Village and participant characteristics
Participants
Thirty-five men (Village A,
n = 10, Village B,
n = 11 and Village C,
n = 14) participated in the FGD. No participant withdrew from the FGD before it was completed. The participants differed in a number of ways as described in Table
2. The mean age of the participants was 29 years. Most men were married or cohabitating (91%), but 9% (
n = 3) were widowers.
Table 2Characteristics of participants in focus group discussions
Age | 18–50 years |
Marital status |
Married | 25 (71%) |
Widowed | 3 (9%) |
Co-habit | 7 (20%) |
Education |
Formal (at least primary school) | 31 (89%) |
Informal | 4 (11%) |
Themes
The themes are (a) love and responsibility (b) belonging, (c) resistance, (d) traditional roles, and (e) exclusion / inclusion.
Love and responsibility
This theme highlights the participants’ love for their wives and their newborn babies, while acknowledging the responsibilities they, the men, had both inside and outside of the home. Most men felt a need to communicate and to build a loving relationship with their baby. Their sharing of responsibility for the newborn also fostered love for their wife. One man described “I will make my baby happy and healthy.” (35 year old man, village B). Another man acknowledged that more family members, in addition to the husband and wife, bring love to the infant. He stated, “The baby will be more cheerful than if [he/she] was with extended family (i.e. not with the mother).” (a young man, village C).
Caring for the newborn, as expressed by a 39 year old man, enabled many of the needs of an infant to be met when both parents hold the responsibility. This man stated,” Baby with both parents is obviously cared for (attending to) material and moral need” (village A).
Some of the men either disagreed with, or had no experience of, sharing responsibility. One man was quoted as saying; “There is no importance of fathers if mothers are around” (45 year old man, village C). Another man, in the same village, spoke of his lack of closeness with his infant because “most of the time the baby is with the mother so there is no closeness to it” (a middle aged man, village C).
The love and responsibility these men felt towards their infants when their wives were breastfeeding was influenced by the time they spent with their infants and their involvement in infant care. It was unusual for most men to advise their partners on effective breastfeeding. Some men, for example, spent the whole day outside the home, only to return and make assumptions about the baby’s care. The mothers did not see infant care as a man’s responsibility and tension formed between the couple, particularly when breastfeeding was framed negatively to the mother and assumptions were made. For example, one woman was reported to have angrily shouted, “You! Breastfeed her (the baby) yourself, while she knows you are a man” (38 year old man, village A). Women were cited as saying that responsibility for infant care needs to come from the person who is in the home, not the person that is away during the day and working. A middle aged man in village A reported, “For real. Mothers understand, it needs someone from my home or her home to come and help her to work”. A man from another village felt that women would feel different about their responsibilities if their husbands started supporting them in the home. He said, “The women will get used to the support and start moving to clubs and village community banks for her own good” (a 35 year old man, village B).
Some wives in these villages accepted the support of their husbands. One young man in village C said, “The woman will be happy and you love each other.” Another commented, “To spend time with [baby] brings emotion to (love for) the child and relationship strength” (36 year old man, village B).
Many of the men, despite being aware of their responsibilities to their breastfeeding wives, did not feel that they had the time to provide such support. The time available to them to uphold these responsibilities was limited to early morning and following work. During the day, the men had work responsibilities. One middle age man stated, “It is true the responsibility is known to us, but we do not get enough time, at least in the early morning and when you are back home, you can be asked to carry the baby in brief sessions”.
Belonging
Most men agreed experiencing feelings of reward with their babies as they hugged and embraced them. Culturally, these men have a feeling of automatic ownership; the infant belongs to them. One man compared the sense of belonging as being similar to his harvest. He said, “I feel prestige to see my wife has a baby, like as well when I harvest the crops at large. I know other men also appreciate to be called fathers of someone” (a 39 year old man, village A). In addition, another equated that sense of belonging to the infant needing them; “A baby will cry needing you” (19 year old man, village C).
Some men, however, were embarrassed and dissatisfied with the situation and stated that they would move outside their home to another woman during this period of care. These men did not have a sense of belonging during this breastfeeding experience and were reluctant to discuss the matter as they saw the baby’s care as solely a woman’s responsibility. For example, a man in village B said, “I do not think I will have frequent interactions of any kind with an infant or need to remind the mother to breastfeed, since baby is always with the mother” (40 year old man).
Resistance
It was evident by the men’s conversations that they were ready and/or willing to attend to their wives’ health needs, but they did not feel they were supposed to take on this initiative. That is, they resisted this provision of support, either because of the predominant men’s culture or because the women would not permit them to do so. From the older men there was resistance to support and to discussing issues outside of the home. One man stated, “I do not see the reason of this discussion here; it needs to be with women alone” (50 year old man, village B).
It was evident from many of the conversions, demonstrated in the previous two themes, that resistance by men over 40 years to supporting breastfeeding is more prominent than in younger men.
Traditional roles
It was evident that men considered themselves as persons of wisdom and respect in rural Tanzania. Women were expected to be humble in order to gain support for breastfeeding. That is, there was a belief among men that traditionally, women respected men, talked less and did not instruct their partner. One man stated, “She needs to respect and appreciate my personality” (19 year old man, village C). Moreover, breastfeeding support will occur as long as traditional values are upheld.
Other men, however, saw a need to assist in roles that they considered were traditionally carried out by mothers or other relatives. Examples included “Your relatives shall come from home to assist with the chores” (men in village A) and “It depends on how you were raised. Some siblings are born with only males (in some households there were only boys), thus from the beginning of the childhood they must do domestic work. And then it may be easy to do it in adulthood” (32 year old man, village B). When adherence to perceived traditional roles cannot be met, as in the example above, these men were more accustomed to breaking with that tradition and supporting their breastfeeding wife.
Some men were worried when they were asked about their involvement in family care. It was their belief that home chores should be relegated to women. However, some men in our study occasionally cooked for their family, which had the potential to instigate conflict. A 34 year old man stated, “What will be the wife’s tasks, if I cook, and likely she will get used to it and disrespect me! I do not want to be detected” (34 year old man). If breastfeeding support came in the way of men carrying out chores, some of the men were worried that others would see that they were breaking with tradition. Some of the men even went as far as to say that “There is a lot of work, and when you are back home, the wives have harsh language which annoys us. Some are talkative and abusive which you cannot correct” (40 year old man, village A). Despite wanting to support their wives to breastfeed, perception of traditional roles was present in the FGDs. For instance, “A woman may say: are you cooking today? This is not good for the men and it should never happen in normal circumstances” (40 year old man, village B).
It was interesting to note that younger village men had minimal conflict when it came to involvement in pre or postnatal clinic attendance. For instance, one commented, “Some may be the transporter of their women to the hospital, riding a bicycle and or walk together” (18 year old man, village B). Adherence to traditional roles, was spoken of by most participants. The younger men, however, were more likely to not adhere to traditional roles.
Exclusion / inclusion
Fathers in all villages complained that they were excluded from receiving health information. Even though the younger men may have attended the clinics, the information was shared only with the women. For example, men were rarely invited to, or received, care information from the RCHCs when their partners visited during pregnancies or after delivery. Comments about the sharing of information included, “Despite escorting your woman, you may be ignored for health education or not given any instructions. And, by nature, our women understand less how to act or what to tell after” (31 year old man, village C). And, “Attendance (at) clinic helps to know what is not known, otherwise the health workers used to leave the men outside the room; even though men want to learn. This will especially happen if the woman is clerked briefly, the men will not gain anything” (34 year old man, village B).
Some men admitted to a lack of reproductive knowledge. This was seen primarily among young couples who wanted to differentiate between the old and the new generation, they wanted to be included. One man reported, “It is good to escort the family to clinic, so that you understand early the clinical features of illnesses, and you address the problem; it brings love and courage, men then understand the information and any advice can be smoothly followed” (40 year old man, village B).
Despite distinctions, it is clear that each theme is embedded and influenced by traditional beliefs about Tanzanian breastfeeding cultural practices.