Abstract
Background
Social support provided by men during pregnancy is critical in the promotion of maternal health and improving pregnancy outcomes. Few studies have reported the social support men provide during pregnancy, its influence on pregnancy and outcomes. This study investigated social support men provide to their spouses during pregnancy.
Methodology
This cross-sectional study utilized proportionate sampling technique to select 220 mothers across 6 Primary Health Centers (PHCs) that provide antenatal care (ANC) services in Ibadan, Nigeria. A validated quantitative instrument with 18-point knowledge scale on social support was used for data collection. Data were analyzed using descriptive and inferential statistics at p=0.05.
Results
Respondents mean age was 27.6±5.5 years. Over a third (36.8%) of the respondents were accompanied to the ANC clinic by their husbands. Majority (96.4%) of the respondents had good knowledge of social support (17.0±2.6). Almost all (98.6%) reported being made happy and given peace of mind by their husbands during pregnancy. Parity and family type were significantly related to social support men provide in helping to take care of other children and identifying wife's fears and worries and subsequently offer encouragement respectively.
Conclusion
Though men were generally supportive of their wives during pregnancy, they were not directly involved in their antenatal care. A template can be developed by the government to include sessions where men can be taught ways they can support their spouses during pregnancy. This is important for positive pregnancy outcomes and reduction in maternal mortality.
Keywords: Social Support, Pregnancy, Men
Introduction
Social support may be physical or emotional, for example, interpersonal communications [1] and could involve exchange of resources between individuals and are perceived by both parties to promote the health of the recipient [2]. There are different practices related to social support including spousal attendance at antenatal visits, financial support to make hospital visits, provision of useful health information during pregnancy and emotional support (showing care and affection) during labor and childbirth [3].
Pregnancy is a critical state for women and provision of social support and effective attention is of great importance during this period. However, in many African countries, the period of antenatal care and childbearing is viewed mainly as a woman's affair and men are usually exempted or it is considered less duty for men.[4].Similar perspectives are conventional in other countries within sub-Saharan Africa with regards to pregnancy and childbirth[5] and feminization of maternal health issues abound [6].
Male partner involvement is recognized as a key factor in the effort to improving maternal health, and general promotion of the health and wellbeing of mothers and babies, thus decreasing occurrences of maternal and infant mortality, pre- and post-delivery [7]. Despite the importance of this context of men's support during pregnancy, few studies in Nigeria have highlighted levels of social support provided by men during pregnancy from the perspectives of women attending primary health care [8-10]. In addition, the influence on pregnancy outcomes and factors influencing social support provided by men during pregnancy are also limited. This study sought to fill these gaps in knowledge.
Materials and Methods
A cross sectional design was adopted for this study. Two hundred and twenty mothers were proportionately selected across the 6 PHCs that offer ANC out of the 14 PHCs in Ibadan North Local Government Area. Mothers with babies between 0-6 months who consented to participate were included in the study.
Validated and pretested interviewer-administered questionnaires were used to elicit information from the mothers on demographic characteristics, knowledge on social support, ways social support was provided during last pregnancy, changes in social support as pregnancy advanced, factors influencing social support men provide during pregnancy and effects of social support on pregnancy outcomes.
Knowledge on social support was assessed on an 18-point scale and scores≤ 9 were categorized as poor while scores > 9 were categorized as good knowledge. Descriptive and inferential statistics at p=0.05 were used to analyze the data.
Results
Socio-demographic characteristics
The mean age of the respondents was 27.6±5.5 years and it ranged from 17 to 46 years. As shown in Table 1, almost all of the respondents (98.6%) were married and Yoruba (90.5%). Most of the respondents (93.6%) had monogamous family and about half of the respondents (53.6%) had secondary school education. Majority of the respondents (87.3%) have had between 1 to 3 pregnancies, but a slightly higher percentage (90.0%) have had between 1 to 3 children. The predominant occupations among the respondents were trading (40.9%) and artisan (40.5%).
Table 1:
Socio-demographic characteristics of the respondents (N=220)
| Socio-demographic Variable | Frequency (N) | Percentage (%) |
|---|---|---|
| Age | ||
| 17-26 years | 99 | 45.0 |
| 27-36 years | 106 | 48.2 |
| 37-46 years | 15 | 6.8 |
| Marital Status | ||
| Single | 3 | 1.4 |
| Married | 217 | 98.6 |
| Educational Status | ||
| No formal education | 1 | .5 |
| Primary education | 28 | 12.7 |
| Secondary Education | 118 | 53.6 |
| Tertiary education | 73 | 33.2 |
| Occupation | ||
| Civil servant | 18 | 8.2 |
| Trading | 89 | 40.9 |
| Artisan | 89.1 | 40.5 |
| Student | 7.0 | 3.2 |
| Professionals (doctors, bankers, engineers.) | 9.9 | 4.5 |
| Full Housewife | 5.9 | 2.7 |
| Religion | ||
| Christianity | 110 | 50.0 |
| Islam | 110 | 50.0 |
| Ethnicity | ||
| Igbo | 16 | 7.3 |
| Hausa | 5 | 2.3 |
| Yoruba | 199 | 90.5 |
| Family type | ||
| Monogamous | 206 | 93.6 |
| Polygamous | 14 | 6.4 |
| If married, Husband Occupation | ||
| Professional(Medical Doctors, engineers and bankers) | 31 | 14.1 |
| Artisan | 56 | 25.5 |
| Civil Servant | 35 | 15.9 |
| Unemployed | 2 | .9 |
| Trader | 76 | 34.5 |
| Long distance Driver | 12 | 5.5 |
| Clergy | 5 | 2.3 |
| Student | 3 | 1.4 |
| How many time have you been pregnant | ||
| 1 -3 pregnancies | 192 | 87.3 |
| 3 pregnancies and above | 28 | 12.7 |
| Number of Children | ||
| 1-3 Children | 198 | 90.0 |
| 3 Children and above | 22 | 10.0 |
Knowledge of social support
Table 2 showed the respondents' knowledge of social support. Their mean knowledge score was 17.0±2.6 and 96.4% had good knowledge of the social support that should be provided by their husbands. Majority of respondents correctly stated that their husband should show care and affection (96.8%) and ask about their fears and worries (95.9%), as forms of emotional support. In addition, majority (94.5%) correctly stated that assistance with domestic work (94.5%), providing money when needed (96.4%) and providing education in relation to their pregnancy status (93.6%) were forms of social support.
Table 2:
Knowledge on Social Support (N=220)
| Knowledge Variable | (N) | (%) |
|---|---|---|
| Emotional Social support | ||
| To be shown care and affection | 213 | 96.8 |
| To be asked about fears and worries | 211 | 95.9 |
| Instrumental Social support | ||
| To be assisted with some domestic work | 208 | 94.5 |
| Husband providing money when needed | 212 | 96.4 |
| To be accompanied during hospital appointments | 195 | 88.6 |
| Informational Social support | ||
| Giving of advice and guidance at the time needed | 209 | 95.0 |
| Educating on healthy lifestyle based on one's medical state | 206 | 93.6 |
| Appraisal Social support | ||
| To be reminded of medical appointments | 209 | 95.0 |
| To be reminded on the importance of healthy living | 213 | 96.8 |
| Level of Knowledge | ||
| Poor Knowledge | 8 | 4.6% |
| Good knowledge | 212 | 96..4% |
Ways by which men provided social support to their spouses during pregnancy.
Respondents' reported ways by which their spouses provided social support during pregnancy were subdivided into four (4) categories for ease of comprehension.
Emotional ways of providing social support
Many of the respondents reported that their spouses helping with back massage (62.3%), helping identify fears and worries and encouragement with kind words (95.0%), meeting sexual demands during pregnancy (93.6%) and ensuring that the pregnant wife is happy and have peace of mind (98.6%) were ways that emotional social support was provided by their spouses during pregnancy (Table 3).
Table 3:
Ways by which men provide social support to their spouses during pregnancy (N=220)
| Variable | (N) | (%) |
|---|---|---|
| Emotional social support provided | ||
| Massaged back when tired | 137 | 62.3 |
| Identified fears and worries and encouraged with kind words | 209 | 95.0 |
| Met sexual demands during pregnancy | 206 | 93.6 |
| Ensuring I am happy and given peace of mind | 217 | 98.6 |
| Instrumental social support provided | ||
| Provided money for clinic bills and other needs | 212 | 96.4 |
| Accompanied to antenatal clinic | 81 | 36.8 |
| Transported to and fro the ante natal clinic | 72 | 32.7 |
| Helped with some house chores (e.g. sweeping, washing of clothes, cooking....) | 179 | 81.4 |
| HeIped in taking care of other children | 133 | 60.5 |
| Prayed for me and baby at all times | 214 | 97.3 |
| Informational social support provided | ||
| Encouraged me to book early at the antenatal clinic | 184 | 83.6 |
| Reminded me of appointments at the clinic | 196 | 89.1 |
| Advised me on ways to be healthy throughout pregnancy | 208 | 94.5 |
| Appraisal social support provided | ||
| Asked for feedback from the clinic when he is not present | 204 | 92.7 |
| Monitored my nutritional intake | 205 | 93.2 |
Perceived changes in social support provided by men as pregnancy advances.
Table 4:
Factors influencing social support men provide to their spouses during pregnancy (N=220)
| Variables | Frequencv(N) | Percentage (%) |
|---|---|---|
| Husband's occupation | 125 | 56.8 |
| Waiting time in the health facility | 128 | 58.2 |
| Husband's income (husband not buoyant) | 115 | 52.3 |
| Husband's educational level | 108 | 49.1 |
| Husband does not know about the need to be present at ANC | 116 | 52.7 |
| Family type (e.g. polygamous) | 128 | 58.2 |
| Health Worker prohibit husband from waiting/healthcare provider's attitude | 131 | 59.5 |
| The Society frowns at husband assisting in house chores | 94 | 42.7 |
| Husband lives in another city | 123 | 55.9 |
| Husband family members (e.g. mother-in-law complains the wife is fetish and prevents her from having access to his son) | 90 | 40.9 |
| Husband's friends | 95 | 43.2 |
| Husband having mistress outside the home | 133 | 60.5 |
| Neighbors (husband has been turned into a slave) | 93 | 42.3 |
| Society frowns at husband accompanying to ANC | 91 | 41.4 |
Table 5:
Effects of social support provided by men to their spouses during pregnancy (N=220)
| Effects of social support provided bv men | Frequency (N) | Percentage (%) |
|---|---|---|
| Had no premature birth or miscarriage | 216 | 98.2 |
| Baby had a normal weight | 215 | 97.7 |
| My baby was not admitted after delivery | 214 | 97.3 |
| Had no complication throughout pregnancy (e.g. bleeding, hypertension, anemia) | 216 | 98.2 |
| Had no still birth (baby delivered dead) | 216 | 98.2 |
| No depression at any time during pregnancy | 216 | 98.2 |
| Attended ANC throughout pregnancy | 195 | 88.6 |
| Easy Delivery | 217 | 98.6 |
Instrumental ways of providing social support
Less than half of respondents (36.8%) stated that their husbands accompanied them to the antenatal clinic while 32.7% stated that their husbands transported them to and from the antenatal clinics. However, majority (96.4%) reported that provision of money for clinic bills and other needs, helping with some house chores (81.4%) were instrumental ways their spouses provided social support (Table 3).
Informational ways of providing social support
Majority of the respondents (83.6%) reported that encouragement to book early at the antenatal clinic, reminders of appointments at the clinic (89.1%) and advice on ways to be healthy throughout pregnancy (94.5%) were informational ways their spouses provided social support (Table 3).
Appraisal ways of providing social support
Majority of the respondents mentioned being asked for feedback about antenatal clinic visits when spouses were not present (92.7%) and monitoring of their nutritional intake (93.2%) were appraisal ways their spouses provided social support (Table 3).
Emotional Social Support
Massaging the back when tired
Many of the respondents (60%) reported that back massage at first trimester decreased as pregnancy advanced (36.4% and 13.6% at second and third trimesters respectively).
Identifying fears and worries and encouraged with kind words.
Many of the respondents (67.3%) however reported that identification of their fears and worries and encouragement with kind words by their spouses increased throughout the pregnancy period (67.3%, 66.4%, 72.4%; first to third trimester).
Meeting sexual demands during pregnancy
Less than half of the respondents (41.0%) reported having their sexual demands met during the first trimester, decreased to 19.8% at second trimester and increased to 45.8% at third trimester.
Making wife happy and giving peace of mind
Majority of the respondents (91.6%) reported that their spouses made them happy and gave them peace of mind throughout the pregnancy period.
Instrumental Social Support
Accompanying to clinic
Despite the fact that overall, only 36.8% of the respondents' husbands were reported to have accompanied the women to the clinic, this increased from 43.2% (first trimester) to 45.7% at third trimester.
Transporting to and from the clinic
Respondents reported that transporting them and from the clinic increased from 28.2% at second trimester to 46.2% at the third trimester.
Helping with some house chores (e. g sweeping, cooking, and washing of clothes)
Majority of women reported that provision of help with house chores increased from 43.1% at first trimester to 66.1% at the third trimester.
Helping in taking care of other children
About half of the respondents reported that provision of help regarding care of other children by spouses remained same (49.6%) at first and second trimester but however increased to 59.2% at the third trimester.
Informational Social Support
Encouragement to keep ANC appointments.
Provision of encouragement to keep antenatal visits. were reported by more than half (51.4%, 50.9%, 55.1%) of the respondents at the 1st, 2nd, and 3rd trimesters respectively.
Reminders of appointments at the clinic
Less than half of the respondents (46.6%) and (46.3%) reported being provided with a high level of this support at the 1st and 2nd trimester but this increased during the third trimester (54.4%).
Appraisal Social Support
Asking for feedback about clinic visit
The level of this support was highest at the third trimester with many of the respondents (56.9%) reported that spouse provided this support.
Monitoring of nutritional intake
More than half of the respondents (60.7%) received high level of this support at the first trimester. This reduced a bit to 56.5% at the second trimester but later increased to 64.9% at the third trimesters.
Factors influencing social support men provide to their spouses during pregnancy.
Respondents reported that the waiting time in the health facility (58.2%), husband's occupation (56.8%), husband's income (52.3%), husband's educational level (49.1%), family type (58.2%) and attitude of health workers (59.5%) were some of the factors influencing social support men provide to their spouses during pregnancy.
Effects of social support provided by men to their spouses during pregnancy.
Majority of the respondents stated that the social support provided by their spouses during pregnancy had positive effects. Responses included: no premature birth or miscarriage (98.2%), baby had a normal weight (97.7%), baby was not admitted after delivery (97.3%), no complication throughout pregnancy (98.2%), no still birth (98.2%), no depression at any time during pregnancy (98.2%), ANC attendance throughout pregnancy (88.6%) and easy delivery (98.6%).
Test of hypothesis
Three hypotheses were tested to show the association between sociodemographic factors and social support provided by spouses during pregnancy. These associations were tested using chi-square. Parity and family type were statistically significantly related to social support provided by men in helping to take care of other children (x2=6.864, P=0.009) and identifying wife's fears and worries and encouraging with kind words (x2=8.496, P=0.004) respectively (Table 6).
Table 6:
Relationship between parity, family type and husband's social support provided during pregnancy.
| Social Support | Number of children | ⍰⍰ | Df | P-value | |
|---|---|---|---|---|---|
| 1-3 | >3 | ||||
| Husband taking care of other children | |||||
| Yes | 114 | 19 | 6.864 | 1 | 0.009* |
| No | 84 | 3 | |||
| Social Support | Family Type Monogamous Polygamous | ⍰⍰ | Df | P-value | |
| Identify fears and worries and encouragement with kind words | |||||
| Yes | 198 | 11 | 8.496 | 1 | 0.004* |
| No | 8 | 3 | |||
P-value is less than 0.05 for social support, helping to take care of other children as a social support.
P–value is less than 0.05 for social support of identifying fears and worries and encouraging with kind words.
Discussion
The findings of this study provided a reported overview of different categories of social support provided by men to their wives during pregnancy. The age of respondents was similar to the age range of women of reproductive age (15-45years) in Nigeria, which was between 17 to 46 years [11]. The Nigerian Demographic Health Survey (NDHS) [11, 12] reported that fertility is high among women between age 25 and 29years. Majority of the respondents were within the fertility period, with the potential of having more children and identifying ways through which social support was provided by their spouse’s during pregnancy was important for this cohort. Findings would be useful in educating and encouraging men on the importance of providing social support to their spouses during pregnancy, and possible effects on pregnancy outcomes.
Majority of the respondents identified the following as ways by which they were provided social support during pregnancy: being made happy and given peace of mind, always prayed for during pregnancy, and provided money for clinic bills during pregnancy. These results were corroborated by other studies [13, 14], where most of the participants agreed that men's role during pregnancy is to provide emotional and moral support. Most women expected their husbands to pay their bills during pregnancy and majority highlighted support by their husbands through provision of financial needs during pregnancy [9]. The social support that men can provide to their spouses, for example support in antenatal care (ANC), is important in improvements for maternal health with a potential to reduce maternal mortality [13]. Findings from this study showed that few women reported that their spouses accompanied them to ANC [10]. This might be because the patriarchal nature of the society in which this study was conducted where pregnancy related issues and especially ANC attendance are usually viewed as woman's responsibility in many quarters.
According to the respondents, social support changed as pregnancy advanced. Instrumental support in terms of assisting with some house chores and taking care of other children were reported to be high at advanced stages of the pregnancy. This can be attributed to the physiological changes at advanced stages of pregnancy which usually hinders or could prevent a pregnant woman from being able to effectively carry out the normal activities in the house.
Long waiting hours at the ante natal clinic was identified by many respondents as one of the factors influencing social support provided by men to their spouses during pregnancy. This was corroborated by other studies, which highlighted that long waiting and extended time for receiving antenatal and laboratory services discourage men from attending their spouses' antenatal clinic [15, 16]. These findings indicate promotion of policies that encourage some time off work for men on their spouses' antenatal dates. Antenatal health services should also encourage men's visit for antenatal care by reducing the time spent or delineating a specific time for each woman's visit. Furthermore, attitude of health workers was another factor identified by many respondents as a hindering factor that could be responsible for poor support of men towards antenatal visits [6, 5]. Low or lack of respect for men as men, especially in the society in this context, could discourage men's attendance, and thus involvement, in spouses' antenatal care.
Respondents stated that the social support they were provided by their spouses during pregnancy had positive effects on their pregnancy outcomes. These findings were similar to that of another study, where mothers reported good outcomes as a result of the support provided during pregnancy with babies with gestational age of over thirty-eight weeks, easy progressive labor and majorly reduced maternal and neonatal complications[17].This was further corroborated by another study which reported less stressful pregnancy, increased emotional security and wellbeing[9].
Conclusions
As a patriarchal society, decision making processes in relation to access to health care services, and initiation and utilization of maternal health services are usually influenced by men for women. To improve maternal health, with the view of reducing maternal mortality, men have to be seen as critical partners and their involvement encouraged at every stage of pregnancy. This can be done by providing them with the knowledge and information about the demands and expectations of pregnancy, and the vital roles they are to play in ensuring pregnancy positive outcomes. Also, beliefs about pregnancy being a woman's domain and feminine matter requires attention, as some men still view accompanying their spouses to ANC and assisting their pregnant wives to reduce workload during pregnancy as inappropriate. Hence, educating men about the positive effects of providing holistic support to their wives (in terms of emotional, informational, instrumental and appraisal social support) during pregnancy is crucial. In addition, further education on the negative effects of not providing such support, at every stage of pregnancy, would assist in changing all the misconceptions and beliefs about support during pregnancy, and provide men with adequate information on the extent they can be involved during pregnancy.
References
- 1.Moak ZB, Agrawal A. The association between perceived interpersonal social support and physical and mental health: results from the National Epidemiological Survey on Alcohol and Related Conditions. Journal of public health. 2010; 32:191-201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Chen CM, Kuo SF, Chou YH, Chen HC. Postpartum Taiwanese women: their postpartum depression, social support and health‐promoting lifestyle profiles. Journal of Clinical Nursing. 2007; 16:1550-60. [DOI] [PubMed] [Google Scholar]
- 3.Carter M. Husbands and maternal health matters in rural Guatemala: wives' reports on their spouses' involvement in pregnancy and birth. Social Science & Medicine. 2002; 55:437-50. [DOI] [PubMed] [Google Scholar]
- 4.Iliyasu Z, Abubakar IS, Galadanci HS, Aliyu MH. Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community. African journal of reproductive health. 2010;14. [PubMed] [Google Scholar]
- 5.Kakaire O, Kaye DK, Osinde MO. Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda. Reproductive health. 2011; 8:1-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Kululanga LI, Sundby J, Chirwa E. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi-a qualitative study. Reproductive health. 2011; 8:1-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Nwokocha E. E. Maternal crises and the role of African men: The case of a Nigerian Community. African Population Studies 2007; 22, 35-36. [Google Scholar]
- 8.Sokoya M, Farotimi A, Ojewole F. Women's perception of husbands' support during pregnancy, labour and delivery. IOSR Journal of Nursing and Health Science. 2014; 3:45-50. [Google Scholar]
- 9.Adeniran AS, Aboyeji AP, Fawole AA, Balogun OR, Adesina KT, Adeniran PI. Male Partner's role during pregnancy, labour and delivery: expectations of pregnant women in Nigeria. International journal of health sciences. 2015; 9:305. [PMC free article] [PubMed] [Google Scholar]
- 10.Plantin L, Olykoya A, Ny P. Positive health outcomes of fathers' involvement in pregnancy and childbirth paternal support: a scope study literature review. Fathering: A Journal of Theory, Research, and Practice about Men as Fathers. 2011; 9:87-102. [Google Scholar]
- 11.National Population Commission (NPC) [Nigeria] and ICF International. 2014. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International. [Google Scholar]
- 12.National Population Commission (NPC) [Nigeria] and ICF International. 2014. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International. [Is there any difference in content] [Google Scholar]
- 13.Olugbenga-Bello AI, Asekun-Olarinmoye EO, Adewole AO, Adeomi AA, Olarewaju SO. Perception, attitude, and involvement of men in maternal health care in a Nigerian community. Journal of public health and epidemiology. 2013. Jun 30; 5:262-70. [Google Scholar]
- 14.Olayemi O, Bello FA, Aimakhu CO, Obajimi GO, Adekunle AO. Male participation in pregnancy and delivery in Nigeria: a survey of antenatal attendees. Journal of biosocial science. 2009; 41:493-503. [DOI] [PubMed] [Google Scholar]
- 15.Secka E. Men's involvement in care and support during pregnancy and childbirth (Master's thesis); 2010. University Of Oslo, Institute of Health and Society. 2010.[https://www.duo.uio.no/bitstream/handle/10852/30026/EbbaxSecka.pdf?sequence] [Google Scholar]
- 16.Nkuoh GN, Meyer DJ, Tih PM, Nkfusai J. Barriers to men's participation in antenatal and prevention of mother-to-child HIV transmission care in Cameroon, Africa. Journal of midwifery & women's health. 2010; 55:363-9. [DOI] [PubMed] [Google Scholar]
- 17.Haobijam J, Sharma U, David S. An exploratory study to assess the Family support and its effect on Outcome of Pregnancy in terms of Maternal and Neonatal health in a selected Hospital, Ludhiana Punjab. Nursing and Midwifery research journal. 2010; 6:137-45. [Google Scholar]