Abstract
Background
Both maternal and neonatal mortality were high in the immediate postnatal period. Men's involvement is essential to improve maternal, neonatal as well as the health of their children in the postpartum period. However, reproductive health has long been seen as a woman's concern, and as such, it continues to be a significant difficulty, particularly in developing countries including Ethiopia. Despite this, Limited studies were done to assess the predictors of male involvement in postnatal care in Ethiopia. Therefore, this study aimed to assess male partner involvement in postnatal care service in the South Gondar zone, North West Ethiopia in 2024.
Objective
This study assessed male involvement in Postnatal care services of their partners and its predictors in South Gondar Zone, Ethiopia.
Method
A community-based cross-sectional study was conducted from October –November 30/2023. Four hundred seventeen participants were recruited by using the multistage sampling technique. The data were collected through face-to-face interviews using a pretested and semi-structured questionnaire. Multivariable logistic regression analyses were computed to identify factors associated with the outcome variable. Adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.
Results
The overall magnitude of male partner involvement in postnatal care service was 23.7%. Urban residence, College and above education, men whose wives' occupations were students, Good knowledge about PNC, and, joint health care decisions were the main predictors of male involvement in postnatal care service.
Conclusion and Recommendation
The magnitude of male involvement in postnatal care was low. The finding highlights the importance of women's empowerment, awareness creation joint decision-making, and increasing men's educational levels are essential to increase the involvement of male partners in postnatal care service.
Key words: involvement, male partner, postnatal care
AJOG Global Reports at a Glance.
Why was this study conducted?
Men's involvement is essential to improve maternal, neonatal as well as the health of their children in the postpartum period. However, reproductive health has long been seen as a woman's concern, and as such, it continues to be a significant difficulty in developing countries including Ethiopia. Despite this, Limited studies were done to assess the predictors of male involvement in postnatal care in Ethiopia. Therefore, this study aimed to assess male partner involvement in postnatal care service in the South Gondar zone, North West Ethiopia in 2024.
Key findings
The overall magnitude of male partner involvement in postnatal care service was 23.7%. Urban residence, educational status, wives' occupation, knowledge, and joint decisions about postnatal care were the main predictors of male involvement in postnatal care.
What does this study add to what is already known?
This study was to determine the prevalence and the main predictors of male involvement in PNC service in Ethiopia
Introduction
Globally in 2017, an estimated 295,000 women worldwide have lost their lives due to easily preventable pregnancy and childbirth-related complications, 94% of which are contributed by low-income countries. In this figure, sub-Saharan Africa alone is accountable for 66% of those deaths.1 According to the 2016 Ethiopian Demographic and Health (EDHS) report, Ethiopia has one of the highest maternal mortality ratios globally (MMR) of 412 maternal deaths per 100,000 live births.2 Ethiopian Demographic and Health Survey (EDHS) 2016 also showed that infant and neonatal mortality rates were 48 and 29 per 1000 live births respectively.2
Focused antenatal care, institutional delivery, and postnatal care (PNC) were important to reduce both maternal and neonatal mortality.3, 4, 5 The 1994 International Conference on Population and Development (ICPD), held in Cairo, recommended males to be involved in the reproductive health of their wives or partners. It also encouraged reproductive health care programmers to adopt a more holistic approach that includes men and focuses on couples rather than focusing on women alone. In addition, male involvement in maternal health is now being advocated as an essential element of the World Health Organization (WHO) initiative for making pregnancy safer. Male involvement in maternal health care services including PNC is vital to improve both their partner's and children's health.6
The postnatal period is critical to the health and survival of a mother and her neonate. Lack of care at this time may result in death or disability as well as missed opportunities to promote healthy behaviors, affecting women, newborns, and children. The postpartum period was important for counseling on birth spacing and family planning methods. WHO recommends that women who have delivered in a health facility should receive PNC for at least 24 hours after delivery. If a birth is at home, the first postnatal contact should be as early as possible within 24 hours of birth. Three additional PNC contacts were recommended on day 3, between days 7 to 14 after birth, and 6 weeks after birth. It is important to reach women before they are at risk for unintended pregnancy with information about the return of fertility, their options to space or limit future pregnancies, and the benefits to their own and their newborn's health.7 A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Therefore, prompt postnatal care (PNC) for both the mother and the child is important to treat any complications. WHO recommends that all women receive a check of their health within 2 days after delivery. However, in Ethiopia, only 17% of women reported having received a PNC checkup in the first 2 days after birth.2 One of the determinate factors of PNC utilization is male involvement because males are decision-makers and they control the overall income of the family.8,9 From the above figure, we can conclude that the magnitude of PNC was low in Ethiopia and male involvement is one of the determinant factors of PNC utilization. Moreover, as far as our knowledge is concerned, few studies were done to assess male involvement in PNC in Ethiopia. Therefore, this study was conducted to assess the magnitude of male involvement in postnatal care service utilization and associated factors among fathers whose wives had delivered children in the last twelve months in the south Gondar zone, Ethiopia, 2023.
Methods
The study was conducted in South Gondar Zone four districts (Tach Gayint Woreda, Fogera Woreda, Ibnat, woreda, and Debere Tabor Town). South Gondar is a Zone in the Ethiopian Amhara Region. 468,238 households were counted in this Zone, which results in an average of 4.38 persons per household.
South Gondar zone is bordered on the South by East Gojam, on the Southwest by West Gojam and Bahir Dar, on the West by Lake Tana, on the North by North Gondar, on the Northeast by Wag Hemra, on the East by North Wollo, and the Southeast by South Wollo. There are 18 districts (10 rural and eight urban) in this zone. There are 140 private clinics, 403 health posts, 96 health centers, 7 primary hospitals, and 1 general hospital in the zone. All health centers and hospitals provide antenatal care (ANC), labor delivery, and PNC services. According to the 2011 Central Statistical Agency(CSA), the South Gondar zone has a total population of, 2,239,077 (female 1,103,490 male1, 135,587).
Study design and period
A community-based cross-sectional study was conducted from October –to November 30/2023 using a quantitative approach.
Source and study population
Source population: All male partners reside in the South Gondar zone whose wives gave birth within the last year and who had postnatal care follow-up
Study population: All men partners reside in the selected kebeles of the South Gondar zone whose wives gave birth within the last year and had postnatal care follow-ups.
Inclusion and exclusion criteria
Men who resided for at least six months in the south Gondar zone selected districts and whose wives gave birth within the last 12 months were included and men who were critically ill and unable to communicate during the data collection period were excluded from the study.
Sample size determination
the sample size was calculated by using the assumption of a single population proportion formula considering the prevalence of male involvement in postnatal care service in the Motta district was 20.8%.10 With a 95% confidence interval, 5% Margin of error, 10% nonresponse rate, and design effect of 1.5.20 Hence, the final sample size was found to be 417.
Sampling method and procedure
A total of ten districts or woreda were found in the South Gondar Zone of which four of them were selected by lottery methods and by Simple random sampling technique, a total of 14 kebeles were selected. Based on the number of men whose wives gave birth in the last 12 months and had PNC follow up in each kebeles from the data taken from the health extension workers proportional allocation was done for each kebeles finally the data was collected by systematic random sampling technique (Figure 1).
Figure 1.
Sampling procedure about male involvement in PNC service among men whose wives gave birth in the last one year in South Gondar zone 2024
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Data collection tools and procedures
Data were collected using a pretested and semi-structured interviewer-administered questionnaire developed by reviewing various literature (22–34). The questionnaire had four parts. The first part regards the socio-demographic characteristics of participants, the second part concerns to reproductive history of participants, and the third part regards male involvement in PNC. The fourth part is about, Awareness, knowledge, and attitude on PNC.
Male involvement was measured by ten yes/no questions. (These are, discussing with health professionals about, PNC service and complications occurring in the postpartum period, discussing with a spouse about PNC service, physical support, discussing postpartum contraception, emotional support, sharing decision-making power on PNC service with the spouse, financial support, help in domestic activities, accompanying spouse for PNC service and looking after children. Those who scored up to or above the mean were regarded as having involvement in postnatal care.10,11
A total of five-health extinction workers were assigned to collect the data and two BSc midwives were assigned for supervision. Data collectors described the purpose of the study and interview process by emphasizing privacy and confidentiality to the participants before starting the interview process. After checking the filled questionnaires for any missing items and correctness, the data were collected and signed by supervisors. Besides this, there was continuous follow-up and supervision by the principal investigator throughout the data collection period.
Operational definition
Postnatal care: Postnatal care is the care provided to the mother and their babies within 42 days after delivery.12
Male partner: a male who has/had a spouse through formal marriage or informal union.10
Male involvement: male involvement is measured by the total number of 10 questions with yes/no responses. After computing the mean score of involvement questions, it was categorized as not involved in Post Natal care services and involved in Post Natal care services based on the mean score. Then Respondents who scored below the mean were regarded as having low involvement in postnatal care services while those who scored up to or above the mean were regarded as having high involvement in postnatal care services.10,11
Male partner accompanied in PNC service: A male partner who accompanied his spouse to the PNC clinic on at least one PNC visit, excluding the first 6-hour PNC visit.10
Knowledge of men about PNC: The knowledge of men on PNC was measured by the total number of 5 questions. After computing the mean score of knowledge questions, it was categorized as poor knowledge and good knowledge based on the mean score.
Good knowledge: Men were considered to have good knowledge of PNC if they had answers greater than or equal to the mean score of knowledge questions.11
Knowledge of postpartum obstetric danger signs: Knowledge of danger signs. Those male partners who had replied three or more maternal or neonatal danger signs or complications.10
Attitude towards PNC service: The attitude of the respondents towards PNC service was evaluated by using five questions. The questions were designed using a Likert scale format with three answer alternatives; ranging from agree, not sure, and disagree.
Favorable attitude: respondents who scored the mean score or above were considered to have a favorable attitude towards PNC services.
Results
A total of 412 men participated in this study with a response rate of 98.8%. The respondents’ age ranged from 25 to 53 years with a median age of 34 years. More than half 217 (52.7.%) of the study participants were in the age group 25 to 34 years. Most (98.5%) of men were orthodox Christians and more than one quarter, 131 (31.8) of study participants had completed secondary education. Regarding occupation, about 160 (38.2%) were government employe (Table 1).
Table 1.
Socio-demographic characteristics of study participants in South Gondar zone Ethiopia, 2024 (n = 412)
| Variables | Frequency | Percent |
|---|---|---|
| Age (years) | ||
| 25–34 | 217 | 52.7 |
| 35–44 | 138 | 33.5 |
| ≥ 45 | 57 | 13.8 |
| Religion | ||
| Orthodox | 406 | 98.5 |
| Muslim | 5 | 1.2 |
| Protestant | 1 | 0.3 |
| Residence | ||
| Urban | 159 | 38.6 |
| Rural | 253 | 61.4 |
| Ethnicity | ||
| Amhara | 393 | 95.5 |
| Others | 19 | 4.5 |
| Educational status | ||
| No education | 96 | 23.3 |
| Primary | 62 | 15 |
| Secondary education | 131 | 31.8 |
| College and above | 123 | 29.9 |
| Monthly income (ETB) | ||
| High | 178 | 43.2 |
| Medium | 120 | 29.1 |
| low | 114 | 27.7 |
| Occupational Status | ||
| Govt. employ | 160 | 38.8 |
| Private employ | 135 | 32.8 |
| Farmer | 64 | 15.5 |
| Daily laborer | 23 | 5.6 |
| Merchant | 30 | 7.3 |
| Living with your spouse | ||
| Yes | 365 | 88.6 |
| No | 47 | 11.4 |
| Age of spouse's | ||
| 15–24 | 62 | 15.1 |
| 25–29 | 172 | 41.7 |
| 30–34 | 120 | 29.1 |
| 35–39 | 58 | 14.1 |
| Spouse's education | ||
| No education | 111 | 26.9 |
| Primary | 119 | 28.9 |
| Secondary | 124 | 30.1 |
| College and above | 58 | 14.1 |
| Spouse's occupation | ||
| Housewife | 112 | 27.2 |
| Government Employed | 133 | 37.1 |
| Private employee | 63 | 15.3 |
| Student | 36 | 3.9 |
| Farmer | 68 | 16.5 |
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Reproductive characteristics of the study participants
Among the study participants, 173 (42%) of them had two live children and more than half of 230 (58.8%) of men and their wives had 2 to 3 deliveries. Regarding the age of the last child, Less than half 181 (43.9%) of men had children greater than six months old, and about 239 (58%) of the study participants had their last child was female. Among the study participants about, 37 (9%) of their wives had complications in the last pregnancy. Among 37 respondents about, 15 (40.5%) of their wives develop Excessive vaginal bleeding in the last pregnancy (Table 2).
Table 2.
Reproductive characteristics of study participants in South Gondar zone Ethiopia, 2024 (n = 412)
| Total number of deliveries your wives had | Frequency | Percent | |
|---|---|---|---|
| 1. 1 | 124 | 30.1 | |
| 2. 2–5 | 230 | 55.8 | |
| 3,≥5 | 58 | 14.1 | |
| Number of live children | |||
| 1. 1 | 118 | 28.6 | |
| 2. 2. | 173 | 42.0 | |
| 3. ≥3 | 121 | 29.4 | |
| Age of your last child | |||
| 1. <6 month | 231 | 56.1 | |
| 2. >6 month | 181 | 43.9 | |
| Sex of last-child | |||
| 1. Male | 173 | 42.0 | |
| 2. Female | 239 | 58.0 | |
| Wives had complications in the last pregnancy | |||
| Yes | 37 | 9.0 | |
| No | 375 | 91.0 | |
| List of Complications that happen in the last pregnancy | |||
| Excessive vaginal bleeding(n=37) | |||
| 1. Yes | 15 | 40.5 | |
| 2. No | 22 | 59.5 | |
| Severe Headache | |||
| 1. Yes | 6 | 16.2 | |
| 2. No | 31 | 83.8 | |
| Blurred Vision | |||
| 1. Yes | 8 | 21.6 | |
| 2. No | 29 | 78.4 | |
| Convulsions/Loss of Consciousness | |||
| 1. Yes | 3 | 8.1 | |
| 2. No | 34 | 91,9 | |
| Swollen Hands/Face | |||
| 1. Yes | 4 | 10.8 | |
| 2. No | 33 | 89.2 | |
| High-grade Fever | |||
| 1. Yes | 5 | 13.5 | |
| 2. No | 32 | 86.5 | |
| Rise blood BP | |||
| 1. Yes | 7 | 18.9 | |
| 2. No | 30 | 81.1 | |
| Malodorous Vaginal discharge | |||
| 1. Yes | 3 | 8.1 | |
| 2. No | 34 | 91.9 | |
| The number of minutes taken to reach health facility | |||
| 1. <30 minute | 239 | 58.0 | |
| 2. ≥ 30 minute | 173 | 42.0 | |
| Decision about PNC service | |||
| 1. Husband | 115 | 27.9 | |
| 2. Wives | 58 | 14.1 | |
| 3. both wives and husband | 239 | 58.0 | |
| Are there any other family members staying Within your house other than your wife and children? | |||
| Yes | 185 | 44.9 | |
| No | 227 | 55.1 | |
| Safe motherhood news listened to by husband | |||
| Yes | 294 | 71.4 | |
| No | 118 | 28.6 | |
| Type of marriage | |||
| Monogamy | 411 | 99.8 | |
| Polygamy | 1 | 0.2 | |
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Awareness of married men about PNC
Of the total respondents, 202 (49%) of men had awareness about PNC. Among this majority, 123 (61%) of study participants, heard from health professionals (Figure 2).
Figure 2.
Source of information about PNC among men whose wives gave birth in the last year in South Gondar zone, Ethiopia, 2024
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Knowledge of men about postnatal care
In this study, one–fourth of 50(24.8%) of respondents had good knowledge about postnatal care. About, 81 (40.1%) of men responded that the postnatal period was more dangerous to the life of the mothers and their babies (Table 3).
Table 3.
Knowledge of study participants in South Gondar zone Ethiopia, 2024 (n = 202)
| Variable | Category | Frequency | Percent |
|---|---|---|---|
| Did you know the availability of health services for Postnatal care for your wives and your babies within the first six weeks after delivery | Yes | 66 | 32.7 |
| No | 136 | 67.3 | |
| The postnatal period was more dangerous to the lives of the mothers and their babies than pregnancy and delivery | Yes | 81 | 40.1 |
| No | 121 | 59.9 | |
| A woman and her baby must go to the health facility for postnatal care | Yes | 46 | 22.8 |
| No | 156 | 77.2 | |
| know the PNC complications of the mother and Neonet | Yes | 30 | 14.9 |
| No | 172 | 85.1 | |
| The appropriate time to begin PNC is immediately after delivery | Yes | 60 | 29.7 |
| No | 142 | 70.3 |
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Attitude men towards PNC
In this study, 41 (20.3%) of men had positive attitudes about postnatal care. Among those more than half 128 (63.4%) of men disagree that PNC service can minimize the morbidity and mortality of babies (Table 4).
Table 4.
Attitude of study participants in South Gondar zone Ethiopia, 2024 (n = 202)
| Variables | Category | Frequency | Percent | |
|---|---|---|---|---|
| PNC service is important | Agree | 50 | 24.8 | |
| Not sure | 41 | 20.3 | ||
| Disagree | 111 | 54.9 | ||
| PNC service can minimize morbidity and mortality of mothers | Agree | 54 | 26.7 | |
| Not sure | 40 | 19.8 | ||
| Disagree | 108 | 53.5 | ||
| PNC service can minimize morbidity and mortality of babies | Agree | 44 | 21.8 | |
| Disagree | 34 | 16.8 | ||
| Not sure | 124 | 61.4 | ||
| Male involvement is important for PNC improvement | Agree | 68 | 33.7 | |
| Not sure | 87 | 43.1 | ||
| Disagree | 47 | 23.2 | ||
| The mother should have a PNC follow-up within 42 days | Agree | 51 | 25.2 | |
| Not sure | 81 | 40.1 | ||
| Disagree | 70 | 34.7 | ||
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Culture related factors
Of 412 respondents 74(18%) of respondents perceived that PNC is a women's affair and 62(15%)) considered the PNC clinic as a place only for women. Nearly one-fourth of 116 (28.2%) men had a culture of discussion with their partner about PNC service utilization. About, 92 (22.3%) of respondents reported that some misconceptions and myths influence the involvement of the male partners in PNC service utilization.
Health service-related characteristics
More than half (58%) of respondents had health facility access within 30 minutes and only, (27.7%) of respondents had transport access to the health facility. About, (16.3%) of respondents had a good welcome by the health professionals when they visited. About, (28.4%) of men respond that healthcare providers are not allowed to the room other than health workers to ensure privacy.
Male partner involvement in PNC service utilization
In this study, the magnitude of male involvement in PNC was 23.7% with a 95% CI (21.6–29.9). Nearly one-fourth (22.8%) of men accompanied their partner to the health facility for PNC service utilization. The most common reasons for male partners who did not accompany their partner were lack of knowledge about PNC and, the postpartum complications, being preoccupied with work, a belief that the PNC is an issue for women only, and women not being allowed to accompany their partner (Table 5).
Table 5.
Husband involvement in PNC utilization in South Gondar zone, North East Ethiopia, 2024 (n=412)
| Variables | Frequency | Percentage | |
|---|---|---|---|
| Discusses PNC service with their partner | No | 299 | 72.6 |
| Yes | 113 | 27.4 | |
| Discusses family planning with their partner | No | 329 | 79.9 |
| Yes | 83 | 20.1 | |
| Discusses PNC service and complications during the postpartum period with a healthcare provider | No | 327 | 79.4 |
| Yes | 85 | 20.6 | |
| Provided physical support for his wife during the postnatal period | No | 310 | 75.2 |
| Yes | 102 | 24.8 | |
| Provides emotional support to their partner for PNC service utilization | No | 260 | 63.1 |
| Yes | 152 | 36.9 | |
| Provides financial support to their partner for PNC service utilization | No | 248 | 60.2 |
| Yes | 164 | 39.8 | |
| Accompanied their partner to the health facility to PNC service | No | 318 | 77.2 |
| Yes | 94 | 22.8 | |
| Looks after children | No | 236 | 57.3 |
| Yes | 176 | 42.7 | |
| Helps domestic tasks | No | 265 | 64.3 |
| Yes | 147 | 35.7 |
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Factors associated with husband involvement in PNC service utilization
In binary logistic regression: Residence, education, wives' occupation, wives' education health care decision, Number of live children, knowledge about PNC, knowledge about danger signs, attitude, and income were found to be a p-value of <0.2 and entered into the multivariable analysis.
Finally, educational status, residence, wives' occupation, good knowledge About PNC, and health care decisions were significantly associated with male involvement in PNC in the multivariable analysis.
Male partners living in urban areas were 2.5 times more likely to be involved in PNC service utilization than their counterparts ([AOR = 2.48, 95% CI = (1.22–4.76)]
Men who had attained secondary education were 2.2 times more likely to be involved in PNC service utilization than Men who had no formal education (AOR=2.23, 95% CI: 1.42–7.34). Men who had attended college and above education were 3.8 times more likely to be involved in PNC service utilization than those who had no formal education (AOR=3.82,95% CI:1.74–7.52).
Male partners whose wives' occupation was government-employed were 2.6 times more likely to be involved in PNC utilization than housewives ((AOR=2.56, 95CI:1.12–6.51). Furthermore, Maleparteners whose wives' occupation was a student were 14 times more likely to be involved in PNC service utilization than housewives (AOR=13.94,95% CI:6.73–26.32). The result also suggested that male partners who had good knowledge of PNC service were 2.4 times (AOR=2.43,95 CI:1.18–4.24) more likely to be involved in PNC service utilization as compared to those who had poor knowledge of the service Moreover, male partners who make health care decision jointly with his wives were 4.6 times more likely to involved in PNC service utilization than their counterparts. (AOR= 4.56,95% CI:2.10–9.97) (Table 6).
Table 6.
Factors associated with male partner involvement in PNC utilization among men whose wives had given birth in the last one year in the South Gondar zone Ethiopia, 2024 (n=412)
| Variables | Male Involvement in PNC |
COR (95% CI) | AOR (95% CI) | |
|---|---|---|---|---|
| Yes | No | |||
| Educational status | ||||
| No education | 21 | 75 | 1 | |
| Primary | 30 | 32 | 2.42 (1.15–4.85) | 1.55 (0.567–4.18) |
| Secondary | 88 | 43 | 2.45 (1.69–5.70) | 2.23 (1.42–7.34)* |
| College and above | 93 | 30 | 6.07 (4.42–11.74) | 3.82 (1.74–7.52)* |
| Spouse Occupation | ||||
| Housewife | 37 | 75 | 1 | 1 |
| Goven‟t employee | 87 | 46 | 8.29 (4.78–14.38) | 2.76 (1.11–6.81)* |
| Private employee | 25 | 38 | 1.29 (.70–2.39) | .621 (0.24–1.58) |
| Farmer | 23 | 45 | .72 (.31–2.23) | .689 (0.19–2.80) |
| Student | 20 | 16 | 16.45 (2.38–24.92) | 13.94 (6.73–26.32)** |
| Residence | ||||
| Rural | 108 | 145 | 1 | 1 |
| Urban | 101 | 58 | 1.95 (1.18–2.89) | 2.48 (1.22–4.76)* |
| Men's knowledge about PNC | ||||
| Poor knowledge | 40 | 112 | 1 | 1 |
| Good knowledge | 31 | 19 | 2.95 (1.19–5.34) | 2.43 (1.18–4.24)** |
| Healthcare decisions | ||||
| Husband | 20 | 95 | 1 | 1 |
| Both | 138 | 101 | 3.93 (2.01–6.19) | 4.56 (2.12–9.97)** |
| Wife | 25 | 33 | 2.53 (1.45–4.41) | 2.1 (0.88–4.4) |
Significant at p-value <0.05
Significant at p-value <0.001.
Sisay et al. Determinants of male involvement in postnatal care service utilization among men whose wives gave birth in the last year. Am J Obstet Gynecol 2025.
Discussion
The overall magnitude of male partner involvement in PNC service utilization was 23.7% with a 95% CI (21.6–29.9). This finding is in line with the findings of a study done in Ethiopia (20.8%),10 and Ghana(20%).13 The similarity of this study from Ethiopia might be due to the similarity in the study population and socio-demographic characteristics. The similarity of this study from Gahana might be due to the similarity in the study population.
However, the result of this study is lower than a study done in Nigeria (56.3%),11 Indonesia (50%),14 Chitwan (33.8%),15 and, Ghana (31.7%).16 The possible explanation for this difference from the studies conducted in Nigeria might be due to differences in socio-demographic characteristics: In the study done in Nigeria, the majority of respondents had completed Tertiary education(74.3%), However; in this study, 23.3% of respondents have no formal education. Another reason might be due to the difference in knowledge status about PNC: the majority of men had Good Knowledge about PNC (66.6%) but in this study, onely 24.8% of men had good knowlodgy
The possible explanation for the difference between this study from Chitwan might be a difference in the study population: unlike this study studies done at Chitwan were among women. Another reason might be due to the difference in income. In the study done in Chitwan Half (50%) of the respondents had high income. However, in this study, 27.7% of respondents had low income. However, studies done in Kenya showed that men who had high incomes were more involved in PNC than women who had low incomes.17 The possible explanation for this difference from the studies conducted in Ghana might be due to the different study settings. Unlike this study, the study done in Ghana was institutional-based. The possible explanation for the difference in this study from Indonesia might be due to the difference in knowledge status about PNC: In the study done in Indonesia the majority of men had Good Knowledge about PNC (56.7%) but in this study, only 24.8% of men had good knowledge. However, Studies showed that men's Knowledge about PNC can increase their involvement.18
Based on the findings of this study, residence was associated with the involvement of men in PNC: Male partners living in urban areas were 2.5 times more likely to be involved in PNC service utilization than their counterparts. This finding was supported by the study conducted in Ethiopia.10 This might be due to Men who were from urban residences being able to access information about PNC services and postnatal complications from different sources like newspapers, TV, and the internet. Men who had attained secondary education were 2.2 times more likely to be involved in PNC service utilization than Men who had no formal education.
In this study educational status of the husband was associated with the involvement of men in PNC. Men who had attained secondary education were 2.2 times more likely to be involved in PNC service utilization than Men who had no formal education.
Furthermore, Men who had attended college and above education were 3.8 times more likely to be involved in PNC service utilization than those who had no formal education. This result was supported by the study in Ethiopia10 and Kenya.19,20 This might be due to educated men having more access to information from different sources like the Internet, schools, and newspapers. However, this is in contrast with the study done in Nigeria which found that the level of husband involvement decreases when the educational level increases. To rule out this association further qualitative studies were required.
The novel finding in this study was wives' occupational status: Male partners whose wives' occupation was government-employed were 2.6 times more likely to be involved in PNC service utilization than housewives. Furthermore, Male partners whose wives' occupations were as students were 14 times more likely to be involved in PNC service utilization than housewives. This might be due to employed and student women having access to media and the chance to get updated information from other staff members and classmates and share that information with their husbands. Women who were students might also get information from their teachers and share information with their husbands. This might be also due to employed women participating in decision-making about PNC.
The result also suggested that male partners who had good knowledge of PNC service were 2.4 times more likely to be involved in PNC service utilization as compared to those who had poor knowledge of the service. This result was supported by the study done in Ethiopia,10 Bangladesh21 and Nigeria.22 This might be due to When men know how they and their families can benefit from PNC services, they are more likely to be involved in the uptake of the services.
Moreover, male partners who make health care decisions jointly with their wives were 4.6 times more likely to be involved in PNC service utilization than their counterparts. This result was supported by a study done in Kenya.19 This might be due to couples who make Decisions jointly with their wives sharing necessary information about PNC service and postnatal complications.
Conclusion
In this study, the magnitude of male partner involvement in PNC service was low as compared with other studies. Residence, Husband's educational status, wife's occupational status, knowledge about PNC, and joint health care decisions with wives were important predictors of male partner involvement in PNC.
Recommendation
To the policymakers
Better to give more attention to men's education and empower women.
To the regional health bureau and educational bureau
It is better to encourage men to have better academic involvement and achievement to improve their knowledge through better exposure to information from social media, other staff members from the workplace, and social networks.
To the zonal health office
It is better to make efforts to increase communities’ awareness and knowledge about male involvement by providing information through mass media and educative campaigns to improve men's knowledge and attitude towards PNC.
For health workers
Strengthen information to create awareness and increase the level of knowledge about PNC through health education at PNC.
It is better to provide appropriate counseling about, an advantage of PNC during labor delivery and PNC, especially for men who live in rural areas and have no formal education.
For further researches
Further qualitative study is needed to explore factors associated with pale partner involvement in PNC.
CRediT authorship contribution statement
Fillorenes Ayalew Sisay: Writing – original draft, Project administration, Methodology, Investigation, Formal analysis, Conceptualization. Abeba Belay Ayalew: Formal analysis, Data curation. Besfat Berihun Erega: Writing – review & editing, Formal analysis, Conceptualization. Wassie Yazie Ferede: Validation, Formal analysis. Assefa Kebie Mitiku: Writing – review & editing, Data curation. Eyaya Habtie Dagnaw: Writing – review & editing, Supervision. Tegegne Wale Belachew: Writing – review & editing, Funding acquisition. Temesgen Dessie Mengistu: Formal analysis. Begizew Yimenu Mekuriaw: Validation. Yonas Zenebe Yiregu: Resources, Formal analysis. Tigist Seid Yimer: Validation, Formal analysis, Data curation, Conceptualization.
Footnotes
Patient consent: Purpose of the research: To assess the magnitude of male involvement in postnatal care service utilization and associated factors among fathers whose wives had delivered children in the last twelve months.
Voluntary Participation: You have the full right to refuse to participate in this research. You also have the full right to withdraw from this study at any time you wish. You can also decide if you only want part of the study.
Risk: Risk/ Discomfort: The risks of participating in this study are very minimal, but you may feel some discomfort, especially on spending time of 30 minutes. I hope you will participate in the study for the sake of the Benefit of the research result.
Benefits: At this moment you may not get any direct benefit by being involved in this study but the information you provide is very important to solve problems associated with postnatal care.
Procedures: Each participant will fill out a short questionnaire.
Confidentiality: The information you will provide us will be confidential. There will be no information that will identify you in particular.
The authors reports no conflict of interest.
Supplementary material associated with this article can be found in the online version at doi:10.1016/j.xagr.2025.100459.
Appendix. Supplementary materials
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