Abstract
Background: There is evidence that a woman who receives continuous labour support from a companion of her choice can have shorter labour duration, is likely to give birth without medical interventions, and report a satisfying childbirth experience. These outcomes result from the beneficial effects of emotional and practical support from the woman’s chosen companion, and care provided by health providers. When a woman’s chosen companion is her male partner, in addition to the above benefits, his presence can promote his bonding with the baby, and shared parenthood. However, in low-and-middle income countries (LMICs), little is known about the extent to which, and the factors affecting whether health facilities in Rwanda facilitate a woman’s choice to have her male partner attend childbirth.Methods: A series of systematic reviews and an exploratory study, informed by Aaron’s conceptual model of stages and factors affecting implementation of practice change, were undertaken. The primary research involved two phases. Phase One focused on designing two questionnaires, the Male Partners’ Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs), and the Male Partners’ Attendance at Childbirth-Questionnaire of Maternity Staff (MPAC-QMS). The content and face validity of the two questionnaires were assessed in a three-round modified Delphi study. In Phase Two, a pilot survey of health facilities and maternity staff in Rwanda was undertaken:
• to explore the acceptability and feasibility of using the MPAC-QHMUs and MPAC-QMS,
• to obtain preliminary data about facilities’ current practice of facilitating a woman’s male partner to attend childbirth when it is her choice, and contextual factors affecting this practice in Rwandan health facilities.
Results: The review work identified individual, sociocultural, and health system factors influencing whether or not male partners from LMICs are facilitated to attend childbirth when it is the woman’s choice.
The finalised MPAC-QHMUs and MPAC-QMS included items which garnered over 80% content relevance according to the experts’ rating. Of 18 facilities from Kigali, Rwanda invited to participate in the pilot study, 14, comprising seven public and seven private facilities, agreed to participate. Of 232 copies of the MPAC-QMS distributed to maternity staff at the 14 health facilities, 203 were returned, giving a response rate of 88%. The majority of facilities permitted the woman’s male partner to stay with her throughout childbirth. Lack of protocols and/or guidelines about birth companionship, and limited staff training were identified as major barriers to male partners’ attendance at childbirth. As for the facilitators, maternity staff were generally enthusiastic about encouraging male partners’ attendance at childbirth and reported positive views on the acceptability and feasibility of allowing male partners’ attendance at childbirth.
Conclusion: This thesis provides preliminary information about current practice and factors influencing the implementation of male partners’ attendance at childbirth if it is the women’s choice in Rwandan health facilities. A large-scale survey incorporating facilities across Rwanda is needed. This can contribute to national estimates about the current status of birth companionship policies, practices, and factors influencing facilities’ implementation of women’s choices of male partners as birth companions.
| Date of Award | 2021 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Alison McFadden (Supervisor), Heather Whitford (Supervisor) & Nicola Gray (Supervisor) |