introduction
This chapter presents the discussions, conclusions, recommendations of the study and implication to the nursing practice.
5.2 Discussion of results
5.2.1 Demographic Characteristics
Regarding the age of the respondents, the majority 14 (46.7%) were between 18 -25 years while the minority 4 (13.3%) were above 34 years which implies that the researcher acquired information from mature respondents whom she expects to provide accurate information.
On religion, majority of the respondents 13 (43.3%) were protestants while the least 2 (6.7%) were Muslims this implies that the factors that influence men involvement care for their spouses during labor cuts across all religion but for this study the protestant religion was dominant.
According to research findings, majority of the respondents 25 (83.3%) were married while 2 (6.7%) had Divorced. This implies that most of the respondents had ever experienced child birth and gave reliable information.
According to the findings of the study majority of respondents 14 (46.7%) had attended primary level education while minority 3 (10%) had attended tertiary and university level education implying that majority of the respondents had attended formal education and were able to read and interpret the research questions. This also enables them not to entirely follow their religious and cultural norms to take decisions of adopting new
Majority of respondents 25 (83.3%) were monogamous while minority 5 (16.7%) had polygamous families. Implying that men had time to get involved in care for their spouses during child birth but due to cultural practices, they could not get involved and because they believed that it’s not their work.
The results in the study indicate that majority 25 (83.3%) were not polygamous while minority 2 (6.7%) had two wives. This implies that most of the respondents were able to get involved in the reproductive health of their spouses.
The results in the study also reveal that majority of respondent 16 (53.3%) had 1-3 children while minority 5 (16.7%) had 7 and above children. This meant that the study population were well aware of the challenges that come with child birth.
5.2.2 Individual factors that influence male involvement in care of their spouses in labor
The results shows that majority of respondents 21 (70%) had never received maternal health education while minority 9 (30%) said they have received it. This is contrary to Carter, (2012), who in his study carried out in rural Guatemala revealed that variations in male involvement was due to exposure to maternal health education and their maternal health knowledge, which are the main predictors of their involvement in maternal care. The level of husbands” involvement in maternal health was found to be off-balanced. Their level of financial support was high (95.8 % for antenatal care and postnatal care) but very low on the direct involvement as accompaniment for child birth (35.6%).
The results in the study futher revealed that majority of respondents 21 (70%) gave other sources of of maternal health information while minority 1 (3.3%) said mass media which is commonly used in Uganda. This implies that very few respondents were exposed to marternal health information from mass media which is commonly used in Uganda which is in line with Ditekemena et.al, (2012), who reviewed that determinants of male involvement in maternal and child health services in 5 African countries (Malawi, Congo Brazaville, Mozambique, Ethiopia and Guinea Bissau), where they found out that, the major barrier to men’s involvement during pregnancy and child birth was the lack of knowledge on the health implications to the woman and the newborn baby.
The findings also show that majority of the respondents 24 (80%) revealed that they have ever accompanied their spouses for child birth wholle minority 6 (20%) said they have never. This is in line with Ditekemena et.al, (2012) who revaled in his study in 5 African countries (Malawi, Congo Brazaville, Mozambique, Ethiopia and Guinea Bissau) that majority of men expressed that their duty was only to make the woman pregnant and issues to deal with pregnancy and child birth are purely for the woman.
The results further revealed that, majority of respondents 18 (60%) said that were welcomed by friebdly halth workers when they accompnied their spouses for child birth while miority 1 (3.3%) said they were harassed and scolded by health workers. Which is in line with Gungor & Beji, (2010) who carried out a study in Turkey among 142 fathers who escorted their wives to labour suites and exposed that majority (92.8%) male spouses were alienated from the birth process,, ignored or mistreated by healthcare providers in unsupportive hospital environments, (Gungor & Beji, 2010)
The findings of the study reveal that majority of respondents 16 (53.3%) said its not acceptable for men to escort their wives for delivery while minority 14 (46.7%) said that its not acceptable. Thyis is in line with A study was conducted in Turkey by Gungor & Beji, (2010), to examine the effects of fathers” attendance to labor and experiences of childbirth among 142 fathers who escorted their wives to labour suites and exposed that attempts at being involved during child birth predisposed men to psychological or mental scarring. In their study majority (92.8%) male spouses were alienated from the birth process
Concerning the acceptability of men to escort their wives to delivery, majority of respondents 16 (53%) said “that its ladies work to take their fellow ladies for delivery while some others said it’s not appropriate and uncomfortable for them to go”.
The results indicate that majority of respondents 18 (60%) said that their friends think escorting their wives to delivery is a task for women while minority 2 (7%) said that those who do are charmed by their wives
According to the results in the study, majority of the respondents 18 (60%) said that it’s the duty of females to escort their fellow women for delivery while the least 12 (40%) said it’s not anyone can take that role
The reasons why some respondents believed that it’s a female’s duty to escort their fellow women for delivery were
- That women know better how to handle fellow women in times of pregnancy than men.
- Experience was also another reason given; that since some of these females have ever delivered, they can easily help a fellow woman in labor pains
This contradicts with Iliyasu et.al, (2010), in his study in Nigeria to establish the birth preparedness, complication readiness and fathers’ participation in maternity care among 148 fathers found in Ibadan General Hospital labour ward exposed that they had a high level of involvement in women activities related to child birth including; escorting their wives to the health facility for delivery, arranging for where their women would deliver, and responding to the invitation to the health center for delivery services. They noted a moderate positive correlation between Involvement of men in child delivery and health system factors.
5.2.3 Socio-cultural factors that influence male involvement in care of their spouses in labor
According to the results in the study, majority of the respondents 21 (70%) said that it’s not important for men to be involved in care during child birth while minority 9 (30%) said it’s important. This is in line with Mugisha et.al. (2013) who stated that limited information about the benefits of men involvement in child birth has blinded men from realizing that its very necessary for them to be around their spouses during child birth.
Respondents argued that it’s not important for them to be involved during child birth because during that time they are busy arranging the home and looking for money to cater for the mother after delivery. Meanwhile those who said yes never gave reasons why.
The results reveal that majority of respondents 17 (56.7%) said that there are cultural barriers that prevent men from accompanying their wives for delivery while minority 13 (43.3%) said that there are no such limitations in their culture. This corresponds with Kululanga et.al, (2012), who evaluated the barriers to husbands’ involvement in maternal health care in a rural setting in Malawi and found that majority (46.7%) husbands had a positive perception towards attending maternal health services with their wives but had unreceptive attitudes towards their own involvement, attributed to external factors such as men’s perspectives of pregnancy as a socially constructed ‘female domain’, their lack of awareness of the importance of their involvement and perceived low accessibility to labor wards.
The reason why respondents believed that there are social or cultural barriers that prevent them from accompanying their wives for delivery were; socially/gender roles dictate that men should ensure that they provide only financial support for their wives in times of delivery and they don’t need to escort them to the hospital during delivery therefore majority 17 (56.7%) of the respondents decided to keep on with that tradition.
5.2.4 Health facility based factors that influence male involvement in care of their spouses in labor
The findings in the study revealed that majority 27 (90%) said that they are not aware of any policies or regulations accepting them to accompany their spouses for delivery services while minority 3 (10%) said they are aware. This corresponds with Kainz, Eliasson & Von Post, (2010), who stated that health workers should set policies that compels men to accompany their wives for antenatal care and during child birth.
The findings further revealed that majority of respondents 21 (70%) said that they have never been invited by midwives to attend the delivery of their spouse while minority 9 (30%) said they had ever been invited. This is contrary to the study carried out by Misra et.al, (2010), which revealed that in Turkey nurses always invite husbands to get involved in the process of child birth.
The results in the study revealed that majority of respondents 25 (83.3%) said that they didn’t feel welcome in the labor ward while minority 5 (16%) said that they felt welcomed this is in line with Kwambai et.al, (2013), who lamented that much as some men wanted to be with their wives during child birth, they stated that labor wards are so chaotic that men are not welcomed inside.
According to the findings majority of respondents 16 (53.3%) said that they were told to wait outside while minority 2 (6.7%) said there was enough space with waiting rooms for men. This corresponds with Kunene et.al, (2009), in their study among 338 randomly selected males in South Africa revealed that on the overall, men who had positive attitudes towards escorting their wives for hospital delivery stated that men should stay outside the labour ward since their presence may cause more problems.
5.3 Conclusion
The study concludes that that majority of respondents 21 (70%) had never attended to maternal health education, another 21 (70%) gave other sources of of maternal health information while minority. majority of respondents 24 (80%) revealed that they have never accompanied their spouses for child birth and 18 (60%) said that were welcomed by friebdly halth workers when they accompnied their spouses for child birth.
The study revealed that majority of respondents 17 (56.7%) said that there are cultural barriers that prevent men from accompanying their wives for delivery and another majority 21 (70%) of the respondents said that it’s not important for men to be involved in care during child birth
The study further concludes that majority 27 (90%) said that they are not a aware of any policies or regulations regarding male involvement in child birth and another majority of respondents 21 (70%) said that they have never been invited by midwives while 25 (83.3%) said that they didn’t feel welcome in the labor ward and majority of respondents 16 (53.3%) said that they were told to wait outside
In all men don’t accompany their spouses during labor because of social-cultural factors and also healthy facility factors that are not conducive that prohibit them to do so.
5.4 Recommendation
The study made the following recommendations
5.4.1 To the government
The study recommended that government of Uganda should invest in awareness campaign programmes that will facilitate hospitals all over the country to carry out massive training and improve on antenatal care services that will involve men. Also improve infrastructures that promotes privacy even when men are in the labor ward because lack of space to maintain privacy makes health workers to chase men out of labor ward for the sake of other women who are not their wives but they have come to deliver.
5.4.2 Kapchorwa Hospital, Kapchorwa District
The study recommended that the hospital management should carry out refresher training programmes that will improve on the skills of their health workers to be able to encourage men who are willing to be there with their wives during delivery.
5.4.3 To the health workers.
The study recommended that health workers should act professionally while sensitizing men and women who attend antenatal care and inform them that it’s ok for men to get involved and don’t leave everything to their female counterparts.
5.4.4 To husbands
The study further recommends that husbands should pay attention to health workers advices and take part in the birth of their children.
5.5 Implication to the nursing practice
The study recommends nurses to counsel men on the benefits of getting involved when their wives are delivering.
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APPENDICES
APPENDIX I CONSENT FORM
Information to respondents
I Cherotich Immaculate a student of Public Health Nurses’ College Kyambogo carrying out a study to identify factors influencing male involvement in care for their spouses during labor in Kapchorwa hospital, Kapchorwa district so as to devise interventions to increase upon the involvement of male partners in labor and child birth.
Privacy and Confidentiality. You are requested voluntarily to consent and participate in the study and numbers will be used instead of names to ensure that the information given will be kept confidential.
Time to be taken for interview. The interview only 15-30 minutes of your time
Researcher’s signature……………………………Date………….
Right not to participate. All men above 18 and have accompanied their wives for delivery.
Monetary benefits. Once you participate in this study there is no any payment
I have explained the purpose and objective of the study to the participant and they have understood and voluntarily consented to participate in the study.
The topic and its objectives have fully been explained to me; I have understood and voluntarily agreed to participate in the study.
Signature or thumb print of Respondent:…… ……………… Date………………………
APPENDIX II QUESTIONNAIRE
I am Cherotich Immaculate, a student of Public Health Nurses’ College pursuing a Diploma in Midwifery. I am carrying out a study on the Factors Influencing Male Involvement in Care for their Spouses during Labor in Kapchorwa Hospital, Kapchorwa District
Respondents No:………………………. Date:………………………
Instructions
Do not put your name on this questionnaire.
Tick the correct answer provided OR fill in the space provided.
Section A: Social Demographic Characteristics
- Age
- 18-25 years [ ]
b. 26-35 years [ ]
c. 36- 45 years [ ]
d. 46 years and above [ ] - Religion
- Catholic [ ]
b. Protestant [ ]
c. Muslim [ ]
d. Any other (Specify) …………………………… - Marital status
- Single [ ]
b. Married [ ]
c. Divorced [ ]
d. Any other (Specify)………………………………….. - Level of education
- No formal education [ ]
b. Primary level [ ]
c. Secondary level [ ]
d. Tertiary / University [ ] - Type of marriage
- Monogamous [ ]
b.Polygamous [ ]
- If polygamous (In Qn. 5 above), how many wives do you have?
a. 2 wives [ ]
b. 3 wives [ ]
c. More than 4 wives [ ] - Mow many children do you have?
- 1-3 children [ ]
- 4-6 children [ ]
- 7 and above [ ]
Section B: Individual factors that influence male involvement in care of their spouses in labor
- Have you received any maternal health education?
- Yes [ ]
- No [ ]
- If yes, where were you health educated on maternal health?
- During antenatal care visits with spouse [ ]
- Community health workshops [ ]
- Mass media [ ]
- Family and friends [ ]
- Any other (Specify)…………………………………………
- Have you ever accompanied your spouse for child birth?
- Yes [ ]
- No [ ]
- If yes, what was your experience at the labour ward?
- Neglected from the birth process [ ]
- Harassed and scolded by health workers [ ]
- Welcomed by friendly health workers [ ]
- Just ignored by midwives [ ]
- Do you know what ‘a mama kit’?
- Yes [ ]
- No [ ]
- What do you understand by birth preparedness?
- Availability of delivery kits, funds and transport to health facility [ ]
- Money for transport to the health facility [ ]
- Money for drugs and blood in case of transfusion [ ]
- Nothing, God is in control [ ]
- In your opinion, is it acceptable for men to escort their wives for delivery?
- Yes [ ]
- No [ ]
- If no, give reasons to support your answer
……………………………………………………………………………………………………………………………………………………………………………………
- What do your friends say to men who escort their wives to deliver?
- It is a task for women [ ]
- They are charmed by their wives [ ]
- They are idle and disorderly [ ]
- Others (specify)………………………………………………………………………….
Section C: Socio-cultural factors that influence male involvement in care of their spouses in labor
- Is it generally the duty of females to escort a woman for delivery?
- Yes [ ]
- No [ ]
- If yes, give reasons to support your answer?
……………………………………………………………………………………………………………………………………………………………………………………
- Do you believe that it is important for men to be involved in care during child birth?
- Yes [ ]
- No [ ]
- If no, give reasons why
……………………………………………………………………………………………………………………………………………………………………………………
- If yes, please give explanations to support your answer
……………………………………………………………………………………………………………………………………………………………………………………
- Are there social or cultural barriers that prevent you from accompanying your wife for delivery?
- Yes [ ]
- No [ ]
If yes, what are some of those?
……………………………………………………………………………………………………………………………………………………………………………………
- Do you know of any benefits of accompanying your spouse to the labor ward?
- Yes [ ]
- No [ ]
- If yes, what are some of the benefits?
……………………………………………………………………………………………………………………………………………………………………………………
Section D: Health facility based factors that influence male involvement in care of their spouses in labor
- Are you aware of any policies or regulations accepting you to accompany your spouse for delivery services?
- Yes [ ]
- No [ ]
- Have you been personally invited by midwives to attend the delivery of your spouse?
- Yes [ ]
- No [ ]
- If yes, did you feel welcomed to the labour ward?
- Yes [ ]
- No [ ]
- If no, please explain
- How would you describe the facility where your spouse gave birth?
- Spacious with enough waiting rooms for men [ ]
- Congested and filthy [ ]
- No sitting space [ ]
- Told to wait outside [ ]
- Any other (specify)………………………………………………………..
- What was your waiting time at the labour ward before you were discharged?
- 1-2 days [ ]
- 3-5 days [ ]
- 6 or more days [ ]
Thank you for your precious time. God Bless you.
APPENDIX III: INTRODUCTION LETTER
