Male Involvement and Facility Delivery

Although ANC attendance by pregnant women was high in 2007 (96%), less than 50% of deliveries in Zambia occur in health facilities and are attended to by qualified staff in health institutions. The high rate of dropout between ANC attendance and health facility delivery has significant effects on both maternal and infant outcomes. As part of integrated reproductive health services in ANC, prevention of mother-to-child transmission (PMTCT) services have been scaled up from 19% of all health centers in 2005 to 81% by 2012, resulting in an increase in HIV testing among pregnant women from 14% in 2005 to 94% in 2010. The high HIV prevalence rates in Zambia (14.3%) have a direct impact on mother-to-child transmission of HIV (MTCT). Therefore, the provision of HIV counselling and testing (HCT) to all pregnant women and their partners during ANC is an important entry point to interventions for preventing MTCT. Good obstetric practices during labour and delivery by skilled birth attendants as well as immediate postnatal care are part of the continuum of services for both mothers and exposed infants born to HIV-positive women. Interventions that will support pregnant women in attending ANC services and delivering in health facilities need to be encouraged. One such proposed intervention is for pregnant women to attend ANC services with their partner. Some studies have shown that male involvement through participation in couples counselling and testing during ANC is effective in lowering attrition along the ANC and PMTCT programs cascade. This study aimed to determine the association between male involvement in ANC and health-facility-level delivery by skilled attendants and women's attendance of postnatal visits at health facilities. We also determined the association between male involvement in PMTCT activities among HIV-positive pregnant women and health-facility-level delivery by skilled attendants and attendance of postnatal visits at health facilities. Adherence to the interventions administered at each of these stages of care in ANC for the HIV-positive woman and her exposed infant will reduce MTCT. A retrospective cohort study was conducted using health information management aggregation registers from the ANC department in public health facilities in Zambia. The study used these national registers to extract data that were standard across all 10 study sites. A data extraction form was designed to collect study participants' variables from safe motherhood, integrated counselling and testing, labour ward, and delivery registers. The study included all pregnant women who attended ANC services irrespective of HIV status between March and December 2012 in 10 health facilities in three provinces of Zambia. The study found that more women who had been accompanied by their male partner during ANC delivered at a health facility than those who had not been accompanied (88/220=40% vs. 543/1787=30.4%, respectively; OR 1.53, 95% CI: 1.15-2.04). Also, a greater proportion of the women who returned for postnatal visits had been accompanied by their partner at ANC visits, compared to those women who came to ANC without their partner (106/220=48.2% vs. 661/1787=37.0%, respectively; OR 1.58, 95% CI: 1.20-2.10). Male involvement seems to be a key factor in women's health-seeking behaviors and could have a positive impact on maternal and infant morbidity and mortality.