The impact of partner’s behaviour on pregnancy related outcomes and safe child-birth in Pakistan

Pregnancy is one of the most exciting and happy moments in the couple’s lives; however, it might also be challenging. As she becomes used to their growing baby, the pregnant partner may undergo significant emotional and physical changes. Although most women perceive pregnancy as a happy, beautiful experience, doubts and worries frequently arise. They feel exposed during pregnancy, and as a result, they grow more dependent on their relationship, and the help of friends and family becomes more critical [1, 2]. Maryam et al. [3] showed that the spouse’s support affects the emotional and physical health of a woman during pregnancy.

By responding to problems, requesting medical attention, covering travel expenses, and managing household resources, men can reduce several risk factors of maternal mortality [4, 5]. In addition, research has shown that men’s involvement in pregnancy outcomes significantly helps lowering teenage pregnancy, maternal and infant mortality, risky abortions, and fertility rates. Although, the care a mother receives before, during, and immediately after childbirth is crucial to the health and life of the mother and infant. However, in many countries, husbands’ contributions to women’s health and delivery are frequently neglected. Men, for instance, have minimal experience with or awareness of maternal health in South Asian context [6, 7].

The ignorance on the part of the male partner can influence several factors. These factors include delays in the decision of availing health care facilities, attaining antenatal care, and availing health care facilities before, during, and after pregnancy. These are the major contributing factor to raised maternal mortality and child death ratio [8]. However, awareness regarding men’s contributions to preserving pregnancy outcomes has grown recently [9, 10].

Naushin [11] argues that socioeconomic and demographic factors substantially affect the decision-making on reproductive behaviour. For example, women’s empowerment may help explain why women want fewer children and use contraception more regularly. In addition, the rising involvement of Pakistani women in family decision-making affects fertility outcomes, which are key policy objectives.

Pakistan has achieved a decline in maternal and neonatal mortality rate since 1990, yet there has been a small gain in these outcomes comparatively to other countries [12]. Stillbirth and pregnancy lost have rarely been addressed and remains under-reported in Pakistan [13]. Causes for these poor outcomes potentially include women of reproductive age being poorly educated, anaemic, and delivering a high percentage of preterm and low-birth weight babies [14]. In Pakistan, males are crucial in the decision-making process for family matters, particularly when it comes to reproduction [15]. Therefor, it is important to explore the role of husband in providing Antenatal care and ensure safe childbirth. Several studies have been conducted to discuss this issue, but all of these studies consider socio-demographic factors. To our knowledge, so far, no study has examined the role of a husband in antenatal care before, during, and after his wife’s pregnancy. Therefore, this study aimed to assess male involvement in providing antenatal care to their wife in Pakistan. The objective of this research is to examine the role of the husband’s attitude on the physical health of pregnant women. This will help understand males’ awareness and serve as a guide for primary care physicians and reproductive health targeted programs.

Maryam et al. [3] discovered that emotional and financial support from partners can significantly reduce stress levels in expectant mothers. They also observed that when partners actively participated in prenatal meetings, it led to a decrease in the stress levels experienced by expectant mothers. women who perceive their spouse as supportive during pregnancy tend to experience a greater sense of adequacy and higher relationship satisfaction in the postpartum period. While, Powell and Karraker [16] emphasized that women feel more adequate postpartum period and higher relationship satisfaction when they sense a supportive spouse during pregnancy. Contrary, lacking support of the spouse during pregnancy has a negative association with the emotional well-being of wives, resulting in an increased risk of negative pregnancy outcomes and postpartum period [17]. Similarly, Bhuiya and Chowdhury [18] highlighted the lower chances of survival for children of divorced mothers compared to non-divorced mothers. Suresh and Balram [19] stressed the significance of educating and empowering males regarding pregnancy complications to improve maternal and neonatal health outcomes. spouses who have knowledge about complications during pregnancy and childbirth are more likely to actively support their wives in seeking antenatal care, opting for institutional deliveries, and receiving postnatal assistance. Their understanding of these complications plays a crucial role in promoting birth preparedness [20]. Furthermore, Spousal accompaniment during women’s health assistance is associated with increased utilization of skilled maternal health services, as reported by Rahman et al. [21] and Adeniran et al. [22]. It is recommended to implement special initiatives that encourage partners to accompany their wives and raise awareness about maternal health issues. Additionally, Yargawa and Leonardi-Bee [23] found that male involvement in pregnancy-related outcomes leads to a lower risk of postpartum depression and improved utilization of maternal health services. Women with supportive partners are more likely to receive skilled birth attendance and proper postnatal care. Mannion et al. [24] emphasized the significance of partner support in enhancing breastfeeding confidence and sustainability. Partner support, including vocal motivation and active participation in breastfeeding practices, plays a crucial role in empowering mothers in their breastfeeding journey. Furthermore, Mohammed et al. [25] emphasized the need for interventions that focus on enhancing partner support to improve pregnancy-related outcomes, such as reducing prenatal stress, depression, and smoking among pregnant women. Interventions targeting partner support can have a positive impact on pregnancy outcomes and contribute to better overall maternal and infant health. Overall, the literature suggests that partner support plays a crucial role in promoting maternal well-being and positive pregnancy outcomes, highlighting the need for interventions to enhance partner involvement and support during pregnancy.

Pakistan’s position among the countries with poor pregnancy-related outcomes is a concerning issue, and it lags significantly behind many other nations. The exact reasons for these alarming maternal health situations in Pakistan have not been fully elucidated. However, this study aimed to investigate and shed light on the factors that may contribute to these disparities. The study utilized a representative sample of women collected from the PMMS conducted by the NIPS under the Ministry of National Health Services, Regulations, and Coordination. The PMMS survey was conducted between January \(20^{th}\) and September \(30^{th}\), 2019. The PMMS used a multistage and multi-phase cluster sampling methodology based on the sampling frames derived from the \(6^{th}\) Population and Housing Census. The complete data is available for a total of 15,143 women participants over 18 years of age. Among them 2.9% have missing data on marital status, 52.5% on problems during pregnancy, 57.6% on problems during delivery and labor, 52.5% on problems during postpartum period, and 2.6% on miscarriage. To overcome such a large number of missing cases on certain attributes the case wise deletion method was used in the analysis.

In Pakistan, men take up the role of the women’s guardians by taking care of and meeting their financial needs. Males are expected to provide for the material needs of the family, while women are in charge of the children’s upbringing, education, grooming, and other requirements. In most nations, families base their health decisions on a variety of socioeconomic and cultural factors [54, 55]. Therefore, in Pakistan, the husbands decide everything pertaining to health. Most pregnant women did not obtain adequate treatment due to the male population’s lack of knowledge regarding the value of ANC in maternal health. Nevertheless, the use of ANC services in Pakistan needs to be better understood [56]. The study supports the theory that a husband’s level of engagement in a woman’s pregnancy, labor, and postpartum might influence her overall health, improve her conduct as a mother, and lessen her postpartum depression symptoms. It was discovered that pregnant women living alone experience several health issues, including bleeding, excessive vomiting, chest discomfort, coughing, high blood pressure, excessive weight gain, body pains, and swelling of the feet and face. Both inadequate prenatal care and lack of medical assistance during labour and delivery affect these women. They, therefore, also experienced medical issues during their postpartum period. Lack of prenatal care causes women who live away from their spouses to miscarry. These findings are crucial as no such study has been carried out in Pakitan that addresses the impact of the husband’s role during pregnancy on their spouse’s health. This can help policymakers to devise different education campaigns that encourage men to support their spouses throughout pregnancy and offer appropriate prenatal care.

This study is based on the dataset collected in the Maternal Mortality Survey 2019, which has certain limitations. These limitations are briefly discussed here.