Perceptions of Paternal Involvement in Maternal Healthcare in Rural Pakistan

Sacha St-Onge Ahmad1, Sarojini Hirshleifer2, Mustafa Naseem3, Arman Rezaee4, Agha Ali Raza5 (1)University of Maryland College Park School of Public Health, (2)University of California, Riverside, (3)University of Michigan, (4)University of California, Davis, (5)Lahore University of Management Sciences

APHA 2022 Annual Meeting and Expo

Context: Paternal involvement (PI) in maternal healthcare (MH) has the potential to improve birth outcomes and is increasingly being advocated as a public health approach in low-income country contexts. The purpose of this study was to measure PI and demand for increased involvement among expectant couples in the rural district of Chiniot, Pakistan.

Methods: Data from a cross-sectional study with 199 husband-wife pairs were collected through telephonic surveys in 2021. Recruitment was restricted to couples who were pregnant, living together, and between ages 18-55 years. We characterize PI as: (1) participating in decision-making about wife’s healthcare, (2) seeking MH knowledge, (3) knowledge about current pregnancy, and (4) performance on an MH knowledge assessment. We define demand for increased PI by women’s perceptions of their husband’s (1) MH knowledge level, and (2) pregnancy conversation frequency with (a) each other and (b) healthcare providers (HCPs).

Results: Most men were involved in decisions about antenatal tetanus vaccination (81%) and general healthcare (85%). Over half ever sought MH knowledge (56%). Men were least knowledgeable about their wife’s tetanus vaccination status (65%) and complication history (78%) compared with gestational age (94%) and antenatal care history (99%). Men’s mean MH knowledge score was 7.40 (SD 2.28, possible range: 0-13). Among men who scored <75th percentile (<9 points) on the knowledge assessment (n=161), 49% of them and 65% of their wives felt their knowledge was ‘not enough’. The mean number of recent conversations couples had about the current pregnancy was 4.22 (SD 3.74); 69% of women who had <4.22 conversations felt it was ‘not enough’. Of the men who had not discussed the pregnancy with an HCP (n=121), 86% of them and 94% of their wives felt this was ‘not enough’. Older, more educated men were more likely to have ever sought MH information.

Conclusion: This paper utilizes novel data on couples’ perceptions of PI. Higher PI in decision-making relative to paternal knowledge and discrepancies between male and female perceptions are concerning. Demand for increased PI from both partners, however, suggests that if programs in Pakistan prioritize educating husbands in MH, they may be successful.