title: Birth preparedness, complication readiness and male partner involvement for obstetric emergencies in rural Rwanda.
abstract: BACKGROUND
  Birth preparedness and complication readiness (BP/CR) promotes timely access to skilled maternal and neonatal services, active preparation and decision-making for seeking health care to prevent any adverse outcomes. The aim was to assess level of male partner (MP) involvement in the birth plan, the attitude of the women towards maternal care and factors associated with BP/CR among obstetric referrals in rural Rwanda.
  
  
  METHODS
  This was a cross-sectional study among 350 pregnant women who were admitted as referrals at Ruhengeri hospital, between July 2015 and November 2015. Data was collected on socio-demographics, level of MP's participation in maternal health care and domestic activities, women's attitude towards involvement of men in maternal care and BP/CR. Any woman who arranged to have a birth companion, made a plan of where to deliver from, received health education on pregnancy and childbirth complications, saved money in case of pregnancy complication and had attended antenatal care (ANC) at least 4 times, was deemed as having made a birth plan.
  
  
  RESULTS
  The mean age was 27.7 years, while mean age of the spouse was 31.3 years. Majority of the women (n=193; 55.1%) and their spouse (n=208; 59.4%) had completed primary education. Men's role was found to be mainly in the area of financial support. The level of men ANC attendance was low (n=103; 29.4%), while 78 (22.3%) women were accompanied to the labor ward. However, there was a strong opposition to the physical presence of MP in the labor room (n=178; 50.9%). The main reason cited by women opposing MP presence is that it is against their culture for a man to witness the delivery of a baby. On multivariable analysis, maternal education level of secondary or higher adjusted odds ratio [AOR] 1.4 95% CI (1.8-2.6), formal occupation of spouse, AOR 2.4 95% CI (1.4-4.2) and personnel checked during ANC being community health worker AOR 2.2, 95% CI; (1.3-3.7) were associated with being well prepared.
  
  
  CONCLUSIONS
  Male involvement in pregnancy and antenatal care is low. To increase men involvement in birth plan addressing cultural barriers and refraining care-givers and health facility policies towards family delivery is paramount.
authors.affiliation: Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda; Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Kalisa
authors.affiliation: Department of Pediatrics, Faculty of Health Sciences, Egerton University, Nakuru, Kenya.
authors.forename: Oliver Ombeva
authors.initials: OO
authors.lastname: Malande
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000523:psychology; D004630:Emergencies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology; D008297:Male; D007744:Obstetric Labor Complications / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D064186:Prenatal Education / Q000379:methods* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012432:Rwanda; D018454:Spouses / Q000523:psychology*; D055815:Young Adult
keywords: Antenatal care; barriers to access; male partner involvement; pregnancy