Male partners' participation in birth preparedness and complication readiness in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Background: Maternal and neonatal health outcomes remain a challenge in low- and middle-income countries (LMICs) despite priority given to involving male partners in birth preparedness and complication readiness (BPCR). Men in LMICs often determine women's access to and affordability of health services. This systematic review and meta-analysis determined the pooled magnitude of male partner's participation in birth preparedness and complication readiness in LMICs.

Methods: Literature published in English language from 2004 to 2019 was retrieved from Google Scholar, PubMed, CINAHL, Scopus, and EMBASE databases. The Joanna Briggs Institute's critical appraisal tool for prevalence and incidence studies were used. A pooled statistical meta-analysis was conducted using STATA Version 14.0. The heterogeneity and publication bias were assessed using the I² statistics and Egger's test. Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis was carried out to validate publication bias and heterogeneity. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of birth preparedness and complication readiness. The review protocol has been registered in PROSPERO number CRD42019140752. The PRISMA flow chart was used to show the number of articles identified, included, and excluded with justifications described.

Results: Thirty-seven studies with a total of 17, 148 participants were included. The pooled results showed that 42.4% of male partners participated in BPCR. Among the study participants, 54% reported having saved money for delivery, whereas 44% identified skilled birth attendants. 45.8% of male partners arranged transportation and 57.2% of study participants identified health facility as a place of birth. Only 16.1% of the male partners identified potential blood donors.

Conclusions: A low proportion of male partners were identified to have participated in BPCR in LMICs. This calls countries in low- and middle-income setting for action to review their health care policies, to remove the barriers and promote facilitators to male partner's involvement in BPCR. Health systems in LMICs must design and innovate scalable strategies to improve male partner's arrangements for a potential blood donor and transportation for complications that could arise during delivery or postpartum haemorrhage.

Keywords: Birth Preparedness; Complication Readiness; LMICs; Male involvement; Participation.

Fig. 1

Flow diagram of the included studies. Moher, D., et al., Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 2009. 6(7)

Fig. 2

Funnel plot used to assess possible publication bias of studies published from 2004 to 2020

Fig. 3

Pooled magnitude of male partners’ participation in birth preparedness and complication readiness in LMICs, 2004–2020

Fig. 4

Pooled estimate of male partners’ who saved money for delivery in LMICs, 2004–2020

Fig. 5

Pooled estimate of male partners’ who arranged blood donor for complications during delivery and postpartum period in LMICs, 2004-

Fig. 6

Pooled estimate of male partners’ who identified skilled birth attendant in LMICs, 2004–2020

Fig. 7

Pooled estimate of male partners’ who arranged transportation for the pregnant mother and postpartum women in global south, 2004–2020

Fig. 8

Pooled estimate of male partners’ who identified health facility as place of birth for the baby in global south, 2004–2020

Fig. 9

Pooled estimate of male partners’ who knew danger signs during pregnancy and childbirth in LMICs, 2004–2020

Fig. 10

Pooled estimate of male partners’ who accompanied their wife to antenatal clinic in global south, 2004–2020