CHAPTER ONE

CARE.INTRODUCTIONMen’s role in antenatal care is pivotal to changing the course of the epidemic maternal death rate. When men participate in antenatal care, their knowledge of women sufferings before and after birth increases, their behavior becomes supportive, and their receptiveness to postnatal care testing in medical centers increases. In recent time, multiple efforts have been implemented by governmental and non-governmental organizations that encourage men to ‘‘follow’’ their wives to obstetric and gynic, However, only few of men have participated in this care.

The limited progress in meeting the Goal of reducing maternal mortality in developing countries, particularly in africa, necessitates new approaches to maternal health interventions. Education and health services provided during the antenatal period can reduce pregnancy and delivery complications and improve birth outcomes in resource-poor settings; however, these benefits are contingent upon user compliance. At the same time, women's ability to seek health care or implement lessons learned from health education interventions is often determined by the household head, usually the husband.

The important role that male partners play in women's reproductive health is becoming increasingly recognized, and, especially as a result of the rate of maternal death epidemic, more attention is being focused on how to incorporate men into reproductive health education interventions. Male involvement in reproductive health decisions and practice has been shown to be considerable, particularly related to antenatal and even post natal care.

Educational interventions for pregnancy health have traditionally been inadequate in addressing a woman's degree of influence within the household on health-related decisions, particularly as compared with her husband. Observational studies have shown that educating men about the importance of health care for the family increases the promotion of some health-seeking behaviors, such as antenatal care (ANC) and child immunizations, and enhances communication and support of female partners.In general, men who are exposed to a multimedia entertainment–education intervention regarding birth preparedness responded favorably by exhibiting new knowledge gains and birth preparations.

While such evidence indicates that men can influence health care utilization during pregnancy and thereby the outcome of an obstetric emergency, few interventions have targeted men directly in ANC, birth preparedness or obstetric decision making, and randomized trials of the impact of involving men in such interventions are scarce. Using a randomized controlled design, we evaluated the impact of including husbands in antenatal health education sessions on birth preparedness and maternal health care utilization.

BACKGROUND OF THE PROBLEM

The reproductive health field is paying more attention to men’s roles in women’s

reproductive health. However, much researches has overlooked adolescents. As part of an adolescent reproductive health intervention study, researchers, with input from international center for research on women( ICRW), examined patterns of husbands’ participation in health seeking for their adolescent wives’ antenatal, delivery, and postnatal care.Socio cultural context: The mean age at marriage is 23 years for men compared to 16 years for women.Thus, while men marry after adolescence, on average, women tend to marry early. These young couples face enormous pressure to bear children soon after marriage from the joint family and from peers. Consequently, childbearing is early with 86% of the wives of sample husbands reporting at least one pregnancy by the age of 22 years. Young women have limited mobility and depend on husbands or other family members to take them to a health centre. This entails time spent by husbands, who may not accompany their wives unless they perceive it necessary. However, given the high value placed on proving fertility early in the marriage, pregnancy care is sought relatively promptly, especially for the first child.Husbands’ awareness of maternal care: While a majority of husbands are aware of the need for care, and that problems can arise during pregnancy, fewer know details. While 77% say that women should seek antenatal care, only one third know about all the antenatal care services that can be provided. A high 85% say care is needed during delivery, but for most reported the need for institutional deliveries (72%) rather than care during home deliveries. Interviews with husbands reveal, however, that though they may not know medical details, they help wives follow treatment advice, and are concerned about nutrition and other care within the home environment.

STATEMENT OF THE PROBLEM Most husbands feel responsible for routine care and treatment of problems. Men indicate they want to participate in maternal care. Yet, high awareness and sense of responsibility do not translate into participation: only about half the husbands accompanied wives for routine care. Husbands were more likely to accompany their wives and pay for treatment for problems. In both routine care and treatment of problems, husbands participated more often by paying for care than accompanying their wives.Husbands may be dissuaded by the belief that maternity is ‘women’s affair’ and by young women going to their natal home for delivery. In addition, beliefs of health staff and poor conditions in health centers mean that even husbands who accompany their wives to clinics are often made to wait outside.Men who were better educated, married later, and whose wives were educated and were older when they married knew more about and were more likely to participate in all three phases of care. Experience matters:

being young, many men were first-time fathers-to-be and were less likely to know about care and problems than their peers whose wives had been pregnant in the past. Moreover, it is the same sub-set of men who participate: those who know about the need for care are more likely to accompany their wives for care, be it antenatal, delivery, or postnatal routine care or treatment for problems. Similarly, husbands who accompany their wives for routine care in one phase of maternity are more likely to accompany them for treatment of problems or for care in other phases.

OBJECTIVE OF THE STUDY·1 To educate Young couples to experience pregnancy and childbearing in a context of early marriage, social pressure for early childbearing, and restricted mobility and decision making for young women·2 To let Men know about maternal care: more than two-thirds will be aware of the need for antenatal, delivery, and postnatal care and feel responsible to accompany and pay for routine care and treatment of problems·3 more husbands will accompany their wives for care; because at the moment husbands are more likely to be present for care of problems than for routine care·4to inculcate the Beliefs that maternity is not only a “woman’s issue” as well as attitudes and conditions in the health centers contribute

SIGNIFICANCE OF THE STUDY.Educational efforts on maternal care with men should go beyond basic information to also include specifics of maternal services, precautions, and problems· Work with the health system should improve conditions – such as lack of privacy that make it difficult for husbands to participate, and identify other ways health staff could encourage husbands to be present· Where young women have limited say over their care, “men’s involvement” needs to be defined more broadly to include husbands’ support to young wives in negotiating their environment.

SCOPE AND DELIMITATION The study will examines the relative (and additive) roles of community mobilizationand improved quality of government services in increasing young married women’s use of reproductive health services, and a variety of qualitative and quantitative methods to explore the constraints, attitudes of women, their families and their communit ies, and best approaches to increase use of reproductive health services by adolescents and youth. In this process, their husbands and mothers-in-law, community-based organizations, and village- and district-level government health workers will participate in antenatal care.

RESEARCH QUESTION

How much do husbands participate in their adolescent and young wives’ pregnancy and maternity care?DEFINATION OF TERMS1 antenatal care:-2 pregnancies:-3 childbearing:-4 obsteric :- Obstetrics (from the Latin obstare, "to stand by") is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and postnatal 5. Midwifery :- is the non-surgical equivalent of obsterics5 gynecology:-