Study Explores How to Get More Men Involved in Their Pregnant Partners’ Healthcare
November 7, 2019
Last spring, undergraduate Saumya Sao ’20 (Gender, Sexuality & Feminist Studies and Global Health), doctoral student Jessica Coleman ’23 (Clinical Psychology) and master’s student Godfrey Kisigo ’20, M.D. (Global Health) received a Bass Connections Student Research Award to examine male involvement in antenatal care and HIV services in Tanzania. Their research was inspired, in part, by the work of the Big Data for Reproductive Health team, and is part of a study funded by the National Institutes of Health (NIH) to address HIV stigma and promote HIV care among couples both during and after pregnancy.
Twende Pamoja: Let Us Walk Together
By Saumya Sao, Jessica Coleman and Godfrey Kisigo
The Tanzania Ministry of Health strongly encourages women to bring their male partner to their first antenatal care (ANC) visit. This provides a unique opportunity to engage male partners in pregnancy care. Partner involvement in pregnancy care has been linked to improved health outcomes for the mother and child, yet challenges to male engagement in ANC persist.
An essential component of the first ANC visit is universal testing for HIV of the pregnant woman and, if present, her partner. In sub-Saharan Africa, men are less likely than women to test for HIV, and, if diagnosed positive, are less likely to link to care and remain in treatment. Therefore, this first visit could serve as an opportune moment to link men who test positive for HIV to care, and to involve men in supporting prevention of mother-to-child transmission among women who are diagnosed with HIV.
The purpose of our project was to gain a deeper understanding of female and male experiences in ANC, and to explore how women and men perceive men’s involvement in ANC in order to identify opportunities to engage men in care. This past summer, our team worked in two public clinics in Moshi, Tanzania, to conduct 19 in-depth interviews with pregnant women and their male partners.
Prior to initiating our fieldwork, we developed in-depth interview guides based on questions that emerged from the research literature, our team’s NIH-funded R21 Maisha study (led by Melissa Watt) and feedback from our local collaborators. For example, our teammates in Moshi pointed out that women who presented with partners at one clinic were often prioritized to receive care over those who presented without a partner, which led us to include probes about this in our interview guides.
In Moshi, our fieldwork was conducted with support from our partners at the Kilimanjaro Christian Medical Center. We worked in our two clinic sites to recruit and interview women and men who were already enrolled in the Maisha study. Interviews were conducted in a private room on the clinics’ premises. Our study participants were very thoughtful in providing constructive responses and sharing their partner dynamics, ANC experiences and thoughts about male engagement in care. We appreciated the narratives and insights attained from these conversations with our study participants, which helped us to gain knowledge related to our research question.
The interviews were audio-recorded and simultaneously translated and transcribed in Swahili. Upon returning to Duke, the team has started reading English transcripts of the interviews and is beginning data analysis.
We have discerned preliminary themes related to barriers and facilitators of male presentation to ANC and similarities among our participants’ experiences of ANC visits. The interview data has been robust and exciting to explore, and our team is grateful to Bass Connections for allowing us to design and carry out a study we are passionate about.
Additionally, we have begun analyzing survey data, collected through the R21, to examine demographic and psychosocial factors of pregnant women that predict whether or not they present to ANC with a male partner. Throughout the fall semester, we will continue working on quantitative and qualitative analyses. We will share our findings at the 2020 Annual Consortium of Universities for Global Health conference and the 2020 Annual Meeting of the Society of Behavioral Medicine in the spring. We hope our data will inform improvements to ANC practice and policy to better support women and men in receiving quality pregnancy and HIV care.