The findings of the study have been presented in three broad themes, namely traditional gender roles at home, fear of HIV testing, and unfavourable infrastructure in health facilities.
Traditional gender roles at home
There were mixed perceptions among women and community leaders regarding men accompanying their partners to ANC clinics. Female respondents preferred to be accompanied by their partners during the first ANC visit to receive HIV testing. Similarly, male respondents reported that they attended the first ANC visits in order to test for HIV. They also attended ANC to ensure that their partners are received at the ANC clinic by the health providers. One respondent had this sentiment:
It is important for the couple to undergo medical check-up so that we can get treated in time if we happen to have medical problems to avoid infecting the child (Pregnant woman).
Another responded said:
“It is important to accompany a wife as she attends clinics because there at the clinics, there are instructions that we are given by nurses which the father also needs to know. It is also important for both of you to get tested to avoid infecting the baby if we are infected” (A male partner).
However, while a few female respondents preferred to be accompanied by their male partners during routine ANC visits, some women and community leaders did not see the importance of men attending routine ANC visits.
“I am happy to go to the clinic alone. I only need my husband to attend the first antenatal visit for HIV testing” (A pregnant woman).
Some female respondents did not see any problem to attend routine ANC visits without their partners. One respondent exemplified this way:
“For routine visits, I continued coming alone as I did not see any justification for my husband to come. I thought it better for him to continue with other duties. I just ask him to hire a motorcycle for me” (A Woman with a child under 12 months).
Another respondent added this way:
“For routine clinics, I come alone. I have never asked my husband to accompany me to the clinics on routine visits” (A pregnant woman).
There was consensus among all types of respondents that men were the main breadwinners of the households. Men were supposed to support their partners financially and they were in charge of preparing for delivery. In particular, men had the responsibilities of preparing essential items required for delivery like gloves, clothes (khangas or vitenge), makintosh, a basin or a bucket, razor blades and money in case of emergencies.
All categories of respondents reported that the gender roles in the community were strengthened by the tradition of
jando and
unyago which was still practiced in the study area. According to the tradition, at the age of puberty boys and girls are taken separately to the bush or any appropriate place and trained on their responsibilities as mothers and fathers. This tradition puts clear a division of responsibilities between boys and girls. Among other things, boys are told not to get involved in women’s activities and the vice versa. According to this tradition, issues related to ANC, pregnancy care and childbirth were defined as women affairs. Attending clinics for example, was categorized as solely women’s role. A man who was seen to attend clinics with his wife was perceived to be under the control of a woman, which was seen as shameful for men. One respondent narrated this way:
“One day my friend went to the clinic with her wife. After coming back as we were chatting, I asked him where he had come from. He said he had taken his wife to the clinic. Other friends intervened” “You are hopeless, what has the woman done to you?...” (A male partner with a pregnant woman).
As for participation of men during delivery, generally, men did not prefer to be in the delivery room with their partners. Men preferred their spouse to be accompanied by their mother in-law, sisters, and other female relatives. One respondent clarified this position:
“Some of the women use abusive language because of the pain they get during the time of labour. It is not good for men to be in the labour room” (A male respondent).
Another respondent added:
“Sometimes the complaints of a woman due to labour pains are full of shameful statements for the man to hear” (A male respondent).
A similar view was shared by the female respondents, community leaders, and health providers.
“It is not important for the father to accompany the mother on the delivery day because that is the duty of the women. Even if he goes there, he remains outside” (A female respondent).
When asked to mention people who would like to accompany them during delivery, female respondents mentioned female relatives such as mothers, aunts, grandmothers, sisters, and sisters-in-law. Most often, men featured last in the list and their roles were mainly to pay for medical bills and be responsible in case of emergencies and referrals.
There was systematic distribution of responsibilities between male and female relatives in handling a woman during labour and delivery. Women relatives, such as mothers, grandmothers, sisters, sisters-in-law and traditional birth attendants (TBAs) were responsible for accompanying a pregnant woman to the health facility for delivery. TBAs were found to be important in case a woman gave birth before reaching the health facility. Other relatives such as mothers, grandmothers, sisters, and sisters-in-law were found to be important in taking care of a pregnant woman and newly born child while at the health facility. Female relatives were responsible for preparing food and washing clothes.
Men’s responsibilities included the preparation of means of transport to and from the health facility, purchasing essential delivery items and preparing money for meeting the living expenses and other requirements at the health facility as might be recommended by the health workers.
Unfavourable environment in health facilities
Respondents reported that the infrastructure in most of the health facilities was not appropriate for men. According to our respondents, in almost all health facilities, several women could be in a labour room at the same time, with no privacy and thus it was not suitable for a man to be in the room and watch someone’s wife to deliver. Therefore, due to lack of space in the delivery rooms, men were not allowed.
“As far as our hospital environment is concerned, men are not allowed in the delivery room. Normally, men stay outside” (Male partner).
Another respondent added:
“A husband is not allowed to get in. It is only female relatives that are allowed to get in. We do not allow men because the labour room is only one where you can find more than one woman. So we cannot allow men for privacy” (Health worker).
However, when male respondents were asked whether they would be present during delivery if there was a change in infrastructure to improve privacy, there were mixed responses. While a few male respondents agreed to be with their partners in the delivery room, others pointed out that their culture does not support men watching pregnant women during delivery. They pointed out that in most cases, during delivery pregnant women use shameful statements which are not morally good for men to hear.