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Male Participation in Pregnancy and Delivery in Nigeria: A Survey of


Antenatal Attendees

Article  in  Journal of Biosocial Science · April 2009


DOI: 10.1017/S0021932009003356 · Source: PubMed

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J. Biosoc. Sci., (2009) 41, 493–503,  2009 Cambridge University Press
doi:10.1017/S0021932009003356 First published online 23 Mar 2009

MALE PARTICIPATION IN PREGNANCY AND


DELIVERY IN NIGERIA: A SURVEY OF
ANTENATAL ATTENDEES

O. OLAYEMI, F. A. BELLO, C. O. AIMAKHU, G. O. OBAJIMI 


A. O. ADEKUNLE

Department of Obstetrics and Gynaecology, University of Ibadan, Ibadan, Nigeria

Summary. This was a cross-sectional study carried out on 462 pregnant


women attending antenatal care in Ibadan, Nigeria. The study’s aims were to
assess the level of participation of Nigerian men in pregnancy and birth, the
attitude of the women and likely targets for improved care delivery. Three
hundred and forty-nine women (75.5%) were aware that husbands could
participate in childbirth. Most women did not think it was their husbands’
place to attend antenatal clinic (48.3%) or counselling sessions (56.7%).
Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic
– paying antenatal service bills (96.5%), paying for transport to the clinic
(94.6%) and reminding them of their clinic visits (83.3%). Three hundred and
thirty-five husbands (72.5%) accompanied their wives to the hospital for their
last delivery, while 63.9% were present at last delivery. More-educated women
were less likely to be accompanied to the antenatal clinic, while more-
educated men were likely to accompany their wives. Yoruba husbands were
less likely to accompany their wives, but Yoruba wives with non-Yoruba
husbands were 12 times more likely to be accompanied. Women in the rural
centre were less likely to receive help with household chores from their
husbands during pregnancy, while educated women were more likely to
benefit from this. Monogamous unions and increasing level of husbands’
education were associated with spousal presence at delivery. It appears that
male participation is satisfactory in some aspects, but increased attendance at
antenatal services and delivery would be desirable.

Introduction
The participation of the male partner in childbirth (family labour/delivery) has
evolved over time. In modern times, given the choice, many men are willing to attend
and support their partners (Leavitt, 2003). A survey on Salvadoran men (Carter &
Speizer, 2005) identified wanted pregnancies, couples living together, higher level of
male partner’s education/socioeconomic class and urban residence as associations of
male participation. Male participation ideally starts from pregnancy; involvement in
493
494 O. Olayemi et al.
antenatal visits and childbirth classes has been shown to increase their willingness to
attend the delivery (Wieglos et al., 2007). Male participants have different attitudes to
family birth, ranging from eagerness (Chan & Peterson-Brown, 2002; Carter Speizer,
2005), even actively protesting hospital policies that bar them from participating,
according to a mid-20th century history review in the US (Leavitt, 2003), to
acquiescing simply to please their partner (Rykowska-Pierzchala et al., 2001). Most
men claim that the decision to be at delivery was theirs, not their wives’. An Indian
study concluded that men believed the health of a woman during pregnancy is her
husband’s responsibility, but physical and moral support should be from other
women. Socio-cultural restrictions impeded them accompanying their wives to clinic
visits or being present at delivery (Khan et al., 1997). It appears that hospital policies
and staff’s hostile attitude to male ‘intrusion’ in the labour room still contribute to
limit family delivery (Dragonas, 1992; Khan et al., 1997; de Carvalho, 2003). For their
own part, women often want their partners to attend labour. Some studies concluded
that both partners felt their relationships with each other had improved following
their shared experiences irrespective of mode of delivery (Dragonas, 1992; Chan &
Peterson-Brown, 2002). Yet, some of them prefer a traditional delivery. Reasons
proffered include that men would be out of place in the labour ward and that the
experience may adversely affect their sexual relationship afterwards (Hung et al., 1997;
Wieglos, 2007).
One-to-one support in labour, according to the Cochrane Review, has been shown
to be beneficial, in that women who experienced continuous support during labour
were more likely to give birth without using analgesia or anaesthesia, less likely to
have a Caesarean or instrumental vaginal birth, and less likely to report dissatisfac-
tion with their childbirth experiences (Hodnett et al., 2006). The review looked at
female support in labour, though, and the place of male support has been less studied.
From a wider public health view, maternal mortality has remained a scourge of
the developing world; the current figure for Nigeria is 1100 per 100,000 live births
(WHO, 2007). Greater emphasis has been put on its non-medical causes and avenues
for stemming them. A great contributor to Phase I delay (that is, delay in making the
decision to seek medical care) is the fact that male partners make decisions in most
families, including those related to health and reproductive care. In many cases, the
woman (the partner at direct risk) is not empowered to make these decisions. Other
benefits include those demonstrated by a study on antenatal blood donation by
husbands (an option often explored where voluntary blood donation is low), which
showed that they were more likely to donate when they participated in antenatal
programmes (Obi, 2007).
This study aims to assess the level of pregnancy and birth participation in
Nigerian men, the possible associations, the attitude of the women and likely targets
for improved care delivery.

Methods
This was a descriptive hospital-based, cross-sectional study carried out on pregnant
women attending antenatal care in three government-owned health facilities in
Ibadan, in Yoruba-speaking south-western Nigeria: Idi-Ogungun Maternity Centre
Male participation in pregnancy and delivery in Nigeria 495
(IMC; a primary care facility), Adeoyo Maternity Hospital (AMH; secondary) and
University College Hospital (UCH; tertiary), catering for rural, semi-urban and urban
populations, respectively. A total sample of all consenting clients from 28th April to
9th May 2008 was taken. Nulliparous women were excluded, as information on their
previous experience with deliveries was sought. The instrument used was a 48-item
interviewer-administered questionnaire, which elicited information on the couple’s
biodata, the women’s knowledge of and attitude towards male participation, and the
practice of their male partners in this respect.
The outcome variables were: husbands’ participation in household chores,
attendance at antenatal care and attendance at delivery. Explanatory variables were
age of respondents, educational attainments, ethnicity and occupations of both
husbands and wives.
Data was entered into Microsoft Excel spreadsheets and imported into Stata
software for analysis. Categorical variables were analysed using the 2 (Fisher’s exact)
test while continuous variables were analysed by t test for both equal and unequal
variance using the variance ratio function of the Stata software to determine the
appropriate use of the Satterthwaite correction for the degrees of freedom. Multi-
variate analyses were performed by multiple logistic regressions. Level of statistical
significance was at p<0.05 for all the analyses.

Results
Demographic data
Four hundred and sixty-two women were surveyed, with a mean age of 30.5 (95%
CI 30.0–31.0) years. Mean parity was 2. Table 1 shows the demographic character-
istics of the respondents and Table 2 shows that of their husbands.

Participation of husbands during pregnancy


Three hundred and forty-nine women (75.5%) were aware that husbands could
participate in childbirth. Of these, most of them were educated by nurses (35.5%).
Older respondents were more likely to be aware of the concept (p<0.01), as were
UCH patients (p<0.01). Parity was not associated with awareness. Nearly all
husbands (450, i.e. 97.4%) encouraged their wives to attend antenatal clinic – paying
for the antenatal service bills (96.5%), paying for transport to clinic (94.6%) and
reminding them of their clinic visits (83.3%). Many husbands also encouraged their
wives to take adequate nutrition (96.5%) and helped with household chores during the
pregnancy (86.1%). Table 3 shows that respondents were more likely to be assisted at
home if they attended the urban centre, if they were in their late 20s and if the couples
had at least tertiary education. However, less than half of the husbands (44.4%)
accompanied their wives to antenatal clinics. Table 3 shows that husbands from the
minority tribes were the most likely to do this.

Participation of husbands during last delivery


Three hundred and thirty-five husbands (72.5%) accompanied their wives to the
hospital for their last delivery, while 63.9% were present at delivery. Again, couples
496 O. Olayemi et al.
Table 1. Demographic characteristics of respondents

Variable UCH AMH IMC Total


n (%) n (%) n (%)

Age group
%20 0 (0) 8 (4.2) 1 (1.3) 9 (2.0)
21–25 16 (8.1) 51 (27.0) 11 (14.5) 78 (16.9)
26–30 75 (38.1) 49 (25.9) 25 (32.9) 149 (32.2)
31–35 71 (36.1) 61 (32.3) 30 (39.5) 162 (35.1)
36–40 28 (36.1) 16 (8.5) 7 (9.2) 51 (11.0)
>40 7 (3.5) 4 (2.1) 2 (2.6) 13 (2.8)
Parity
1 75 (38.3) 64 (33.9) 28 (36.9) 167 (36.2)
2 75 (38.3) 73 (38.6) 27 (35.5) 175 (38.0)
3 25 (12.8) 27 (14.3) 14 (18.4) 66 (14.3)
R4 21 (10.7) 25 (13.2) 7 (9.2) 53 (11.5)
Wife’s ethnicity
Yoruba 167 (84.8) 183 (96.9) 62 (81.6) 412 (89.2)
Hausa 2 (1.0) 1 (0.5) 1 (1.3) 4 (0.9)
Ibo 18 (9.1) 4 (2.1) 9 (11.8) 31 (6.7)
Other 10 (5.1) 1 (0.5) 4 (5.3) 15 (3.2)
Wife’s education
None 1 (0.5) 7 (3.7) 1 (1.3) 9 (1.9)
Primary 6 (3.1) 31 (6.4) 11 (14.5) 48 (10.4)
Secondary 24 (12.2) 78 (41.3) 24 (31.6) 126 (27.3)
Undergraduate 16 (8.1) 30 (15.9) 7 (9.2) 53 (11.5)
Tertiary 150 (76.1) 43 (22.7) 33 (43.4) 226 (48.9)
Wife’s occupation
Teacher 30 (15.2) 23 (12.2) 7 (9.2) 60 (13.0)
Artisan 6 (3.0) 28 (14.8) 15 (19.8) 49 (10.6)
Civil servant 36 (18.3) 24 (12.7) 14 (18.4) 74 (16.0)
Trader 36 (18.3) 14 (7.4) 9 (18.4) 59 (12.8)
Professional 48 (24.4) 86 (45.5) 20 (26.3) 154 (33.3)
Other 41 (20.8) 14 (7.4) 11 (14.5) 66 (14.3)
Total 197 (42.6) 189 (40.9) 76 (16.5) 462

IMC, Idi-Ogungun Maternity Centre; AMH, Adeoyo Maternity Hospital; UCH, University
College Hospital.
with higher education were more likely to share this experience (Table 3). Most of
these women admitted to benefiting from their partner’s presence (although there was
no statistically significant advantage), most citing emotional support as the main
benefit. Almost half of the respondents (45.9%) stated that the attending health
workers resisted their husband’s presence at delivery.

Attitude to male participation


The attitude of the respondents to various forms of male participation was sought
(Table 4). Most women did not think it was their husband’s place to attend antenatal
Male participation in pregnancy and delivery in Nigeria 497
Table 2. Demographic characteristics of husbands

Variable UCH AMH IMH Total


n (%) n (%) n (%)

Age group
%20 0 (0.0) 1 (0.5) 0 (0.0) 1 (0.2)
21–25 0 (0.0) 12 (6.3) 1 (1.3) 13 (2.8)
26–30 16 (8.1) 41 (21.7) 15 (19.7) 72 (15.6)
31–35 72 (36.6) 55 (29.1) 23 (30.3) 150 (32.5)
36–40 58 (29.4) 43 (22.8) 21 (27.6) 122 (26.4)
>40 51 (25.9) 37 (19.6) 16 (21.1) 104 (22.5)
Ethnicity
Yoruba 158 (80.2) 184 (97.3) 66 (86.9) 408 (88.3)
Hausa 2 (1.0) 2 (1.1) 1 (1.3) 5 (1.1)
Ibo 23 (11.7) 2 (1.1) 7 (9.2) 32 (6.9)
Other 14 (7.1) 1 (0.5) 2 (2.6) 17 (3.7)
Education
None 1 (0.5) 3 (1.6) 3 (4.0) 7 (1.5)
Primary 2 (1.0) 14 (7.4) 4 (5.3) 20 (4.3)
Secondary 13 (6.6) 79 (41.8) 21 (27.6) 113 (24.5)
Undergraduate 12 (6.1) 13 (6.9) 8 (10.5) 33 (7.1)
Tertiary 169 (85.8) 80 (42.3) 40 (52.6) 289 (62.6)
Occupation
Teacher 14 (7.1) 19 (10.1) 5 (6.6) 38 (8.2)
Artisan 12 (6.1) 53 (28.0) 13 (17.1) 78 (16.9)
Civil servant 50 (25.4) 36 (19.1) 26 (34.2) 112 (24.2)
Trader 28 (14.2) 43 (22.7) 10 (23.7) 89 (19.3)
Professional 73 (37.1) 29 (15.3) 9 (11.8) 111 (24.0)
Other 20 (10.1) 9 (4.8) 5 (6.6) 34 (7.4)
Total 197 (42.6) 189 (40.9) 76 (16.5) 462

clinic (48.3%) or the counselling sessions (56.7%). They did, however, expect them to
be responsible for paying the hospital bills, attend the delivery and to be involved in
decision-making as regard the pregnancy and childbirth. Most (93.7%) would discuss
their provider’s health advice with their husbands, and most (68.2%) would prefer
their husband to a female relative at delivery (p<0.01). Most women (65.9%) would
make a decision in their partner’s absence in an emergency (p<0.001); others (13.0%)
would allow another relative to make the decision, while 13.2% would wait for their
partner’s return. A few respondents (6.1%) felt they could not anticipate their
behaviour in this instance.

Logistic regression analysis


When adjusted for age, education, ethnicity, religion, plurality of marriage
relationship and location of facility, more-educated women were less likely to be
498
Table 3. Husbands’ participation in household chores, attendance at antenatal clinic and attendance at delivery

Household chores Attendance at antenatal clinic Attendance at delivery


Yes No p Yes No P Yes No p
n (%) n (%) n (%) n (%) n (%) n (%)

Centre
UCH 182 (92.4) 15 (7.6) 0.001 99 (50.2) 98 (49.8) 0.073 99 (50.2) 98 (49.8) 0.227
AMH 158 (83.60) 31 (16.4) 78 (41.3) 111 (58.7) 78 (41.3) 111 (58.7)
IMH 58 (76.3) 18 (23.7) 28 (36.8) 48 (63.2) 28 (36.8) 48 (63.2)
Age group

O. Olayemi et al.
%20 7 (77.8) 2 (22.2) 0.006 6 (66.7) 3 (33.3) 0.543 6 (66.7) 3 (33.3) 0.559
21–25 57 (73.1) 21 (26.9) 38 (48.7) 40 (51.3) 38 (48.7) 40 (51.3)
26–30 137 (92.0) 12 (8.0) 67 (45.0) 82 (55.0) 67 (45.0) 82 (55.0)
31–35 141 (87.1) 21 (12.9) 70 (43.2) 92 (56.80) 70 (43.2) 92 (56.80)
36–40 45 (88.2) 6 (11.8) 20 (39.2) 31 (60.8) 20 (39.2) 31 (60.8)
>40 11 (84.6) 2 (15.4) 4 (30.8) 9 (69.2) 4 (30.8) 9 (69.2)
Husband’s ethnicity
Yoruba 347 (85.1) 61 (14.9) 0.213 173 (42.4) 235 (57.6) 0.011 173 (42.4) 235 (57.6) 0.149
Hausa 5 (100.0) 0 (0.0) 3 (60.0) 2 (40.0) 3 (60.0) 2 (40.0)
Ibo 29 (90.7) 3 (9.3) 15 (46.9) 17 (53.1) 15 (46.9) 17 (53.1)
Other 17 (100.0) 0 (0.0) 14 (82.4) 3 (17.6) 14 (82.4) 3 (17.6)
Wife’s ethnicity
Yoruba 351 (85.2) 61 (14.8) 0.273 186 (45.2) 226 (54.8) 0.113 186 (45.2) 226 (54.8) 0.076
Hausa 4 (100.0) 0 (0.0) 2 (50.0) 2 (50.0) 2 (50.0) 2 (50.0)
Ibo 30 (96.8) 3 (3.2) 8 (25.8) 23 (74.2) 8 (25.8) 23 (74.2)
Other 13 (86.7) 0 (13.3) 9 (60.0) 6 (40.0) 9 (60.0) 6 (40.0)
Table 3. Continued
Household chores Attendance at antenatal clinic Attendance at delivery
Yes No p Yes No P Yes No p

Male participation in pregnancy and delivery in Nigeria


n (%) n (%) n (%) n (%) n (%) n (%)

Parity
1 148 (89.5) 19 (10.5) 0.115 81 (46.6) 86 (53.4) 0.025 81 (46.6) 86 (53.4) 0.257
2 153 (87.4) 22 (12.6) 81 (46.3) 94 (53.7) 81 (46.3) 94 (53.7)
3 56 (84.8) 10 (15.2) 21 (31.8) 45 (68.2) 21 (31.8) 45 (68.2)
R4 40 (76.1) 13 (23.9) 21 (39.1) 32 (60.9) 21 (39.1) 32 (60.9)
Husband’s education
None 5 (66.7) 2 (33.3) 0.002 1 (16.7) 6 (83.3) 0.080 1 (16.7) 6 (83.3) 0.028
Primary 13 (65.0) 7 (35.0) 4 (20.0) 16 (80.0) 4 (20.0) 16 (80.0)
Secondary 89 (78.8) 24 (21.2) 46 (40.7) 67 (59.3) 46 (40.7) 67 (59.3)
Undergraduate 30 (91.0) 3 (9.0) 17 (51.5) 16 (48.5) 17 (51.5) 16 (48.5)
Tertiary 261 (90.3) 28 (9.7) 137 (47.4) 152 (52.6) 137 (47.4) 152 (52.6)
Wife’s education
None 5 (55.6) 4 (44.4) 0.001 0 (0.0) 9 (100.0) 0.078 0 (0.0) 9 (100.0) 0.016
Primary 37 (77.1) 11 (22.9) 23 (48.2) 25 (52.0) 23 (48.2) 25 (52.0)
Secondary 102 (81.0) 24 (19.0) 59 (46.8) 67 (53.2) 59 (46.8) 67 (53.2)
Undergraduate 46 (86.8) 7 (13.2) 26 (49.1) 27 (50.9) 26 (49.1) 27 (50.9)
Tertiary 208 (92.0) 18 (8.0) 97 (42.9) 129 (57.1) 97 (42.9) 129 (57.1)

499
500 O. Olayemi et al.
Table 4. Attitude of respondents to male participation in pregnancy and delivery

Variable Agree Disagree Not sure


n (%) n (%) n (%)

Husband should pay bills 387 (83.8) 48 (10.4) 27 (5.8)


Husband should attend antenatal care 164 (35.5) 223 (48.3) 75 (16.2)
Husband should attend antenatal counselling 117 (25.3) 262 (56.7) 83 (18.0)
sessions
Husband should give consent for 340 (73.6) 65 (14.1) 57 (12.3)
intervention in case of complications in
pregnancy
Husband should be informed before C/S is 360 (78.3) 53 (11.5) 47 (10.2)
done
Husband should attend delivery 239 (52.0) 133 (28.9) 88 (19.1)
Husband should decide on mode of delivery 263 (56.9) 134 (29.0) 65 (14.1)

accompanied to antenatal clinic (OR 0.73, 95% CI 0.57–0.93), while more-educated


men were likely to accompany their wives (OR 1.57, 95% CI 1.19–2.07) (Table 5).
A Yoruba husband was less likely to accompany his wife (OR 0.08, 95% CI
0.016–0.33), but Yoruba wives with non-Yoruba husbands were 12 times more likely
to be accompanied (OR 12.63, 95% CI 2.72–58.1).
Women in the rural centre were less likely to receive help with household chores
from their husbands during pregnancy (OR 0.41, 95% CI 0.20–0.82), while educated
women were more likely to benefit from this (OR 1.39, 95% CI 1.02–1.91).
Monogamous unions (OR 4.77, 95% CI 1.50–15.12) and increasing level of husband’s
education (OR 1.44, 95% CI 1.10–1.88) were associated with spousal presence at
delivery.

Discussion
The awareness that husbands can participate in childbirth is high amongst the women
in this study. Health talks and counselling sessions are carried out by nurses in all the
centres, and is probably the source of most of their information. Women are well
supported during pregnancy, as evidenced by financial support, better nutrition (the
tradition usually is for the husband to have the best part of the meals, etc.) and
assistance with household chores. The latter is particularly welcome, as it is probably
seen as effeminate in a patriarchal society. In a similar study carried out in a Delhi
slum (Dutta et al., 2004), less than a tenth of husbands improved on their wives’ diet
during pregnancy. Respondents from the rural centre were less likely to be assisted at
home with chores, comparable to another study in rural India where household help
was low (Singh & Arora, 2008). More highely educated men were more likely to
attend antenatal clinic and delivery, in concord with Wieglos’ Polish study, and
contrary to the findings of a Taiwanese study (Hung et al., 1997).
Male participation in pregnancy and delivery in Nigeria 501
Table 5. Logistic regression analysis of male participation

Variable ORa 95% (CI) p value

Husband attending ANC


Education of woman (ranked) 0.73 0.57–0.93 0.012
Education of husband (ranked) 1.57 1.19–2.07 0.001
Yoruba husband
Yes 0.08 0.016–0.33 0.001
No 1.00 —
Yoruba wife
Yes 12.63 2.74–58.1 0.01
No 1.00 —
Husband helping with house chores
Education of woman (ranked) 1.39 1.02–1.91 0.036
Education of husband (ranked) 1.19 0.85–1.68 0.296
IMC (rural centre)
Yes 0.41 0.20–0.82 0.012
No 1.00 —
Husband present at delivery
Education of woman (ranked) 0.96 0.76–1.23 0.787
Education of husband (ranked) 1.44 1.10–1.88 0.006
Monogamy
Yes 4.77 1.50–15.12 0.008
No 1.00 — —
a
Adjusted for age of respondent, age of husband, centre, religion and ethnicity of couple.

Men’s attendance at antenatal clinic was low. This may be partly due to the
discomfort of men to attend a female-oriented and dominated programme. Socio-
cultural restrictions may play a role, as shown in the Indian study discussed earlier
(Khan et al., 1997). Another study in Bangladesh showed that men did not feel
comfortable taking their wives to a health facility because they did not like to discuss
sexual reproductive health issues with the service providers (Shahjahan & Kabir,
2007), and poor couple interaction made it difficult for them to understand their
wives’ reproductive health issues. Most of the respondents, however, claim to discuss
the health advice given them with their husbands. With some education and
encouragement, there would probably be better attendance, given the high level of
participation of the husbands in other aspects of pregnancy in this study. It would be
advantageous for them to attend the counselling sessions at the clinic as this would
allow them to support their wives better, and to prepare them for labour. Wieglos
et al. (2007) demonstrated that men who attended childbirth classes were more likely
to attend labour. Our respondents’ own testimony confirmed the benefit of their
partner attending labour, preferring it to the presence of a doula.
The attitude of the women themselves is important in the actualization of male
participation: sometimes male partners only attend childbirth in response to their
wives’ desire (Rykowska-Pierzchala et al., 2001). While most women feel that the man
should bear the financial responsibility, it is gratifying that they feel empowered
502 O. Olayemi et al.
enough to make emergency decisions in his absence, reducing the delay that often
contributes to maternal morbidity and mortality. Findings from another Nigerian
study (Odimegwu, 2005) were similar: surveyed men corroborated their wives’ ability
to decide in their absence. Most of our respondents seemed to agree with the
traditional model of male financial and social support, without intruding into
antenatal care services.
In conclusion, it appears that male participation in pregnancy and delivery is
satisfactory in some respects in Ibadan, but more is desirable, especially for husbands’
attendance at antenatal services and delivery. The importance of counselling sessions
by nurses is emphasized. Education at all levels is desirable, due to all its positive
associations, with specific education on family participation. Care-givers and hospital
policies need to refrain from hostile policies towards family delivery, given its known
benefits.

Acknowledgment
The authors acknowledge the medical students of Group D2005 of the College of
Medicine, University of Ibadan, for their invaluable contribution in administering the
questionnaires to the respondents.

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