Involving Men in Maternity Care: South Africa

Executive summary

The Reproductive Health Research Unit (RHRU) University of the Witwatersrand, in partnership with the FRONTIERS Program of the Population Council, and the KwaZulu Natal Department of Health conducted a three-year operations research study titled “Men in Maternity” (MIM) in the Ethekwini district. The study was completed in July 2003. A randomized cluster matched paired design was used with six clinics implementing the intervention and another six control clinics continuing to provide services following the current practices and guidelines of the Department of Health. Both rural and urban clinics were included.


The intervention was clinic-based and included two broad strategies:

• improving antenatal care services by strengthening the existing antenatal package and service monitoring and supervision;
• introducing couple counseling by providing training to health providers, inviting partners of antenatal women to attend counseling twice during pregnancy and once post delivery, and providing information to couples with a new antenatal booklet.

At baseline 2082 women (1087 control and 995 intervention) and 584 male partners of the intervention women were interviewed using a structured questionnaire. A follow-up rate of 68 percent was achieved for women, and 80 percent of their partners were interviewed in both control and intervention sites. Analysis of baseline data showed that both control and intervention populations were similar in most variables measured by the study.

At follow-up few differences were found between the control and intervention groups to support the hypothesised effect of the intervention. Significant differences were found only in changing communication, partner assistance during pregnancy emergencies, and knowledge of the condom as a method of dual protection.
Although the intervention was intended for all couples in which the woman consented to have her partner participate, not all partners were exposed to the couple counseling intervention. Nevertheless, all participants who were interviewed post-intervention were included in the analysis, regardless of actual exposure to the intervention; therefore, positive effects among men exposed to counseling may have been diluted by those who were not.

All women, regardless of their attendance at couple counseling, were exposed to the strengthened clinical service package in the intervention sites. The hospital where most women deliver and laboratory services were the same for both control and intervention groups would therefore have been equal in exposure to experience of delivery and postpartum initiation of family planning. The same supervisors and managers visited both intervention and control clinics, and there may have been some contamination in terms of improved service delivery.

The intervention may be considered successful in demonstrating that male participation in this context is feasible. At least one-third of couples took the opportunity to attend the counseling. This is a positive outcome, given that this was a very new concept in a community where there was negligible male participation in maternity care and most couples were not cohabiting. Some men expressed willingness to participate, but were unable to due to employment schedules that conflicted with clinic hours of operation, inability to obtain permission from employers, or not being told of the counseling by their partners. The antenatal booklet was given to the most women and a high proportion shared the booklet with their partners. The response to the booklet was very positive from all those who read it.

The intervention was feasible, relevant and effective in significantly changing communication, partner assistance during emergency, condoms as a dual protection method, condom use, and condom use in last sexual encounter. Had the intervention been in place for a longer period or supported by mass communication efforts to encourage men to come to the clinic, we may have seen a much greater impact.