BACKGROUND: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men’s participation in antenatal care with their pregnant partner in PNG. METHODS: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across four provinces of PNG. Fourteen key informant interviews were also conducted with health workers. Qualitative data generated were analysed thematically. RESULTS: While some men accompany their pregnant partners to the antenatal clinic and wait outside, very few men participate in antenatal consultations. Factors supporting fathers' participation in antenatal consultations included feelings of shared responsibility for the unborn child, concern for the mother’s or baby’s health, the child being a first child, friendly health workers, and male health workers. Sociocultural norms and taboos were the most significant barrier to fathers' participation in antenatal care, contributing to men feeling ashamed or embarrassed to attend clinic with their partner. Other barriers to men’s participation included fear of HIV or sexually transmitted infection testing, lack of separate waiting spaces for men, rude treatment by health workers, and being in a polygamous relationship. Building community awareness of the benefits of fathers participating in maternal and child health service, inviting fathers to attend antenatal care if their pregnant partner would like them to, and ensuring clinic spaces and staff are welcoming to men were strategies suggested for increasing fathers' participation in antenatal care. CONCLUSION: This study identified significant sociocultural and health service barriers to expectant fathers' participation in antenatal care in PNG. Our findings highlight the need to address these barriers - through health staff training and support, changes to health facility layout and community awareness raising - so that couples in PNG can access the benefits of men’s participation in antenatal care.
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We are grateful to the men, women, and health workers in Chimbu
Province, National Capital District, Southern Highlands Province and Western
Highlands Province who gave their time to take part in FGDs and KIIs. We
thank Wendy Holmes from Burnet Institute and Christiana Morf from UNICEF
PNG Country Office for their assistance with study design and Wing-Sie
Cheng, HIV Regional Advisor for UNICEF East Asia and Pacific Regional Office,
for reviewing the study report. The authors would also like to acknowledge
the support of the Provincial AIDS Councils in providing local data collectors
to implement this study, and the data collection teams who organised and
completed FGDs and KIIs, and assisted in data analysis for this study. We
gratefully acknowledge the contribution to this work of the Victorian
Operational Infrastructure Support Program received by the Burnet Institute.
This study was funded by UNICEF PNG, to support a pilot program for
improving male involvement in PPTCT implemented in partnership with PNG
Catholic HIV/AIDS Services Incorporated (CHASI). The Study received
technical support and approval from UNICEF PNG, CHASI and the National
Department of Health.