Rwanda has seen an improvement in public health over the past 20 years. The maternal health field has benefited greatly from such improvements. In particular, the country has seen a remarkable reduction in deaths related to pregnancy. But more must still be done to meet key national and international maternal health targets. Achieving continued improvement will require identifying and acting on new opportunities, including deepening men’s involvement in maternal health.
In Rwanda, as with most African countries, there are few programmes that promote men’s involvement in maternal health. Maternal health is widely thought of as primarily a woman’s issue, and so opportunities for men’s involvement as partners are often unclear. The social stigma placed on men’s involvement in maternal health is a significant barrier to their participation.
What are the opportunities for men to become more involved in supporting maternal health? We explored this in a recent study through speaking with pregnant and recently pregnant Rwandan women. We learned that men have particularly important roles to play in increasing access to maternal health services. Interventions involving men are encouraged to increase their understanding of the implications of their involvement in maternal health. But this must be done without compromising women’s autonomy in decision-making.
We conducted in-depth interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s role during pregnancy. We spoke to women across five districts in rural and urban parts of the country.
We identified three key ways men can play a more active role in maternal health.
First, men can practically help their partners access care by assisting with the costs of attending clinical appointments such as transport, health insurance, and meals while on route to the clinic. Men can also facilitate women’s involvement in maternal care by taking care of household chores while women attend maternal health appointments. Overall, men’s involvement in facilitating access to maternal care could have spillover benefits for using other services, such as family planning.
Second, men can support the maternal health decisions made by women. This can ultimately facilitate care access. And doing so still enables women’s autonomy in decision making – an important and often ignored ingredient in improving maternal health.
Third, women told us that men can meaningfully participate in gathering and reviewing information on maternal health. This positions them to play a role in supporting informed decisions when it comes to maternal health and women’s health more broadly.
Community volunteers who contribute to promoting maternal health in collaboration with the Ministry of Health, known as community health workers, are well positioned to support men’s increased roles in maternal health.
As one woman we spoke with explained:
It is helpful when a community health worker gives information in the presence of my spouse…because that makes him help me.
Given their important roles in the process of involving men in maternal health, community health workers should be supported in actively facilitating men’s involvement.
But there are societal barriers to deepening men’s involvement in maternal care. Perhaps the most significant one is the generally low social expectation that is held regarding men’s involvement in such care. These expectations are often limited to the very basics, whether financially or attending specific appointments. This low social expectation is influenced by factors such as education, income and cultural beliefs. Shifting such fundamental social barriers to assist men to understand the opportunities for their deeper involvement in maternal care requires dedicated effort.
Some women deliberately refuse to be accompanied by their partners to clinical appointments. This is because it may be perceived as a form of public display of affection, which is considered inappropriate. Shifting such beliefs requires an understanding of how they pose a barrier to men’s involvement in maternal health and requires deep community investment.
Making the change
Discussions at the community level that engage men in thinking and talking about maternal health are still rare. But these discussions are vital to increasing men’s understanding of why they should become involved in maternal care and facilitate women’s access to such care. This includes developing a shared understanding of how involvement can happen without compromising women’s autonomy in decision making on maternal health.
Increasing Rwandan men’s involvement in maternal health will enhance health equity and health outcomes within families, communities, and the country at large. The risks of encouraging and achieving this involvement are minimal and the potential benefits are great.
Involving men more in such care will be essential if Rwanda is to meet many of its maternal health goals. As our research has shown, this includes meeting targets related to women’s access to such care.