AIM AND OBJECTIVES - This study qualitatively explored socio-cultural factors associated with men's involvement in care and support of women during pregnancy and childbirth through in-depth interviews and focus group discussions. It also specifically looked into men’s influence of women in taking decision to seek antenatal and delivery care, arrangement of transport and transport fares, escort and company to clinics and perspectives of men's presence during the delivery process.
METHODS: A qualitative research method with purposive sampling was applied.17 pregnant women, 16 husbands, 10 midwives, 2 traditional birth attendant and 2 village health workers were interviewed. Four focus group discussions were conducted in groups of seven as well; two held in the urban areas and two in the rural. 14 husbands and 14 women participated. All informants were between the ages of 21 and 58 years. Interviews were conducted in the main referral hospital, six health centres and six communities in western health region, one of the six health regions in the Gambia.
RESULTS: This study found that women mostly initiated to seek antenatal care, but men eventually decide. Decision making power of men was grounded in religious obligations, cultural and traditional factors and the conventional view of husbands being providers and custodians of monies. TBAs, mothers, mother's in-laws and elderly female relatives in the communities had substantial influenced on women's decision to seek delivery care. Reproductive communication between couples was restricted by cultural beliefs and individual dispositions. Men's knowledge on danger signs was reported limited in this study, but most male informants expressed interest to learn about danger signs. Transport fares were mostly provided by husbands in the urban areas where means of communication were as well easier. In contrast to the urban areas, husbands were reported to have hardly provided transport fares for women to access antenatal care, but involved in arrangement of transport for women to access delivery care. Men mostly stayed at home when women sought antenatal and delivery care. Reasons of men's non escort were derived from husband's job responsibilities, long waiting time of antenatal and laboratory services, repeated antenatal visits, cultural restrictions and husband-wife large age difference as old men married young girls and felt discomfort to be with them in the clinics. The use of mobile phones were reported to help in reaching men where their supports were needed by their partners in emergency obstetric situations to either donate blood or run errands. Educated men, men with travelling experience abroad and foreign nationals like Nigerians and Guineans were reported to have escorted their partners and relatives to clinics. Men who escorted their partners to clinics were some times subjected to gossip by their male counterparts and interestingly by women found in the clinics while in the process of seeking pregnancy care. Foreign nationals escorted their wives and relatives to get the opportunity to negotiate for what was regarded as expensive antenatal and delivery fees. They also served as interpreters between service providers and their partners and relatives. Husband's presence during the delivery process was restricted by cultural and religious beliefs, attitude of midwives, limited space in clinics and non cubicle structured labour wards compromising women's privacy. Spouses who got the opportunity to witness their partners' delivery process expressed satisfaction, sense of companionship, love and support and feelings of empathy and sympathy. This study concluded that the involvement of men in pregnancy and child birth in the Gambia was restricted by myriad of socio- economic and cultural factors including men's limited knowledge on danger signs, as well as health service and structural factors and finally advocates for men’s education on their reproductive responsibilities.