Thesis presentation: "Role of Husband (Involvement) in Utilization of Maternal Healthcare Services Among Muslim Women of Rautahat District, Nepal",

ROLE OF HUSBAND’S
(INVOLVEMENT) IN UTILIZATION
OF MATERNAL HEALTH CARE
SERVICES AMONG MUSLIM
WOMEN IN RAUTAHAT DISTRICT,
NEPAL
Mohammad Aslam Shaiekh
Master of Public Health (MPH)
School of Health and Allied Sciences
Pokhara University
2020
(In partial fulfillment of the requirements for the award
of Master of Public Health)

Presentation outline
 Introduction
 Literature review
 Methodology
 Results
 Discussion
 Conclusion
 Recommendations
 References
2

Introduction
 Maternal health is defined as health of women during
pregnancy, childbirth and the postpartum period
(Bhusal et al., 2015).
 WHO has reported that globally every day about 830
women die due to preventable causes related to
pregnancy and childbirth. Among them 99% of
deaths occur in developing countries (Mahara et al.,
2016).
3

Introduction
 Maternal health is influenced by the cultural beliefs, practices,
as well as access to quality health services (Yargawa and
Leonardi-Bee, 2015).
 Nepal’s MMR is 239 per 100000 live births. In 2016, 84% of
pregnant women had at least an ANC visit, 69% had four or
more visit. Similarly 58% of deliveries were conducted by
SBA only 57% of births were institutional delivered and 57%
mothers were gone for PNC check-up within two days of
delivery (NDHS Report, 2016).
 Sustainable Development Goal three is to reduce the global
maternal mortality ratio to less than 70 per 100000 births, with
no country having a maternal mortality rate of more than
twice the global average. 4

Introduction
 Husband’s involvement during pregnancy and
childbirth plays a vital role by ensuring access to
health care and provision of emotional and financial
support (Iliyasu et al., 2010).
 There is epidemiological and physiological evidence
that husband’s involvement reduces maternal stress
(by emotional, logistical and financial support),
increases uptake of prenatal care, leads to cessation
of risk behaviors (such as smoking), and ensures
men’s involvement in their future parental roles from
an early stage (Kaye et al., 2014).
5

Introduction
 Low use of maternal health services has been
observed among Dalits, Muslims, and Terai/Madhesi
(the Terai/Madhesi people are native inhabitants of
the flat southern region of Nepal) peoples. The use of
maternal health care has been found to be low among
those who reside in rural areas and the poor (Further
Analysis of the NDHS 2011:Maternal and Child
Health in Nepal; 2013).
6

Rationale of the study
 Husband’s participation in reproductive health issues is
new strategy for achieving maternal and child health
(Cohen and Burger, 2000).
 Husbands’ role is critical in pregnancy and childbirth
of women, especially in making a decision about
seeking appropriate health care services (Chapagain
et al., 2019)
7

 There is low utilization of maternal healthcare
services in Rautahat district i.e. institutional delivery
is 33.83%, pregnant women who had at least one
ANC check-up is 106% and complete four visits of
ANC is 44.08% (Department of Health Services,
2015/2016). This shows that there is still gaps in
utilization of maternal health services.
 Maternal health care practice of Muslim community
is influenced by their cultural practices. They have
their own kind of perception about maternal care.
8

 Culturally Islamic women cannot move outside
without permission of their husbands, no use of
family planning services and giving birth of child
how many she can do.
 No women participation in social and community
activities, no decision can done alone without
husband, mother are not allowed to talk any others
male persons
 These are the major rooted cause among Muslim
community which are hindering in utilization of
maternal health care services. 9

 The finding of this study would be supportive to
public health experts to take appropriate decisions
and actions to address issues related to utilization of
maternal health care services among Muslim
community.
 This study will be beneficial to shape the package of
maternal health care services especially for Muslim
community.
10

Research questions
 Does husband’s involvement influence on the
utilization of maternal health care services among
Muslim women in Rautahat, Nepal?
 What is the maternal healthcare utilization rate
among Muslim women in Rautahat?
 What is the role of husband’s in the utilization of
maternal health care services?
 What are the factors associated with the utilization of
maternal healthcare services among Muslim women?
11

Research objectives
 General Objective
Study the role of husband’s involvement in utilization of
maternal health care services and its associated factors
among Muslim women, Rautahat, Nepal.
12

Research objectives
 Specific Objectives
• To identify the utilization of maternal healthcare
services among Muslim women.
• To assess the associated factors of utilization of
maternal healthcare services.
• To identify the role of husband’s involvement in
utilization of maternal health care services.
• To associate husband’s involvement with the
utilization of Maternal Health care services.
13

Search strategy
 Search engines:
Endnote X7 software using PubMed database, Google,
Google scholar and Hinari
 Key words used:
Husbands involvement AND Utilization of maternal health
care services, Utilization of maternal health care services
AND Muslim women, Male involvement AND Utilization
of maternal health care services, Maternal health care
services AND Husband involvement AND Nepal
 Documents used:
Total 51 reference documents (Articles and reports) were
used. 15

Conceptual framework of the study
with variables
16

Operational definitions
• Maternal health care utilization: Utilization of number of
ANC and PNC visit and timing of ANC and PNC visit during
the most recent pregnancy and place of delivery of the most
recent birth were considered.
• Husband involvement in maternal health care: women
accompanied by husbands at ANC visit, at health facility
delivery assisted by the SBA or Non-SBA and home delivery
by TBA of the most recent birth and at PNC visit were
considered.
• Role of husbands: Actions and supports during pregnancy,
delivery and postnatal period done by husbands for the better
utilization of maternal healthcare services.
17

Operational definitions
• Antenatal Care: Number of visits and times of antenatal care
fourth, sixth, eighth and ninth months of pregnancy by skilled
provider, consumption of iron and folic acid tablets, received two or
more Td. injections and consumption of intestinal parasite drugs
during the most recent pregnancy.
• Delivery care/Intranatal care: Delivery assisted by skilled
provider and place of delivery be considered as delivery care
utilization.
• Postnatal care: Number of visits and times of postnatal care within
twenty four hours, third day and seventh days of delivery by skilled
provider, consumption of iron tablets, vitamin A and use of any
family planning methods were considered postnatal care utilization.
18

Study design Cross sectional analytical study
Study method Quantitative (Survey method)
Study setting Paroha Municipality, Rautahat.
Study population
Muslim women of Paroha Municipality,
Rautahat
Study unit
Women having at least one child of one
year
Inclusion criteria
Those women having one year children
were continuously living since last one
year in the Paroha municipality
Study technique Face to face interview
Study tool Structured questionnaire 20

Sample size calculation
Sample size n = Z2pq
d2
p = 0.45 (Proportion of women who
delivered in health facility at
province two is 45%) (NDHS, 2016)
Maximum Allowable error (d) = 5 %
Z statistic = 1.96 at 95% level of
confidence
Then, no = 380
For finite population N = 879, the
sample size was:
n = no , n = 265
1 + no
N
Assuming 10 % non response rate,
the sample size (n) was,
= 265 + 265*10%
= 265 + 27 (26.5 has rounded up)
= 292
21

Sampling procedure
22
1
• Multistage sampling
2
• Paroha Municipality was selected purposively as
study site
3
• Census method was used for ward selection and
data were collected from all wards of the
municipality
4
• Proportionate sampling was used to determine
required households from each wards

Data collection procedure
23
1
• Permission was taken from municipality.
2
• Rapport building with concerned people and
household visits were done to collect the data.
3
• Participants were well informed on study objectives,
confidentiality of their information and neither any
benefit & risk for participation.
4
• Gathered all the collected data and secured it with
proper keeping in the file.
5
• Assured quality of data by rechecking the all collected
information.

Data processing and management
Tool
preparation
• Extensive literature review, supervisor and expert
consultation.
• Translated into Nepali language.
Reliability and
validity of
tools
• Translation validity had been optimized through peers
review
• Pre-tested in 10 percent of similar population and
necessary amendments had been made
Quality
assurance of
data
• Data were rechecked along with cleaning and editing of
data
• Researcher himself had involved in the data collection
process, cross checking and cross validation of data side
by side
Data entry Epi-data
Data analysis SPSS; Descriptive analysis (Frequencies and percentages) &
Inferential analysis (Chi-square test and binary logistic
regression) 24

Ethical considerations
Ethical Approval:
 Ethical approval was taken from NHRC
 Permission was taken from Municipality.
Informed Consent:
 Verbal and written consent were obtained from participants
prior to data collection.
Benefits to participants and handling of possible risks:
 All participants were well informed that there was neither any
direct benefit nor any risk for participation.
25

Demographic characteristics
27
Characteristics Number (N=292) Percent
Age of respondents
<20 0 0.0
20-35 287 98.3
>35 5 1.7
Age of husbands
<20 1 0.3
20-35 252 86.3
>35 39 13.4
Family structure
Nuclear 46 15.8
Joints 246 84.2

Demographic characteristics
28
Respondent’s age at
marriage
<20 41 14.0
20-35 251 86.0
Age at first pregnancy
<20 13 4.5
20-35 279 95.5
Number of parity
≤ 2 150 51.4
>2 142 48.6
Number of children
≤ 2 153 52.4
>2 139 47.6

Socio-economic characteristics
29
Education of respondents
Illiterate 137 46.9
Basic level 96 32.9
Secondary level 40 13.7
Higher-level 19 6.5
Education of husbands
Illiterate 96 32.9
Basic level 58 19.9
Secondary level 82 28.1
Higher-level 56 19.2

Socioeconomic characteristics
30
Respondent’s occupation
Housewife 273 93.5
Job 18 6.2
Agriculture 1 0.3
Husband’s occupation
Agriculture 25 8.6
Job 49 16.8
Daily wages labor 46 15.8
Business 62 21.2
Out of home for employment
Within the country
43 14.7
Foreign employment 66 22.6
Students 1 0.3

Socioeconomic characteristics
31
Wealth quintiles Number (N=292) Percent
Lowest 2 0.7
Second 54 18.5
Middle 124 42.5
Fourth 56 19.2
Highest 56 19.2
Total 292 100.00

Practice of ANC check-up
33
Variables Number (N=292) Percent
ANC check-up
Yes (at least one or
more)
292 100
No 0 0
Number of ANC visits
One time visit 1 0.3
Two to three visits 115 39.4
Four visits 176 60.3

34
Variables Number (N=292)* Percent
Months of ANC visits
4th month of
pregnancy
276 94.5
6th month of
pregnancy
253 86.6
8th month of
pregnancy
243 83.3
9th month of
pregnancy
221 75.6
* Multiple response

35
Place of ANC visits
Government hospital 31 10.6
Primary health care
center
36 12.3
Health post 220 75.3
Private clinic 1 0.3
Nursing home 3 1.2
Private teaching hospital 1 0.3
ANC service providers
Doctor/ANM/Nurse 251 86.0
HA/AHW 41 14.0

ANC service utilization
36
Consumption of iron tablet
Yes 281 96.2
No 11 3.8
The practice of Td. vaccination
Yes 281 96.2
No 11 3.8
Use of anthelminthic (Albendazole)
Yes 267 91.4
No 25 8.6
Counseling for institutional delivery
Yes 127 43.5
No 165 56.5

Practice of birth preparedness
37
Birth preparedness Number
(N=292)*
Percent
No, any arrangement 67 22.9
Arrangement of money 223 76.4
Arrangement of people for
blood donation
4 1.4
Arrangement of SBA for
delivery
3 1.0
Arrangement of transportation 128 43.8
* Multiple response

Utilization of delivery care services
38
Variables Number Percent
Place of delivery (N=292)
Home 122 41.8
Health institution (public
and private both )
170 58.2
Use of transportation (n=170)
On foot 11 6.5
Carried by people 1 0.6
Ambulance 46 27.1
Private vehicle 32 18.8
Public vehicle 3 1.8
Hired vehicle 77 45.3

Utilization of delivery care services
39
The person involved in the delivery (N=292)
Traditional birth attendants 122 41.8
Doctor/ANM/Nurse 170 58.2
Reasons for not delivering at a health facility (n=122)*
Decided to make delivery at
home
76 62.2
The health facility is far away 1 0.8
Having no money 22 18.0
Have no trust in services and
staffs
11 9.0
Having no people at home to
take to the health facility
12 9.8
* Multiple response

Health services and information received during
institutional delivery
40
Variables Number (n=170)* Percent
Health services and information
Eating nutritious food and
breastfeeding
167 98.2
Rest and exercise 169 99.4
Counseling about family planning 43 25.3
Handwashing and personal hygiene
maintenance
72 42.4
Kangaroo care 156 91.8
Newborn immunization 165 97.1
A child vaccinated with BCG 164 96.5
Childbirth registration 5 2.9
Counseling for PNC visits
Yes 137 80.6
No 33 19.4

Practice of PNC check-up
41
PNC visit (N=292)
Yes 196 67.1
No 96 32.9
Place of PNC visits (n=196)
Government hospital 65 33.1
PHCC 20 10.2
HP 69 35.2
Private clinic 8 4.1
Nursing home 8 4.1
Private teaching hospital 26 13.3

Practice of PNC check-up
42
Variables Number (n=196) Percent
Number of PNC visits
<3 49 25.0
≥3 147 75.0

PNC service utilization
43
Use of vitamin A
Yes 253 86.6
No 39 13.4
Use of family planning services
Yes 16 5.5
No 276 94.5

Danger signs at postnatal period
44
Characters Number (N=292) Percent
Knowledge
Yes 114 39.0
No 178 61.0
Danger sign faced
Yes 85 29.1
No 207 70.9

Role of Husbands Involvement in
MCH Service Utilizations
45

Husbands involvement in ANC, institutional
delivery and PNC
46
ANC visits (N=292)
Yes (at least one or more time) 139 47.6
No 153 52.4
Institutional delivery (n=170)
Yes 140 82.4
No 30 17.6
PNC visits (N=196)
Yes (At least one or more time) 129 65.8
No 67 34.2

Reasons of non-involvement of husbands
during ANC visits
47
Reasons of non-
involvement
Number (n=153)* Percent
Busy at work 16 5.5
Husband not at home 79 27.1
Husband has no knowledge
and information about ANC
66 22.6
Sent with family members for
ANC visits
81 27.7
Husband hailing 40 13.7
Perception of as it is the only
responsibility of women
29 9.9
* Multiple response

Reasons of non-involvement of husbands during
PNC visits
48
Reasons of Non-
involvement
Number (n=67)* Percent
Busy in work 4 6.0
The husband was not at
home
48 71.6
Husband has no knowledge
and information about PNC
16 23.9
Feeling embarrassed 2 3.0
Taken to a health facility
with family members
15 22.4
* Multiple response

Helps from husband at postnatal period
49
Types of help Number (n=129)* Percent
Taken to the health facility 128 99.2
Bought medicine 120 93.0
Take care of the baby 110 85.3
Consult with a health worker
about the health of mother and
baby
111 86.4
* Multiple response

Association of Husbands
Involvement During ANC,
Institutional Delivery and PNC
Visits with Socio-demographic
Factors
50

Association of husbands involvement during ANC visits
with socio-demographic factors
51
*Statistically significant at p-value <0.05
Demograph
ic factors
Husbands involvement
Yes (%) No (%)
Chi-square
(χ2)
p-value
Number of children
≤ 2 63 (41.2) 90 (58.8)
5.322 0.021
> 2 76 (54.7) 63 (45.3)
Age of husband
20-35 110 (43.5) 143 (56.5)
12.919 0.0001*
>35 29 (74.4) 10 (25.6)
Age at marriage
<20 10 (24.4) 31 (75.6)
10.304 0.02*
20-35 129 (51.4) 122 (48.6)

52
Demograph
ic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Number of parity
≤ 2 63 (42.0) 87 (58.0)
3.882 0.05*
>2 76 (53.5) 66 (46.5)
Education status of respondents
Literate 117 (74.5) 40 (25.5)
98.66 0.0001*
Illiterate 22 (16.3) 113 (83.7)
Education status of husband
Literate 126 (64.3) 70 (35.7)
66.523 0.0001*
Illiterate 13 (13.5) 83 (86.5)

53
Demograp
hic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Occupation of husbands
Unpaid 37 (32.7) 76 (67.3)
16.318 0.0001*
Paid 102 (57.0) 77 (43.0)

Association of husbands involvement during
institutional delivery with socio-demographic factors
54
Demograph
ic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Family types
Nuclear 17 (58.6) 12 (41.4)
13.550 0.001*
Joint 123 (87.2) 18 (12.8)
Education status respondents
Literate 120 (95.2) 6 (4.8)
55.615 0.0001*
Illiterate 20 (45.5) 24 (54.5)
Education status of husbands
Literate 127 (92.0) 11 (8.0)
47.230 0.0001*
Illiterate 13 (40.6) 19 (59.4)

Association of husbands involvement during
institutional delivery with socio-demographic factors
55
Demograp
hic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Unpaid 39 (81.3) 9 (18.8)
0.056 0.81
Paid 101 (82.8) 21 (17.2)

Association of husbands involvement during PNC visits
56
Demograph
ic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Family types
Nuclear 12 (26.1) 34 (73.9)
7.246 0.01*
Joint 117 (47.6) 129 (52.4)
Age at marriage
<20 8 (19.5) 33 (80.5)
11.767 0.001*
20-35 121 (48.2) 130 (51.8)
Literate 109 (69.4) 48 (30.6)
87.784 0.0001*
Illiterate 20 (14.8) 115 (85.2)

Association of husbands involvement during PNC visits
57
Demograph
ic factors
Yes (%) No (%)
Chi-square
(χ2)
p-value
Literate 116 (59.2) 80 (40.8)
54.433 0.0001*
Illiterate 13 (13.5) 83 (86.5)
Unpaid 36 (31.9) 77 (68.1)
11.345 0.001*
Paid 93 (52.00 86 (48.0)

Influence of demographic factors on husband
involvement during ANC visits
58
Variable
Model-I Model-II Model-III
OR
95% CI
for OR
OR
95% CI
for OR
OR
95% CI
for OR
No. of Children
≤ 2 Ref. Ref. Ref.
>2 1.72 1.08-2.74 1.27 0.76-2.11 1.32 0.79-2.21
Age of husbands
20-35 Ref. Ref.
>35 3.27 1.44-7.42 3.19 1.38-7.36
<20 Ref.
20-35 12.13 1.52-96.8

Influence of socio-economic factors on husband
59
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Illiterate Ref. Ref. Ref.
Literate 11.49 5.98-22.09 10.12 5.22-19.61 7.65 3.75-15.59
Unpaid Ref. Ref.
Paid 1.87 1.07-3.25 0.99 0.52-10.24
Wealth index
Poor Ref.
Middle 5.09 2.53-10.24
Rich 24.08 8.57-67.68

60
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Literate 15.02 8.40-26.86 13.60 7.57-24.45 8.47 4.54-15.81
Occupation of respondents
Unpaid Ref. Ref.
Paid 4.36 0.89-21.38 2.09 0.32-13.89
Wealth index
Poor Ref.
Middle 3.88 1.92-7.83
Rich 14.10 4.91-40.47

involvement during institutional delivery
61
Variables
Model-I Model-II
OR
95% CI
for OR
OR
95% CI
for OR
Family types
Nuclear Ref. Ref.
Joint 0.21 0.09-0.50 0.16 0.07-0.41
<20 Ref.
20-35 0.06 0.01-0.35

involvement during institutional delivery
62
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Literate 0.04 0.02-0.12 0.05 0.02-0.13 0.05 0.02-0.15
Unpaid Ref. Ref.
Paid 0.00 0.000- 0.000 0.000-
Wealth index
Poor Ref.
Middle 0.75 0.24-2.40
Rich 0.18 0.03-1.09

involvement during PNC visits
63
Variables
Model-I Model-II
OR
95% CI
for OR
OR
95% CI
for OR
Family types
Nuclear Ref. Ref.
Joint 2.57 1.27-5.19 2.54 1.24-5.19
<20 Ref.
20-35 3.81 1.68-8.62

64
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Literate 13.06 7.28-23.41 11.91 6.60-21.48 7.74 4.16-14.40
Unpaid Ref. Ref.
Paid 3.24 0.85-12.36 1.73 0.39-7.71
Wealth index
Poor Ref.
Middle 2.75 1.38-5.48
Rich 7.37 2.86-18.99

65
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Literate 9.26 4.83-17.74 8.35 4.31-16.15 6.08 3.04-12.18
Unpaid Ref. Ref.
Paid 1.57 0.91-2.72 0.91 0.49-1.70
Wealth index
Poor Ref.
Middle 3.74 1.89-7.39
Rich 13.25 5.32-33.03

Influence of socio-demographic factors on the use of Td.
vaccine
66
Variabl
e
OR
95% CI
for OR
OR
95% CI
for OR
OR
95% CI for
OR
Age at marriage
< 20 Ref. Ref. Ref.
20-35 3.77 1.05-13.50 2.27 0.62-8.41 3.41 0.88-13.18
Illiterate Ref. Ref.
Literate 10.56 1.30-85.73 0.000 0.000-
Illiterate Ref.
Literate 244.8 0.000-

Influence of socio-demographic factors on the use of
Iron tablet
67
Variabl
es
OR
95% CI
for OR
OR
95% CI
for OR
OR
95% CI for
OR
Age at marriage
< 20 Ref. Ref. Ref.
20-35 5.67 1.65-19.55 3.49 0.98-12.46 5.41 1.45-20.24
Illiterate Ref. Ref.
Literate 9.48 1.16-77.46 0.000 0.000-
Illiterate Ref.
Literate 275.7 0.000-

Influence of socio-demographic factors on counseling
for institutional delivery during ANC visits
68
Variables
Model-I Model-II
OR
95% CI
for OR
OR
95% CI
for OR
Age of husband
20-35 Ref. Ref.
>35 0.24 0.10-0.57 0.08 0.03-0.22
Husband involvement in ANC visits
No Ref.
Yes 11.76
6.52-
21.20

Influence of socio-economic factors on counseling for
institutional delivery during ANC visits
69
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Literate 2.46 1.53-3.98 2.08 1.26-3.41 1.65 0.95-2.86
Unpaid Ref. Ref.
Paid 2.47 1.47-3.41 2.07 1.20-3.57
Wealth index
Poor Ref.
Middle 2.56 1.38-4.74
Rich 2.02 0.91-4.48

Influence of socio-demographic factors on counseling
for PNC visits during institutional delivery
70
Variabl
es
OR
95% CI
for OR
OR
95% CI
for OR
OR
95% CI for
OR
Age at marriage
< 20 Ref. Ref. Ref.
20-35 0.32 0.10-0.96 1.69 0.20-14.06 0.74 0.07-7.41
< 20 Ref. Ref.
20-35 0.03 0.001-0.49 0.01 0.000-0.31
Educational status of respondents
Illiterate Ref.
Literate 11.99 1.53-93.97

Influence of socio-demographic factors on the use of
family planning services
71
Variable
OR
95% CI for
OR
OR
95% CI for
OR
OR
95% CI for
OR
Age of husbands
20-35 Ref. Ref. Ref.
>35 4.42 1.51-12.95 3.79 1.26-11.44 11.23 1.72-73.56
Husband involvement during PNC visits
No Ref. Ref.
Yes 5.44 1.50-19.75 2.84 0.28-28.62
Educational level of respondents
Basic Ref.
Secondar
y or
above
22.18 2.91-168.87

In this study In other studies
• 47.6% of husband had
accompanied at least one or
more time during ANC
visits, more than three
quarter (82.4%) of husband
had accompanied during
institutional delivery and
65.8% of husband at least
one or more time
accompanied during PNC
visits
• A study conducted in Ghana
showed 35% of husband
accompanied their partners to
antenatal care during
pregnancy, while 44%
accompanied their partners to
delivery and one-fifth (20%) of
the husband accompanied their
partners for postnatal care
services (Craymah et al., 2017)
The husband were more involved during institutional delivery than
ANC and PNC visits because they have perceptions that women
need more support and help from husband during delivery 73
Husband involvement in ANC,INC and PNC

27.7% of husbands were not
involved during ANC visits
because their wife was sent
with a family member for
ANC check-up, 22.6% of the
husband had no knowledge
and information about ANC
visits, and 27% of the
husband were not at home.
• A study conducted in Nepal
showed that the reasons for not
to accompanied their partners
on antenatal visit were: the
feeling that this is a woman’s
duty (53.0%), they were
preoccupied with other tasks
(29.3%), they were
embarrassed (15.0%), and they
had a lack of knowledge
(2.7%) (Bhatta, 2013)
The inconsistency might be related with the busy of their work
and mostly job opportunity in foreign country that’s why husband
74
Reasons of not involvement during ANC,INC and
PNC

• 79.1% had got advice from
their husbands for adequate
rest and no heavy lift during
pregnancy. 65% of
respondents had to get
advice for regular
consumption of iron tablets
and increase the amount of
food than previous and
31.8% had advised on where
and with whom to deliver
their child. Likewise 50%
had advised for adequate
breastfeeding to their child.
• 89.23% of the husbands
suggested/advised their partners to
take nutritious food, 76.24%
husbands advised/reminded their
partners to take Iron tablets.
54.97% of the husbands
accompanied/advised their
partners for TT immunization
(Subedi and Dhakal).
• 88.6% of husbands discussed with
the doctor on the health-related
condition of their partners. More
than half of the study participants,
62.9% involved in the decision
making where their wife should
(Shine et al., 2020)
75
Advices from husbands

83.6% had got help from their
husband during pregnancy to buy
medicine, 21% had helped in birth
preparedness and arrangement of
money and vehicles to visits for
health facility. At the time of
delivery, 98.5% had helped in the
arrangement of foods, and 94.2% of
the husband had discussed with the
health worker about the health of
mother and baby.
78.4% helped their wives
in household chores and
45.6% cleaned clothes and
other materials during their
wives pregnancy for safe
delivery (Bhusal and
Bhattarai, 2018)
• Getting more helps and support from husband may be due to the
practice of spending more time with husband and wife totally
depends on their husband’s. 76
Helps from husbands

84.9% spousal had made a decision
for a health checkup, 83.6% had
discussed proper diet and nutrition,
76.4% had discussed for their ANC
and PNC visits, 75.7% had
discussed for money arrangement,
51% had discussed for institutional
delivery and only 7.5% had
discussed for use of family planning
services.
Half of the women (55%)
reported that their husband
alone made the decision
about their own health care
(Poudel and Pitamanaket,
2010).
• Husband is only the people with whom a women can share and
do discussed with their health issues and they are not allowed to
talk any other persons. So Muslim women do more
communication with husband only.
77
Spousal communication

62.2% had not visited a health
facility for their delivery
because their self and family
decided to make her delivery at
home, 18% had no money,
9.8% had no people at home to
take them in the health facility
and 9% had no trust on staffs
and the services provided by
health facility
A study conducted in India
showed that he major cause for
not delivering youngest child in
health facility is cost that is too
much (5.01 percent), husband
did not think it is necessary
(5.49 percent), family did not
think it is necessary (3.60
percent) followed by mother
did not think it is necessary and
other causes related health
facilities (Sinha, 2016).
78
Causes of home delivery

39.4% respondents have visited
at least two to three times, and
60.3% respondents have visited
four times for their ANC check-
up. 86.0% have visited
Doctor/ANM/Nurse and 14.0%
have visited with HA/AHW for
their ANC Check-up. 58.2%
had delivered their baby in the
health facility and with SBA
and 41.8% had assisted with
traditional birth attendants
(TBA) at home delivery
NDHS report showed that 84%
of women received ANC from a
skilled provider and 69% of
women had at least four ANC
visits. 58% of deliveries are
conducted by SBAs, and 57%
of deliveries take place in a
health facility. Only 57% of
both mothers and newborns
receive a PNC check within 2
days of delivery. (Ministry of
Health et al., 2017)
79
Practice of ANC,INC and PNC

Limitations of the study
 The study was conducted only in Paroha
municipality of Rautahat district. The findings of this
study may not be generalized for the national level
because of the small sample size and also the
geographical differences.
 Husband’s involvement in maternal health care in
the survey were characterized by woman’s report
and not directly from the male partners which may
be the limitation of the study.
11/29/2021 80

Limitations of the study
 Lack of previous quantitative studies related to
husband’s involvement in maternal health care also
constrained to compare the results
 Possibility of recall bias.
11/29/2021 81

Strengths of the study
Researcher himself had involved in the collection of data.
This study helps to guide maternal health program
planners and policymakers to understand existing
situation of utilization of maternal health care services
and various factors influencing the utilization of ANC,
INC and PNC services among Muslim women.
11/29/2021 82

Conclusion
 This study concluded that majority of the Muslim
women had low utilization of maternal health care
services.
 Only 60.3% women received complete (four times)
ANC checkup while nearly half of the Muslim
women (40%) refused to receive a complete ANC
visits due to their families did not allowed them to
visits the health facility
83

Conclusion
 96.2% of them received Td. Vaccination and had
taken full course of iron tablets and 91.4% taken anti
helminthes drug.
 Nearly half of the respondents (41.8%) had home
delivery with the help of TBAs which is still a major
health issues among the Muslim community.
 Likewise, 67.1 % had PNC checkup but 1/4th of
them (25%) had not completed 3 times PNC
checkups till 45 days after delivery
84

Conclusion
 Husband involvement can affect pregnancy and
childbirth through responding to complications, seeking
medical help, paying for transport, and allocating
household resources.
 Husband involvement and utilization of maternal
health care services is still highly affected by socio-
economic, education cultural factor and traditional
values and norms. Beside this health education,
available of health services and knowledge and
information regarding maternal and child health may
also affect in utilization of maternal health care
services. 85

Recommendations
For policy makers:
• The women of that community were mostly housewives
and they are involved in the activities of indoor works.
So, it must be brought opportunities in indoor and
outdoor for them to improve their economic status.
• Government should organized special program for
Muslim community to make them in access of MCH
services.
• Reproductive health education is necessary to provide
adolescents both boy and girl from secondary school and
mostly in Madarsa (A Islamic School).
86

Recommendations
For improving the utilization of MCH Services:
• It should sensitize the target mothers on the benefits of
visiting ANC clinics, utilizing delivery and postnatal
services at health facilities or at home setting through SBA
• The government should be provided family planning
devices easily in the study area and government should be
conducted a separate package program for Muslim
community
• The respondents of that community have not getting
participants in governmental or non-governmental
programs. So they should be participated in such program.
That’s why they become aware of their status.
87

Recommendations
For further study:
• There is the gap of adequate and proper counseling
from health workers during ANC, institutional
delivery and PNC visits. So a further study can be
done for this issue.
• A study can be undertaken into planning and
implementing a model of an effective reproductive
and safe motherhood program to meet and address the
health problems of the Muslim community
88

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Thesis presentation: "Role of Husband (Involvement) in Utilization of Maternal Healthcare Services Among Muslim Women of Rautahat District, Nepal",