Research proposal writer
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.
