KENYA MEDICAL TRAINING COLLEGE

REASERCH PROJECT ON;

FACTORS INFLUENCING MALE PARTICIPATION IN ANTENATAL CARE

ATTEMDANCE IN NYAMIRA COUNTY REFERRAL HOSPITAL.

WINNIE SALOME MOMANYI

D/NURS/19036/6290

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILMENT OF

THE REQUIREMENT FOR THE AWARD OF DIPLOMA IN KENYA
REGISTERED COMMUNITY HEALTH NURSING

2023
 DECLARATION
This research Project is my own original work and has not been submitted for Diploma in any
other Institution.

SIGNATURE:…………………………………………,,,,… DATE:
………………………………….

WINNIE SALOME MOMANYI

D/NURS/19036/6290

This Project is submitted with my approval as the college supervisor

SIGNATURE:……………………………………………..… DATE:
…………………………………..

MR. GILBERT ONYONO

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 ACKNOWLEDGMENT
I am grateful to the almighty God for sound health guidance, care and protection for the far I
have reached in my research project.

Special gratitude to my supervisor Mr. Gilbert Onyono, my family and friends for their prayers
and support.

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 DEDICATION
I dedicate this work to all those with greatest interest of me in their heart, starting with my
parents, relatives, real friends, my supervisor and lecturers.

May God bless you abundantly.

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Contents
DECLARATION..............................................................................................................................i

ACKNOWLEDGMENT.................................................................................................................ii

DEDICATION...............................................................................................................................iii

CHAPTER ONE..............................................................................................................................1

1.0 INTRODUCTION............................................................................................................1

1.1 BACKGROUND INFORMATION.................................................................................1

1.2 PROBLEM STATEMENT...............................................................................................3

1.3 JUSTIFICATION..................................................................................................................3

1.4 BROAD OBJECTIVES.........................................................................................................3

1.4.1 SPECIFIC OBJECTIVES...................................................................................................4

CHAPTER TWO.............................................................................................................................5

LITERATURE REVIEW............................................................................................................5

2.1 INTRODUCTION............................................................................................................5

2.2INDIVIDUAL FACTORS INFLUENCING MALE ATTENDANCE OF ANTENATAL

CARE...........................................................................................................................................5

2.3 SOCIO ECONOMIC FACTORS..........................................................................................9

2.4 HEALTH SYSTEM FACTORS..........................................................................................10

CHAPTER THREE.......................................................................................................................13

RESEARCH METHODOLOGY..............................................................................................13

3.1 INTRODUCTION...............................................................................................................13

3.2 STUDY DESIGN................................................................................................................13

3.3 STUDY POPULATION......................................................................................................13

3.4 INCLUSION CRITERIA....................................................................................................13

3.5 EXCLUSION CRITERIA...................................................................................................13

3.6 SAMPLE SIZE CALCULATION.......................................................................................13

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 3.7 DATA SOURCES...............................................................................................................14

3.8 SAMPLING TECHNIQUES...............................................................................................14

3.9 STUDY VARIABLE...........................................................................................................14

3.10 DATA COLLECTION TECHNIQUES............................................................................15

3.11. DATA COLLECTION TOOLS.......................................................................................15

3.12 ETHICS CONSIDERATION............................................................................................16

3.13 LIMITATIONS OF THE STUDY....................................................................................16

CHAPTER FOUR.........................................................................................................................17

CHAPTER FIVE...........................................................................................................................25

DISCUSSION OF RESEARCH FINDINGS............................................................................25

CHAPTER SIX..............................................................................................................................27

CONCLUSION AND RECOMMENDATIONS......................................................................27

6.1 Conclusions..........................................................................................................................27

6.2 Recommendations................................................................................................................27

REFERENCE................................................................................................................................29

APPENDIX I. QUESTIONNAIRE...............................................................................................34

APPENIX II RESEARCH WORKPLAN.....................................................................................36

APPENDIX III: BUDGET............................................................................................................37

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 CHAPTER ONE
1.0 INTRODUCTION
This chapter consists of the introduction, the study background, the statement of the problem,
study objectives, the research questions, significance of the study and the conceptual framework

1.1 BACKGROUND INFORMATION.

Antenatal care is the kind of health care given to a mother before birth of a child (WHO, 2005).
ANC is an opportunity to promote the use of skilled attendance at birth and healthy behaviors
such as breast feeding, early postnatal care, and planning for optimal pregnancy spacing. Many
of these opportunities continue to be missed, even though over two-thirds of pregnant women
receive at least one antenatal visit (WHO, 2012).

Internationally, male attendance of skilled ANC and delivery care along with their spouses
remains a challenge to safe motherhood. About 210 million women become pregnant each year
with 30 million (15%) developing complications, resulting into over half a million maternal
deaths (De bernis et al 2008). Developing countries account for more than 99% of all maternal
deaths; about a half occurring in sub-Saharan Africa, and a third in South Asia (WHO, 2007).
There is sluggish progress towards achieving the fifth Millennium Development Goal (MDG) in
developing countries (AbouZahr, 2003). Male involvement in maternal health care has been
described as a process of social and behavioral change that is needed for men to play more
responsible roles in maternal health care with the purpose of ensuring women’s and children’s
wellbeing (UN, 2009). The husband (male partners) is often depicted as the primary decision

maker, and wife’s economic dependence on her husband gives him greater influence on major
household decisions and can thus have bearing on the attendance of antenatal care (Britta et al,
2006). For the reason that men play a big role in decision making in the family, some researchers
suggest that male involvement is a very significant factor to consider in finding a solution to the
three main factors responsible for many of the maternal death (Ibid).

The global attention for involving men in women’s reproductive health programs was triggered
by the International Conference on Population and Development in Cairo in 1994 and the
International Conference on Women in Beijing in the mid-1990s after stakeholders realized the
influence of men on women’s and their own health, including women’s ability to protect

1
themselves from infection with the human immunodeficiency virus (HIV) as well as building
gender equality as seen from the ICPD-POA emphasis below;

"… special efforts should be made to emphasize men's shared responsibility and promote their
active involvement in responsible parenthood, (ICPD Program for Action Chapter 4, paragraph
C).

As early as 2001, the World Health Organization (WHO) established proven safe motherhood
interventions that are required at household, community and facility levels to enable every
pregnant woman to have a safe pregnancy and childbirth, and to provide couples with the best
chance of having healthy infants Portela et al, (2003). The strategies include; providing skilled
attendants to prevent, detect and manage the major obstetric complications, together with
providing equipment, drugs and other supplies (WHO, 2007).

Thus, this formed part of the gradual shift from a demographic to a more holistic and rights-
based approaches to Sexual and reproductive health. At present, in terms of global coverage,

ANC is a success story, 71 percent of women worldwide receive any ANC; in industrialized
countries, more than 95 percent of pregnant women have access to ANC. In sub-Saharan Africa,
69 percent of pregnant women have at least one ANC visit (WHO, 2010).

Uganda carries on to have one of the highest maternal and child mortalities worldwide, with an
estimated Maternal Mortality Ratio (MMR) at 435/100,000 and child mortality at 137/1,000 live
births (UDHS, 2011). The Ugandan government has prioritized reproductive health strategies
which center on accelerated reduction in maternal mortality and severe morbidity related to
pregnancy and childbirth.

Male involvement in maternal health care is a relatively new approach in Uganda. Traditionally,
maternal health care services have focused on women, with very little male involvement.
According to the most recent study by (Kimara, 2013) on male involvement in maternal
reproductive health services, the level of male involvement in Kampala is 48.5% for ANC.

Active male involvement in Antenatal care is necessary to increase utilization of maternal health
services by the pregnant women and mothers. The aim of study was to examine the factors
associated with male involvement in antenatal care in Makindye Division, Kampala District.

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1.2 PROBLEM STATEMENT
Male attendance of skilled ANC is a fairly new field to research in Uganda. The available
estimates depict a low attendance averaging 3% in 2006 MoH, (2006) but are based on health
facility information systems that monitor male attendance in the PMTCT program.

In Kampala the level of male involvement in ANC is at 48.5% (458) (Kimara, 2013). In
Makindye division only 40% (of the total number of women who attended ANC in 2013) were
accompanied by their partners for ANC in the year 2013, (KCCA, 2013).

WHO, 2008 recommends that all expectant mothers should be accompanied by their spouses for
ANC. Antenatal care includes good medical, emotional, and nutritional support during
pregnancy, advice on safe delivery, and management of pregnancy-related complications?

Low male involvement in ANC attendance has resulted in women not being able to have the
recommended four ANC visits (WHO, 2007) thus causing preventable reproductive health
complications and thus maternal mortality. Lack of male involvement in pregnancy and antenatal
care has been identified as one of the major bottlenecks to effective program implementation in
other countries too (Horizons Program Report, 2002).

The study therefore was done to assess the factors influencing male participation in ANC
attendance in Makindye division, Kampala Capital City Authority.

1.3 JUSTIFICATION
The results from the study may be used in enabling women to support their spouses to attend
ANC and therefore adequately be able to recognize complications related to pregnancy. The
results might be used to inform policy and to design new strategies that will encourage males to
participate in ANC.

The study may be useful future researchers in terms of providing baseline data on male
participation in antenatal care programs and act as a reference.

1.4 BROAD OBJECTIVES

To assess the factors influencing male (18-45 years) participation in antenatal care attendance in
Nyamira County Referral Hospital.

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1.4.1 SPECIFIC OBJECTIVES.
1. To determine the individual factors influencing male (18-45 years) participation in ANC
attendance in Nyamira County Referral Hospital.
2. To determine the socio-economic factors influencing male (18-45 years)

participation in ANC attendance in Nyamira County Referral Hospital.

3. To establish the health system factors influencing male (18-45 years) participation in
ANC attendance in antenatal care service in Nyamira County Referral Hospital.

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 CHAPTER TWO
LITERATURE REVIEW
2.1 INTRODUCTION.
This chapter presents literature gathered from various sources on male participation in attendance
of ANC. Among the issues discussed in this literature review are the individual factors, socio-
economic factors and health system factors influencing male participation in ANC attendance.

2.2INDIVIDUAL FACTORS INFLUENCING MALE ATTENDANCE OF

ANTENATAL CARE
Reproductive health services that focus only upon women have limited impact and effectiveness.
The Cairo (International Conference on Population and Development, ICPD) 1994 and Beijing,
1995 conferences have brought necessity of involving men as partner under sharp focus. “Male
involvement” in reproductive health and family planning programs is not just promoting the use
of male methods of contraception, but men’s supportive roles in their families, communities and
workplaces to promote gender equity, girls‟ education, women’s empowerment and sharing of
child rearing and caring.

On the contrary other studies have found that facility interventions providing routine ANC have
minimal beneficial effects to maternal health outcomes; creating a rationale for community-
based interventions for pregnant women where educational and support programs have been
triumphant in increasing and improving skilled delivery, breastfeeding practices and postnatal
attendance Hounton et al, (2009).

This reported success may be mainly attributable to spousal involvement, and not necessarily the
community as a whole. Even though it is widely recognized that there is limited research on the
role of male involvement during pregnancy Alio et al, (2009), there are promising links to
beneficial effects. Indeed, some few prospective studies and literature reviews have successfully
demonstrated that prenatal male involvement is associated with beneficial health outcomes such
as; higher first trimester ANC visits, abstinence from smoking and alcohol consumption Hounton
et al, (2009), and reduction in low birth-weight infants Alio et al, (2009).

Evaluations of Prevention of Mother-to-Child Transmission of HIV (PMTCT) which is often

implemented within the confines of safe motherhood have similarly shown male involvement to

5
positively influence uptake of HIV testing and preventive interventions for vertical and sexual
transmissions of HIV Hounton et al, (2009).

In particular it was argued that further progress in attaining reproductive health goals would
depend on men changing their attitude and behavior towards reproductive health and gender
issues. It also suggests the importance of responsible, respectful and non-coercive sexual
behavior and shared reproductive health decision making (UNFPA, 2005).

Involvement of males in health care is generally poor as demonstrated by studies below from
different scholars. This is evidenced by the fact that level of education among men on safe
motherhood is likely to influence their participation in ANC. Demographic and Health Survey
data (DHS) in Bangladesh between 1993 and 2004 found that education of the woman and her
husband were important determinants of utilization of obstetric services Collin et al (2008).

Younger men, especially teenagers, are more likely to have unplanned pregnancies and lack
information and resources to access ANC services as demonstrated in a Australia by Trinh, et al
(2006). As regards marital status, single women with unplanned pregnancies, like most pregnant
teenagers, may have a negative attitude towards the pregnancy of their spouses and, due to this,
may be less aware of the signs of pregnancy and as a result might be more likely not to attend
ANC with their wives than would older men Kogan, et al.( 2008).

Inadequate knowledge about ANC and the benefits derived from it for the fathers has negatively
influenced their involvement (Mullany, 2006). Sometimes men especially adolescents, may not
be aware of the problems that results from not attending ANC and thus might not be supportive
of their women to get involved in ANC services.

A study conducted in Uttar Pradesh-India found that men have limited knowledge of women’s
reproductive health matters Moore et al, (2007). Around 78 percent men in the study were
unable to correctly identify the fertile period in the menstrual cycle and one-half could not
correctly identify a symptom of serious pregnancy complications. The findings of this study are
supported by another study in Maharashtra Brown et al, (2008), which shows that though
majority of the men are aware of the need for antenatal, delivery, and postnatal care but fewer
know details and fewer husbands accompany their wives for care; husbands are more likely to be
present for care of problems than for routine care Brown et at, (2008).

6
However, an intervention study by Population Council indicated that men are interested in
participating in antenatal care and can take more responsibility if they are provided adequate
information and counseling about ANC Population Council India Study, (2006). The study
clearly demonstrated that allowing men to participate in their wives' antenatal care by providing
information through individual and joint counseling increased couples' discussion and joint use
of antenatal care.

A similar study done in India indicated that men having education above high school were found
to accompany their partners compared to the ones whose education was up to primary school,
Abhishek Singh, Faujdar Ram(2009). While a similar study in Kinshasa indicated that the level
of education did not influence male participation in ANC attendance Ditekemena J et al, (2011)

A study done in Malawi indicated that women have experienced resistance from their partners
because of fear that members in the community might interpret her partner’s role in work that is
culturally regarded as women’s domain. Therefore cultural values and norms may prevent men
from being involved in ANC. Chinkonde J et al (2006).

Several demographic studies have shown that men may want larger families than their wives
(Anderson, 2007). In West Africa for example, men want four more children than women,
though in Bangladesh, East Africa, Egypt, Morocco and Pakistan, men and women express
similar desires in terms of family size, Ezeh, Seroussi, and Raggers, (2006). A study done by
Simkhada et al (2008) revealed that parity negatively influences ANC attendance which means
that the more children a woman had the lower the chances for her to attend ANC hence lower
male participation. This may be attributed to the fact that as the women go through their first
pregnancy, they get support from their spouses but as they gain more experience this ceases to be
the case.

Reproductive studies have always targeted females while males have largely been excluded from
such programs that provide these services Edwards et al, (2004).

Most ANC programs are designed to be used by females. Men seem to be less concerned than
women about ANC, perhaps because the former do not carry the burden of pregnancy and

child birth directly.

7
So far as pregnancy care is concerned, a study conducted in Maharashtra found that majority of
husbands in the State accompany their wives for the first check up to confirm pregnancy; but the
women generally went alone or with the other female members of the family for subsequent
visits Barua et al, (2002). It also found that husbands ignore wife’s health care during pregnancy,
except for the awareness for the need for antenatal registration and a nutritious diet.

The husband’s role during the prenatal period was explained by gender-specific reasons – house
hold chores were women’s job, men only assist when the woman is pregnant and cannot manage
to perform. Men were identified with masculine role of providing - financial support, similarly,
in a study done in Guatemala it was found that the most universal form of male participation
during pregnancy was financial support nutrition, psychological support and birth preparedness
in terms of material support and transport arrangements (Horstman, 2009).

The identification of men with masculine roles affirm the notion that some men are socialized to
be superior in terms of decision making and to be financial providers. As such it has proved to be
difficult for them to participate in activities that are feminine including health issues concerning
their wives (Horstman, 2009). At the same time, although some have desired to support their
partners, they have been curtailed by cultural definitions of maleness and roles of masculinity.
As a result, they fear being disliked and ridiculed by other men in the community whom they
imagine will call their manhood into question.

In addition, Olayemi et al (2009) that argued that men can participate in helping pregnant women
stay health by making sure that the women get proper antenatal care which may entail providing
transportation or funds to pay for her visits, accompany the wife during antenatal visits where the
man can learn about the symptoms of pregnancy complications and how to respond to an
obstetric emergency. Similar views are also shared by Roth and Mbizvo, (2001).

Olayemi et al (2009) found in their study that monogamous unions were associated with
increased male participation in ANC; hence the type of marriage highly influences male
participation in ANC. While a similar study done in northern Tanzania found that partners living
together was associated with male participation in ANC Msuya et al (2008).

A study conducted in Kenya revealed that poor communication between husband and wife is an
important barrier to the involvement of men in antenatal care (Omondi-Odhiamb, 2004). The
success of male involvement in ANC depends on the agreement and cooperation of husband,

8
while communication between spouses also improves the chance of effective ANC. Similarly, in
a study done in western Kenya, Onyango et al (2010) observe that gender norms were one of the
factors that inhibit male involvement in maternal health care. For instance, men are not expected
culturally in Kenya to accompany their wives to the clinic. If they do, this was perceived by their
peers as a demonstration of weakness.

Lack of knowledge about dangers of not seeking health care in pregnancy and delivery,
including inability to make independent decisions were major barriers to seeking health care
among men in Uganda (Matua, 2004).

Long working hours and difficult in taking time off work to attend services were also cited as
reasons why many men would be unable to participate in ANC care services (Nantamu 2011). A
similar study done in Gulu also indicated waiting time as a barrier to male participation in
maternal health services, Tweheyo et al, (2009).

According to (UBOS 2006), it is indicated that low level of education is associated with reduced
ANC by pregnant women. This may as well hinder the men from attending ANC

with their partners.

2.3 SOCIO ECONOMIC FACTORS

For the men who feel that it is their duty to facilitate their wives transport to attend hospital sees
no point in accompanying them if they do not have enough transport for the both of them.
Therefore, they prefer their wives go to the hospital alone so as to save on the transport costs,
Ratcliffe (2001).

Multiple partner relationships promote different interests for the man and his partners and this
will hamper possibilities for transparent decision making on maternal health service issues in
addition to involvement in maternal health services of all his wives when needed. Reporting his
findings (Ratcliffe 2002) noted that men are often involved in multiple sexual relationships that
present a considerable challenge to fertility awareness and reproductive health programs.

Income at household level has a bearing on antenatal attendance for both partners. This was
established in Studies from Jamaica that found that, an increased probability of joint antenatal
care attendance was associated with increased household expenditure Gertler et al. (2003).
Compared to men of low literacy level, educated men bear fewer children and achieve better

9
child survival, because they avoid early marriages, teenage pregnancy, and high parity because
they attend antenatal and postnatal more frequently. A study done in Kwale district, Kenya
revealed that men with at least secondary education or above were more likely to attend for ANC
Brown et al. (2008).

Household income levels and how resources are distributed may affect male participation in
ANC. Msuya, Mbizvo et al (2008) in Tanzania found that having high monthly income is
associated with male participation in ANC.

Alcohol consumption by the men has also been noted to plays an important role in keeping men
away from involvement in maternal health care services as most of the time they may be drunk,
leaving them with no money or time to facilitate the needed care.

2.4 HEALTH SYSTEM FACTORS

Generally, research shows that service-related factors are more important than user related
factors in affecting male involvement in maternal health care services. The most important ones
pointed out include, long physical distance from the health unit, lack of transportation,
inconvenient clinic hours, long waiting time at the clinic, poor technical and interpersonal skills.
The situation is worsened by the fact that information received from health workers on maternal
health care is primarily aimed at women as was reported by (UNFPA 2005) in several
developing countries that women not men were the targets of reproductive health programs yet
most of them are not financially or culturally positioned to make decisions about these issues
without consulting their husbands. This may actively discourage men from participating in
maternal health care services by the structure of services or by attitudes of health care workers.

In a study done by Dennis et al. (2005), some women stated that the reasons affecting their
regular attendance at the antenatal clinic with their pregnant spouses were the long waiting
hours, inconvenient service hours and that they were not treated well by the service providers
probably because of not being the recipients of the service. The judgmental nature of some health
workers towards adolescent spouses may negatively influence teenage male’s efforts to attend
antenatal services Zwellings et al, (2004).

Physical accessibility of health services has been an important determinant of utilization of

health services in developing countries. WHO reported that distance from MCH services, and the
time and the cost involved in traveling to services are significantly associated not only with ANC

10
use but also with the use of institutional delivery, postnatal and infant care services? (WHO,
2007).

However, it is widely recognized that men are often marginalized by the maternal health care
provided with limited access to basic information and knowledge to help them make informed
choices and decisions in order to promote their own health as well as that of their families
Ntabona, (2002). Koisa (2002) reported that most men do not actually accompany their partners
to antenatal care consultations or during labor or delivery.

According to the (WHO 2007), a reasonable distance to the health facility should be about five to
ten kilometers Dennill et al. (2002). (Smart 2000) states that the environment in which services
are provided for young fathers to be should be appealing to them, probably by avoiding the
clinical atmosphere often associated with hospitals or hospital-based care.

A study done in Kalabo district of Zambia Stekelenburg et al, (2004) on maternity services
indicated that, distance is a significant factor affecting delay to decide to seek care from health
facilities. It also influences the delay caused by the travel time from home to the clinic. The
geographical features of Kalabo district, the uneven distribution of facilities and the absence of
any roads or transport systems were also hindrance factors to maternity service utilization
Stekelenburg et al. (2004).

In a similar study done in Cameroon it was revealed that some providers do not allow men to
access ANC settings which on the other hand make these people believe that they are attended to
hence stopping at the door Nkuoh et al, (2010).

Byamugisha et al (2010) in a similar study conducted in eastern Uganda revealed that harsh and
critical language towards women from skilled health professionals was a barrier to male
participation.

In her study (Nantamu, 2011) reported that significant barriers within the health care system
itself are some of the issues cited by clients as impediments to father’s participation in ANC.
Long working hours and difficult in taking time off work to attend services were also cited as
reasons why many men would be unable to participate in ANC.

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In Uganda, Maternal and Child Health (MCH) services implementers and providers largely
ignored the role of men.

In Uganda, 41 percent of the women who deliver in the health facilities are accompanied by their
husbands / partner (UDHS, 2006). The central region where KCCA hospitals are located having
58 percent and 55 percent of women accompanied by their husbands/partner to deliver which is
slightly higher than the national average (UDHS, 2006).

Part of the reason for the low male involvement have come a long way with the traditional
attitude of health workers, coupled with notices in the health care premises, for example

“men are not allowed in the labor ward” which discourage men from giving support to their
wives in ANC and labor Muwa et al, (2008).

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 CHAPTER THREE
RESEARCH METHODOLOGY.
3.1 INTRODUCTION.
This chapter contains the methods that were used to execute the study; it entails a description of
the study design, the study population, sampling procedures, data collection methods and the
tools.

3.2 STUDY DESIGN

This study adopted a descriptive cross-sectional study design. This design will be chosen because
it has the advantage of making it possible to study both the exposure and the outcome at the same
time. Potential exposure (male involvement) and outcome (antenatal care services) will be
measured at the same point in time.

3.3 STUDY POPULATION

The target population will be expectant mothers at the health facilities. This will be chosen
because it would justify why the mothers did not attend ANC with their partners.

3.4 INCLUSION CRITERIA

Expectant mother aged between 18-45 years seeking ANC services at the hospitals and health
centers that consented to participate in the study.

3.5 EXCLUSION CRITERIA

Expectant mother below 18 years and above 45 years or those in the age category for the study
but do not consent to participate in the study.

3.6 SAMPLE SIZE CALCULATION

The sample size will be calculated using the formula by Kish Leslie (1964) as shown below;

n= Z2 x p (1-p)

e2

Where;

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Z = standard normal value corresponding to confidence interval (95%) = 1.96 p = proportion of
attribute in the population under study (male involvement in ANC) = 50% e = Accepted margin
of error = 5%

1.962 x 0.5 (1 – 0.5)

0.052

n = 384 expectant women

3.7 DATA SOURCES

The data sources included: -

Primary Sources: Primary sources provided first-hand testimony or direct evidence concerning a
topic under investigation; in this study, these included the women seeking ANC services from
any of the sampled health facilities and key informants who consisted of health care workers in
the facilities.

Secondary sources: A secondary source of information is one that is already existent.

3.8 SAMPLING TECHNIQUES

Two sampling techniques were used in this study. These were systematic sampling and simple
random sampling. Systematic sampling will be used to sample the health centers in the division.
The list of all health centres and hospitals will be obtained from the division and the facilities to
participate were selected using systematic sampling. A proportion of the mothers to be sampled
will be estimated according to the average number of ANC mothers seen per day at a given
health facility.

At the health centre and hospital level simple random sampling will be used to sample and
interview the expectant mothers. In using this method, a list of names of the women registered as
recipients of ANC services at the health centre will be obtained from the respective records.

Each of the names will be given specific numeric codes, which were then written on pieces of
paper. These pieces were put in a box and shaken to mix them, followed by drawing one by one
from the box and identifying the woman corresponding to the numeric code. This will be done
until the required number is reached.

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3.9 STUDY VARIABLE
A variable is any factor that can take on different values and influences the outcome of the
research. In this research, they include: -

i. Independent variables;

Individual factors including level of education, knowledge of ANC, attitude towards ANC,
beliefs, parity, peer influence, family influence and media, Socio economic factors that include
occupation and level of income, health system factors that include the distance to the health
facility, the waiting time, travel cost, attitude of health workers and services for male alongside
ANC.

ii. Dependent variable;

Male participation in ANC attendance

3.10 DATA COLLECTION TECHNIQUES

Structured questionnaires: questionnaires allow the researcher to “explore and probe
participants‟ responses to gather more in-depth data about their experiences and feelings.

They can examine attitudes, interests, feelings, concerns, and values…” (Gay & Airasian, 2002).

Many qualitative studies opt to combine observations and interviews as methods of data
collection given that they can build on each other and prove quite complementary. In this
fashion, participants typically reveal beliefs and attitudes toward the issue at hand. As in this
study, formal, in-depth interviews were conducted with the women and men in the sampling
frame.

Key Informants Interviews: Key informant interviews involve interviewing a selected group of
individuals who are likely to provide needed information, ideas, and insights on a particular
subject (Burns and groove, 2005). The key informant interviews were held with the in-charges of
the health facility and other key medical personnel in the facilities. These key informants were
chosen centres.

3.11. DATA COLLECTION TOOLS

Researcher administered questionnaires

15
Structured questionnaires were used in this study, these will be given to the study participants
who are able to answer and face to face interviews will be conducted with those who cannot read
and write. Semi structured questionnaires were used because they are inexpensive and useful
where literacy rates are high, and participants are responsive. Both closed and open questions
were asked.

Key informant Interview guide

The Key Informant Interview Guides were used to collect a broad range of perspectives on the
state of male involvement in ANC. The semi-structured interviews were designed to collect
information from the point of view of participants in their own words about the male
involvement, interventions in place to increase involvement.

3.12 ETHICS CONSIDERATION

Confidentiality: the respondents were assured that the information they are sharing will be kept
confidential and will not be used in any other way apart from the purpose of the study. Consent:
a copy of the consent form will be attached and given to the participants to sign. The objectives
of the study were clearly explained to the participants. Those with concerns or questions were
helped to understand.

Respect: All decisions of participation or non-participation were respected. Additionally, the

mothers were handles with the utmost of respect during interviews.

Risks: In this case, the study will be done in the participant’s choice area of healthcare. The
study therefore only aimed at finding out what possible association existed between various
factors and male involvement with a view of recommending improvements. No risks will be
involved; nobody will be publicly embarrassed

3.13 LIMITATIONS OF THE STUDY

Not so many hardships were encountered during the study apart from the bad weather due to the
rainy season that interfered with the data collection especially due to the fact that motorcycles
are the convenient means of transport in the division.

16
 CHAPTER FOUR
PRESENTATION OF RESEARCH FINDINGS

4.1 INTRODUCTION

This study sought to assess the factors influencing male (18-45 years) participation in antenatal
care attendance in Nyamira County Referral Hospital. A total of 384 respondents were selected
for the study, therefore, 384 questionnaires were generated and distributed, all the questionnaires
were filled and returned. Therefore, the research response rate was 100%.

4.2 BIO DATA

The study sought for the biodata of the respondents, on the age of the respondents, 50% were
aged 18 – 20 years, 25.3% were aged 21 – 30 years, 22.1% were aged 31 – 40 years while 2.6%
were aged 31 – 40 years. On the marital status of the respondents, 28.6% were married, 26%
were living together, 23.2% were divorced, 18.2% were never married while 3.9% were
widowed. On the type of marriage, 73.9% were in a polygamous marriage, while 25.1% were in
a monogamous marriage. On the religion of the respondents, 31.2% were Catholics, 29.2% were
SDA, 26% were Pentecostal, and 13.5% were protestants. On the occupation of the respondents,
31.2% were offering skilled manpower, 29.2% were domestic workers, 26.0% were in sales and
services, while 13.5% were unskilled. On the ,distance to the health facility, 50.5% cited they did
not know, 26% cited five kilometers and less while 23.4% cited more than five kilometers. The
study further sought for the rate of school attendance of the respondents 52.1% cited yes while
47.9% declined attendance of school. On the highest level of education of the respondents,
58.3% cited primary, 23.4% cited tertiary, 10.4% cited o level while 7.8% cited a level. The
study further sought for the means of transport the respondents used to hospital, 31.35% cited
walking, 26.3% cited public means, 25.5% cited motorcycle, 13% cited bicycle while 3.9% cited
private means.

17
Table 4.2.1 Age of the respondents

Response Frequency Percentage

18-20 192 50.0%
21-30 97 25.3%
31-40 85 22.1%
41-49 10 2.6%
Total 384 100%
Figure 4.2.1 Age of the respondents

Age of the respondents

60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
18-20 21-30 31-40 41-49

Age of the respondents

Table 4.2.2 Marital status

Response Frequency Percentage

Never Married 70 18.2%
Married 110 28.6%
Living together 100 26.0%
Divorced/separated 89 23.2%
Widowed 15 3.9%
Total 384 100

18
Figure 4.2.2 Marital status

Marital status
35.00%

30.00%

25.00%

20.00%

15.00%

10.00%

5.00%

0.00%
Never Mar- Married Living Divorced/ Widowed
ried together separated

Marital status

Table 4.2.3 Type of marriage

Response Frequency Percentage

Monogamous 100 26.0%
Polygamous 284 73.9%
Total 384 100

Figure 4.2.3 Type of marriage

Type of marriage

Monogamous Polygamous

19
Table 4.2.4 Response on religion

Response Frequency Percentage

Protestant 52 13.5%
Catholic 120 31.2%
Pentecostal 100 26.0%
Muslim 0 0%
SDA 112 29.2%
Total 384 100

Figure 4.2.4 Response on religion

Response on religion
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Protestant Catholic Pentecostal Muslim SDA

Response on religion

Table 4.2.5 Response on occupation

Response Frequency Percentage

Unskilled manual 52 13.5%
Skilled manual 120 31.2%
Sales and services 100 26.0%
Professional services 0 0%
Domestic 112 29.2%
Total 384 100

20
Figure 4.2.5 Response on occupation

Response on occupation
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Unskilled Skilled Sales and Professional Domestic
manual manual services services

Response on occupation

Table 4.2.6 Response on distance to the health facility

Response Frequency Percentage

Five kilometers and less 100 26.0%
More than five kilometers 90 23.4%
Don’t know 194 50.5%
Total 384 100

Figure 4.2.6 Response on distance to the health facility

Response on distance to the health facility

Five kilometers and less More than five kilometers Don’t know

21
Table 4.2.7 Response on school attendance

Response Frequency Percentage

Yes 200 52.1%
No 184 47.9%
Total 384 100
Table 4.2.7 Response on school attendance

Response on school attendance

Yes No

Table 4.2.8 Response on highest level of education

Response Frequency Percentage

Primary 224 58.3%
O level 40 10.4%
A level 30 7.8%
Tertiary 90 23.4%
Total 384 100

22
Table 4.2.8 Response on highest level of education

Response on highest level of education

70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Primary O level A level Tertiary

Response on highest level of education

Table 4.2.9 Response on main source of knowledge about health issues

Response Frequency Percentage

Radio 112 29.2%
VHT member 20 5.2%
Health worker 70 18.2%
Community campaign 182 47.4%
Total 384 100
Figure 4.2.9 Response on main source of knowledge about health issues

Response on main source of

knowledge about health issues
50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Radio VHT member Health worker Community
campaign

Response on main source of knowledge about health issues

23
Table 4.2.10 Response on means of transport

Response Frequency Percentage

Walking 120 31.25%
Bicycle 50 13.0%
Motorcycle 98 25.5%
Public means 101 26.3%
Private means 15 3.9%
Total 384 100
Figure 4.2.10 Response on means of transport

Response on means of transport

35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Walking Bicycle Motorcycle Public means Private means

Response on means of transport

24
 CHAPTER FIVE
DISCUSSION OF RESEARCH FINDINGS
This study sought to assess the factors influencing male (18-45 years) participation in antenatal
care attendance in Nyamira County Referral Hospital. A total of 384 respondents were randomly
picked for the study. The role of men in maternal health has been described in detail in the
literature. In developing countries, such as Indonesia, this role is especially important because of
the culture of paternalism, which tends to favor males and discourages women from decision
making. The findings of this study indicate that the level of male participation in ANC is low
(41.2%). These are consistent with findings that male participation in ANC is low in many
regions of the world, such as sub-Saharan Africa, Ethiopia and Uganda and inconsistent with
findings from Tanzania, Rwanda, Nigeria, England.

From the findings of the study a family with ≤2 children indicates minimal experience with
pregnancy; therefore, the husband is motivated to participate in pregnancy care and expected to
play an active role in maintaining the wife’s health during pregnancy. This result is consistent
with those of studies reporting that husbands who do not provide SIAGA support result in
multigravidas. Men who have two children are more likely to be involved in reproductive health
services. These findings support the family planning (KB) programs related to the “2 children
was better” policy; therefore, men can be more involved and participate in improving maternal
health, especially ANC.

Knowledge influences male participation in ANC because it has great potential in overcoming
the misconceptions and myths that hinder male participation in maternal care. Men with higher
levels of education tend to be more involved in reproductive health care. This is related to higher
income levels and greater access to the media, which provides information about reproductive
health. The low knowledge barrier to male participation in ANC includes negative public
perceptions of men who play an active role in maintaining the health of their families, a lack of
knowledge about men’s role in maternity care, and a poorly designed/implemented health-care
system to facilitate male inclusion.

Surprisingly, our study has revealed a negative association between the perception of participants
on the attitude of health care providers toward men who accompany their partners to ANC and

25
the level of men’s involvement in ANC. Participants who perceived positive attitude of providers
had low odds of involvement compared with those who had a negative perception. This finding
was not expected but could be explained in terms of the protective nature of men towards their
partners whereby those who had a negative perception may accompany their partners as a way of
protecting them from providers with a negative attitude. However, further studies are needed to
explore in depth the perception of men on provider’s attitude towards men’s involvement with
ANC in settings where gender roles are still highly observed in caring for pregnant mothers.

The study assessed only four variables for men’s involvement in ANC, while the variable men’s
involvement is complex. It needs to be assessed by a combination of several variables. The
combination of other variables such as financial support for ANC, arranging transportation for
delivery, planning for a potential blood donor, involvement in decision making of the location
for delivery, accompaniment to the place of delivery could improve the accuracy of the measure.
Although the study included men with children aged less than two years, the issue of recall bias
and the fact that pregnancy issues may not have as much importance to the male partners as they
do to the female may limit the study findings. Additionally there are chances that, social
desirability could have played a negative influence on men to disclose their involvement in
maternal care issues especially given the cultural context of gender roles in the study area.

26
 CHAPTER SIX
CONCLUSION AND RECOMMENDATIONS
6.1 Conclusions
The conclusions of this study are based on the assumptions that the respondents’ responses can
be generalized. The conclusion is that socio-cultural issues affect male participation in the
antenatal clinic. Both men and women are barriers to male participation in antenatal care. They
need to keep off the belief that reproductive care a woman’s affair and that association with the
pregnant wife is unmanly. The study concludes that there is little or no information being given
to the public to enhance their knowledge on their general health. The employers are not giving
the men their paternal duty to attend the antenatal clinic when required to. Some due to the
nature of their jobs may miss the day’s pay or allowances and therefore forego the doctor’s
appointment. Some employers do not motivate their workers with an insurance cover so that the
men do not feel financially pressed when needed to accompany their partners in the clinic.

The researcher also concludes that the men generally do not see the need to go to the clinic hence
many excuses. Thus need to sensitize the public. The study concludes that many health services
keep men off the clinic. The staffs are few making them have burn-out and hence the arrogant
and harsh language use as reported by the clients. This calls for more addition of personnels who
will help the services run fast avoiding taking so much time in the clinic. The health facilities
have very few male personnels and so a need to be gender sensitive while employing as they
could be a motivator to the men. Space need be created because men stand for hours awaiting
their partners to be served till the end The health care providers have not given enough talks to
do with services offered and thus need for more refresher courses to the staffs and frequent
health sensitization to the clients. The staff are overworked especially with the free maternal
health care and do not have time to engage clients fully thus being labelled ignorant and arrogant
to staffs.

6.2 Recommendations
From the findings of the study, the following recommendations were drawn,

27
i) The government could pass laws compelling fathers to be fully responsible for their
unborn children by participating in the antenatal clinic services. This could also help
the employers be flexible by releasing the men from their tight schedules
ii) Nyamira County and referral Hospital being a referral institution should employ more
human resource personnels to the antenatal clinic given the maternity services are free
thus high ratios of expectant mothers to health providers. More so, they should
consider gender balance to avoid dorminance of one gender over the other.
iii) The health providers need be trained on public relations and continuous refresher
courses to have a good workers’ relationship and also know how to handle clients in
their different nature. The staff also need supervision counselling to vent out their
burning issues An intense capacity building or mobilisation campaign is important in
the clinic and the country to educate people on the importance of their health. The
clients need be equipped with all information pertaing birth preparedness, labor signs,
modes of delivery and family planning methods etc.

28
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33
 APPENDIX I. QUESTIONNAIRE.
1. Age of respondents in complete year
a) 1=18-20 years
b) 2=21-30 years
c) 3= 31-40 years
d) 4=41-49 years
2. Marital status
a) 1=Never married [ ]
b) 2=Married [ ]
c) 3=Living together [ ]
d) 4=Divorced/Separated [ ]
e) 5=Widowed [ ]
3. Type of marriage
a) 1=Monogamous [ ]
b) 2=Polygamous [ ]
4. Religion
a) 1=Protestant [ ]
b) 2=Catholic [ ]
c) 3=Pentecostal [ ]
d) 4=Muslim [ ]
e) 5=SDA [ ]
f)6 Other ………………………………………………………………
5. Occupation
a) 1=Unskilled manual [ ]
b) 2=skilled manual [ ]
c) 3=Sales and services [ ]
d) 4=Professional/Technical [ ]
e) 5=Domestic [ ]
6. Distance to nearest health facility
a) 1=Five kilometers and less [ ]
b) 2=More than five kilometers [ ]

34
 c) 3=don‟t know
………………………………………………………
7. Have you ever attended school?
a) 1=Yes [ ]
b) 2=No [ ]
c) If No skip to Qn 9
8. If yes, what is the highest level of education that you achieved?
a) 1=Primary [ ]
b) 2=O ‟level [ ]
c) 3=A‟ level [ ]
d) 4=Tertiary [ ]
9. What is your main source of knowledge about health issues?
a) 1=Radio [ ]
b) 2=VHT member [ ]
c) 3=Health worker [ ]
d) 4=Community campaign [ ]
e) 5=other(specify)…………………………………………………
10. What transport means do you usually use?
a) 1=Walking [ ]
b) 2=Bicycle [ ]
c) 3=Motorcycle [ ]
d) 4=Public means [ ]
e) 5=Private means [ ]

35
 APPENIX II RESEARCH WORKPLAN
ACTIVITY JUNE JULY AUG SEP OCT NOV DEC JAN
Identification and
formation of topic

Formulation of
objectives,
problem statement
and justification

Literature review

Study
methodology,
formulation of
questionnaire,
typing and binding
proposal,
references
Data collection
analysis and
presentation of
research

36
 APPENDIX III: BUDGET
ITEM QUANTITY COST PER ITEM TOTAL
AMOUNT(KSH)

Foolscaps 1 ream 500 500

File 1 peace 50 50

Photocopy papers 1 ream 500 500

Pens 2 50 100

Printing 2 sheets 50 100

questionnaires

Internet 1gb 500 500

Interview 20 500 500

Photocopy 40 pages 3 120

questionnaire

Typing, printing and 1200

binding of research.

miscellaneous 700

TOTAL AMOUNT 4,270

37