As such, a pharmacological or non-pharmacological intervention of a sort is required to alleviate parturient pain. Support for women during labour is a common phenomenon in many parts of the world, while in most developing countries such support from a man is considered as a sign of weakness based on cultural beliefs. In different parts of the world, most especially in developed countries such as UK and Denmark, male involvement is a common practice during labour and delivery with about 95% attendance (Emelonye et al., 2017). Studies conducted in these developed countries show that women who had continuous spousal labour support are reassured, comforted and emotionally encouraged to overcome pain associated with labour and delivery (Aziato et al., 2017).

Furthermore, a similar review has shown that women with continuous support by spouses also experience shorter labours, reduced need for oxytocin, anaesthesia, analgesia, instrumental deliveries and have less than 50% chance of being admitted to a cesarean section (Bohren et al., 2017). The effect of support is more remarkable if the support role is adopted by a spouse rather than a caregiver that is also providing medical care (Vehvilainen-Julkunen and Emelonye, 2014). Another study focusing on the attitude and preferences of pregnant respondents about social support during labour and childbirth found that the pivotal role men play providing support during labour improves delivery outcome for both the mother and her newborn (Lewis et al., 2015). They are also considered to be critical partners for improvement of maternal health-care in Nigeria (Iliyasu et al., 2010). Even though these benefits accrue from the participation of spouse in labour and delivery, it has not yet found its place in the Nigerian maternal health-care system (Vehvilainen-Julkunen and Emelonye, 2014).

In furtherance, studies showed different proportions of male involvement in choice of delivery site. For instance, in Ethiopia one study established high involvement (90.4%) (Wassie et al., 2014). In Uganda, a study in the south western region indicated that 56% of male partners were involved in deciding spouses’ place of delivery (Kabakyenga et al., 2012). Other studies have reported negative perceptions towards men attending Antenatal Clinic services (Ganle and Dery, 2015; Maluka and Peneza, 2018).

Studies have shown that lack of knowledge about maternal health pose a significant challenge to positive male partner involvement (Nesane et al., 2016). Other factors found to hinder the actualization of this desire for males to be involved in labour include education, which has been shown in some studies as a determining factor, reporting high participation of educated men in supporting their wives during antenatal and delivery sessions than uneducated men (Vehvilainen-Julkunen and Emelonye, 2014). Other factors such as ignorance, poverty, cultural and religious practices were shown to be reasons  for low spousal participation during delivery (Lowe, 2017). In Nigeria where culture and religion governs the practices of the society, there is a strong cultural belief in several parts of the country that spousal presence worsens labour pain and prolongs labour (National Population Comission, 2013). It has also been noted that in some instances, spouses are subtly dissuaded from participating in labour by unfriendly hospital settings and staff or through unequivocal inscriptions on the labour ward door such as “you are not needed here” (Iliyasu et al., 2010).

Although the World Health Organization (WHO, 2018), recommends the practice whereby parturient women are allowed to have a birth companion of choice, the reverse is obviously the practice in Nigeria, where practices contrary to the recommendations of the World Health Organization that parturient women be encouraged to undergo labour and delivery with the support of a companion they trust and feel at ease with WHO (2018). While noting the positive maternal experiences of wives in developed countries due to spousal support and participation during labour and delivery, the poor state of the practice in Nigeria therefore demands immediate further research, hence the need to determine women’s perception of male involvement during pregnancy and labour in University College Hospital, Ibadan.

 

Study design

A descriptive cross-sectional study was employed in the study to assess women’s perception of male involvement during pregnancy and labour in University College Hospital, Ibadan (UCH). This study design is imperative because it was able to measure the factors under investigation.

Study setting

This study was carried out in the ante-natal clinic of the University College Hospital Ibadan. UCH is in Ibadan North Local Government of Oyo State, Nigeria. There are 56 service and clinical departments with 96 consultative outpatient clinics in 50 speciality and subspecialty disciplines. In addition, the hospital houses virus research laboratory, a World Health Organisation Collaborating Centre, special treatment clinic and pharmacy department. The hospital comprises over 66 wards and 1000 beds. The average numbers of pregnant women that visited antental clinic in UCH for the month of July, 2018 was 120. The study was conducted among pregnant women attending ante-natal clinic of University College Hospital, Ibadan.

Sampling technique

Accidental sampling technique was used to select 128 available participants who met the eligibility criteria. The researcher used participants met at the antenatal clinic without randomisation and questionnaire was administered to them. Data were collected using Self administered structured questionnaire which was developed after    an    extensive    literature   review.     However,    only    105 questionnaire were suitable for analysis.

Instrument for data collection

An interviewer-administered structured questionnaire was used to collect relevant information from the respondents. The instrument was made up of three sections. Section A collected information about the socio-demographic characteristics of the respondents, Section B collected information about perception of pregnant women towards male involvement while Section C collected information about enabling factors / barriers to male involvement.

Ethical considerations

An ethical approval was obtained from Ethical Review Board of University of Ibadan/ University College Hospital Ibadan. The approval number NHREC/05/01/2008a. Also, the respondent’s informed consent and participation was on voluntary basis. Furthermore, introductory letter was obtained from the medical health officer in charge of the department to facilitate the process of data collection and to meet designed protocols. The collected information was kept confidential and no identifiers were included in the questionnaires.

Statistical analysis

The data obtained was entered into the spread sheet, and analysis was done using the Statistical Package of Social Sciences version 22.0. Descriptive statistics such as frequency, percentage representations, was used to present the result. Inferential statistics such as chi- square test was used to determine significant association between the variables.

 

 

Socio-demographic characteristics

Table 1 shows the demographic data of the participants. Results from the study indicate that the largest percentage of the respondents, 93.3% are married, most of the respondents’ current level of education is the tertiary level, 80.0 and 93.9% are from the Yoruba ethnic group. Also, 58.1% of the respondents are employed while 37.1% had given birth to two children in the past.

 

 

Perception of educated and non-educated women on male involvement

Table 2, the study reviewed that ninety-four of the one hundred educated respondents have a good perception while only five of the uneducated respondents have a good perception towards male involvement during pregnancy and labor.

 

 

Perception about the inter-tribal groups towards male involvement during pregnancy and labor

Table   3,   the   findings   reflect   that  ninety-one  of  the respondents from the Yoruba tribe have a good perception as compared to other tribes such as Igbo, Hausa and Edo about male involvement during pregnancy and labor.

 

 

Perception of the employed and the unemployed women towards male involvement during pregnancy and labour

Table 4, It was observed that fifty-seven of the sixty-one employed respondents have a good perception towards male involvement during pregnancy and labor.

 

 

Enabling factors and perceived barriers towards male involvement

Table 5 result revealed that majority of the respondents, 27.6% strongly agreed that lack of facilities or infrastructure to favour the presence of their husbands during the delivery process is a major barrier to their involvement. Also, 24.8% of them strongly agreed that hospital policies hinder participation of men in the labour process.

 

 

TEST OF HYPOTHESIS

There is no significant association in the perception of the educated and the uneducated women on male involvement during pregnancy and labour

Table 6 shows statistically that there is no significant association in the perception of educated and uneducated women on male involvement during pregnancy and labour (X₂= 0.318, df=1 and P value greater than 0.05).

 

 

There is no significant association in the perception of women from different tribes on male involvement during pregnancy and labour

Table 7 shows that in the chi-square test result, there is no significant association in the perception of women from different tribes on male involvement during pregnancy and labour (X₂=0.525, df = 3 and P value greater than 0.05).

 

 

There is no significant association in the perception of the employed and the unemployed women on male involvement during pregnancy and labour

Table 8 shows that in the chi-square test result, there is no significant association in the perception of employed women and unemployed women on male involvement during pregnancy and labour (X₂=0.146, d_f = 1 and P value greater than 0.05).

 

 

 

 

 

 

Socio demographic data

The study assessed women’s perception of male involvement during pregnancy and labour. The study showed that the largest percentage of the respondents, are married, most of the respondents’ current level of education is the tertiary level, and are from the Yoruba ethnic group.

Perception of educated and non-educated, inter-tribal groups, employed and the unemployed women towards male involvement during pregnancy and labour

The result showed that a lot of women who were uneducated had a poor perception of male involvement in labour. It can therefore be deduced that education is a determinant of women’s perception towards male involvement.  In  addition, low level of education may also distort comprehension and communication of health messages to their male partners. This is consistent with results of studies done in Uganda (Kabakyenga et al., 2012) in Kenya, (Wanjira et al., 2011), in Senegal (Dia, 2014) and in Tanzaniza (Maluka and Peneza, 2018). However, it differs significantly with studies conducted in Kenya (Kenya National Bureau of Statistics, 2008) and in Ethiopia (Wassie et al., 2014). Education has been shown in many studies as a determining  factor reporting high participation of educated spouses of above 50% accompanying their spouses to the antenatal clinic and delivery room than uneducated men (Vehilainen-Julkunen and Emelonye, 2014). It was common practice that nearly all husbands (97.4%) encouraged their wives and pay for antenatal service bills, however only 63.9% were actually present at the delivery. Even though the study shows that more than 50% of men participated in the   delivery   process,   their   participation   was   linked strongly to their educational background. On the other hand, most uneducated men in Nigeria think that their presence are not necessary during delivery, but rather restricted to only the duty of providing financial support for their spouses (Vehilainen-Julkunen and Emelonye, 2014). Thus, education of both males and females must be put into consideration in the development of policies and strategies to increase male participation in labour.

Enabling factors and perceived barriers towards male involvement

Further, majority of the respondents implicated hospital policy and lack of facilities or infrastructures as barriers to their husband’s involvement in the antenatal, intra-natal and postnatal periods. It can therefore be deduced that since more than half of the respondents felt the infrastructure and environment is not conducive for their husbands, they would definitely discourage them from coming into the labour room. A study by Maluka and Peneza (2018), revealed that health facilities have unfavorable environment for men’s participation during delivery. For example, the physical infrastructures hampered male participation in maternal and child health in the study. It was evident from the findings that due to the nature of delivery rooms, men were not allowed in the labour room. The health system attempts to protect the privacy of other women because the delivery room is structured in a way that contains many delivery beds and there are always other women in the room. Lack of space to accommodate male partners during delivery has been reported to deter participation of men in pregnancy and childbirth in several other studies conducted in different countries (Ganle and  Dery,  2015;  Maluka  and  Peneza, 2018; Bohren et al., 2014). These findings therefore support results from this study, and thus calls for effective action by all involved, in order to improve outcome for the woman and her child. Other barriers were also assessed such as the attitude of health care workers, religion and culture but majority of the women did not perceive this as a barrier to male involvement. This therefore shows an improvement in the barriers to male involvement over the years as studies carried out by Iliyasu et al. (2010), NPC snd ICF (2013) and Lowe (2017) revealed that attitude of spouses toward husband's participation in maternal care is strongly opposed to the physical presence of husbands in the labour room during delivery due to the strong cultural and religious effects, especially for Muslims. It was however, noted that Christians were more inclined to spousal participation in antenatal and post-natal care (Umeora et al., 2011 as cited in Vehvilainen-Julkunen and Emelonye, 2014). There is therefore a need to further encourage male participation in labour, especially mitigating the effects of religion, culture and ethnicity, in order to improve prognosis for parturient women.

Implication of the findings to nursing

This study has pointed out the fact that majority of the pregnant women want their husbands to be involved in antenatal, intra-natal and post natal care. Likely barriers such as religion culture educational status were ruled out. However, lack of adequate infrastructure and conducive environments served as barriers to male involvement. It is therefore imperative for nurses and midwives to explore participation of males in the labour process, and use this as a means to reduce intra partum pain and lessen their work. They should also  serve  as  advocates in influencing hospital policies to integrate males into the process of labour and delivery.  

 

 

Male involvement in antenatal care, intra-natal and post natal care has been of utmost importance but little has been said or done about it in Nigeria. This study therefore identified women’s perception towards males’ involvement in labour and found barriers to male involvement to include poor infrastructures and inappropriate hospital policies.

 

Based on the findings of this study, the following recommendations have been put forward:

(i) The hospital should have a written policy as regards male involvement and make it known to the pregnant women and staff of the hospital.

(ii) The hospital management should build structures that favour male involvement in antenatal, intra-natal and postnatal care.

 

The authors have not declared any conflict of interests.