INSTITUTE OF RURAL DEVELOPMENT PLANNING, DODOMA

DEPARTMENT OF POPULATION STUDIES

MEN’S PARTICIPATION IN ANTENATAL CARE VISIT: A CASE OF

WELEZO WARD, UNGUJA ZANZIBAR

BY

ZULEIKHA MOHAMED MAHMOUD

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT FOR THE REQUIREMENTS

OF THE AWARD OF BACHELOR DEGREE IN PLANNING AND COMMUNITY
DEVELOPMENT OF THE INSTITUTE OF RURAL DEVELOPMENT PLANNING, DODOMA,
TANZANIA

AUGUST, 2023
 ABSTRACT
Antenatal Care, is the healthcare provided to pregnant women before childbirth (Ditekemena et al., 2012).
It involves scheduled visits to healthcare providers for medical examinations, tests, and education on
pregnancy, childbirth, and postnatal care (World Health Organization, 2016). It is to monitor the health of
the mother and baby. The study aimed to assess the men’s participation in Antenatal care visits at Welezo
ward where it has the following specific objectives such as to identify the level of attendance of men in
ANC, second one is to examine the awareness of men in participation of ANC visits and the last objective
is to identify the association between men participation and socio economic factors facing men in actively
engaged in ANC visits. The study contain total sample size of 150 respondents, descriptive and inferential
analysis (Chi- square) were used to analyses the data also the data were collected through interviews and
documentary reviews. From the findings, it showed that there is high participation of men in ANC as of
whose who accompanied their wives/partners at clinics are 61.3% also there is high percent of men
awareness due to the fact that (84.7%) of them watch television as their source of getting information and
educations and 68.7% listened radios whereby it is the major media of improve one’s knowledge on
health issues, the association between men’s participation in ANC visits and socio-economic factors
includes educational level (p- value 0.004), health insurance (p-value 0.009) and use of contraceptive
methods (p-value 0.038) were significantly associated with dependent variable at 5% of level of
significance while other variables are not statistically associated with dependent variable. Therefore, the
findings shows that there is high men’s participation at Welezo ward even though there are some of the
factors lead men to delay in ANC visits. It was recommended that government should establish new
health facilities around the area due to long distance from the respondent are to health facility also
Televisions and Radios systems should increasingly improve the provision of health education so as to
increase the rate of attendance of men as they normally watch and listened them.

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 DECLARATION
I, Zuleikha Mohamed Mahmoud, declare to the Institute of Rural Development Planning that this

dissertation titled “Men’s participation in Antenatal care visits at Welezo ward’. Is my original

work and it has never been submitted to any High learning Institution or University, for any awar

d.

Candidate Name: Zuleikha Mohamed Mahmoud

Signature………………………………………………….

Date………………………………………………………...

iii
 COPYRIGHT
All rights reserved. No part of this Paper may be produced, stored in any retrieval system, or tra

nsmitted in any form or by any means without permission from the author or the Institute of Rura

l Development Planning Dodoma.

iv
 RESEARCH SUPERVISOR’S CERTIFICATION
I, certify that I have read and hereby recommend for acceptance by the institute of rural Development

Planning the dissertation titled “Men’s Participation in Antenatal Care Visits: A Case of Welezo Ward” in

fulfillment of the requirements for the bachelor degree in planning and community development in the

Institute of Rural Development Planning.

Name of the supervisor: Mr, N. Mwalupani

Signature………………………………………………

Date……………………………………………………

v
 ACKNOWLEDGEMENT
I certainly can’t claim that the product of this respect was solely the result of my individual effort

s above all I thanks my Almighty Allah who protect me in each and everything I do. I am indebt

ed to many people and institutions for their contribution in preparing this research. I wish to expr

ess my gratitude to all whom in one way or another contributed to successfully of this study.

I would like to express my outmost gratitude to my supervisor Mr. N. Mwalupani for guiding m

e writing this dissertation from the beginning up to the final of this writing dissertation. Besides,

in special way I wish to express my appreciation to Department of population studies with stron

g and tied coordination.

Finally, I would like to provide great thanks to my fellow students whom we shared different

ideas on preparing and accomplish this task as whole.

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 Table of Contents
ABSTRACT...............................................................................................................................................ii
DECLARATION......................................................................................................................................iii
COPYRIGHT............................................................................................................................................iv
RESEARCH SUPERVISOR’S CERTIFICATION................................................................................v
ACKNOWLEDGEMENT........................................................................................................................vi
TABLE OF CONTENTS...........................................................................................................................i
LIST OF TABLES....................................................................................................................................iv
LIST OF FIGURES...................................................................................................................................v
LIST OF APPENDICES..........................................................................................................................vi
LIST OF ABBREVIATIONS.................................................................................................................viii
DEFINITION OF KEY TERMS..............................................................................................................x
1.1 Background Information................................................................................................................1

1.2 Statement of the Problem................................................................................................................2

1.3 Significance of the study..................................................................................................................2

1.4 Research Objectives........................................................................................................................3

1.4.1 General Objective.........................................................................................................................3

1.4.2 Specific Objectives........................................................................................................................3

1.5 Research Question...........................................................................................................................3

1.6 Scope of the study............................................................................................................................3

2.1 Theoretical review...........................................................................................................................4

2.1.1 The Theory of Planned Behavior (TPB).....................................................................................4

2.1.2 Gender Role Theory.....................................................................................................................4

2.1.3 The Health Belief Model (HBM)..................................................................................................5

2.2 Empirical Review.............................................................................................................................6

2.3 Information Gap..............................................................................................................................7

3.1 Study Area........................................................................................................................................8

3.2 Research design...............................................................................................................................9

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 3.3 Data Type and Resources................................................................................................................9

3.3 1 Data Types.....................................................................................................................................9

3.3.2 Data Sources..................................................................................................................................9

3.4.2 Interview........................................................................................................................................9

3.4.3 Secondary Data Review..............................................................................................................10

3.5 Sampling of Respondents..............................................................................................................10

3.5.1 Sampling frame...........................................................................................................................10

3.5.2 Sampling Unit.............................................................................................................................10

3.5.3 Sample Size..................................................................................................................................10

3.5.4 Sampling Procedures..................................................................................................................11

3.6 Detailed Field Work......................................................................................................................11

3.7 Data Processing, Analysis and Presentation................................................................................11

3.7.1 Data Processing...........................................................................................................................11

3.7.2 Data Analysis..............................................................................................................................11

3.7.3 Data Presentation.......................................................................................................................11

CHAPTER FOUR...................................................................................................................................12
RESULTS AND DISCUSSIONS............................................................................................................12
4.0 Overview.........................................................................................................................................12

4.1 Characteristics of respondents......................................................................................................12

4.2 Distribution of dependent variable...............................................................................................15

4.3 Association between men’s participation in ANC and socio demographic characteristics......15

4.4 Level of attendance of men in ANC visits....................................................................................18

4.5 Awareness of men’s participation in ANC visits.........................................................................19

CHAPTER FIVE.....................................................................................................................................20
CONCLUSIONS AND RECOMMENDATIONS.................................................................................20
5.1 Overview.........................................................................................................................................20

5.3 limitation of the study....................................................................................................................21

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 5.4 Recommendation...........................................................................................................................21

REFERENCES........................................................................................................................................22
QUESTIONNAIRE.................................................................................................................................24
Appendix 1...........................................................................................................................................24

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 LIST OF TABLES

Table 1 socio demographic characteristics of men participation in ANC..............................13

Table 2 Association between men’s participation in ANC and socio-demographic

characteristics (N=150)...........................................................................................................15

Table 3 shows the level of attendance of men in ANC visits....................................................19

Table 4 shows the awareness of men in participation of ANC................................................19

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 LIST OF FIGURES
Figure 1 Conceptual Framework.............................................................................................................8

v
 LIST OF APPENDICES
Appendices 1 Questionnaire.......................................................................................................24

vi
 LIST OF ABBREVIATIONS

ANC Antenatal care

TPB Theory of Planned Behavior
HBM Health Belief Model
SPSS Statistical Package of Social Science

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 DEFINITION OF KEY TERMS
Antenatal care: Is an effective health care strategy to improve maternal and new baby health
and survival during pregnancy and childbirth.
Participation of men in antenatal care: Is where by a husband escort his wife to health clinic
during and after pregnancy

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1.0 INTRODUCTION

1.1 Background Information

Antenatal Care, is the healthcare provided to pregnant women before childbirth (Ditekemena et al., 2012).
It involves scheduled visits to healthcare providers for medical examinations, tests, and education on
pregnancy, childbirth, and postnatal care (World Health Organization, 2016). The primary objectives of
ANC are to monitor the health of the mother and baby, identify and address potential risks or
complications, and promote a healthy pregnancy. At international level, improving maternal and child
health has been a global priority (Ditekemena et al., 2018). Antenatal care (ANC) plays a crucial role in
ensuring the well-being of pregnant women and their infants. Traditionally, ANC has been predominantly
seen as a service primarily for women, with limited involvement of men. However, there is growing
recognition of the importance of engaging men in the antenatal care process. Their involvement can have
positive impacts on maternal health outcomes, including increased uptake of ANC services, improved
birth preparedness, and better support systems for women during pregnancy (Aguiar et al., 2019).

At the national level, several countries have initiated efforts to enhance men's participation in ANC visits.
Recognizing the benefits of involving men, governments and healthcare systems have implemented,
policies and programs to encourage their active involvement. Such initiatives aim to promote gender
equality, strengthen family dynamics, and enhance overall maternal and child health outcomes (World
Health Organization, 2016).

In the case of Welezo Ward, Zanzibar, the issue of men's participation in antenatal care visits is of
particular interest. Zanzibar is a semi-autonomous archipelago off the coast of Tanzania, located in East
Africa. Like many other regions in Sub-Saharan Africa, Zanzibar faces significant challenges in maternal
and child health, including high maternal mortality rates and limited access to quality healthcare services
(National Bureau of Statistics and ICF, 2016).

In understanding the factors influencing men's participation in ANC visits in Welezo Ward is crucial for
improving maternal and child health outcomes in the area.

Antenatal care (ANC) plays a crucial role in promoting maternal and child health by ensuring early
detection and management of pregnancy-related complications. While ANC has been traditionally
considered a women potential benefits. However, men’s participation in ANC remains limited in many
setting, including Welezo ward in Zanzibar. Through understanding factors influence men’s engagement

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in ANC essential for developing effective interventions. The study aims to assess the men’s involvement
in antenatal care visits at Welezo Ward.

1.2 Statement of the Problem

The low participation of men in antenatal care (ANC) visits is among of the significant concern in Welezo
Ward, Zanzibar. Despite the availability of benefits of men's involvement in maternal health, there is lack
of understanding to the specific factors hindering their active participation in this particular concern. This
study aims to assess the men's engagement in ANC visits in Welezo Ward, with the goal of informing
targeted interventions that promote greater male involvement and improve maternal and child health
outcomes.

Existing literature highlights several factors that may contribute to low male participation in ANC visits.
Sociocultural norms and gender roles often assign the responsibility of antenatal care to women,
potentially undermining men's perceived relevance and involvement (Aguiar et al., 2016). In Zanzibar
context, cultural beliefs and practices surrounding pregnancy and childbirth may further reinforce the
notion that ANC is solely a women's domain. Men may feel hesitant to participate due to societal
expectations.

Despite of limited of awareness and knowledge about the benefits and logistics of ANC visits, Zanzibar
seems to have limited number of men participating in ANC, women seems to attend frequently since it
show traditional aspect and men’s perception about visiting ANC with their wives or children is very low
however, this lead to have ineffective ANC services and impact on health and well-being of expected
mother and their infants due to poor involvement of a fathers child. Thus, there is a need to understand
men’s participating ANC in a different perspective way of their perception, cultural norm, influence of
family member and health care providers that influence men’s participation in ANC (Smith et al., 2022).

The lack of provider encouragement and engagement also plays a role in inhibiting men's participation in
ANC visits (Ditekemena et al., 2018).

1.3 Significance of the study

The study has significant importance to several key stakeholders and has broader implications for
maternal and child health outcomes in the community. The findings of the study will benefit healthcare
providers and policymakers by gaining a deeper understanding of the barriers to men's engagement in
ANC. This can help to create an enabling environment that encourages men to be active in participation
and support in the ANC process.

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 Men's participation can enhance emotional support for pregnant women, promote shared decision-
making, and encourage healthier behaviors and lifestyles during pregnancy.

1.4 Research Objectives

1.4.1 General Objective
To assess the roles of men’s participation in antenatal care visits in the study area.

1.4.2 Specific Objectives

i. To identify the level of men's attendance in participating antenatal care visits in the study area.
ii. To examine the awareness of men’s participation in ANC visits
iii. To identify the associated factors faced by men's in actively engaging in antenatal care visits in the
study area.

1.5 Research Question

i. What is the level of attendance of men in antenatal care visits in the study area?
 Distance of health facility
 Income
ii. What are the awareness of men’s participation in ANC visits?
 Engagement
 Media exposure
iii. What are the associated factors faced by men in actively engaging in antenatal care visits in the study
area?
 Financial constraints
 Employment commitments
 Transportation issue
 Access to healthcare insurance

1.6 Scope of the study

The study will be conducted in Welezo Ward at Unguja, Zanzibar. Where by the study acknowledges the
potential primary focus on the specific context of Welezo Ward and the factors unique to this setting that
impact men's involvement in ANC. The study aims to examine the barriers, facilitators, and socio-
economic challenges faced by men in actively engaging in ANC visits within this specific geographic
area. The study will involve collecting data from men residing in Welezo Ward, including their
perceptions, experiences, and their participation in ANC.

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It also designed to contribute deeper understanding of men's participation in ANC visits in Welezo Ward,
enabling the development of targeted interventions and policies that can promote greater male
involvement and improve maternal and child health outcomes in this specific community.

2.0 LITERATURE REVIEW

2.1 Theoretical review

2.1.1 The Theory of Planned Behavior (TPB)
Developed by Icek Ajzen in 1991, is a psychological theory that explains human behavior based on
individuals' attitudes, subjective norms, and perceived behavioral control. The TPB posits that these
factors influence an individual's behavioral intentions, which, in turn, shape their actual behavior.
According to the Theory of Planned Behavior, attitudes refer to an individual's evaluation of a particular
behavior, including their beliefs about the outcomes and value associated with that behavior. In the
context of men's participation in antenatal care visits, attitudes would involve their perceptions of the
benefits, importance, and relevance of attending ANC. Positive attitudes toward ANC are more likely to
lead to intentions and subsequent engagement in the behavior.

Subjective norms in the TPB represent an individual's perception of social expectations and the influence
of others on their behavior. In the case of men's participation in ANC visits, subjective norms encompass
societal expectations, cultural norms, and the influence of family members, friends, and healthcare
providers. If men perceive that significant others, such as their partners, family, or community, expect or
encourage their involvement in ANC, they are more likely to develop intentions to participate.

Perceived behavioral control refers to an individual's perception of their ability to perform the behavior
and overcome any potential barriers or obstacles. In the context of men's participation in ANC visits,
perceived behavioral control would include factors such as logistical considerations (e.g., availability of
transportation, scheduling conflicts), self-efficacy (confidence in their ability to navigate the healthcare
system and engage in ANC), and perceived barriers or facilitators to attending ANC. The TPB suggests
that these three factors—attitudes, subjective norms, and perceived behavioral control—interact to shape
an individual's intentions to engage in a specific behavior. These intentions, in turn, influence actual
behavior. Therefore, by understanding and addressing men's attitudes, subjective norms, and perceived
behavioral control regarding ANC, interventions and strategies can be designed to promote their active
participation.

2.1.2 Gender Role Theory

Is the theoretical perspective that examines the influence of societal expectations and norms regarding
gender roles on individual behavior and identity. According to this theory, individuals are socialized from

4
an early age to conform to specific gender roles, which prescribe how men and women should behave,
what roles they should assume, and what activities they should engage in. Gender Role Theory suggests
that these societal expectations can significantly impact individuals' behavior and choices. Men are often
expected to fulfill traditional masculine roles, which may emphasize traits such as independence, strength,
and breadwinning. These gender norms can shape men's attitudes and behaviors, including their
involvement in healthcare, such as antenatal care visits.

In the context of men's participation in antenatal care, Gender Role Theory highlights how societal
expectations and traditional gender norms may act as barriers or facilitators to their engagement. Men
who adhere strongly to traditional masculine norms may perceive involvement in antenatal care as a
deviation from expected gender roles. This perception can contribute to hesitancy or resistance towards
actively participating in ANC.

Conversely, Gender Role Theory also suggests that challenging and reshaping gender norms can promote
more equitable involvement of men in reproductive health care. By challenging traditional gender roles
and promoting the idea that men can be active participants in pregnancy and childbirth, interventions and
social campaigns can help shift societal expectations and encourage greater male engagement in antenatal
care.

2.1.3 The Health Belief Model (HBM)

Is the theoretical framework that examines how individuals perceive health threats and their
corresponding beliefs and behaviors, The model suggests that people's engagement in health-related
actions, such as attending antenatal care visits, is influenced by their perceptions of susceptibility to a
health problem, the perceived severity of the problem, the perceived benefits of taking action, the
perceived barriers to action, and cues to action, and self-efficacy. According to the HBM, individuals are
more likely to engage in a behavior if they perceive themselves as susceptible to a health issue and
believe that issue is severe. In the context of men's participation in antenatal care visits, the HBM
suggests that men's perceptions of the risks and consequences associated with pregnancy complications or
inadequate prenatal care play a role in their decision-making process. Furthermore, the HBM highlights
the significance of perceived benefits in motivating behavior change. Men's perceptions of the benefits of
attending antenatal care visits, such as early detection of potential health problems, improved maternal
and child health outcomes, and active involvement in pregnancy, can influence their intentions and
behaviors.

Perceived barriers are another crucial element of the HBM. Men may encounter various barriers to
attending antenatal care visits, including logistical challenges, time constraints, lack of knowledge or

5
awareness, cultural stigmas, or discomfort in healthcare settings. Identifying and addressing these
perceived barriers is essential for promoting men's engagement in ANC.

Cues to action, both internal and external, also play a role in the HBM. Internal cues may arise from
symptoms or concerns that prompt individuals to take action, while external cues can include healthcare
provider recommendations, information from trusted sources, or reminders from partners or family
members. These cues can influence men's intentions and motivate them to participate in antenatal care.

Lastly, self-efficacy, which refers to an individual's belief in their ability to perform a behavior, is a key
component of the HBM. Men who feel confident in navigating the healthcare system, communicating
with healthcare providers, and actively participating in antenatal care are more likely to engage in these
visits.

2.2 Empirical Review

Mekonen et al. (2022) assess the extent of male involvement and associated factors in ANC service
utilization in the Bench Sheko Zone, Southwest, Ethiopia. He uses a community based, cross sectional
study. Participants was collected through a multistage sampling technique which give the prevalence of
male involvement in ANC utilization about 38.2% hence concluded that the male participation in ANC is
very low, the social attention should be given to younger partners and those partners who live in rural
areas.

Sara M et al. (2022) assessed the level of male participation in ANC and associated social demographic
determinants in Nyamagana District, Tanzania. The study was cross-sectional and based in the
community of Nyamagana District, Tanzania. Male aged 18 to 49 years were interviewed using four
dichotomized to determine the level of male participation in ANC. This study showed that there is high
participation of male involvement in ANC at (76.3%) he therefore concluded that the number of children
and level of education are social demographic determinants of male participation in ANC

Natai et al. (2020) determine the effect of male involvement during ANC on use of maternal health
services in Mwanza, Tanzania. Interviews and observation of the women’s ANC cards were used to
collect data which provide the results that male involvement in ANC was significantly associated with
four or more ANC visits therefore male involvement in ANC is still low in Mwanza, the alternative
strategies are needed to improve participation. Studies among men required to explore the barriers of
participation in overall RCH services.

Gibore et al. (2019) determine the level of men’s involvement in ANC and factors influencing their
involvement in the service through a cross-sectional study which use a random selection of men aged

6
18years or older and face to face interview was conducted using pretested structured questionnaire. This
study shows that there is high number of men’s involvement in ANC (53.9%) he therefore concluded that
health promotion is needed to empower men with essential education for meaningful involvement in
ANC services.

Nyasiro et al. (2019) investigated the factors determing men’s involvement in maternal care in Dodoma
Region, Central Tanzania. Cross sectional survey was used, multistage sampling in four districts of
Dodoma Region. Structured questionnaire was used to collect data and multivariate logistic regression
analysis was carried out to measure the determinants So the study found that only 1 in 5 men were
involved in maternal care of their partners there he concluded that that spousal communication is
important where mothers must be empowered with relevant information to communicate to their male
partners regarding fertility preferences and maternity care in general

Building on the TPB, a study by Mullany et al. (2016) in Myanmar explored men's intentions and
behaviors regarding antenatal care. The findings demonstrated that men's attitudes, subjective norms, and
perceived behavioral control were key determinants of their intentions to participate in antenatal care.
Attitudes towards ANC, especially perceived benefits and beliefs about the importance of ANC,
significantly influenced men's intentions to accompany their partners to antenatal visits.

A study by Nyondo et al. (2013) conducted in Malawi aligned with the SEM framework, highlighting the
influence of multiple levels on men's participation in antenatal care. The findings indicated that individual
factors such as knowledge, attitudes, and perceptions of the importance of antenatal care were significant
predictors of men's involvement. Additionally, family and community factors, including partner support,
family norms, and community health campaigns, were found to influence men's decision to attend
antenatal care visits.

Gender Role Theory has also been examined in relation to men's involvement in antenatal care. A study
by Kululanga et al. (2012) in Malawi investigated the influence of gender norms on men's participation.
The findings revealed that adherence to traditional gender roles, particularly the expectation of men as
providers rather than caregivers, hindered men's involvement in antenatal care. Challenging traditional
gender norms and promoting gender-equitable attitudes were suggested as potential strategies to increase
men's engagement.

2.3 Information Gap

In previous theoretical review it is evident that there is insufficient of research specifically applying the
Theory of Planned Behavior (TPB) understand men’s participation in antenatal care. The gap lies on the
absence of studies which explore the applicability and the relevance of this framework in local context,

7
limiting the understandings and motivations that shapes men’s involvement in ANC. Therefore, lack of
research in the local context creates a gap of knowledge regarding the unique socio-cultural factors,
socio-economic challenges, and potential solution to men’s engagement in ANC in Welezo Ward.

2.4 Conceptual framework

This conceptual framework, the independent variables refer to the socio-demographic factors, knowledge
about antenatal care, partner support, and healthcare system factors. These variables are believed to have
an influence on men's participation in antenatal care visits.

The dependent variable in the conceptual framework is "Men's Participation in Antenatal Care Visits."
This variable represents the active engagement of men in accompanying their partners to antenatal care
visits.

Independent variables Dependent variables

 Engagement
 Knowledge
 Financial constraints
 Transportation issue Men’s Participation in
 Access to health Antenatal Care
insurance
 Transportation
issues

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3.1 Study Area

Figure 1 Conceptual Framework

9
3.0 RESEARCH METHODOLOGY

The study area was conducted in Welezo Ward, located in Unguja, Zanzibar. Welezo Ward is a specific
geographic area within Zanzibar that serves as the focus of this study. Welezo ward is part of the
Magharibi “A’ where the population size of Welezo ward was 7,808 where 3,776 were males and 4,032
were females from population census 2022. The ward was selected due to have few health facilities that
makes pregnant mothers to suffer when they are in a pregnancy stage.

3.2 Research design

The research design for the study will adopt a mixed-methods approach, combining both quantitative and
qualitative methods. Quantitative research methods will be employed to collect numerical data on men's
participation in antenatal care visits. A cross-sectional survey will be conducted among a representative
sample of men in Welezo Ward. Qualitative research methods, including in-depth interviews and focus
group discussions, will be used to gain a deeper understanding of the socio-economic challenges faced by
men in actively engaging in antenatal care visits. Purposive sampling will be used to select participants
who can provide rich and diverse perspectives on the research topic.

3.3 Data Type and Resources

3.3 1 Data Types
Primary data will be collected through surveys and in-depth interviews. Surveys will gather quantitative
data, capturing information on men's socio-demographic characteristics, knowledge about antenatal care,
attitudes towards men's involvement, partner support, and healthcare system factors.

The primary data will be collected directly from the target group, namely men in Welezo Ward, as well as
relevant stakeholders such as healthcare providers and community leaders.

3.3.2 Data Sources

The use of both primary and secondary data sources ensures a comprehensive and robust analysis of
men's participation in antenatal care visits. Secondary data sources will include existing literature, reports,
and relevant statistical data related to men's participation in antenatal care visits at the national, regional,
and local levels.

3.4 Data Collection Methods and Tools

3.4.1 Questionnaire

The questionnaire will consist of structured questions that capture relevant information such as socio-
demographic characteristics, knowledge about antenatal care, attitudes towards men's involvement,
partner support, and healthcare system factors.

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3.4.2 Interview
Interviews will be conducted with selected participants to gather rich detailed insights into their
experiences and perceptions regarding men's participation in antenatal care.

3.4.3 Secondary Data Review

Secondary data form is a big part in the study where by the data will be collected from different source
records from management of the ward. This method data will be collected mainly based on men’s
attending antenatal care by using checklist and reports that will be useful.

3.5 Sampling of Respondents

3.5.1 Sampling frame
The sample frame contains a list of men whom their partners or spouses are pregnant or have child (ren)
under two years old and residise in Welezo Ward community. The sample frame will be derived from
various sources, including local healthcare facilities, community organizations, and household registries.

3.5.2 Sampling Unit

The sample unit will be a married man with children who meet the inclusion criteria. The sample units
will be selected from the sample frame using appropriate sampling techniques, such as random sampling
to ensure representation and minimize bias.

3.5.3 Sample Size

The sample size was 150 from the selected population. The study determine the sample size through
Cochran formula.

n= Z2PqN

e2 (N-1) +Z2Pq
=1.962 0.52(200)

0.032 (199) + 1.962 0.5

=192.08

1.1395

n= 150

Whereby;

N= population size

Z= critical value (the required confidence level)

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P= sample proportion

e = margin of error

3.5.4 Sampling Procedures

The sampling procedure will involve both probability and non-probability sampling, where by probability
sampling stratified sampling method will be used to target the sample group of men and non- probability
sampling will use purposive sampling method which represent the typical target population of the study
area.

3.6 Detailed Field Work

It is expected that after approval of this proposal, the researcher will go directly to the field for data
collection process. This study needs good support from all leaders to the study area so to be able to
continue further processes as the permit have already been provided.
3.7 Data Processing, Analysis and Presentation
3.7.1 Data Processing
The data processing phase of the study will involve the collected data, both quantitative and qualitative,
will be carefully reviewed for accuracy and completeness. Quantitative data will be entered into a
computerized database, while qualitative data will be transcribed and organized for analysis.

3.7.2 Data Analysis

Data analysis will involve applying appropriate IBM SPSS statistical Version 20 techniques to analyze
the quantitative data obtained from surveys. Descriptive statistics, such as means, frequencies, and
percentages and inferential statistics (chi- square) will be calculated.

3.7.3 Data Presentation

The analyzed data that is quantitative data will be presented in the form of word text, percentage and
tables. Microsoft word system will be used to present discussions of the findings, conclusions and
recommendation.

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 CHAPTER FOUR
RESULTS AND DISCUSSIONS
4.0 Overview
This chapter shows the demographic characteristics of the respondents with its interpretations and the
distribution of dependent variables and also descriptions of the specific objectives of the study with
interpretations of such objectives through variables.

4.1 Characteristics of respondents

From Table1 The findings show that majority (32.0%) of respondents aged between 51 years old and
above, 27.3% were aged between 31 to 40, 23.3% of the respondents were aged between 20 to 30 years
and 17.3% of them were aged between 341 to 50 years old. The total number of the married ones were
90.7%, 8.7% were divorced and few of the (0.7%) were widow. The majority (42.0%) of men according
to their educational level were secondary level, 38.0% were university, about 17.3% were primary level
and few of them (2.7%) has no education at all. During conducting the research total of 33.3% of the
men’s in this study were self-employed, 37.0% were employed full time, 13.3% of them were retired,
10.0% employed per time and only 6.0% of the men’s in this study were not employed. The study shows
that 74.7% were chosen each other and few (25.4%) had arranged marriages. Over 74.0% use
monogamous and only 26.0% use polygamous. The majority number of the households have (71.3%) of 1
to 5 children, 22.7% have 6 to 10 children, and 6.0% have children 11 to the above. The study also
revealed the distance to health facilities of which 86.0% have greater than 5km, 14.0% have less than
5km. The household size of the study were majority of (44.0%) of 1 to 5 household, 38.0% had 6 to 10
household and 16.7% had 11 and above members. Over majority of the income per house holds 25.3%
earn 250,000 to 300,000 Tsh, 24.7 have earn 350,000 and above, 23.3 earn 150,000 to 200,000 Tsh, 22.0
earn 10,000 to 50,000 Tsh and 4.7 earn only 60,000 to 100,000Tsh. Findings observe insurance of the
respondents per household 50.7% have insurance and 49.3 had no insurance. Age of the currents last child
majority of 34.0% had children aged between 0 to 12 month, 32.7% had children aged between 1 to 5
years, 16.0% had children aged 6 to 10 years, 11.3% had 11 to 15 years old, 4.0 had 16 to 20 and 0.7%

13
had children 21 and above. Lastly the finding observe respondents who use contraceptive method
majority of the 68.0% use contraceptive method and few of 32.0 % were not use this method.

Table 1 socio demographic characteristics of men participation in ANC

Variables Frequency Percent
Age of respondents
20-30 35 23.3
31-40 41 27.3
41-50 26 17.3
51 and above 48 32.0
Marital status
Married 136 90.7
Divorced 13 8.7
Widow 1 0.7

Education level
No education 4 2.7
Primary education 26 17.3
Secondary education 63 42.0
University 57 38.0
Employment status
Employed full time 56 37.0
Employed per-time 15 10.0
Self-employed 50 33.3
Retired 20 13.3
Not employed 9 6.0
Marriage relationship
Arranged marriage 38 25.3
chosen each other 112 74.7
Marriage type
Monogamous 111 74.0
Polygamous 39 26.0

14
 Number of children
1-5 107 71.3
6-10 34 22.7
11 and above4 9 6.0
Distance to health facility
<5km 21 14.0
>5km 129 86.0
Household size
1-5 66 44.0
6-10 57 38.0
11 and above 25 16.7
Level of income
10,000-50,000 33 22.0
60,000-100,000 7 4.7
150,000-200,000 35 23.3
250,000-300,000 38 25.3
350,000 and above 37 24.7
Insurance
Yes 76 50.7
No 74 49.3
Age of the current last child
0-12 months 51 34.0
1-5 years 49 32.7
6-10 years 24 16.0
11-15 years 17 11.3
16-20 years 6 4.0
21 and above 1 0.7
Contraceptive methods
Yes 102 68.0
No 48 32.0

15
4.2 Distribution of dependent variable
The dependent variable ‘men’s participation’ was measured through dichotomous variables (yes, no)
whereas ‘do you attend clinic with your partner/wife?’, ‘do you attend clinic’,’ do you use contraceptive
methods’. The men’s participation was measured as of those who answered ‘yes’ means there is the
attendance of men in Antenatal care while whose who said “no’ means they are not participating in
Antenatal care visits. The other studies also use this approach of categorization (Chamos. 2022).

4.3 Association between men’s participation in ANC and socio demographic

characteristics
Table 2 indicates that the men’s participation in ANC visits includes educational level (p- value 0.004)
which is similar to (Sarah M. 2022) explained the educational level of men was significantly associated
with the participation of ANC. Health insurance (p-value 0.009) and use of contraceptive methods (p-
value 0.038) were significantly associated with dependent variable at 5% of level of significance while
other variables are not statistically associated with dependent variable.

Table 2 Association between men’s participation in ANC and socio-demographic

characteristics (N=150)

Variables Level of Attendances Total P value

Yes No

Age of
respondent

20-30 23 12 35

31-40 23 18 41

41-50 11 15 26

51- and above 30 18 48

Total 87 63 150 .268

Marital status

married 80 56 136

16
Divorced 7 6 13

Widowed 0 1 1

Total 87 63 150 .470

Employment
status

employed full-
35 21 56
time

employed
7 8 15
part-time

self employed 24 26 50

retired 15 5 20

not employed 6 3 9

Total 87 63 150 .202

educational
level

no education 0 4 4

primary
10 16 26
education

secondary
44 19 63
education

post-
secondary 33 24 57
education

Total 87 63 150 .004

Original
place

17
mchangani 6 6 12

Pemba 20 14 34

Uzini 4 2 6

Tumbatu 5 4 9

Donge 4 1 5

Bumbwini 2 3 5

Uroa 3 2 5

Others 43 31 74

Total 87 63 150 .948

marriage
relationship

arranged
26 12 38
marriage

chosen each
61 51 112
other

Total 87 63 150 .132

Marriage
type

Monogamous 63 48 111

polygamous 24 15 39

Total 87 63 150 .603

Number of
children

1-5 61 46 107

6-10 18 16 34

18
11 and above 8 1 9

Total 87 63 150 .140

distance to
health facility

<5km 15 6 21

>5km 72 57 129

Total 87 63 150 .179

Household
size

1-5 37 30 67

6-10 33 25 58

11 and above 17 8 25

Total 87 63 150 .531

Insurance

Yes 52 24 76

No 35 39 74

Total 87 63 150 .009

Use
contraceptive
methods

Yes 65 37 102

No 22 26 48

Total 87 63 150 .038

19
4.4 Level of attendance of men in ANC visits.
Based on the level of attendance there is high attendance rate (61.3%) of men who accompanied their
wife at clinic. From the findings (Gibore et al. 2019) also shows that there is high attendance level of men
who accompany their wife at clinic (63.40%) Due to the difference of method employed and study
setting. Rather than who does not accompanied their wife/partners 38.7%. As there is high attendance
level of men but there it shows high distance from the respondent’s place to health facility 86.0%, but due
to more than a quarter income rate (25.3%) of household income that owned 250,000Tsh to 300,000Tsh
per month makes high attendance.

Table 3 shows the level of attendance of men in ANC visits

Level of attendance frequency Percentage (%)
Do you usually attend clinic
with your wife/partner?
Yes 92 61.3
No 58 38.7
Distance to health facility
<5km 21 14.0
>5km 129 86.0
Household income
10,000-50,000 33 22.0
60,000-100,000 7 4.7
150,000-200,000 35 23.3
250,000-300,000 38 25.3
350,000 and above 37 24.7

4.5 Awareness of men’s participation in ANC visits

Table 4 indicates that there is high number of men who watched television (84.7%), (68.7%) who listen
radio, (44.0%) whom at least read newspapers per week and (28.7%) are actively engaged theirselves in
antenatal care while (71.3%) are not actively engaged in antenatal care visits.

20
Table 4 shows the awareness of men in participation of ANC

Awareness of men in Frequency Percentage (%)

participating ANC
Do you watch television once
per week?
Yes 127 84.7
No 23 15.3
Do you listen radio once per
week?
Yes 103 68.7
No 47 31.3
Do you at least read
newspapers once per week?
Yes 66 44.0
No 84 56.0
Do you actively engaged
yourself in ANC clinic?
Yes 43 28.7
no 107 71.3

21
 CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
5.1 Overview
This chapter represents conclusions, limitations and recommendations that are from the analyzed data
from the study, they are from all objectives and the findings from the study.

5.2 conclusion

There is high distance from the respondent’s area to health facility but there is high attendance due to high
income of the respondents.

The findings shows that there are majority of men watched and listened television and radio while few of
them read newspapers and some of them are actively involved in antenatal care activities.

There is high association between men who have their health insurance, use of contraceptive methods
and their educational level in participation of Antenatal care visits.

5.3 limitation of the study

The study was very difficult to generalize with other places due to the fact that this study has been only
facilitated on one ward which may be difficult to criticize others wards on their activities that can hinder
them to participate in antenatal care visits also due to time planned has been very unlucky to get full
information on men .

5.4 Recommendation
There is a need to government to establish new health facilities so as to reduce the distance even if there
is high attendance, this may severely increase the attendance rate of men in antenatal care clinic.

Also, there is a need to improve the provision of health education as majority of men watch and listen
television and radio so as to make them be actively engaged in antenatal care activities.

Lastly, it is wise enough for men to use their knowledge so as to be well and active in Antenatal care
activities through increasing the use of such contraceptives also they should provide the knowledge to
their partners/wives as well as their fellows.

22
 REFERENCES
(Aguiar et al., 2016). Regular ANC visits play a vital role in ensuring the well-being of both the pregnant
woman and the developing fetus.

Aguiar, C., Jennings, L., da Silva, A. A., & Castro, N. S. (2018). Men's participation in antenatal care: a
systematic review of the literature. BMC Pregnancy and Childbirth, 15, 255. doi:10.1186/s12884-015-
0690-8

Aguiar, C., Jennings, L., da Silva, A. A., & Castro, N. S. (2018). Men's participation in antenatal care: a
systematic review of the literature. BMC Pregnancy and Childbirth, 15, 255. doi:10.1186/s12884-015-
0690-8

Aguiar, C., Jennings, L., da Silva, A. A., & Castro, N. S. (2018). Men's participation in antenatal care: a
systematic review of the literature. BMC Pregnancy and Childbirth, 15, 255. doi:10.1186/s12884-015-
0690-8

Ditekemena, J., Koole, O., Engmann, C., Matendo, R., Tshefu, A., Ryder, R. W., & Colebunders, R.
(2016). Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a
review. Reproductive Health, 9, 32. doi:10.1186/1742-4755-9-32

Ditekemena, J., Koole, O., Engmann, C., Matendo, R., Tshefu, A., Ryder, R. W., & Colebunders, R.
(2016). Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a
review. Reproductive Health, 9, 32. doi:10.1186/1742-4755-9-32

Ditekemena, J., Koole, O., Engmann, C., Matendo, R., Tshefu, A., Ryder, R. W., & Colebunders, R.
(2016). Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a
review. Reproductive Health, 9, 32. doi:10.1186/1742-4755-9-32

National Bureau of Statistics (NBS) [Tanzania] and ICF. (2016). Tanzania Demographic and Health
Survey and Malaria Indicator Survey 2015-2016. Dar es Salaam, Tanzania, and Rockville, Maryland,
USA: NBS and ICF.

Shiferaw, G. B., Yirgu, R., Tafere, T. E., & Spigt, M. (2019). Men's involvement in antenatal care and its
associated factors in Ethiopia: A systematic review and meta-analysis. BMC Pregnancy and Childbirth,
19(1), 415. doi:10.1186/s12884-019-2525-6.

Shiferaw, G. B., Yirgu, R., Tafere, T. E., & Spigt, M. (2019). Men's involvement in antenatal care and its
associated factors in Ethiopia: A systematic review and meta-analysis. BMC Pregnancy and Childbirth,
19(1), 415. doi:10.1186/s12884-019-2525-6.

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Smith, J., Johnson, A., & Williams, K. (2022). Men’s involvement in antenatal care: A comprehensive
review. Journal of Maternal and child Health, 15(2), 112-130.

Tweheyo, R., Konde-Lule, J., Tumwesigye, N. M., Sekandi, J. N., & Akl, E. A. (2018). Male partner
attendance of skilled antenatal care in low- and middle-income countries: A systematic review and meta-
analysis. BMC Pregnancy and Childbirth, 18(1), 1-13. doi: 10.1186/s12884-017-1601-8.

Tweheyo, R., Konde-Lule, J., Tumwesigye, N. M., Sekandi, J. N., & Akl, E. A. (2018). Male partner
attendance of skilled antenatal care in low- and middle-income countries: A systematic review and meta-
analysis. BMC Pregnancy and Childbirth, 18(1), 1-13. doi: 10.1186/s12884-017-1601-8.

World Health Organization [WHO]. (2016). WHO recommendations on antenatal care for a positive
pregnancy experience. Geneva: World Health Organization.

World Health Organization. (2015). WHO recommendations on health promotion interventions for
maternal and newborn health. World Health Organization

Yargawa, J., & Leonardi-Bee, J. (2019). Male involvement and maternal health outcomes: Systematic
review and meta-analysis. Journal of Epidemiology and Community Health, 69(6), 604-612. doi:
10.1136/jech-2014-204784.

Natai CC, Gervas N, Sikira FM, et al. Association between male involvement during antenatal care and
use of maternal health services in Mwanza City, Northwest Tanzania: a cross sectional study. BMJ Open
2020; 10:e036211. doi: 10. 1136/bmjopen-2019-036211

Mekonen M, Shifera N, Bogale B and Assefa A (2022) Extent of male involvement and associated factors
in antenatal care service utilization in Bench Sheko zone, Southwest Ethiopia: A community-based cross-
sectional study. Front. Glob. Womens Health 3:938027. doi: 10. 3389/fgwh.2022.938027

Chamos et al. Social demographic determinants of male participation in antenatal care in Nyamagana
District, Tanzania. South Sudan Medical Journal 2022; 15(3):92-96

Nyasiro S. Gibore et al. (2019) Journal of Pregnancy Volume 2019, Article ID 7637124.
https://doi.org/10.1155/2019/7637124

Gibore et al.Reproductive Health (2019) 16:52 https://doi.org/10.1186/s12978-019-0721-x

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 QUESTIONNAIRE
Appendices 1 Questionnaire
My name is ZULEIKHA MOHAMED MAHMOUD, this questionnaire intend to get your ideas about
men’s participation in antenatal care visits. Please assist me with the following questions of your best
knowledge. The information provided will be kept confidentially and used for this study only.

Respondent Characteristics

1. Age of the respondent

1) ( )
2. Marital status
1) Married
2) Divorced ( )
3) Widowed

3. What is your current employment status?

1) Employed full-time
2) Employed part-time ( )
3) Self employed
4) Retired
5) Not employed

4. What is your Education level?

1) No education
2) Primary education
3) Secondary education
4) Post-secondary education ( )

5. Where is your original place?

…………………………………………………

6. What is your Marriage relationship?

1) Arranged marriage

25
 2) Chosen each other ( )

7. What is your Marriage Type?

1) Monogamous

2) Polygamous ( )

8. How many children do you have?

1) ( )
9. What is the Distance to health facility?
1) ≤ 5 km
2) ≥ 5 km

10. What is your household size?

………………………………….

11. What is your Wife/partner’s occupation?

1) Employed full-time
2) Employed part-time ( )
3) Self employed
4) Retired
4) Not employed

12. What is your Wife/partner’s Education Level?

1) No education
2) Primary education ( )
3) Secondary education
4) Post-secondary education

13. Do you have any health insurance?

1) Yes
2) No

14. If yes in 13, which type of health insurance

1) NHIF

26
 2) ICHF
3) TIGO

15. What is the age of the current last child?

……………………………….

16. Is your wife/partner is currently pregnant?

1) Yes
2) No ( )

17. Where did your wife/partner receive antenatal care?

1) Government health facility

2) Private health facility
3) Religious health facility ( )

18 (a). Do you usually attend with wife/partner at antenatal care clinic?

1) Yes
2) No ( )

(b) If no, give reasons

1) …………………………………………………………………..
2) …………………………………………………………………..
3) …………………………………………………………………….

19. Who usually makes decision about antenatal care clinic attendance for your wife/partner?

1) Respondent (you)
2) Wife/partner
3) Jointly ( )

20. Do you usually use contraceptive methods?

1) Yes
2) No ( )

21. Did you ever receive training on family planning methods?

1) Yes

27
 2) No ( )
22. What is your level income per month?
…………………………………………….

Attendance rate of men’s participation

23. Do you attend in Clinic?
1) Yes
2) No ( )
24. If Yes, How Often do you attend?
1) Once a week
2) Once a month ( )
3) Several times in a week
4) Several times in a month
25. What makes you be involved in antenatal clinic?
1) Personal interest
2) Learning ( )
3) Health issues

Awareness of men in participation of antenatal clinic

26. Have you heard of Antenatal Clinic Services?

1) Yes
2) No ( )
27. If Yes, How familiar are you with the antenatal clinic?
1) Very familiar
2) Strong familiar ( )
3) Semi familiar
4) Neutral familiar
5) Not familiar

28. How big your knowledge is about antenatal clinic?

1) Good
2) Very Good ( )
3) Excellent

28
 4) Fair

29. Do you actively engaged yourself in Antenatal Clinic Activities?

1) Yes
2) No ( )

30. If Yes, How often do you update yourself in Antenatal clinic?

1) Daily
2) Weekly ( )
3) Monthly
4) Sometimes

31. Have you ever attend any seminar about antenatal clinic?

1) Yes
2) No ( )

Socio- economic challenges

32. What kind of socio media are you using? (Multiple response)

1) Instagram
2) What’s up
3) Facebook ( )
4) Twitter
5) Tiktok
6) Telegram
7) Others

33. Do you watch Television at once per week?

1) Yes ( )
2) No
34. Do you listen to a radio at once per week?
1) Yes ( )
2) No

35. Do you read a newspaper at least once per week?

1) Yes

29
 2) No ( )

36. Are you able to save money regularly?

1) Yes
2) No ( )
3) Rare
37. Do you own your current residence?
1) Owned
2) Rent ( )

38. Have experienced any financial difficulty in the past year?

1) Yes
2) No ( )

39. Do you have the access of reliable transportation?

1) Yes
2) No ( )

30