title: 'You try to play a role in her pregnancy' - a qualitative study on recent fathers' perspectives about childbearing and encounter with the maternal health system in Kigali, Rwanda.
abstract: BACKGROUND
  Rwanda has raised gender equality on the political agenda and is, among other things, striving for involving men in reproductive health matters. With these structural changes taking place, traditional gender norms in this setting are challenged. Deeper understanding is needed of men's perceptions about their gendered roles in the maternal health system.
  
  
  OBJECTIVE
  To explore recent fathers' perspectives about their roles during childbearing and maternal care-seeking within the context of Rwanda's political agenda for gender equality.
  
  
  METHODS
  Semi-structured interviews were conducted with 32 men in Kigali, Rwanda, between March 2013 and April 2014. A framework of naturalistic inquiry guided the overall study design and analysis. In order to conceptualize male involvement and understand any gendered social mechanisms, the analysis is inspired by the central principles from relational gender theory.
  
  
  RESULTS
  The participants in this study appeared to disrupt traditional masculinities and presented ideals of an engaged and caring partner during pregnancy and maternal care-seeking. They wished to carry responsibilities beyond the traditional aspects of being the financial provider. They also demonstrated willingness to negotiate their involvement according to their partners' wishes, external expectations, and perceived cultural norms. While the men perceived themselves as obliged to accompany their partner at first antenatal care (ANC) visit, they experienced several points of resistance from the maternal health system for becoming further engaged.
  
  
  CONCLUSIONS
  These men perceived both maternal health system policy and care providers as resistant toward their increased engagement in childbearing. Importantly, perceiving themselves as estranged may consequently limit their engagement with the expectant partner. Our findings therefore recommend maternity care to be more responsive to male partners. Given the number of men already taking part in ANC, this is an opportunity to embrace men's presence and promote behavior in favor of women's health during pregnancy and childbirth - and may also function as a cornerstone in promoting gender-equitable attitudes.
authors: Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden; jessica.pafs@kbh.uu.se.
authors: Jessica
authors: J
authors: Påfs
authors: Department of Obstetrics & Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.|Department of Clinical Research, University Teaching Hospital of Kigali, Kigali, Rwanda.
authors: Stephen
authors: S
authors: Rulisa
authors: Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden.|Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda.
authors: Aimable
authors: A
authors: Musafili
authors: Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden.
authors: Birgitta
authors: B
authors: Essén
authors: Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden.
authors: Pauline
authors: P
authors: Binder-Finnema
keywords: gender; intimate relationship; male involvement; masculinity; relational theory; sub-Saharan Africa