TABLE OF CONTENTS
DECLARATION……………………………………………………………………………………………….. ii
DEDICATION…………………………………………………………………………………………………… iii
ACKNOWLEDGMENT……………………………………………………………………………………. iv
TABLE OF CONTENTS……………………………………………………………………………………. v
LIST OF TABLES…………………………………………………………………………………………….. ix
LIST OF FIGURES……………………………………………………………………………………………. x
ABBREVIATIONS AND ACRONYMS…………………………………………………………….. xi
DEFINITION OF TERMS………………………………………………………………………………… xii
ABSTRACT…………………………………………………………………………………………………….. xiii
CHAPTER ONE: INTRODUCTION………………………………………………………………….. 1
CHAPTER TWO: LITERATURE REVIEW……………………………………………………… 9
CHAPTER THREE: MATERIALS AND METHODS……………………………………… 15
CHAPTER FOUR: RESULTS………………………………………………………………………….. 21
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS
…………………………………………………………………………………………………………………………. 31
REFERENCES………………………………………………………………………………………………… 36
APPENDICES………………………………………………………………………………………………….. 41
APPENDIX I: INFORMED CONSENT…………………………………………………………… 41
APPENDIX I:QUESTIONNAIRE……………………………………………………………………. 44
APPENDIX III: LETTERS OF APPROVAL……………………………………………………. 49
APPENDIX IV: ETHICAL REVIEW CLEARANCE……………………………………….. 50
LIST OF TABLES
Table 1.1 Spousal participation in labour and delivery in NCRH…………………………………. 4
Table 3.1 Target population………………………………………………………………………………….. 16
Table 4.1 Reliability Results…………………………………………………………………………………. 21
Table 4.2 Socio-demographic characteristics of respondents…………………………………….. 22
Table 4.3 Partner Participation………………………………………………………………………………. 23
Table 4.4 Knowledge of danger signs of pregnancy………………………………………………… 24
Table 4.5 Reason for choosing hospital delivery……………………………………………………… 25
Table 4.6 Awareness of Benefits of partner participation in labour and delivery…………. 26
Table 4.7 Socio-cultural factors associated with partner participation in labour and delivery 27
Table 4.8 Health system factors…………………………………………………………………………….. 27
Table 4.9 Reasons for low partner participation in labour and delivery………………………. 28
Table 4.10 Measures to enhance partner participation in labour and delivery………………. 28
Table 4.11 Chi-square test results for knowledge and spousal participation………………… 29
Table 4.12 Chi-square test results for socio-cultural factors………………………………………. 30
Table 4.13 Chi-square test results for health system factors………………………………………. 30
LIST OF FIGURES
Figure 1.1 Conceptual framework model showing the relationship between selected variables and partner participation in labor and delivery………………………………………………………………… 8
Figure 4.1 Knowledge of partner participation in labor and delivery………………………….. 23
Figure 4.2 Source of information on partner participation program……………………………. 24
ABBREVIATIONS AND ACRONYMS
GoK Government OF Kenya
MCH Maternal and Child Health
NGO Non-Governmental Organization
SPSS Statistical Package for Social Sciences
DEFINITION OF TERMS
Health system refers to the people, institutions and resources, arranged together in accordance with established policies, to ensure maternal and child health.
Knowledge refers to knowledge on pregnancy and childbirth issues as well as the benefits of the partner participation in the same
Socio-cultural factors refer to the set of beliefs, customs, practices and behavior that surrounds pregnancy and childbirth
Spousal participation refers to involvement of the man in childbirth labour and delivery process.
Spouse refers to the biological fathers of children being delivered at Nyeri County Referral Hospital.
ABSTRACT
There are enormous benefits accruing from spousal support during childbirth including emotional comfort, improved family communication, bonding, pain relief without analgesia and positive birth experience. Unfortunately, in low income countries like Kenya which are known to be patriarchal male dominated societies where pregnancy and child birth is regarded as exclusively women’s affairs, partner participation in labor and delivery remains acutely low. The purpose of this study was to establish determinants of partner participation in labour and delivery at Nyeri County Referral Hospital. The objectives of the study were to find out the influence of knowledge of partner participation program, to assess the influence of socio-cultural factors on partner participation in labour and delivery and to determine the influence of health system factors on partner participation in labour and delivery at Nyeri County Referral Hospital. The study used the analytical cross-sectional design. The study was conducted in Nyeri county Referral hospital. The study targeted male partners of post-natal women in the postnatal ward at Nyeri county Referral hospital. A total of 189 men were purposefully sampled and a researcher administered questionnaire was used to collect data. Descriptive methods such as frequency distribution, percentages, mean and standard deviation were used to summarize the data. Chi-square tests were used to asses relationships between the independent variables (knowledge, socio-cultural factors and health system factors) and the dependent variable (partner participation in labor and delivery). Statistical package for social sciences (SPSS) was used for data analysis. Significance was judged at p<.05 level. The findings were presented using tables and figures. There was a significant relationship (χ2=55.056, df=16, p=0.000) between ever hearing about partner participation program and partner participation in labour and delivery. There was a significant relationship (χ2=41.150, df=16, p=0.001) between knowledge of danger signs of pregnancy and partner participation in labour and delivery. There was also a significant relationship (χ2=41.769, df=16, p=0.000) between Awareness of Benefits of partner participation in labour and delivery and partner participation in labour and delivery. Among the socio-cultural factors gender norms (χ2=31.726, df=16, p=0.011) and societal expectations (χ2=60.167, df=16, p=0.000) were significant. Provision of information (χ2=60.194, df=16, p=0.000) and staff capacity (χ2=19.084, df=16, p=0.000) were significant among the health system factors. The study concluded that a concert of knowledge, socio-cultural and health system factors influence partner participation in labour and delivery. The study recommended health education efforts be stepped up to enhance the awareness of men on the partner participation program and benefits of spousal participation. It was also recommended that health workers especially midwives should also be trained to enhance their communication skills and now how of how to handle and address men in the delivery room so that they feel welcome.
CHAPTER ONE: INTRODUCTION
Background to the study
During pregnancy and childbirth the father/partner can play a vital role lending support and encouragement to the mother. Longworth and Kingdon (2010) indicate that that fathers׳ level of involvement during labour ranges from being a witness or passive observer of labour and birth to having an active supporting and coaching role. Melo et al. (2015) add that the father’s involvement goes beyond material supply, and can be understood by their participation in activities directed at the pregnant women’s, preparations for the arrival of the child, the emotional support to women and their interaction with the child. In developed countries such as UK and Denmark, partner participation is common practice during labor and delivery with about 95% attendance (Vehviläinen-Julkunen & Emelonye, 2015). Contrarily, in low income countries like Nigeria, Uganda and Kenya which are known to be patriarchal male dominated societies where pregnancy and child birth is regarded as exclusively women’s affairs, partner participation in labor and delivery remains acutely low (Kaye et al., 2014)
Vehviläinen-Julkunen and Emelonye (2015) reported that majority of women desire their spouses as birth companions and attest to having emotional comfort and support when their spouses participate in their labor and delivery. Spousal presence during childbirth is also instrumental in relieving the distress associated with uncertainty and anxiety faced by parturient when they feel physically and psychologically vulnerable. Additionally, there are enormous benefits accruing from spousal support during childbirth including
emotional comfort, improved family communication, bonding, pain relief without analgesia, and positive birth experience (Blackshaw, 2009).
Melo et al., (2015) indicates that the support and encouragement to the father in the delivery room from health professionals is not a reality experienced by most couples. Nanjala and Wamalwa (2012) indicate that lack of knowledge by male partners of complications associated with delivery, cultural beliefs, high fees charged for deliveries at health facilities and “un-cooperative” health workers are major contributing factors to low male partner involvement in child birth activities. Kaye et al. (2014) also indicates that most men were willing to learn about their expected roles during childbirth and were eager to support their partners/wives/spouses during this time. However Vehviläinen- Julkunen and Emelonye (2015) add that personal, relationship, family and community factors are barriers to their involvement. Health system is unwelcoming, intimidating and unsupportive.
Nyeri County is located in Central and constitutes 6 constituencies; Tetu, Kieni, Mathira, Othaya, Mukurwe-ini and Nyeri town. According to Government of Kenya (GoK) (2010) the county has a population of 761,407people with a population of 208 people per km2.As at January, 2015; the county has 103 public health facilities. In 2011, the preventive services budget stood at KES 981 per capita whereas the curative services budget stood at KES 1,200 per capital (GoK, 2012).The morbidity rate for the county is 28.8 per cent with that of male being 27.03 per cent and 30.5 per cent for female. The total number of women of reproductive age is 24186. In the county, the maternal mortality rate stands at 318 per 100,000, while the child mortality rate stands at 10 out of a 1000. Findings of
GoK (2014) showed that women living in Nyeri marry the latest, at a median age of 21.8 years. Almost half of women living in Nyeri, Kirinyaga, and Mombasa are overweight or obese. Delivery in hospitals is very high with 96% of births being delivered at a health facility. However, published information on partner participation in labor and delivery is lacking despite its public health importance. This study therefore seeks to fill this gap by assessing determinants of partner participation in labour and delivery at Nyeri County Referral Hospital.
Problem statement
Companionship in labour and delivery provides emotional benefits to the couple as well as health-related benefits including better labour outcomes, earlier initiation of breastfeeding and increased birth intervals. Adeniran et al. (2015) indicates that pregnant women have desires expected from the men during conception, labour and delivery.
The Kenyan laws allow women to have a chaperon during the labor, birth and immediate postpartum, if so desired. The Ministry of Health in conjunction with non-governmental organizations has put programs to encourage partner participation in labour and delivery in public hospitals (Nyeri County Referral Hospital, 2016). Preparation for partner participation in labour and delivery starts at maternal and child health (MCH) clinic where invitations cards are sent to the spouses so that they can join the women in the maternity. Micro teachings are done in the waiting bays in the hospitals to encourage men to accompany their wives in labor. On admission, spouses are encouraged to accompany their wives in labor. Privacy in labor ward is enhanced such that every couch has curtains.
