title: Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis.
abstract: BACKGROUND
  Male involvement in various health practices is recognized as an important factor in improving maternal and child health outcomes. Male involvement interventions involve men in a variety of ways, at varying levels of inclusion and use a range of outcome measures. There is little agreement on how male involvement should be measured and some authors contend that male involvement may actually be detrimental to women's empowerment and autonomy. Few studies explore the realities, perceptions, determinants and efficacy of male involvement in newborn care, especially in African contexts.
  
  
  METHODS
  Birth narratives of recent mothers (n = 25), in-depth interviews with recent fathers (n = 12) and two focus group discussions with fathers (n = 22) were conducted during the formative research phase of a community-based newborn care trial. Secondary analysis of this qualitative data identified emergent themes and established overall associations related to male involvement, newborn care and household roles in a rural African setting.
  
  
  RESULTS
  Data revealed that gender dictates many of the perceptions and politics surrounding newborn care in this context. The influence of mother-in-laws and generational power dynamics were also identified as significant. Women alone perform almost all tasks related to newborn care whereas men take on the traditional responsibilities of economic providers and decision makers, especially concerning their wives' and children's health. Most men were interested in being more involved in newborn care but identified barriers to increased involvement, many of which related to gendered and generational divisions of labour and space.
  
  
  CONCLUSIONS
  Men defined involvement in a variety of ways, even if they were not physically involved in carrying out newborn care tasks. Some participant comments revealed potential risks of increasing male involvement suggesting that male involvement alone should not be an outcome in future interventions. Rather, the effect of male involvement on women's autonomy, the dynamics of senior women's influence and power and the real impact on health outcomes should be considered in intervention design and implementation. Any male involvement intervention should integrate a detailed understanding of context and strategies to include men in maternal and child health should be mutually empowering for both women and men.
authors.affiliation: Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. mari.dumbaugh@unibas.ch.
authors.forename: Mari
authors.initials: M
authors.lastname: Dumbaugh
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah-Agyemang
authors.forename: Alexander
authors.initials: A
authors.lastname: Manu
authors.forename: Guus Ha
authors.initials: GH
authors.lastname: ten Asbroek
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
authors.forename: Zelee
authors.initials: Z
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D003657:Decision Making; D005191:Family Characteristics; D005220:Fathers; D005260:Female; D005783:Gender Identity; D005869:Ghana; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D016901:Intergenerational Relations; D008297:Male; D008875:Middle Aged; D009035:Mothers; D010465:Perception; D036301:Qualitative Research; D012380:Role; D055815:Young Adult
references.citation: AIDS Behav. 2009 Jun;13 Suppl 1:92-102
references.pmid: 19308720
references.citation: Soc Sci Med. 2002 Aug;55(3):437-50
references.pmid: 12144151
references.citation: Int J Gynaecol Obstet. 2009 Nov;107(2):103-6
references.pmid: 19716557
references.citation: Reprod Health. 2011 May 07;8:12
references.pmid: 21548976
references.citation: Afr J Reprod Health. 2007 Apr;11(1):76-89
references.pmid: 17982950
references.citation: BMC Pregnancy Childbirth. 2010 Apr 01;10:14
references.pmid: 20359341
references.citation: Afr J Reprod Health. 2010 Mar;14(1):21-32
references.pmid: 20695136
references.citation: AIDS Care. 2010 Jun;22(6):743-50
references.pmid: 20461572
references.citation: Trop Med Int Health. 2010 Oct;15(10):1140-7
references.pmid: 20723185
references.citation: Reprod Health. 2011 Dec 02;8:36
references.pmid: 22133209
references.citation: Trials. 2010 May 17;11:58
references.pmid: 20478070
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S38-45
references.pmid: 19057567
references.citation: Afr J Reprod Health. 2005 Dec;9(3):59-71
references.pmid: 16623190
references.citation: Matern Child Nutr. 2012 Jan;8(1):19-35
references.pmid: 21951995
references.citation: Health Care Women Int. 2012;33(4):359-74
references.pmid: 22420677
references.citation: Gend Dev. 1997 Jun;5(2):8-13
references.pmid: 12292619
references.citation: Soc Sci Med. 2005 Nov;61(9):1993-2006
references.pmid: 15922498
references.citation: BMC Pregnancy Childbirth. 2010 Sep 16;10:53
references.pmid: 20846369
references.citation: Cult Health Sex. 2012;14(2):181-94
references.pmid: 22085043
references.citation: Glob Public Health. 2010;5(5):539-53
references.pmid: 19513910
references.citation: Int J Gynaecol Obstet. 2012 Apr;117(1):48-55
references.pmid: 22281244
references.citation: J Biosoc Sci. 2008 May;40(3):413-29
references.pmid: 17988428
references.citation: J Health Commun. 2004 May-Jun;9(3):233-58
references.pmid: 15360036
references.citation: J Health Commun. 2011 Nov;16(10):1122-35
references.pmid: 21718188
references.citation: Afr J Reprod Health. 2010 Dec;14(4 Spec no.):32-42
references.pmid: 21812196
references.citation: Lancet. 2013 Jun 22;381(9884):2184-92
references.pmid: 23578528
references.citation: Soc Sci Med. 2006 May;62(10):2411-9
references.pmid: 16300871
references.citation: BMC Pregnancy Childbirth. 2008 Jun 21;8:21
references.pmid: 18570672
references.citation: AIDS Care. 2008 Jul;20(6):700-9
references.pmid: 18576172
references.citation: Trop Med Int Health. 2008 Jan;13(1):123-8
references.pmid: 18291010
references.citation: PLoS Med. 2012 Feb;9(2):e1001180
references.pmid: 22389634
references.citation: Reprod Health Matters. 2001 Nov;9(18):114-25
references.pmid: 11765387
references.citation: J Acquir Immune Defic Syndr. 2004 Dec 15;37(5):1620-6
references.pmid: 15577420