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Male prenatal care: challenges in nursing practice in primary health care

Male prenatal care: challenges in nursing practice in primary

health care
Rosa Maria Santos de Medeiros1, Sheila Passos Mota Coutinho2, Ana Margarete Cordeiro da S. Maia3, Anderson Reis de Sousa4,
Michelle Teixeira Oliveira5, Clivesson Rodrigues do Rosário6, Núbia Cristina Rocha Passos7
How to cite: Medeiros RMS, Coutinho SPM, Maia AMCS, Sousa AR, Oliveira MT, Rosário CR, Passos
NCR. Male prenatal care: challenges in nursing practice in primary health care. REVIEW. 2019;
8(4):394-405. Doi: https://doi.org/10.36239/revisa.v8.n4.p394a405

1. Federal University of Bahia,
Nursing School. Salvador, Bahia,
Brazil.
2. Candido Mendes University.
Feira de Santana, Bahia, Brazil.
3. Faculdade Nobre de Feira de
Santana. Feira de Santana, Bahia,
Brazil.
4. Federal University of Bahia,
Nursing School. Salvador, Bahia,
Brazil.
5. Faculdade Nobre de Feira de
Santana. Feira de Santana, Bahia,
Brazil.
6. Federal University of Bahia,
Nursing School. Salvador, Bahia,
Brazil.
7. Faculty of Science and
Entrepreneurship, Santo Antônio de
Jesus, Bahia, Brazil.
Received: 07/10/2019
Accepted: 09/10/2019
SUMMARY
Objective: to describe the existing challenges in Nursing practice
regarding the implementation of male prenatal care. Method:
Descriptive, qualitative study carried out with ten nurses who work in
Primary Health Care, in Family Health Units, in the city of Feira de
Santana, Bahia, Brazil. Individual, semi-structured interviews were
carried out, analyzed using the Collective Subject Discourse method.
Results: There are challenges related to the dimensions of academic
and professional training, such as male recruitment and adhesion and
in technical, attitudinal and care directed to men's health, and
consequently the male insertion in prenatal care, which is directed to
the meeting the logic of the production of demands, and focused on the
cisheteronormative perspective.
Conclusion: The presence of challenges in
the implementation of male prenatal care implies the absence of
production of Nursing care directed to this context, with direct relation
to gender constructions, as well as the organization of the academic
training process and the organization of practices in health in the system.
Descriptors: Men's Health; Prenatal Assistance; Nursing; Basic
Attention.
ABSTRACT
Objective: To describe the challenges in nursing practice regarding
the implementation of male prenatal care. Method: Descriptive,
qualitative study, conducted with ten nurses who work in Primary Health
Care, in Family Health Units, in the municipality of Feira de Santana,
Bahia, Brazil. An individual semi-structured interview was conducted,
analyzed by the Collective Subject Discourse method. Results: There
are related to the dimensions of academic and vocational training, such
as male uptake and adherence and technical, attitudinal and care
delivery challenges directed to men's health, and consequently male
insertion in prenatal care, which is directed to meeting the logic of the
production of demands, and focused on the cisheteronormative
perspective. Conclusion: The presence of challenges in the
implementation of male prenatal care implies the absence of nursing
care production directed to this context, with direct relation to gender
constructions, such as the organization of the academic formation
process and the organization of practices. in health in the system.
Descriptors: Men's Health; Prenatal Care; Nursing; Primary care.

ISSN Online: 2179-0981 REVIEW.2019 Oct-Dec; 8(4): 394-405

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Introduction

Aligned with Primary Care, and integration with the implementation of the National
Policy for Integral Attention to Men's Health (PNAISH), male prenatal care, has been
disseminated by the Ministry of Health, as a strategy to expand the promotion of men's
health care.1 In this context, nurses have played an important role because they act in an
elementary way in the coordination and production of health care, especially the pregnancy
process.
The World Health Organization emphasizes that care in prenatal and perinatal care
should be family-centered and directed not only to women but to their child and men.
2 Governmental actions such as Law No. 11,108, which guarantees
the right to the presence of a companion during labor, delivery and immediate postpartum,
into the Unified Health System (SUS), was implemented in the country.2 In this sense,
nurses should be aware of the participation of men in prenatal care, motivating the promotion
of involvement in the gestational process, childbirth and the postpartum period.3

The proposal of the male prenatal strategy emerges integrating

PNAISH, as well as the other existing health policies, in order to facilitate
the implementation of assistance directed to the male population, being an
opportunity to encourage men regarding the adoption of care. with your
health. 4
Through the implementation of this strategy, significant contributions pointed out in
Brazil and in other countries around the world have been identified, such as the satisfaction
of postpartum women, as a support utility during labor.5 They favor emotional support,
enhance health education and disease prevention through access to examinations and
evaluation strategies by health professionals, along with the control of infections such as
HIV, Viral Hepatitis and Syphilis, diagnosis of chronic diseases, dental care and
immunizations.6

These contributions also extend to the possibility of consolidating a line of care that
has the door between Primary Care, as a way of integrating and contributing to the
programmatic actions formulated by PNAISH.4-9
Based on the foregoing, given the need to highlight the development of nursing
practice, with a view to promoting caregiving and responsible parenthood, this study sought
to answer the research question: How are the existing challenges in nursing practice for the
implementation of male prenatal care ? In order to answer this problem, this article aims to
describe the challenges in nursing practice regarding the implementation of male prenatal

care.

Method

This is a descriptive and qualitative study conducted with nurses working in Family
Health Units (FHU) in Primary Care, in the municipality of Feira de Santana, Bahia, Brazil.

Ten nurses, who had taken one year in the occupation, participated in the study and
were submitted to an in-depth individual interview about the object in question, which place
between April and May 2015, guaranteeing them the opportunity to know the study
beforehand, to have access to the Informed

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Consent Form and to consent to the subsequent empirical investigation.

The interviews were conducted at the USF premises, in a reserved
environment, at a different time from the work hours, according to the convenience
and availability of the interviewees, which were recorded and later transcribed in full,
organized by means of the NVIVO Software.
In all stages of operationalization of the research, the ethical and bioethical
recommendations for conducting studies involving human subjects were met. To this
end, the project was approved by the Research Ethics Committee of the Noble
Faculty, under the opinion number: 996,841. In order to guarantee the anonymity
and confidentiality of the participants, we chose to use the letters DSC, which
represent the Collective Subject Discourse, the method used for data analysis.

The data were analyzed in the light of the DSC10, which through its
methodological figures, represented by the Key Expressions, Central Ideas and
Anchoring, makes it possible to achieve a representation of a collectivity, in a given
inscription and social context, while also respecting the recommended criteria. by
the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure
rigor in qualitative research.

Results

From the discourse of the collective subjective of nurses about male prenatal
care, it was evidenced the existence of challenges for its implementation, in the daily
professional practices, in the Primary Health Care services, specifically those of the
Family Health Strategy. These challenges are concentrated in training for the
inclusion of men in prenatal care, as well as in improving male adherence and uptake,
in the technical, attitudinal and care delivery of nurses, expressed in the following
Central Ideas.

Central idea 1a: Challenges in prenatal inclusion for men

The collective discourse of nurses reveals to obtain prior knowledge about

male prenatal care, which is related to the development of strategies for the insertion
of men in prenatal consultations, as well as their persuasion / awareness, with the
possibility of offering exams. guidance and help given to their partners. However, it
demonstrates that such implementation is in the future plan, given the presence of
challenges encountered, which are structured in the fact that such a strategy was not
appropriate, a recent approach and no specific training was obtained in the area.

To tell the truth, I don't have much knowledge or training about male prenatal care.
It's something new in Primary Care, and it's all new to me too, and that's why I haven't
done it yet. What I do know is basically the insertion of the parents in the prenatal
consultation, together with the woman, as a way for them to be aware of what the
prenatal consultation is about and to seek to follow the growth and development of
the fetus. It would be a way to attract more men to perform tests, such as laboratory
tests, which women already perform during prenatal consultations, as a way to avoid
risks to the baby during pregnancy, and participate in related events. with the prenatal
time, in the health unit, promoting guidelines, strengthening the image of men with women,

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showing their importance, through arguments, so that pregnant women feel more
confident and become more assiduous in consultations, by showing
helping partners
them howand
mothers
can be helped through this phase, as women face a flurry of hormones, which change
them a lot, making them more sensitive, and in need of their support. husbands. (DSC,
of nurses working in Family Health Units).

Core Idea 1b: Challenges Found in Male Adhesion and Uptake

The challenges encountered regarding male adherence and prenatal uptake

were unveiled in the nurses' discourse as a limiting factor of the practice, which is
permeated by the relationship of men only exercising health care in situations of severity
greater and, because they are mostly workers and home providers, making them unable
to access health services.

It is already very complicated for the man to come to the unit, they do not participate,
they only come when things are ugly, and in prenatal consultations is very difficult.
Most men are home providers, and because of this, they are working during prenatal
consultation hours. I know this issue is changing a little, but the work influences a lot,
because the lack of activities to come to a health service, becomes the greatest difficulty
for not seeking. Some men want a certificate of attendance, but some companies do
not accept it, and this is one of the problems I have faced, which makes it very difficult.
The adherence is very bad, men do not attend the health service and this is something
that is very present and needs to be overcome, because there is still a lot of male distancing.
(DSC, of nurses working in Family Health Units).

Central Idea 1c: Challenges encountered in technical, attitudinal and care delivery

The technical, attitudinal and assistential practice performed by nurses regarding

the implementation of male prenatal care is challenging, when observed the insertion
of men in this context, which is related to the fact that the demand is decreased, the
adhesions are low and the attention be almost exclusively to women, when directed at
the production of nursing care.

They only show up when you need some treatment with women, but they are in very
extreme situations. Demand is very small, about two per center, of the total I have in
the area. If I have an average of 25 prenatal care, only two or three men show up for
appointments. Sometimes I ask pregnant women about mates and they tell me they
can't come for work. In addition, in my work, I deal more with questions that address
prenatal care itself, rather than the health of the father itself. Pay more attention to the
sensitivity of the woman at that moment, that she is living and the difficulties. Prenatal
care is so focused on the woman that I sometimes sin, and I forget that she has a
partner involved there, and that he contributed to that pregnancy, especially when they
are first-time sailors. In this sense, I recognize that I do not talk about this subject and
have never had this directed look. I really don't think about it, and I always worry more
about women's demands. And there is also the fact that I did not have access to any
discussion, specific training or continuing education, for the realization of male prenatal,
because of this I have not made this host. (DSC, of nurses working in Family Health
Units). To tell the truth, I don't have much knowledge or training about male

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prenatal care. It's something new in Primary Care, and it's all new to me too, and
that's why I haven't done it yet. What I do know is basically the insertion of the parents
in the prenatal consultation, together with the woman, as a way for them to be aware
of what the prenatal consultation is about and to seek to follow the growth and
development of the fetus. It would be a way to attract more men to perform tests,
such as laboratory tests, which women already perform during prenatal consultations,
as a way to avoid risks to the baby during pregnancy, and participate in related
events. with the prenatal time, in the health unit, promoting guidelines, strengthening
the image of men with women, showing their importance, through arguments, so that
pregnant women feel more confident and become more assiduous in consultationsby helping,
partners and showing them how mothers can be helped through this phase, as women
face a flurry of hormones, which change them a lot, making them more sensitive, and
in need of their support. husbands. (DSC, of nurses working in Family Health Units).

discussion

It would be a way to attract more men to perform tests, such as laboratory

tests, which women already perform during prenatal consultations, as a way to avoid
risks to the baby during pregnancy, and participate in related events. with the prenatal
time, in the health unit, promoting guidelines, strengthening the image of men with
women, showing their importance, through arguments, so that pregnant women feel
more confident and become more assiduous in consultations , by helping partners
and showing them how mothers canflurrybe helped throughwhich
of hormones, this phase,
changeasthem
women face a
a lot,
making them more sensitive, and in need of their support. husbands. (DSC, of nurses
working in Family Health Units).

There are weaknesses in the scope of Primary Care, regarding the

implementation of male prenatal care. The discourse supports the justification for the
non-operationalization of male prenatal care because it is a recent practice to be
adopted in services. However, the Ministry of Health assumes that prenatal care is
the privileged time to discuss and clarify issues that are unique to each couple.
Emphasizing the importance of frank dialogue, the sensitivity and insight of those
who follow prenatal care. It is also emphasized that it is important for pregnancy to
be seen as a stage that integrates both women's and men's process of living, which
necessarily contradicts the idea that this is a recent practice.11

The initial prenatal care milestones emphasize to health professionals what

has been proposed since September 2010, during the I International Seminar on
Men's Health of the Americas, which draws attention to the implementation of male
prenatal care, giving just a new name, because of the implementation of the National
Policy of Integral Attention to Men's Health in Primary Health Care. In this logic, the
intention of male prenatal care is to make health professionals take advantage of the
moment when men are in this context, often sensitized to develop a caregiving
practice, as they are on their way to becoming parents, to encourage Not only to
follow the consultations during the nine months of pregnancy, but also to carry out
preventive exams for the purpose of diagnostic detection and full health monitoring,
contributing to the strengthening of bonds.4

In addition, the knowledge produced about male prenatal care expressed

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by nurses in the collective discourse demonstrates the idea that men should
be inserted in prenatal consultations together with their partners, as a way to
assist them, provide emotional support and contribute to some activities.
However, a broader perspective of thinking about the logic of providing care
to trans people, such as trans men and transmasculine people, who can, if
they wish, can conceive and perform prenatal care is not unveiled.

One of them refers to the public health aspect, when considering the
relationship of prenatal care as a strategy to reduce congenital infectious
diseases, the promotion of health knowledge related to protective care,
prevention of the transmission of morbidities, investigations of incompatibilities,
such as blood typing and genetic configuration, and the second, linked to the
individual aspect, which encompasses the dynamics of relationship, affective
configuration and arrangements designed to prenatal experience and active
participation with the newborns.12 Even understanding the need for this
understanding, it is important to draw attention to the fact that, in the dynamics
of public health, men are not inserted in prenatal care by the exclusive bias of
the possibility that these are potential generators of infection, which would
make them allocated to a pole of such stigmatization. Still reflecting the logic
of thinking about the essence of male prenatal care, from the perspective of
public health, it becomes emerging the discussion about meeting the
specificities of trans men, who have increasingly accessed health services,
with demands that report to sexual health and reproduction , making care
support strategies designed to meet the needs (social name, body modification
practices, horminization, among others).
The discourse points to the notion of a little present, non-assiduous
fatherhood, which is configured by the sense of help, help and not based on
full protagonism, leaving only for the imaginary field of future aspirations. It is
also not observed the conduct of professionals to change the scenario, making
the paternal care is enhanced, and strategies to enable this expansion are
constituted and become frequent in the daily practice of health services.
In order to reduce the impacts of the social construction of hegemonic
masculinity, which implies male carelessness, through the technical area of
men's health of the Ministry of Health, new PNAISH axes of action were
created. Five axes are structured that are grouped around thematic strategies,
namely: Access and Reception; Prevalent Diseases in the Male Population;
Sexual and reproductive health; Paternity and Care, Health Promotion and
Prevention of Violence and Accidents. The implementation of these axes
contributes significantly to the implementation of integral actions for men's
health, which are not limited to the prostate issue, for example, strongly
emphasizing the present and responsible fatherhood.14
International actions are involved in this scenario of thinking about the
promotion practices of men's health care, and have highlighted the need to
include political guidelines on the subject, as well as the contribution of care
based on the paternity bias, as shown by way of meeting the needs and the
reduction of health problems and damages, which have a satisfactory impact
on the reach of well-being and longevity.15-16
We realized that the thought built around the idea that the couple
gestates, which men also gestate, wants to be physiologically, whether

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psychological, social and political, is not present in the understanding of

professionals. Attention is drawn to the clinical, and / or psycho-emotional
manifestations of women, in this case cis women (who have vagina bodies
and / or non-conformities with their bodies and gender, including at birth), and
not also to manifestations that may be part of the experiences and daily life of
men, in this case, cis, who may be experiencing pregnancy. Thus, advancing
in this direction will promote the reach of a comprehensive, inclusive, and
diverse care that will correspond broadly to each need, as in the case of trans
men, which in the context of the use of hormones (testosterone) as a means
for trans passability, may and will need to receive appropriate care when the
context of pregnancy is present.17
The challenges encountered in professional nursing practice in the
context of Primary Care, for the implementation of male prenatal care, also
arise from the strengthening of stereotypes and imaginary thoughts that
crystallize the idea that men do not take care of their health and that this care
is given from the logic of going to services and adherence to established
therapies. In this case, when this occurrence occurs, the understanding of the
need to continue the work of promoting male health, even in the context of
pregnancy, is lost, whether it is based on cisgenderity, as well as transgenderity,
as is the case with men trans men, who often have their forgotten, invisible
and even unmet health demands.
What is observed is the fact that the speech enhances the fact that men
do not attend the units, as well as do not access prenatal consultations, nor
accompany their mates. However, it is necessary to reflect and problematize
that there is a gender standardization that has removed men from the places
and roles of promoting care. In this sense, it is essential to recognize that the
social constructs about what is up to man in the social setting, as well as the
relationships to be structured while being a father, still very focused on the
image of a man who only collaborates in Promoting the health of his partner,
when it is graphic, and the baby, such as family provision and traditional family
conformation (cisheterocentric), interference will be generated to health care
actions.18
The emergence of mismatches between the health of men in a position
to promote participatory parenting and sexual and reproductive health in
Primary Health Care, due to gender issues, which are still preventing male
insertion to occur, has been rooted. since the organization of the health
system itself. In addition, factors such as health actions have been organized
in a watertight, fragmented and isolated way from the social context of the
male, not fully contemplating the promotion of bonds that bring them closer to
the production of care from the dimension of health. health system in Primary Care.19
From this perspective of thinking the promotion of male care, through
fatherhood, and in the light of gender relational issues, historically constructed
obstacles may be repositioned. Sensitivity and creativity stand out as essential
elements for the construction of new paths for the exercise of this inclusive
caregiving practice. In this logic, health professionals need to be qualified to
promote welcoming, which must go from reception and identification of male
presence and demands, to integration with the services and / or services
offered (contraception, consultations, examinations, participation in groups).
reflective, educational and other activities).20

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There are even barriers to access are unveiled by nurses in the speech,
which proves the fact that men, when faced with difficulties in releasing work,
or even when companies / institutions do not respect the right to exercise
present paternity, challenging them. granting permission to attend prenatal
consultations, fail to establish as they would like, this right. These barriers are
already being investigated on a large scale in Brazil, and are strongly
influenced by the hegemonic construction of masculinities, all ways still need
actions that aim to minimize them, as a way of expanding access to health
services and promoting care. to health by men.21
We also highlight the fact that discourse builds an idea about what it is
to be a man, as well as the role it plays, which causes markers to be fixed,
which will directly or indirectly intersect with the way in which these nurses
will think, plan and execute the production of nursing care. This aspect can
be analyzed by understanding that men are home providers, are in the public
space, work and therefore do not access health facilities or participate in
prenatal care. We need to think on how these professionals build their
conceptions about gender, masculinities, femininities, sexualities, as well as
how they were formed, because it is easy to imagine that they are intertwined
in the cis heteronormative structural conformation, western, white-centered ,
patriarchal, binary and sexist.
Given this context, it implies to mention that the male presence in health
institutions, although it has still happened on a larger scale in the medium and
high levels of health care, especially to meet curative demands, their insertion
in Primary Care, ensures the promotion prevention and avoidable health
problems and should therefore be enhanced among men. For this advance to
occur, it is necessary that the PNAISH be implemented, and actions such as
prenatal care follow-up be carried out.22-24
Such repercussions of this process of social construction can be
transposed in the production of care, which is still shy, when seeking to
identify the investment directed to the demands of men, which also impacts
the generation of removal from services. In this sense, the technical, attitudinal
and care practice in Nursing, regarding the implementation of male prenatal,
presents emergency challenges to be overcome, such as the demystification
of the logic of production (judging to be essential to have high demand of men
in services ), the notion of men's passivity in the context of pregnancy, and
the lack of production of specific / unique care technologies for men.
Impacts generated due to low male sensitization during pregnancy,
causes repercussions that extend until delivery. As in a study conducted in
Mato Grosso, Brazil, which showed the low presence of men in the gestational
process, as well as their absence at the moment of delivery, as they
understand that this is an exclusive moment for women.22 From a different
perspective, a research conducted in Fortaleza, Brazil, showed that men's
understanding that masculinity is not lost when there is a man's present
participation during childbirth and in caring for children, through their
experience with participation in childbirth, has generated expansion of
possibilities in the male approach to health systems, as well as the
maintenance of well-being, which is in the opposite logic of the treatment of diseases.
We highlight, from the discourse, the centrality of the production of
prenatal nursing care, the demands and needs of women and their vagina

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bodies, excluding other possibilities, such as men with vagina bodies and with the
possibility of becoming pregnant, In addition to the need to meet the demands
and needs of cisgender men, who will also be pregnant, with their partners/
significant people, which makes this production, cut, and often limited to meet
formatted dynamics, structured, from a certain logic of seeing and thinking people,
their bodies, identities and possible needs.
Based on this scenario, it is possible to recognize in the discourse the
absence of a conduct directed to responsible and caring parenthood and the
exercise of the promotion of paternal care, especially during prenatal care. From
this problematic, the need arises for the creation and / or the strengthening and
expansion of specific male care lines, focused on sexual health, reproduction and
paternity, as well as the creation of proposals for prenatal men's involvement
flows.18

Conclusion

The discourse of the collective subject of nurses working in Primary Health

Care, evidenced the present of challenges regarding the implementation of male
prenatal care in the daily practice of services. The challenges were focused on
vocational training regarding the acquisition of competences and professional
skills to achieve the inclusion of men in prenatal care, as well as the implementation
of strategies for capturing and adhering to prenatal men and in the technical,
attitudinal and healthcare practice for the inclusion of men in the leading role of
nursing care production.
Nurses are essential professionals for the development of SUS, with regard
to the execution of prenatal care, being essential that trained and understanding
the importance of this strategy. Although the nurses' desire and understanding of
the need for men's participation in prenatal care were evidenced, this scenario
remains only in the future aspiration, with the decision-making and implementation
of actions aimed at effective and effective operationalization not being evidenced. .

From the results of this study it was possible to identify how little has been
spread male prenatal, and its relevance with regard to the promotion of men's
health care and the full exercise of present and responsible parenthood, in their
different dimensions of gender constructions and family structures. It is also
emphasized that the adoption of strategies such as this implies the promotion and
strengthening of bonds, which translates into benefits for children, their families,
the community and men themselves, through the reduction of morbidity and
mortality. improvement of well-being and quality of life. In this context, we highlight
the relevance of this study and its usefulness for the improvement of professional
nursing practices, as well as the production of health care, development of the
sphere of Primary Care.

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Correspondent Author:
Anderson Reis de Sousa
241 Basilio da Gama St. ZIP: 40110-907. Lower leg.
Salvador, Bahia, Brazil.
Anderson.sousa@ufba.br

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