Earlier children get more fatherly attention than later ones, report suggests
A couple with their child. The majority of men have interest in and are closely informed about maternal and child health.
What you need to know:
- According Kenya Demographic and Health Survey 2022 report, wives are more likely to be better taken care of in their earlier pregnancies.
- Men in urban areas were "more likely to be present during antenatal care visits (65 per cent) and to accompany the child’s mother to a health facility during childbirth (72pc)".
The Kenya Demographic and Health Survey (KDHS) 2022 report shows that “91 per cent of men aged 15–49, with the youngest child aged 0–2 years, reported that the child’s mother had attended antenatal clinic (ANC) visits during her pregnancy.”
This shows that the majority of men have interest in and are closely informed about maternal and child health (MCH), with 55 per cent having been present during ANC check-ups. However, the percentage declined “from 58 per cent among those with one to three children to 45 per cent among those with six or more”.
This suggests that earlier children receive more fatherly attention than later ones, meaning wives are also more likely to be better taken care of in their earlier pregnancies. Could this be due to men’s greater excitement about maiden offspring and fatigue with later ones?
Men in urban areas were “more likely to be present during ANC visits (65 per cent) and to accompany the child’s mother to a health facility during childbirth (72 per cent) than those in rural areas (47 per cent and 62 per cent respectively)”. This indicates a more liberal attitude towards MCH by men in urban areas.
“The percentage of men present during any ANC check-up increased from 34 per cent among those with no education to 70 per cent among those with more than secondary education,” and from 35 per cent in the lowest to 71 per cent in the highest quintile. These findings depict education and wealth as game changers in securing men’s involvement in MCH and family welfare.
Men’s involvement in MCH is receiving increasing attention in research. A 2016 study by Lilian Nyamusi and colleagues on utilisation of skilled birth services in Malindi noted that “local women (could not) make decisions regarding their health” without consulting their husbands. Consequently, most of them gave birth at home, more so because the husbands could not afford the services, nor could the wives, who were stay-home partners. The husbands also had to give permission for referral in cases of emergency. When such was not forthcoming, women’s lives were put at risk.
A 2012 review by John Ditekemena and others on the situation in sub-Saharan Africa noted that involvement in MCH was higher among men aged 25 years and above and those cohabiting. In Uganda, “men who had completed eight or more years of education were twice more often involved compared with those with less.” Men in stable and well-paying professions were more likely than those in occasional jobs to participate, which resonates with the KDHS findings.
Elizabeth Mkandawire and Sheryl Hendrik’s 2018 qualitative study looked at men’s involvement in MCH as a policy intervention in rural Central Malawi. It established that men were encouraged by the perceived benefit of participating in MCH, in that the technical information received enabled them to: protect the unborn babies from contracting HIV; promote nutrition for the wives; reduce the women’s workloads; and monitor danger signs.
Motivation
The men were also motivated to have their villages declared leaders in safe motherhood. Those who saw healthy children at clinics also wanted theirs to look the same, hence catered better for the wives. Men’s involvement was also accelerated by male champions reaching directly to peers with messages on safe motherhood.
A carrot and stick incentive used by health facilities to give priority to women who brought their husbands along increased men’s participation but created a new form of discrimination as it penalised women for their husbands’ mistakes and shifted power to men.
Furthermore, it alienated women who had babies out of wedlock and had no husbands to tag along. In response, women hired fake husbands in order to comply, giving such men a golden opportunity to make easy money. This suggests that the design of male involvement initiatives can easily reinforce existing inequalities and introduce new ones unless informed by socio-cultural dynamics.
Because reproductive health is feminised, men who participated in the experiment were stigmatised as emasculated by peers. Men also incurred opportunity costs of time from income-earning activities. Moreover, merely getting men to attend clinics did not holistically transform them into practitioners of gender equality.
Studies concur that the environment of MCH clinics deters male involvement. In Uganda, men were unwilling to re-visit the facilities after experiencing hostile behavior from health service providers.
Those in the Democratic Republic of Congo disliked the congestion in the facilities, long waiting time and restriction of services to weekdays and official working hours. They also felt estranged in a space dominated by women. Interestingly, some women disliked their partners accompanying them.
In Malawi, specifically, the presence of men prevented the wives from talking freely to the attendants.
More research on this topic would unequivocally establish factors that should be built into service delivery, to increase male involvement and consequently improve national MCH outcomes.
The writer is an international gender and development consultant and scholar ([email protected]).
