Lesson for men: Parenting must start before sex

As we celebrate Mothers’ Day tomorrow, we cannot ignore the unfortunate fact that the maternal mortality rate in Uganda, according to the 2011 Uganda Demographic Health Survey (UDHS), is stagnant at 438 deaths per 100,000 live births. This translates to about 16 mothers dying every day. While the worrying statistics are linked to the poor performance of Uganda’s health system, men partly hold the key to reducing the numbers. VICKY WANDAWA finds out how active male involvement in maternal health can reduce the number of deaths.

IN TEARS, Agnes, 22, who is nine-months pregnant, makes her way down the muddy path to the Budondo LC3 chairman, Ivan Tibenkana’s makeshift office, to report her partner. Budondo is one of the remotest areas of Busoga. Agnes has no money, yet she is due and has to travel to Jinja Hospital for delivery.

Her husband ran away without paying rent and she has been kicked out of the small room they shared. Fortunately, a group of student researchers, out of pity, raise some money and give her sh100,000 to cater for her medical bills.

Agnes was lucky that she still had some energy to walk and seek help, before the onset of labour. But had the contractions come earlier, she could have lost her baby, or even her life due to complications and lack of care.

Currently, the maternal mortality rate in Uganda, according to the 2011 Uganda Demographic Health Survey (UDHS), is stagnant at 438 deaths per 100,000 live births, which translates to about 16 women dying every day. Prof. Pius Okong, a commissioner at the Ministry of Health, says for over 10 years, there have been studies going on that have shown the negative impact on women’s health when men merely participate rather than get involved in maternal health.

The studies show that men’s involvement would reduce maternal deaths by at least 1/3. He says with participation, a man may just ride a bicycle to take his pregnant partner to whichever facility she wants to go, but with involvement, there is a change in the man’s attitude towards his role in his partner’s maternal health.

He is more knowledgeable about her condition, suggests ideas such as the type of contraception to use, where to give birth from and ensuring she attends antenatal care the required number of times, as well as reduces her work burden. Dr. Olive Sentumbwe, the family health and population advisor at the World Health Organisation, says while issues like high maternal mortality rate have been linked to the poor performance of Uganda’s health system, there are other factors at play.

“Many Ugandan women receive little or no support from their husbands during pregnancy, labour, delivery and the postpartum period, leaving them mentally and physically drained. They are expected to quickly swing back into action to look after the family as they struggle to heal during the postpartum period,” says Sentumbwe.

What an ideal partner should do
Okong notes that male participation in maternal health starts with the couple agreeing on when to have a baby.

As a couple, they should seek for more information about their health before deciding to have a baby. When they suspect she is pregnant, they should confirm the pregnancy together by either going to a medical facility or, for the urban dwellers, by buying a pregnancy test kit. Prof. Samuel Luboga of Mulago Hospital says: “Male participation should start at zero time.

The couple should not be ambushed by a pregnancy, but sit down together and discuss when they should have one.” It is not uncommon for a man to blame his partner for becoming pregnant, yet contraception is the responsibility of both partners. In the rural areas, since the man may not agree with or care.

 Are traditional roles to blame?
Prof. Pius Okong, a commissioner at the Ministry Of Health, explains that in most tribes in Uganda, there are stereotypes regarding what men should do or not and maternal health is one of those issues, where least involvement is expected from men.

“It is the norm that they just need to know general things and leave the nitty-gritties to their partners and her relatives,” says Okong. In rural areas, when a woman becomes pregnant, her partner assumes that her mother-inlaw or other female relatives would plan for her delivery and should complications occur, the man is helpless

For some families in urban areas, a woman is sent back to her parents’ home after delivery, to return at least three months later, when she is stronger. Okong, however, says the trend is slightly changing in urban areas; a man is forced to participate in his partner’s maternal health since there is no mother-in-law and other relatives to help out.

Thumbs up to men who stand by their wives
There are families where men are willing to assist their spouses with household chores, nurturing children, generating income and in accessing health care.

One of them is Edwin Musiime, the director of Kingdom Network. He says men can only actively participate in maternal health after they are helped to understand the concept of family. “It requires sacrifice. Men should understand that even when it means missing out on hanging out with friends over bottles of beer, their pregnant wife should be priority. I was an employee then but my priority was my wife.”

The father of one admits that he may not have been there for his pregnant wife all the time, considering that he was in and out of the country, but did his best whenever he was around, including helping with chores and attending antenatal clinics with her. “It was not rosy all the way, especially when the cravings set in.

It did get a bit difficult catering to her cravings but because I understand the concept of family, I had to take it all,” he says. Prof. Samuel Luboga, of Mulago Hospital believes adults can change for the better when taught to do so.

He says one evening as he and his wife drove home, he stopped to buy milk. Through the car window, his wife, who was seated in the passenger seat, received the milk and dropped it. He immediately, castigated her, “How could you do that, the packet could have burst!” She politely turned to him and said, “I can’t bend.” Luboga says he felt so ashamed of himself.

For the first time, he realized how heavily pregnant his wife was and for the rest of her pregnancies, he made sure she did less chores. About family planning, there is poor child spacing. The woman ends up giving birth to many children, which endangers her health. 

When it comes to nurturing during pregnancy, Luboga adds, women do most of the work. So men should take on some physical roles to help the woman during pregnancy.

Traditionally, a woman continues all her physical responsibilities as if she is not pregnant, but men must realise there are things their women should not do during pregnancy.The workload should be reduced considerably with the support of her husband,” says Luboga.

Okong advises that the couple should discuss how the pregnancy affects the woman’s work and how the man can help with the heavier chores such as gathering firewood.

Regarding antenatal care, the two should discuss how she will access the care and when to accompany her. Many women develop complications because they do not attend antenatal care. They are burdened with arranging for and attending antenatal care alone.

The man should attend antenatal visits because he most likely has questions to ask. “Questions such as whether it is okay to continue with sexual intercourse should be handled by the health worker when both partners are present.

It should not be a case of the woman telling the man that the midwife said it was okay, because he might have heard myths from his contemporaries,” says Okong.

As the pregnancy progresses, they should have a checklist, to ensure everything is going as planned, such as when to go for antenatal visits.

Luboga says while a pregnant woman should attend a minimum of four antenatal visits, many women, especially in rural areas, only attend the first antenatal visit, while for others, the number of visits declines with time. An even smaller number, 40%, deliver in hospital.

Also, a pregnant woman may be required to take three doses of preventative medication for malaria, but may not because they have no support to access it. “She may be told that she is anaemic, but a man assumes she knows how to take care of herself and so he does not bother to find out more about the condition.

Before long, she develops complications,” he says. He should be able to discuss with her how she can get them. Partners should discuss how the pregnant woman will get to the health facility or else, when caught unawares by complications, she is likely to succumb because there was no birth preparedness.

For example, if a woman fails to get to hospital and gives birth at home or on the way, she could succumb to bleeding, also known as post-partum haemorrhage (PPH), which, in East Africa, accounts for 36% of maternal deaths.

PPH can also occur when the mothers continue doing a lot of work after delivery, yet they are weak. Soon after delivery, the two should decide which method to use for contraception to avoid unwanted pregnancies.

                                                                Musiime with his wife and child

HOW THE SITUATION CAN BE CHANGED
Through peer groups and champions, the attitudes of society can be changed over time. According to Prof. Pius Okong, a commissioner at the Ministry of Health, this can start by changing the way children are brought up by skilling boys to take on some of the physical burdens women carry.

If a baby cries and a 10-year-old girl and her 14-year-old brother are at home, the girl is more likely to carry the baby, yet if such a boy started doing chores and helping out with the baby early in life, he would not have a problem taking great interest in his wife’s maternal health.

Prof. Samuel Luboga, of Mulago Hospital, says there are men who would punish their boys for helping out with chores often done by women. Furthermore, Okong notes that the youthful potential partners can be reached through social media.
Also, antenatal care should be an entry point, where men are asked to take keen interest in their partners’ health.

Dr. Olive Sentumbwe, the family health and population advisor at the World Health Organisation, says strengthening male involvement in reproductive health will result in better family planning.

The number of deliveries with skilled attendants will increase and the rate of maternal and newborn deaths will decline. Changing male attitudes and involvement will take time. But it is possible and worth working for.

Efforts by health ministry
According to Okong, there is no policy on male participation in maternal health, but there are bits and pieces of it in the different parts in the health ministry. “There are posters in health facilities depicting what a man should do, for example, HIV testing as a couple and family planning. However, involvement in child birth is less prominent.

” Asuman Lukwago, the health ministry permanent secretary, says there are village health teams in rural areas, which move around sensitising masses on the importance of male participation in maternal health. There are many challenges on all fronts, but overall for the majority, there are still constraints significantly by social cultural values.