The table below shows demographic characteristics of participants.
Demographics of study participants (N=50)
Characteristics
|
|
N
|
%
|
Age+
|
|
|
|
25-34 years
|
15
|
30
|
|
≥35 years
|
35
|
70
|
Highest education level achieved
|
|
|
|
Primary
|
41
|
82
|
|
Secondary (I-IV)
|
8
|
16
|
|
High (Form VI+)
|
1
|
2
|
Occupation/category
|
|
|
|
Peasant
|
42
|
84
|
|
Village leader
|
2
|
4
|
|
CHW
|
2
|
4
|
|
Health provider
|
2
|
4
|
|
Pastor
|
1
|
2
|
|
Other (driver)
|
1
|
2
|
Marital status
|
|
|
|
Married
|
40
|
80
|
|
Common law relationship
|
10
|
20
|
Two broad themes were identified in the data: (1) Perceived exclusion during ANC visits among men (2) Traditional gender norms resulting to low attendance among men.
Men reported inconsistent experiences when attending ANC visits together with partners. While Tanzanian government directives recommend that pregnant women who attend ANC services with a male partner will be given priority, this practice was inconsistent.
There are no priorities [silence]… when you are at the clinic, provider’s help who comes first and after you are done with the examination with the provider, you will be given the card for you to come back next visit. That means there is no priority. (Expectant father)
Some men reported they were or feared they might be excluded from interactions with health providers during the ANC appointment. Men described choosing not to escort their partners since most facilities lack the physical space to accommodate an additional attendee during assessment. Often they described being left outside a facility during ANC while their wives/partners received service within the building. One father shared, “The challenge is when you go to the clinic with your wife, they enter her in the room, and then you stay outside like a watchman of the bicycle [laugh]” (father with more than one child).Men shared that they felt their time was wasted when they could not attend in the examination room:
“But there is one challenge that, when you escort your wife for ANC, when you reach the health facility you can find… no chairs or space…you just remain walking around the clinic and no one is considering you. Your wife is busy with a child and clinic services but for me, you are just wasting your time for walking around the health facility and exchanging ideas with your fellow men, this makes us not want to accompany our wives to the clinic” (expectant father).
Beyond the physical space, men who attended reported receiving limited or no information regarding their partner, pregnancy progress or other pertinent medical information during the visit. Many men shared that they had expected to be actively included in the checkup:
… I want to be involved in the examination room and to be given findings [laugh] but not for me to remain outside…when I reached the clinic, they call my wife’s name, then they leave me outside… men have to go with their wife in examination room in order to hear the results she is told, if it is nutrition and if it is a lack of blood I need to know and not wait only her to tell me. What if she forgets other important things…so in my opinion men need to be in examination room (father with more than one child)
Traditional gender norms resulting to low attendance among men
This theme revolved around common or local cultural beliefs and traditional gender roles in the surrounding community. Included were two subthemes: (a) Secrecy, and (b) Shame. It was reported that in the Sukuma community, men most often work outside the home with women fulfilling the household labour. Pregnancy, childbirth and childcare are often categorized as “women’s work.” Many men reported that as a result of their work-related roles their time is better spent working, rather than attending ANC appointments:
What causes men not to escort their partners first is economy. Our economy is poor, and you cannot go together at [ANC] clinic if you do not have something for consumption at home…when we go together, what will we eat after coming back from the clinic? (Father with one child).
a) Secrecy: Men described that it was common practice for a woman to keep her pregnancy a secret from her partner. Even when pregnancy is disclosed to a partner, women may keep pregnancy progress details a secret, reducing a male partner’s ability to engage fully in maternity issues and care. One expectant father shared his experience:
… they do not tell us, their husbands, that is what am seeing. When she comes from the [ANC] clinic she will not even communicate to her husband. She might be told to tell her husband [cough] but she will not…we are seeing that in our households--they don’t give us information (expectant father).
Fathers whose partner/wife were pregnant and community in-depth informants recounted this practice. According to one health provider, “you may find women are secretive, they don’t put things open to their men, they don’t give them information” (health provider).
b) Shame: Men report feeling shame, stigma and resistance related to ANC attendance. Many men perceive that the act of attending ANC will be interpreted by others as being dominated or “whipped” by their wife/partner. One father explained:
We escort our wives to clinic but everyone has his or her perception; others will perceive that you are right, others will judge you negatively by saying… "This man has been charmed by his wife’’. (Expectant father)
Participants described that in the (majority) Sukuma tribe, a male walking together with his female partner is uncommon. One village leader explained:
For us Sukuma people we are not used to walk long distance with partner; you let her go first and then you come after she has reached a certain distance. We feel ashamed; traditionally that is what we are used to.
One father explained how ‘educated’ versus ‘traditional’ views might be differently associated with perceptions around male engagement in ANC:
There are two categories in this community; those who are somehow educated and those who are too traditional. For the educated category, the act of escorting your partner to ANC services is regarded as caring and loving and is seen as normal but for the other group of men escorting their partner to the clinic is regarded as someone who has been whipped by his wife” (father with one child)
Furthermore, shame and discomfort were reported by men owing to being surrounded by women while waiting at the facility. For example, men reported embarrassment and feeling as though they did not belong:
You find at the clinic you’re only one or two men alone while seated with many pregnant women around you, you feel ashamed… you get fear of coming next time because you’re alone in the bench sitting with many women ( -Father with more than one child)
Others reported men may feel ashamed attending ANC with partners if they perceived themselves and their partners to not possess good clothing or not having the financial ability to provide the recommended delivery supplies. Men described fear of others’ judgement and being mocked:
There are some men in this community who don’t want to escort their partners to clinic because their partners do not have proper clothes. Men fail to buy nice clothes for their partners and when the time of going to clinic arrives you find that the woman has no proper attire thus making the husband ashamed of going with his wife (Father with more than one child).