Exploring Factors Associated with Limited Male Partner Involvement in Maternal Health: A Sesotho Socio-Cultural Perspective from the Free State, South Africa.

Despite efforts to promote gender-inclusive approaches to maternal health, male partner involvement (MPI) remains limited, underscoring the need for a comprehensive understanding of the factors associated with a lack of MPI. A mixed method, concurrent/parallel design was applied to explore MPI in maternal health and to identify factors associated with limited MPI. Data collection entailed a cross-sectional survey among 407 fathers together with 16 focus group discussions with men and women of reproductive age and eight community discussions with community leaders. MPI was defined in terms of communication, decision making, physical and emotional support and physical presence at ANC. Data was subjected to descriptive, multiple linear regression and thematic analysis. Three out of five participants (63.9%) scored above the mean for higher levels of MPI in maternal health. Factors significantly associated with a lower level of MPI were younger age, unemployment, men not living with the mother of their youngest child, men who had not had a male role model involved in domestic chores, and men who were not interested in attending future maternal health programmes. In addition, the qualitative analysis also identified relationship problems, family conflicts, health systems barriers and alcohol abuse as hinderances to MPI in maternal health. Health systems capacity is required for the promotion of male partner interventions that are in line with socio-cultural practices and gender norms.