Date Published: April 11, 2018
Author(s): Minyahil Tadesse, Andualem T. Boltena, Benedict O. Asamoah.
The poor emphasis on the role of husbands in birth preparedness and complication readiness (BPCR) is a major factor that should be addressed in tackling maternal mortality.
To assess the level of husbands’ participation in BPCR and associated factors.
Wolaita Sodo town, Southern Ethiopia.
A community based cross-sectional study was conducted among 608 husbands of pregnant women and nursing mothers. Multivariate logistic regression model was used for the analysis.
Forty-five per cent of husbands studied had poor participation in BPCR. Out of the total husbands studied, 40% (235) did not identify transportation, 49% (291) did not accompany their wives to antenatal care (ANC) clinic, 59% (350) did not identify skilled birth attendant, 26% (155) did not identify health facility for delivery and 30% (179) did not save money for emergency. Only 42% (250) of husbands had awareness of emergency conditions, while 75% (444) did not make postpartum plan. Husbands who knew the place of birth of the baby [adjusted odds ratio (AOR) = 7.23; 95% confidence interval (CI): 2.98–17.54] and those who discussed with their wives about birth preparedness (AOR = 2.03; 95% CI: 1.37–3.02) were significantly more likely to participate in BPCR compared to those who did not.
Participation of husbands in BPCR was poor in the study area. The level of participation in relation to selection of service provider and health facility, financial and transportation planning for delivery and identifying blood donor needs attention to achieve better husband participation in BPCR.
Maternal mortality is one of the most sensitive indicators of health disparity among low-, middle- and high-income countries and remains largely a major contributor to unmet public health concerns globally. Remarkable disparities in maternal deaths exist between and within countries, with wide variations between the rich and the poor, and urban and rural areas.1,2 For instance, in 2015, the risk of losing one’s life through pregnancy in the sub-Saharan African region was 1:36 compared to the global average lifetime risk of 1:180. At the country level, in 2015, lifetime risks of maternal deaths ranged from 1 death per 23 700 women in Greece to 1 death per 17 in Sierra Leone.3 The Fifth Millennium Development Goal (MDG 5), which sought a 75% reduction in every country’s maternal mortality ratio by 2015, lagged the farthest behind in developing countries.
A total of 592 subjects participated in the study, yielding a response rate of 98%. Forty-six per cent of husbands (273) were in the age range of 31–40 years, while slightly above half (52%, 310) were followers of Protestant Christianity. Only 37% (218) of husbands attained educational level of a college degree or diploma, while 28% (163) were government employed by occupation. Regarding socio-demographic characteristics of wives, 60% (355) were aged 20–29 years, 58% (345) were housewives by occupation and 30% (180) had attended primary education. About 64% (381) of the households had income more than 1000 Ethiopian birr (≈ 45 USD) per month. Regarding husbands’ sources of information about BPCR, about half of the husbands (51.4%, 304) had heard about it from radio, whereas 43.9% (260) had heard about it from television. Moreover, only 28.0% (166) of the husbands had read about BPCR from newspapers, while 45.9% (272) reported discussing BPCR with their wives. Nearly one-third of the husbands (31.6%) reported discussing with their neighbours, while nearly one-quarter (22.5%) reported discussing BPCR with a health professional (Table 1).
This study has shown that approximately half of the husbands were either not participating at all or had poor participation in BPCR as they were practising four or less elements of the nine items during pregnancy, delivery and postpartum period. This finding indicates higher percentage of husbands not participating in BPCR compared with the study conducted in Mekele town, Northern Ethiopia, in which the husbands who participated in BPCR constituted 40%.31 In this study, one in four husbands did not save money for delivery and postpartum. Having no money during delivery and postpartum could mean that the mother is subject to high risk of birth complications and death from unskilled birth attendants. The fact that only one in five husbands identified blood donor can be seen as a threat to maternal survival as bleeding during delivery and post-delivery is the topmost cause of maternal mortality. A study conducted in Uganda found that one in 10 women had blood loss during delivery. This could drastically increase the risk of mortality32 as haemorrhage remains one of the topmost causes of maternal mortality,1 and most deaths occur within 24–48 h of delivery because of prolonged blood loss.33 On the other hand, the donated blood should be carefully managed and screened for blood-borne infections such as HIV and hepatitis.
Participation of husbands in BPCR was poor in the study area. In relation to the level of preparation and participation, saving money for delivery and identifying blood donor were the lowest. Therefore, interventions should be targeted towards improving male participation through promoting targeted policies and advocacies across all relevant stakeholders’ levels, including community education for men and women. Efforts should be made by the health care system to assist and welcome both men and women at ANC and delivery care.