Dissertation
Masculinity and maternal, newborn, and child health: rethinking male engagement in pregnancy and childbirth
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2021
DOI: 10.17077/etd.006306
Abstract
Men's engagement in maternal, newborn, and child health (MNCH) is associated with positive health outcomes for mothers and their newborns. However, most evidence supporting these claims is limited to industrialized countries, and studies from low- and middle-income countries, especially those from patriarchal societies, report mixed results. Furthermore, the current literature related to male engagement in MNCH has other limitations, including poor conceptualization of male engagement and lack of focus on masculinity, masculine capital, and relationship capital. Guided by the implicit gender role theory, this dissertation sought to understand the intersection of the socio-cultural construction of gender identity and male engagement in MNCH. Chapter 2 employs a meta-analytical approach to the study of male engagement in MNCH and included studies from Africa, Middle East, Asia, and Latin America (n=89). Gender-equitable male engagement approaches had a statistically significant positive association with the use of at least four antenatal (ANC) visits (adjusted odds ratio[aOR]=1.46, 95% confidence interval [95%CI]=1.22-1.70), having a skilled attendant at birth (aOR=1.74, 95%CI=1.32-2.17), use of postpartum care (aOR=1.31, 95%CI=1.18-1.44), use of postpartum modern family planning (aOR=1.52, 95%CI=1.27-1.77), adherence to antiretroviral treatment (aOR=2.37, 95%CI=1.37-3.38), and exclusive breastfeeding at least for six months (aOR=2.87, 95%CI=1.10-4.63). Gender-equitable engagement also had a statistically significant inverse association with the experience of pregnancy complication (aOR=0.50, 95%CI=0.30-0.69) and infant/neonatal mortality (aOR=0.35, 95%CI=0.17-0.53). Accompanying one's partner to the health facility and provision of support also had a significant association with some of the outcome variables.
Chapter 3 used primary data collected among married men in Western Kenya who had a child in the last 12 months (n=280) to investigate whether there is an association between the perception of masculinity and male engagement in MNCH and whether masculine capital and relationship capital explain the association. Perception of masculinity had a statistically significant inverse association with male engagement in MNCH (aOR=0.80, 95%CI=0.71-0.91), and 34% of the association is explained by masculine capital.
Chapter 4 used data from seven Focus Group Discussions (FGDs) conducted among married women (mothers and mothers-in-law) in Western Kenya (n=53) to examine women's perspectives on men's engagement in MNCH. Social pressure was reported as one of the factors that prevented gender-equitable male engagement in MNCH. The support for increased male engagement in MNCH varied between mothers and mothers-in-law, with mothers-in-law showing less support and more negative attitudes toward greater male engagement in MNCH. Mothers-in-law's resistance to male engagement in MNCH appeared to be framed by broad factors, including their view that women, by virtue of their gender, are designed to take care of children, the perception that MNCH is “women's business,”, their desire to avoid social pressure or negative stereotyping, and their desire to safeguard the space from men's control.
Overall, the three empirical chapters demonstrate the importance and the need for greater integration of gender-transformative conceptual approaches into future male engagement interventions, with effective measures built into such interventions to develop the evidence base for their impact on a broad range of health and gender equity outcomes. It also showed the importance of incorporating women's views and voices in male engagement policies, research, and intervention designs. Thus, researchers, policymakers, funders, and practitioners in the field of MNCH may benefit from an increased focus on a gender-equitable male engagement that recognizes men as agents of positive change with the ability to transform underlying gendered constraints on MNCH and support men to challenge pre-existing roles and norms surrounding masculinity, intimate partner relationships, and parenting.
Details
- Title: Subtitle
- Masculinity and maternal, newborn, and child health: rethinking male engagement in pregnancy and childbirth
- Creators
- Halkeno Tura
- Contributors
- William T Story (Advisor)Edith A Parker (Committee Member)Paul A Gilbert (Committee Member)Sato Ashida (Committee Member)Jennifer L Glanville (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Community and Behavioral Health
- Date degree season
- Autumn 2021
- DOI
- 10.17077/etd.006306
- Publisher
- University of Iowa
- Number of pages
- 242 pages
- Copyright
- Copyright 2021 Halkeno Tura
- Language
- English
- Description illustrations
- color illustrations, color maps
- Description bibliographic
- Includes bibliographical references (pages 158-208).
- Public Abstract (ETD)
Men's engagement in maternal, newborn, and child health (MNCH) is generally associated with positive health outcomes for mothers and their newborns. However, there is a dearth of evidence about the impact of male engagement approaches on uptake of MNCH services and MNCH outcomes in low- and middle-income countries (LMICs), and little is known about how gender identity (i.e., perception of masculinity) and men's increased investment in their gender identity ( i.e., masculine capital) and relationships with their partners (i.e., relationship capital) affects their engagement in MNCH. Furthermore, views of childbearing women on increased male engagement in the roles traditionally held by women is largely missing from the current male engagement literature. This dissertation used meta-analysis of male engagement studies from LMICs, as well as qualitative and quantitative primary data collected from Western Kenya to address the aforementioned gaps in the male engagement literature. Study 1 (presented in Chapter 2) assessed the associations between types of male engagement and uptake of MNCH services and showed that gender-equitable approaches to male engagement improved uptake of MNCH services compared to other male engagement approaches. Study 2 (presented in Chapter 3) assessed the association between perception of masculinity and male engagement in MNCH and whether masculine capital and relationship capital explained the association. This study showed that increased perception of masculinity was inversely associated with male engagement in MNCH, and the association was partially mediated by masculine capital. In Study 3 (presented in Chapter 4) qualitative methods were used to assess women's views of increased male involvement in MNCH. Compared to mothers in the study, mothers-in-law had a less favorable view of increased male engagement in MNCH. Overall, these three studies demonstrate that better understanding gender-equitable approaches to male engagement in MNCH may inform future male engagement research, policies and interventions that recognizes men's ability to transform underlying gendered constraints on MNCH.
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984210749802771
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