title: Male involvement and maternal health outcomes: systematic review and meta-analysis.
abstract: BACKGROUND
  The developing world accounts for 99% of global maternal deaths. Men in developing countries are the chief decision-makers, determining women's access to maternal health services and influencing their health outcomes. At present, it is unclear whether involving men in maternal health can improve maternal outcomes. This systematic review and meta-analysis aimed to investigate the impact of male involvement on maternal health outcomes of women in developing countries.
  
  
  METHODS
  Four electronic databases and grey literature sources were searched (up to May 2013), together with reference lists of included studies. Two reviewers independently screened and assessed the quality of studies based on prespecified criteria. Measures of effects were pooled and random effect meta-analysis was conducted, where possible.
  
  
  RESULTS
  Fourteen studies met the inclusion criteria. Male involvement was significantly associated with reduced odds of postpartum depression (OR=0.36, 95% CI 0.19 to 0.68 for male involvement during pregnancy; OR=0.34, 95% CI 0.19 to 0.62 for male involvement post partum), and also with improved utilisation of maternal health services (skilled birth attendance and postnatal care). Male involvement during pregnancy and at post partum appeared to have greater benefits than male involvement during delivery.
  
  
  CONCLUSIONS
  Male involvement is associated with improved maternal health outcomes in developing countries. Contrary to reports from developed countries, there was little evidence of positive impacts of husbands' presence in delivery rooms. However, more rigorous studies are needed to improve this area's evidence base.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Yargawa
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
mesh_terms: D003657:Decision Making; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D000068097:Maternal Health; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology / Q000523:psychology*; D012944:Social Support; D018454:Spouses / Q000523:psychology*
keywords: ACCESS TO HLTH CARE; DEVELOPING COUNTR; INTERNATIONAL HLTH; MATERNAL HEALTH; SYSTEMATIC REVIEWS