A comprehensive interventional program for promoting father’s participation in the perinatal care: protocol for a mixed methods study

Throughout life, special stages which would leave a profound impact on individual’s life exist [1]. One of these stages is pregnancy and delivery, which is the greatest event in a woman’s life and her family. According to the 7th clinical guideline of the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics in 2012, perinatal care include a full range of preconception counseling, preparing prenatal and delivery care, neonatal care and postpartum care [2] and the main goal of these care is to prevent any complications for the mother and the infant [3]. Men’s participation is an important strategy for reaching the third Millennium Development Goals (MDGs) such as women’s empowerment and improvement of mothers’ health [4]. Many studies have mentioned the positive outcomes of men’s participation during pregnancy and delivery [5‐8]. In this regard, in the International Conference on Population and Development (ICPD) in 1994, the shared responsibility of men and improvement of their active participation in parental responsibilities, sexual behaviors and reproductive responsibility in family planning, pregnancy health, maternal-neonatal health, preventing unwanted and risky pregnancies, health and nutrition of the children and preventing violence against women and children, were emphasized [9]. But despite this emphasis and international agreement on the importance of men’s participation for the improvement of maternal and neonatal health, advancements in this regard are slow and there are challenges in preparing the environments for the presence and participation of men in the care of mothers [10], in a way that the United Nations Population Fund in 2009 stated that:“ Despite the significant evidence about the benefits of men’s participation thus far, and although men have responded well to the efforts of their participation during delivery., their participation during pregnancy, delivery and childcare has not been effectively promoted globally” [9].

No specific formula exists for men’s participation in the healthcare system and the most accepted strategies are those that are culturally acceptable, appropriate and applicable. To find these strategies, research and need-assessment should be conducted [11]. In this regard, during the recent years in industrial Western countries, fathers’ participation and presence during pregnancy and delivery has been increased [12]; but in most parts of the world, men’s participation is the missing link in countries’ and governments’ policies, information and plans and it is usually neglected and most of the global health systems have no specific plan for attracting men’s participation in reproductive health programs [13]. In Iran, like many other countries, the governmental departments have considered the usual care for women, but no comprehensive plan exists for men. Only during recent years, for encouraging women to have vaginal delivery, delivery preparation classes are being conducted for pregnant women in 8 sessions and the husband can participate in one session. But practically, this matter is just being executed at a limited number of health centers and there are problems for executing this program. Also, in some hospitals, fathers who have participated in the delivery preparation classes are allowed to be with their wives during labor and delivery but this is also very limited. Furthermore, the paternity leave for fathers, which is a two-week leave, would only be given to men with working wives; but this could not be generalized for all of the male employees or even to those whose wives have a part-time job with no insurance policy [14]. However, this plan is still not being implemented by all the organizations and offices. So far, most of the conducted studies about men’s participation, internationally and nationally, were about family planning, sexually transmitted diseases (STD) and AIDS; while other aspects of women’s health like pregnancy and delivery were not considered much; even though the need for information in these fields is necessary [12].

Therefore, regarding the informational challenge about father’s role in mothers’ health and also due to the lack of a comprehensive program for father’s participation based on Iranian culture, this study will be carried out to provide a comprehensive and culturally sensitive program for father’s participation during the perinatal period.

This study is a sequential exploratory (qualitative – quantitative) mixed methods design that consists of three consecutive phases. In this study, following a qualitative approach, the researchers will explain the concept, obstacles, facilitators and strategies related to promoting father’s participation in perinatal care. In the second phase, the researcher will design an appropriate interventional program for promoting father’s participation in perinatal care by using the results of the qualitative phase and literature reviews (Fig. 1). The purposed intervention is designed by a panel of experts based on prioritization guidelines and will be finalized for execution. In the third stage, the effectiveness of interventional program on the awareness, attitude and practice of fathers on their participation in perinatal care will be investigated in a semi-experimental study.

Considering that fathers’ participation in perinatal care is an important key factor in the improvement of mother’s and infant’s health, therefore, the need for fundamental interventions in this field is essential. In this mixed methods study, sequential exploratory approach will be used for providing an interventional program sensitive to the culture and conditions of the Iranian society for men’s participation in perinatal care. Sequential exploratory approach is a known method for researching, especially when little information is available about the study subject. It is an appropriate method for achieving participants’ experiences. When one method is not sufficient for revealing the study subject, it is better to use a combination of two methods [18]. Using a mixed methods study will help the researcher gain a more comprehensive understanding of the phenomenon and relate its different aspects with each other [19, 20]. Since the present research question has a new multidimensional nature and the researcher is not able to predict the factors that will affect the subject, therefore, it seems that the use of a mixed methods study and the application of both the qualitative and quantitative methods will be an appropriate way to reach the goals of the study. Men’s participation in all of the stages of the mother’s and infant’s life has significant effects on their physical and psychological health; and international conducted studies have mentioned the great potential of fathers for participation during pregnancy, delivery and postpartum periods on decreasing mothers’ mortality and morbidity rates [21]. According to the report of the World Health Organization, 99% of these deaths could be prevented [22] and also, addressing the obstacles for using perinatal care and providing a supportive environment in the society and the family for women’s access to these care have been mentioned as the main strategies for decreasing mothers’ mortality rate [23]. Therefore, it seems that the results of the present study will help policymakers, managers of health deputies, healthcare providers and families especially husbands to perform their essential roles in improving fathers’ participation in perinatal care by using the presented interventional program, and consequently have a positive effect on mothers’ and infants’ health and decrease their rate of mortality and morbidity.