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Mohamed Nazeer NSB, Chua JS, Shorey S. Birth plan and fathers: A scoping review. Midwifery 2024; 135:104053. [PMID: 38861779 DOI: 10.1016/j.midw.2024.104053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND With increasing paternal involvement in maternal and infant care, expectant fathers, who are often present during the labour process have been seen to use birth plans to express their wishes during childbirth. Despite their involvement, existing literature mainly focuses on maternal outcomes, highlighting the need to explore paternal involvement with birth plans. AIMS To explore and consolidate the available literature on the involvement of fathers in the birth plan process, their perspectives toward birth plans, and how it has influenced their overall childbirth experience. METHODS This scoping review was conducted based on Arksey and O'Malley's five-stage framework. Seven databases were searched from 1980 till March 2024: PubMed, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. Data were screened, extracted, and cross-checked between two independent reviewers. A thematic analysis was conducted to summarise the data. RESULTS BASED ON THE FINDINGS FROM THE 33 INCLUDED STUDIES, ONE OVERARCHING THEME WAS IDENTIFIED: : 'Factors promoting and restricting fathers' participation in birth plan'; supported by two main themes 1) Motivations behind paternal engagement in the birth plan process and 2) Roadblocks to paternal involvement in the birth plan. CONCLUSION The findings of this review provided insights to guide future practice to engage fathers during childbirth by enhancing their involvement in birth plans. The findings on the motivating factors for fathers to be involved in the birth plan process and barriers affecting their participation also provided directions for future research by highlighting the gaps in the current evidence.
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Affiliation(s)
- Nur Syahidah Bte Mohamed Nazeer
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Jing Shi Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
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Jamir A, Kharde S, Dalal A. Attitudes of First-Time Fathers in South India Toward Their Role in Their Wives' Prenatal Period. Nurs Womens Health 2024; 28:128-134. [PMID: 38346680 DOI: 10.1016/j.nwh.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess the attitudes of first-time fathers toward their role during their wives' prenatal period. DESIGN Cross-sectional study. SETTING Tertiary care hospital in South India. PARTICIPANTS First-time fathers accompanying their pregnant wives to an antenatal clinic. METHODS Participants were surveyed to collect information on their attitudes toward their role during the prenatal period. The survey captured attitudes about fathers' role in pregnancy care; role as financial provider; and need to provide physical, emotional, moral, and social support. RESULTS Two hundred fathers were included in the sample. Approximately 17.5% (n = 35) had a positive attitude toward their role in the prenatal period, whereas 40% (n = 80) had a negative attitude. Having a joint family (i.e., husband, wife, children, and husband's parents) was found to be negatively associated with fathers' attitudes toward their role during the prenatal period (p < .05). CONCLUSION The findings revealed that the presence of a joint family structure was associated with a more negative attitude among fathers toward their role in their wives' pregnancies. Antenatal care should include education programs aimed at enhancing husbands' knowledge, awareness, and active participation during the prenatal period.
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Finlayson K, Sacks E, Brizuela V, Crossland N, Cordey S, Ziegler D, Langlois EV, Javadi D, Comrie-Thomson L, Downe S, Bonet M. Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011086. [PMID: 37137532 PMCID: PMC10163465 DOI: 10.1136/bmjgh-2022-011086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is a key component of maternity provision and presents opportunities for healthcare providers to optimise the health and well-being of women and newborns. However, PNC is often undervalued by parents, family members and healthcare providers. As part of a larger qualitative review exploring the factors that influence PNC uptake by relevant stakeholders, we examined a subset of studies highlighting the views of fathers, partners and family members of postpartum women. METHODS We undertook a qualitative evidence synthesis using a framework synthesis approach. We searched multiple databases and included studies with extractable qualitative data focusing on PNC utilisation. We identified and labelled a subset of articles reflecting the views of fathers, partners and other family members. Data abstraction and quality assessment were carried out using a bespoke data extraction form and established quality assessment tools. The framework was developed a priori based on previous research on the topic and adapted accordingly. Findings were assessed for confidence using the GRADE-CERQual approach and are presented by country income group. RESULTS Of 12 678 papers identified from the original search, 109 were tagged as 'family members views' and, of these, 30 were eligible for this review. Twenty-nine incorporated fathers' views, 7 included the views of grandmothers or mothers-in-law, 4 incorporated other family member views and 1 included comothers. Four themes emerged: access and availability; adapting to fatherhood; sociocultural influences and experiences of care. These findings highlight the significant role played by fathers and family members on the uptake of PNC by women as well as the distinct concerns and needs of fathers during the early postnatal period. CONCLUSION To optimise access to postnatal care, health providers should adopt a more inclusive approach incorporating flexible contact opportunities, the availability of more 'family-friendly' information and access to psychosocial support services for both parents.
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Affiliation(s)
- Kenneth Finlayson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nicola Crossland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Sarah Cordey
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Daniela Ziegler
- Direction de l'enseignement et l'Académie CHUM | Bibliothèque du CHUM, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Liz Comrie-Thomson
- Global Women's and Newborn's Health Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Mercedes Bonet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Babughirana G, Gerards S, Mokori A, Charles Baigereza I, Baba Magala A, Kwikiriza R, Alum V, Mukiza D, Kremers S, Gubbels J. Effects of timed and targeted counselling by community health workers on maternal and household practices, and pregnancy and newborn outcomes in rural Uganda. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100845. [PMID: 37099845 DOI: 10.1016/j.srhc.2023.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/07/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Pregnancy and birth-related complications claim the lives of millions of women and newborns every year. Improving their survival chances remains an urgent global challenge, including in Uganda. Community health workers (CHWs) play a crucial role in bridging the gap between the community and the official health system in Uganda. Timed and targeted Counselling (ttC) is an individual-level behavioral change communication method used by CHWs, aimed at pregnant women and caregivers of children under the age of two. AIM This study examined whether the implementation of the ttC intervention by the CHWs was associated with improved household practices and outcomes during the pregnancy and newborn period. METHODS A multi-stage sampling technique was employed with a total of 749 participants in the intervention group (ttC intervention), and 744 participants in the control group (no ttC). Data on quality of maternal and household antenatal care (ANC) and essential newborn care (ENC) practices, as well as on pregnancy and newborn outcomes were collected through questionnaires from May 2018 to May 2020. McNemar's Chi-square tests were used to compare outcomes before and after implementation, and between the intervention and control group. RESULTS Results showed that, compared to baseline, ttC contributed significantly to the demand for quality of service during ANC, ENC and partner involvement in maternal and newborn health. In comparison to the control group, the ttC group showed significantly higher early ANC attendance rates and higher quality of ANC and ENC. CONCLUSION ttC is a comprehensive, goal-driven approach that seems to contribute to the improvement of quality of maternal and household practices, and pregnancy and newborn outcomes in Uganda. TRIAL REGISTRATION PACTR, PACTR202002812123868, registered on 25 February 2020, http://www.pactr.org/PACTR202002812123868.
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Affiliation(s)
- Geoffrey Babughirana
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands.
| | - Sanne Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | | | | | | | | | - Victo Alum
- District Health Office, Masindi District Local Government, Uganda
| | | | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
| | - Jessica Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, The Netherlands
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Teferi HM, San Sebastian M, Baroudi M. Factors associated with home delivery preference among pregnant women in Ethiopia: a cross-sectional study. Glob Health Action 2022; 15:2080934. [PMID: 35867544 PMCID: PMC9310790 DOI: 10.1080/16549716.2022.2080934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Home delivery is associated with a high risk of maternal and neonatal mortality. The prevalence and factors associated with home delivery have been studied retrospectively among women in Ethiopia. However, no national studies have assessed pregnant women’s preferences for home delivery. Objective To assess factors associated with preferences for home delivery among pregnant women in Ethiopia. Methods We analysed a sample of 678 pregnant women derived from the 2019 performance monitoring for action cross-sectional survey. The association between pregnant women’s preferences for home delivery and several individual, household, healthcare, and community factors were explored through log-Poisson regression with robust variance. Results The weighted prevalence of pregnant women’s preferences for home delivery in Ethiopia was 33%. Pregnant women between the ages of 15–19 years (PR = 2.3; 95% CI: 1.43–4.00) had a higher preference for home delivery compared to those above 34 years. Those who had no Antenatal care (ANC) visit in the current pregnancy (PR = 1.5; 95% CI: 1.11–2.11), multipara women (PR = 1.8; 95% CI: 1.19–2.92) those who did not discuss place of delivery with their partners (PR = 1.5; 95% CI: 1.18–2.10), did not participate in a community-based program called ‘1 to 5’ network meetings (PR = 4.5; 95% CI: 1.09–18.95), and those who perceived low community support for facility delivery (PR = 2.2; 95% CI: 1.53–3.20) had a higher prevalence of home delivery preference compared to their references. Conclusions A significant proportion of pregnant women preferred home deliveries in Ethiopia. Household and community supporting factors such as not discussing place of delivery with a partner, not participating in women developmental army meetings, and perceived low community support were associated with preference for home delivery. Interventions should address these factors to increase facility deliveries in Ethiopia.
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Affiliation(s)
| | | | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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6
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Jeong J, Ahun MN, Bliznashka L, Velthausz D, Donco R, Yousafzai AK. Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique. Soc Sci Med 2021; 287:114363. [PMID: 34500322 DOI: 10.1016/j.socscimed.2021.114363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers' roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October-November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers' involvement included the absence of fathers in many households; opportunity costs associated with fathers' accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers' broader engagement with their child at home; fathers' desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Université de Montréal School of Public Health, Montréal, QC, Canada
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kawaguchi Y, Sayed AM, Shafi A, Kounnavong S, Pongvongsa T, Lasaphonh A, Xaylovong K, Sato M, Matsui M, Imoto A, Huy NT, Moji K. Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis. PLoS One 2021; 16:e0255193. [PMID: 34339442 PMCID: PMC8328292 DOI: 10.1371/journal.pone.0255193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities. METHODS A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model. RESULTS Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs' assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD. CONCLUSIONS Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.
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Affiliation(s)
- Yoshiko Kawaguchi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ahmad M. Sayed
- Department of Organic Chemistry, College of Pharmacy, Al-Azhar University, Cairo, Egypt
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Alliya Shafi
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
- School of Medicine, American University of Caribbean, Sint Maarten
| | | | | | | | - Khamsamay Xaylovong
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Atsuko Imoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
- * E-mail: (NTH); (KM)
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- * E-mail: (NTH); (KM)
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Lusambili AM, Wisofschi S, Shumba C, Muriuki P, Obure J, Mantel M, Mossman L, Pell R, Nyaga L, Ngugi A, Orwa J, Luchters S, Mulama K, Wade TJ, Temmerman M. A Qualitative Endline Evaluation Study of Male Engagement in Promoting Reproductive, Maternal, Newborn, and Child Health Services in Rural Kenya. Front Public Health 2021; 9:670239. [PMID: 34307276 PMCID: PMC8296463 DOI: 10.3389/fpubh.2021.670239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced RMNCH in rural Kisii and Kilifi. Methods: The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions (FGDs) with 82 community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews (KIIs) with facility health managers, and sub-county and county officials who were aware of the AQCESS project. Results: Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning (FP), spousal/partner accompaniment to facility care, and defeminization of social and gender roles. Conclusion: This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children's health as well as in improving spousal support for use of FP methods.
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Affiliation(s)
- Adelaide M Lusambili
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Stefania Wisofschi
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Constance Shumba
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Peter Muriuki
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Jerim Obure
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Michaela Mantel
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | | | - Rachel Pell
- Aga Khan Foundation, Canada, Ottawa, ON, Canada
| | - Lucy Nyaga
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Anthony Ngugi
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - James Orwa
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya.,Aga Khan Foundation, Canada, Ottawa, ON, Canada.,Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Kennedy Mulama
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya
| | - Terrance J Wade
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya.,Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Medical College, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Department of Obstetrics and Gynaecology, Medical College, Aga Khan University, Nairobi, Kenya
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9
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Garrison-Desany HM, Wilson E, Munos M, Sawadogo-Lewis T, Maïga A, Ako O, Mkuwa S, Hobbs AJ, Morgan R. The role of gender power relations on women's health outcomes: evidence from a maternal health coverage survey in Simiyu region, Tanzania. BMC Public Health 2021; 21:909. [PMID: 33980197 PMCID: PMC8117490 DOI: 10.1186/s12889-021-10972-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gender is a crucial consideration of human rights that impacts many priority maternal health outcomes. However, gender is often only reported in relation to sex-disaggregated data in health coverage surveys. Few coverage surveys to date have integrated a more expansive set of gender-related questions and indicators, especially in low- to middle-income countries that have high levels of reported gender inequality. Using various gender-sensitive indicators, we investigated the role of gender power relations within households on women's health outcomes in Simiyu region, Tanzania. METHODS We assessed 34 questions around gender dynamics reported by men and women against 18 women's health outcomes. We created directed acyclic graphs (DAGs) to theorize the relationship between indicators, outcomes, and sociodemographic covariates. We grouped gender variables into four categories using an established gender framework: (1) women's decision-making, (2) household labor-sharing, (3) women's resource access, and (4) norms/beliefs. Gender indicators that were most proximate to the health outcomes in the DAG were tested using multivariate logistic regression, adjusting for sociodemographic factors. RESULTS The overall percent agreement of gender-related indicators within couples was 68.6%. The lowest couple concordance was a woman's autonomy to decide to see family/friends without permission from her husband/partner (40.1%). A number of relationships between gender-related indicators and health outcomes emerged: questions from the decision-making domain were found to play a large role in women's health outcomes, and condoms and contraceptive outcomes had the most robust relationship with gender indicators. Women who reported being able to make their own health decisions were 1.57 times (95% CI: 1.12, 2.20) more likely to use condoms. Women who reported that they decide how many children they had also reported high contraception use (OR: 1.79, 95% CI: 1.34, 2.39). Seeking care at the health facility was also associated with women's autonomy for making major household purchases (OR: 1.35, 95% CI: 1.13, 1.62). CONCLUSIONS The association between decision-making and other gender domains with women's health outcomes highlights the need for heightened attention to gender dimensions of intervention coverage in maternal health. Future studies should integrate and analyze gender-sensitive questions within coverage surveys.
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Affiliation(s)
- Henri M Garrison-Desany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA.
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Talata Sawadogo-Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Onome Ako
- Amref Health Africa Canada, 489 College Street, Toronto, ON, M6G 1A5, Canada
| | - Serafina Mkuwa
- Amref Health African Tanzania, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Amy J Hobbs
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA
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