Elsevier

Midwifery

Volume 31, Issue 12, December 2015, Pages 1149-1156
Midwifery

‘They would never receive you without a husband’: Paradoxical barriers to antenatal care scale-up in Rwanda

https://doi.org/10.1016/j.midw.2015.09.010Get rights and content
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open access

Highlights

  • Experiences of antenatal care and perspectives of partner involvement in Rwanda are identified.

  • The required partner involvement exposes single women.

  • Men wish to join to ensure quality of care but are denied access.

  • Partner involvement should be embraced but upon the consent of the expectant mother.

Abstract

Objective

to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy (‘near-miss’).

Design

a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda.

Findings

all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women’s disincentive to complete all four recommended visits and men’s interest in attending to ensure their partners’ reception of care. However, the participants experienced a restriction of men’s access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy.

Conclusions

‘near-miss’ women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications

Implications for practice

these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women’s and men’s real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

Keywords

Policy
HIV-testing
Partner testing
Male involvement
Health inequity
Care-seeking

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