'Because it is a joyful thing to carry a baby': involving men in reproductive, maternal and newborn health in East New Britain, Papua New Guinea.

Abstract

Background: There are many benefits to involving expectant fathers in maternal and newborn health, including reducing vulnerability to HIV (human immunodeficiency virus) and sexually transmitted infections (STIs). Women are at risk of HIV infection and other STIs during pregnancy and breastfeeding and in Papua New Guinea (PNG) a number of complex factors interact to enhance this vulnerability. PNG health policies do support men's involvement in maternal and newborn health, but currently there is limited understanding of appropriate or effective ways by which this could be achieved.

Aims: The aims of this research were to gather information to inform strategies to enable the greater involvement of men in maternal and newborn health services and to explore the factors that contribute to STI and HIV vulnerability among pregnant women in East New Britain Province.

Methods: Between June 2011 and February 2012 we conducted a total of 14 focus group discussions with pregnant women, expectant fathers, older men and older women. Ten in-depth interviews were conducted with health workers and staff within the provincial administration.

Key findings: Expectant fathers were concerned for the health of their wife and baby both during and after pregnancy. They had many questions about pregnancy, childbirth and the care of their baby and were eager for information. Protecting their family is viewed as an important role for men and could be a useful way of engaging with them. Misconceptions about the safety of sex during pregnancy are one reason that couples are often sexually abstinent for long periods. This may contribute to the likelihood that either partner will seek sex outside marriage during pregnancy or postpartum, and increase a pregnant woman's risk of contracting STIs and HIV. We heard that it is common for men as well as women to have extramarital sex at this time. Currently, male involvement in maternal and child health care is uncommon and community attitudes are mixed. Some significant barriers to involving men relate to traditional customs and feelings of shame and embarrassment. Others can be attributed to health service factors, such as a lack of privacy and the attitudes of health care workers. Various community channels for reaching expectant fathers were suggested.