Exploration of Nakivale Refugees' and Stakeholders' Perceptions and Priorities of Male Engagement in Pregnancy, Childbirth, Postpartum, and Family Planning: A Qualitative Study.

Abstract

Background: African refugee communities in Uganda encounter significant barriers to maternal health services, particularly regarding men's involvement in maternal health. This study explored the perspectives of African refugees and stakeholders on men's engagement in couple's maternal health decisions, utilizing an interdependence-based theoretical model as a framework.

Methods: This qualitative study, conducted in Uganda's Nakivale refugee settlement, included 14 in-depth interviews with healthcare providers, community leaders, and religious leaders, along with eight focus group discussions (n = 78) with refugee men and women. Participants were purposefully recruited to represent diverse experiences. Data were analyzed through deductive analysis to identify factors influencing men's engagement and couple's behaviors in maternal health, emphasizing predisposing factors that affect motivation and communal coping.

Results: Key individual-level factors influencing engagement included men's financial status, mental health, and peer/community influence. At the couple level, closeness, trust, commitment, communication, and joint household decision-making were crucial for fostering male participation. Couples with a high transformation of motivation viewed maternal health as a shared concern rather than an individual one. Those practicing effective communal coping, discussing and jointly deciding to address maternal health issues, also expressed higher engagement in health-promoting behaviors, such as saving for birth, attending antenatal visits together, utilizing family planning, and sharing household chores.

Conclusions: Maternal health should be reframed as a shared responsibility between partners, not solely women's issue. To effectively engage African refugee couples and improve outcomes, interventions must prioritize men's involvement alongside women-focused efforts, eventually addressing couples together. These initiatives should enhance men's financial literacy, mental health, knowledge, and relationship quality to foster equitable discussions, decisions, and behaviors between refugee couples.