Relational contexts and men's responsibilities informing men's participation in antenatal care in rural sub-Saharan Africa: A scoping review.

Men's participation is critical to improving antenatal care (ANC) and maternal and child health outcomes in sub-Saharan Africa (SSA), the region where these outcomes are the worst globally. Many current studies employ narrow, biomedical definitions that focus on men's direct involvement in ANC. Little is known about how fatherhood and men's participation in ANC are conceived or experienced in specific sociocultural contexts in SSA. We aimed to synthesize the existing scientific literature on the relational contexts that shape fatherhood and men's participation in ANC, and men's specific responsibilities within those contexts in rural SSA. Following Arksey and O'Malley's classical methodology, we searched ten electronic databases (African Index Medicus, Africa Journals Online, CINAHL, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, Sociology Collection, Social Sciences Abstract, and Social Sciences Citation Index) for peer-reviewed articles published from January 1st, 2000, to October 31st, 2024. Articles were included if they examined fatherhood and men's participation in ANC in rural SSA, systematically analyzed primary or secondary data, and were written in any language. Seventy-seven articles reporting 58 qualitative, 6 quantitative, and 13 mixed-methods studies spanning 15 countries in SSA were included in this review. We identified ten main themes that addressed our review's objective. Two themes depicted relational contexts that shape fatherhood experiences and men's participation in ANC in rural SSA: (1) familial and communal collaboration, and (2) gendered and culturally-defined role structures. Eight themes described men's specific responsibilities in ANC within the relational contexts identified above: (3) family leaders, (4) decision-makers, (5) providers, (6) protectors, (7) advocates, (8) advisors, (9) nurturers, and (10) helpers. The findings of this review highlight contextually-valid and socioculturally-meaningful experiences that broaden understandings of fatherhood and men's participation in ANC in rural SSA. Future studies can employ Afrocentric approaches to capture often-marginalized perspectives.