Spousal participation in labor and delivery in nigeriaa

National and subnational variations in gender relations and the utilization of maternal healthcare services in Nigeria

Introduction

poor maternal health outcomes remain a major public health issue in Nigeria. These have been shown to be affected by the low level of utilization of maternal healthcare services. This study investigates the levels of gender relations (GR) among Nigerian women and how these influence their utilization of maternal healthcare services. The relations are conceptualized as feminine (FGR), masculine (MGR) and egalitarian.

Methods

data on household decision-making, antenatal care (ANC) visits, health facility delivery, and associated sociodemographic variables, were extracted from the 2018 Nigeria Demographic and Health Survey for 29,992 parous women aged 15-49 for a cross-sectional study. Associations were investigated using Chi-Square and regression analyses.

Results

women with FGR constituted 5.7% of the population at the national level, while subnational variations ranged from 1.8% in the North-East to 12.8% in the South-South regions. The prevalence rates of the recommended minimum ANC visits (RMANC) and health facility delivery were 42.1% and 30.0% at the national level and were lowest in the northern regions. At both the unadjusted and adjusted levels, FGR was not significantly associated with RMANC and health facility delivery at the national level and in all the regions except the South-West. MGR was however significantly associated with increased odds of RMANC (OR: 2.235, CI: 2.043-2.444) and health facility delivery (OR: 2.571, CI: 2.369-2.791) at national level. Significant subnational variations in the association between gender relations and the utilization of maternal healthcare services were also recorded.

Conclusion

sub-national variations in GR and their varying impacts on the utilization of maternal healthcare services in Nigeria suggest that gender-related policies to improve maternal health outcomes should be location-specific, rather than general. As FGR did not affect maternal healthcare services utilization, educating men on the benefits of supporting their wives to scale-up utilization is recommended.

Non-pharmacological labor pain management practice and associated factors among skilled attendants working in public health facilities in Gamo and Gofa zone, Southern Ethiopia: A cross-sectional study

Background

Labor pain management is crucial to ensure the quality of obstetric care but it is one of the neglected areas in obstetrics. This study aimed to assess the practice of labor pain management and associated factors among skilled attendants working in public health facilities in Southern, Ethiopia from November 1–January 26, 2019.

Methods

An Institution-based cross-sectional study design was conducted from November 1–January 26, 2019. A simple random sampling technique was used to select a total of 272 obstetric care providers. Data were collected using pretested, and structured questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P-value <0.05 with 95% confidence level were used to declare statistical significance.

Result

Overall, 37.5% (95%CI: 32%, 43%) of health care providers had a good practice on non-pharmacological labor pain management. Clinical experience of 5 years and above (AOR = 2.91, 95%CI: 1.60, 5.42), favorable attitude (AOR = 2.82, 95%CI: 1.56, 5.07), midwife profession (AOR = 1.45, 95%CI: 1.98, 4.27), and working in satisfactory delivery rooms (AOR = 3.45, 95%CI: 2.09, 7.43), were significantly associated with a health professional good practice of labor pain management.

Conclusion

This study showed that the practice of non-pharmacological labor pain management was poor in public health facilities in Gamo and Gofa zone. It was observed that having a favorable attitude, having ≥5 years of work experience, being a midwife by professional, and having a satisfactory delivery room were found to be significant predictors of the practice of non -pharmacological labor pain management. Therefore, all health facilities and concerned bodies need efforts to focus on providing training to midwives on non-pharmacological labor pain management practice.

A qualitative inquiry into pregnant women's perceptions of respectful maternity care during childbirth in Ibadan Metropolis, Nigeria

Women’s perceptions of respectful maternity care (RMC) are critical to its definition and measurement globally. We evaluated these in relation to globally defined RMC norms. We conducted a descriptive study involving eight focus group discussions with 50 pregnant women attending antenatal clinic at one primary and one secondary health facility each in the North-west and South-west local government areas of Ibadan Metropolis, Nigeria. One focus group each with primigravidae and multiparas were held per facility between 21 and 25 October 2019. Shakibazadeh et al’s 12 domains of RMC served as the thematic framework for data analysis. The women’s perceptions of RMC resonated well with seven of its domains, emphasising provider-client inter-personal relationships, preserving their dignity, effective communication, and non-abandonment of care, but with mixed perceptions for two domains. However, their perceptions deviated for four domains, namely maintaining privacy and confidentiality; ensuring continuous access to family support such as birth companions; obtaining informed consent; and respecting women’s choices about mobility during labour, food and fluid intake, and birth position. The physical environment was not mentioned as contributing to an experience of RMC. Whilst the perceptions of the Nigerian women studied about RMC were similar to those accepted internationally, there were significant deviations which may be related to cultural differences and societal disparities. Different interpretations of RMC may influence women’s demand for such care in different settings and challenge strategies for promoting a universal standard of care.

The solutions to increase the participation of men in sexual and reproductive health of women in Iran: an analytic hierarchy process (AHP) analysis

Ever since the Cairo Declaration in 1994, women's Sexual and Reproductive Health (SRH) has become a priority and substantial efforts have been made to improve it. Men's contribution to promote the SRH of women is essential. Therefore, this study aimed to identify the best solutions to increase the men's participation in the SRH of women in Iran, using an analytic hierarchy process (AHP) approach. A cross-sectional study was conducted among 150 married men in Iran. The data was collected using a questionnaire. To determine the best solutions to improve the men's participation in women's SRH, the opinions of an expert group from academia, Ministry of Health (MOH) were employed and the best solution were selected based on the scores, applying analytic hierarchy process (AHP) approach. The statistical analysis was performed using SPSS V.20 and Expert Choice software. In the final analysis 'Well-oriented sex education focused on men's involvement', 'Well-trained professional employment' and 'Sex education in society, schools, and universities' were the solutions with highest coefficients, respectively.Impact statementWhat is already known on this subject? SRH of women, is a major part of primary efforts regarding the increase of SRH's quality; among which, the role and place of men is of utmost importance. Struggling to participate men in issues related to the health of women can not only promote inter family relationships, but also can affect the quality of relationship between man and woman in the society.What do the results of this study add? According to results of the study, one of the main obstacles of men participation was educational and information barriers, regarding which, having adjusted and improved educational systems, opportunity could be prepared for men participation. Current centres for educating those who are already getting married are the first and main places where men can be educated to meet their educational needs in their marriage life such as SRH. Through integrating three selected approaches in the experts' meetings in the educational program of before marriage, men participation can be increased in SRH.What are the implications of these findings for clinical practice and/or future research? The findings could inform and guide the policies in formulating effective solutions to improve the men's participation in SRH in Iran.

A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths

Objective

To explore the experiences and perceptions of stillbirth among mothers from a tertiary medical centre in Kano, Northern Nigeria.

Design

Qualitative, interpretative.

Setting

Tertiary healthcare facility, Murtala Muhammad Specialist Hospital (MMSH), Kano, Northern Nigeria.

Sample

Mothers who had given birth to a liveborn baby at the MMSH in the prior 6 months (n = 31). In order to capture the experiences and perception of stillbirth within this cohort we approached mothers who had in a previous pregnancy experienced a stillbirth. Of the 31 who attended 16 had a previous stillbirth.

Methods

Semi-structured Focus Group Discussions, consisting of open-ended questions about stillbirth, beliefs, experiences and influences were held in MMSH, conducted over 1 day.

Results

Our findings highlight that this is a resource-poor tertiary facility serving an ever-growing population, increasing strain on the hospital and healthcare workers. Many of the participants highlighted needing permission from certain family members before accessing healthcare or medical treatment. We identified that mothers generally have knowledge on self-care during pregnancy, yet certain societal factors prevented that from being their priority. Judgement and blame was a common theme, yet a complex area entwined with traditions, superstitions and the pressure to procreate with many mothers described being made to feel useless and worthless if they did not birth a live baby.

Conclusions

As access to healthcare becomes easier, there are certain traditions, family and social dynamics and beliefs which conflict with scientific knowledge and act as a major barrier to uptake of healthcare services. The findings highlight the need for investment in maternity care, appropriate health education and public enlightenment; they will help inform appropriate interventions aimed at reducing stigma around stillbirth and aide in educating mothers about the importance of appropriate health seeking behaviour. Stillbirths are occurring in this area of the world unnecessarily, globally there has been extensive research conducted on stillbirth prevention. This research has highlighted some of the areas which can be tackled by modifying existing successful interventions to work towards reducing preventable stillbirths.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04207-4.

Quality of intrapartum care at health centers in Jabi Tehinan district, North West Ethiopia: clients' perspective

BACKGROUND

Despite progress recently, Ethiopia remains one of the largest contributors to the global burden of maternal deaths. As facility-based childbirth and skilled-birth attendant at birth reduces maternal morbidity and mortality, the country has been implementing expansions in infrastructure during the past decades. Whether this phenomenal expansion in infrastructure and improvement in coverage of healthcare services matched with quality of maternal health service is not well investigated. This study assessed the quality of intrapartum care experienced by mothers at health centers in Jabi Tehinan district, North West Ethiopia.

METHOD

An institution-linked community-based cross-sectional study was carried out from August to September 2018 to assess the quality of intrapartum care experienced by mothers during facility deliveries. Quantitative data were collected from 378 women who had uncomplicated births at health centers within 6 months preceding the survey and interviews were held with 25 women. The quantitative data were entered into SPSS for Windows versions 23 for analyses. Qualitative data were transcribed verbatim and data were used to substantiate the quantitative data.

RESULT

The results indicated that 13% of mothers experienced good quality of intrapartum care services. About 49, 45, 31, and 25% of mothers respectively experienced good quality of human and physical resources; respect, dignity, and equity; emotional support; and cognition. Only 2% of mothers experienced good quality of services on the four dimensions and 15% did not experience good quality of services on neither of the dimensions. Mothers from rural areas and mothers who did not use ANC services for recent born children were found more likely to experience good quality of intrapartum care. Informants discussed poor quality of labor environment, lack of privacy, and poor client-provider communications at health facilities.

CONCLUSION

The results indicated that the quality of intrapartum care experienced by mothers were minimal. The findings highlighted that efforts exerted to increase infrastructure and improve maternal health service coverage did not ensure quality maternal health services. Therefore, to increase the uptake of facility births and improved maternal health outcomes, stakeholders should make the health system humane, respectful, equitable, and responsive to mothers' concerns.

Sociodemographic Factors Associated with Women's Perspectives on Male Involvement in Antenatal Care, Labour, and Childbirth

BACKGROUND

Evidence suggests that in patriarchal societies such as Ghana, access to and survival of maternal and child healthcare services require the active involvement of men. However, interventions to promote men's involvement in maternal and child health care are less likely to succeed if the views and concerns of women are not considered. This study provides an understanding of women's perspective on men's involvement in antenatal care, labour, and childbirth in the Northern Region of Ghana.

METHODS

Data for this cross-sectional study were collected from 300 pregnant women using a structured questionnaire. Logistic regression models were then used to determine the socio-demographic factors associated with women's perspectives on men's involvement in antenatal care, labour, and childbirth.

RESULTS

The mean age of the participants was 28 (SD = 5.21) years. More than four-fifths of the women in this study express the desire for male partner involment in natenatal care (ANC) services (n = 258, 86%) and as companions during labour and child birth (n = 254, 84.7%). We found that married women were 9.8 times more likely (95%CI 1.59, 60.81) to encourage male involvement in ANC compared to women who were unmarried. The probability of encouraging male involvement in ANC decreased with increased level of education among the women while support for male companionship during childbirth increased significantly with an increased level of education. After accounting for the effect of other significant covariates, there was good evidence to suggest that married women (p = 0.002), women with only primary/Junior High School education (p = 0.048) and those with two (p = 0.010), three (p =  0.008), or ≥4 (p = 0.044) previous pregnancies had a desire for male partner involvement in ANC while women who attained secondary (p = 0.004) or tertiary (p = 0.001) level education expressed the desire for male companionship in labour and childbirth in the adjusted model.

CONCLUSION

Male involvement in antenatal care, labour, and childbirth received overwhelming support from the women in this study.

"That's a woman's problem": a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria

Background

Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria.

Methods

This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori.

Results

This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members.

Conclusion

These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women’s autonomy and avoiding reinforcement of gender inequitable roles and behaviors.

Fathers' presence in the birth room - implications for professional practice in the Caribbean

Aims or Objectives: This study explored the perspectives of Obstetricians and Registered Nurses/Midwives on the presence of expectant fathers in the birth room.

METHODS

A qualitative research design was used to explore perceptions and attitudes of Obstetricians and Registered Nurses/Midwives. Data were collected using five focus group and five key informant interviews and analysed using van Manen's [2007. Phenomenology of practice. Phenomenology & Practice, 1(1), 11-30] interpretative phenomenological approach.

RESULTS

Four themes emerged (i) perception of the Obstetrician/Registered Nurse/Midwife, (ii) demands on the practitioner, (iii) support for staff and (iv) potential challenges for practice. While participants held positive views, the nature of the birth experience could have negative implications for themselves and expectant fathers. Poor communication could exacerbate negative perceptions in emergency settings.

CONCLUSIONS

The presence of expectant fathers in the delivery room could have a positive impact on the birth experience for mothers, fathers and health professionals in the Caribbean. However, it could be challenging in emergencies.

Views on spousal support during delivery: a Turkey experience

BACKGROUND

Spousal support is important during delivery since it satisfies the women and their spouses. Thus both women and their spouses should be included, where appropriate, in research on labour and birth. This descriptive study aimed to determine Turkish women's and their spouses' views on spousal support during delivery.

METHODS

The study population included women who stayed in the postpartum unit of a hospital and gave birth vaginally to their first child between the thirty-seventh and forty-second week of pregnancy. It also included their spouses. The study sample included 170 couples. The data were collected using introductory information forms administered to women and their spouses. The data were analyzed using percentages, averages, the chi-square test and logistic regression modeling.

RESULTS

This study indicated that 67.6% of the women and 71.8% of women's spouses were in favor of spousal support during delivery. It also suggested that the women with negative experiences of childbirth needed social support during delivery and demanded to receive more spousal support but could not receive this support from the healthcare personnel (p < 0.05). The logistic regression models revealed that the risk of demanding to receive spousal support during delivery was 9.4 times higher in the women who needed social support during delivery than those who do not.

CONCLUSION

This study demonstrated that women's spouses wanted to be included in the delivery process more than the women wanted them to be, and the women who could not receive the necessary support needed more spousal support.

The meaning of a poor childbirth experience - A qualitative phenomenological study with women in Rwanda

OBJECTIVE

Being pregnant and giving birth is a pivotal life event and one that a woman ordinarily remembers for most of her life. A negative childbirth experience can affect a woman's health well beyond the episode of the labour and birth itself. This study explored the meaning of a poor childbirth experience, as expressed by women who had given birth in Rwanda.

METHODS

In a cross-sectional household study conducted in Northern Province and in Kigali City, the capital of Rwanda, a structured questionnaire was answered by women who had given birth one to 13 months earlier. One question, answered by 898 women, asked them to rate their overall experience of childbirth from 0 (very bad) to 10 (very good). Of these, 28 women (3.1%) who had rated their childbirth experience as bad (≤ 4) were contacted for individual interviews. Seventeen of these women agreed to participate in individual in-depth interviews. The texts were analysed with a reflective lifeworld approach.

RESULTS

The essential meaning of a "poor" childbirth experience was that the women had been exposed to disrespectful care, constituted by neglect, verbal or physical abuse, insufficient information, and denial of their husband as a companion. The actions of carers included abandonment, humiliation, shaming and insult, creating feelings of insecurity, fear and distrust in the women. Two of the women did not report any experience of poor care; their low rating was related to having suffered from medical complications.

CONCLUSION

It is challenging that the main finding is that women are exposed to disrespectful care. In an effort to provide an equitable and high quality maternal health care system in Rwanda, there is a need to focus on activities to implement respectful, evidence-based care for all. One such activity is to develop and provide education programmes for midwives and nurses about professional behaviour when caring for and working with women during labour and birth.

Spousal Presence as a Nonpharmacological Pain Management during Childbirth: A Pilot Study

Background. Measures of spousal effect during parturient pain should take a tripartite approach involving the parturients, spouses, and midwives. Aim. To develop and validate three questionnaires measuring spousal presence in management of parturient pain in Nigeria. Methods. There are two phases: (1) development of questionnaires, Abuja Instrument for Midwives (AIM), Abuja Instrument for Parturient Pain (AIPP), and Abuja Instrument for Parturient Spouses (AIPS), utilizing literatures, Kuopio instrument for fathers (KIF) and expertise of health professionals, and (2) pilot study to validate the questionnaires which were administered in two hospitals in Nigeria: midwives (n = 10), parturients (n = 10), and spouses (n = 10).  Results. Internal consistency for the three questionnaires indicated Cronbach's alpha coefficient of 0.789 (AIM), 0.802 (AIPP), and 0.860 (AIPS), while test-retest reliability was r = 0.99 (AIM), r = 0.99 (AIPP), and r = 0.90 (AIPS). Conclusions. AIM, AIPP, and AIPS provide a means of investigating the effectiveness of spousal presence in management of parturient pain in Nigeria. However, further testing of each instrument is needed in a larger population to replicate the beneficial findings of AIMS, AIPP, and AIPS which can contribute rigor to future studies.

Male Partner's Role during Pregnancy, Labour and Delivery: Expectations of Pregnant women in Nigeria

OBJECTIVES

To evaluate the expectations of pregnant women on the role of the male partner during conception and delivery.

METHODOLOGY

A prospective multi-centre observational study comprising 506 pregnant women at eight health facilities in Ilorin, Nigeria from January to June 2014. Consenting women were recruited at antenatal clinics using multistage purposive sampling and a self-administered questionnaire was administered with provision for interpreters in local dialects for those without western education. The data was analyzed using SPSS using percentages and chi-square test; p <0.05 was termed significant.

RESULTS

Participants were aged 17 to 49 years (mean 30.23±4.81), 82.4% desire male partners company during antenatal clinic visits and 59.1% experienced this in index pregnancy. During labour and delivery, 427(84.4%) want company; 345(80.8%) chose the male partner with 211(57.7%) hoping men will appreciate the value of females afterwards although 27.9% feared the men may disturb the health workers, 72(14.2%) male partners attended previous delivery and 84.8% of the women were satisfied with the experience. Significant predictors of support for male partner's presence at delivery were maternal age (p=0.001), secondary or higher education (p=0.001) and parity less than four (p=0.001); religion (x(2)1.010; p>0.001) and social status (p>0.001) were statistically insignificant. Pregnant women wanted education for male partners on care of pregnant women (77.0%) and sex during conception (25.2%).

CONCLUSION

Parturient desire male partners' presence at deliveries but their past participation was low; health facility modifications and education for men are required to meet the desires.

Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia

Background

According to the 2011 Ethiopian Demographic and Health Survey, 90.1% of mothers do not deliver in health facilities, with 29.5% citing non-customary service as causative. A low level of skilled attendance at birth is among the leading causes of maternal mortality in low - and middle-income countries.

Methods

A cross-sectional study was undertaken in four health facilities (one specialized teaching hospital and its three catchment health centers) in Addis Ababa, Ethiopia, to quantitatively determine the level and types of disrespect and abuse faced by women during facility-based childbirth, along with their subjective experiences of disrespect and abuse. A questionnaire was administered to 173 mothers immediately prior to discharge from their respective health facility. Reported disrespect and abuse during childbirth was measured under seven categories using 23 performance indicators.

Results

Among multigravida mothers (n = 103), 71.8% had a history of a previous institutional birth and 78% (75.3% in health centers and 81.8% in hospital; p = 0.295) of respondents experienced one or more categories of disrespect and abuse. The violation of the right to information, informed consent, and choice/preference of position during childbirth was reported by all women who gave birth in the hospital and 89.4% of respondents in health centers. Mothers were left without attention during labor in 39.3% of cases (14.1% in health centers and 63.6% in hospital; p < 0.001). Although 78.6% (n = 136) of respondents objectively faced disrespect and abuse, only 22 (16.2%) subjectively experienced disrespect and abuse.

Conclusions

This quantitative study reveals a high level of disrespect and abuse during childbirth that was not perceived as such by the majority of respondents. It is every woman’s right to give birth in woman-centered environment free from disrespect and abuse. Understanding how women define abuse is crucial if Ethiopia is to succeed in increasing the uptake of facility-based births.