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ORIGINAL ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 2  |  Page : 178-184  

Male participation in reproductive health care of women and factors associated with interpersonal relationship: A cross-sectional study in a rural community of Ambala District in Haryana


1 MBBS, Final Year (Phase-I) Student, Presently Posted as an Intern, MMIMSR, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
2 Professor and Head, Department of Community Medicine, MMIMSR, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
3 Associate Professor Cum Statistician, Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India

Date of Submission10-May-2020
Date of Decision14-Jul-2020
Date of Acceptance07-Apr-2021
Date of Web Publication14-Jun-2021

Correspondence Address:
Anshu Mittal
Department of Community Medicine, MMIMSR, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_262_20

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   Abstract 


Background: Male participation plays an important role in affecting reproductive health outcomes. Communication between a wife and husband regarding reproductive matters is well recognized as a factor influencing good interpersonal relationships. Objectives: The objectives of this study were to assess male participation in reproductive health care of women and spousal communications and also to identify factors associated with interpersonal relationship. Methods: The present descriptive study was conducted among 104 married women aged 18–49 years in a rural community of Haryana during the months of June and July 2019. Study variables included sociodemographic characteristics, reproductive health characteristics, male participation in reproductive health care of women, and interpersonal communication. Results: Male participation was reported by 72 (69.2%) women with an overall involvement of spouses in antenatal care by 71 (68.3%) women. Joint decisions concerning desired number of children, use of contraceptive, and choice of contraceptive use were reported by 47 (45.2%), 48 (46.2%), and 55 (52.9%) women, respectively. Good interpersonal relationship was reported by 80 (76.9%) women and 67 (64.4%) felt their expectations were fulfilled. Male partners played dominant roles in decisions concerning contraceptive use and place of delivery only. Low socioeconomic status came out to be a significant risk factor of not having good interpersonal relationships (P = 0.02). Conclusion: Male participation in reproductive health care of women was reasonably high. Spouses were having good interpersonal relationships meeting expectations of women. Efforts should be made for increasing male involvement and encouraging better interpersonal communications for attaining desired reproductive health outcomes for women.

Keywords: Contraception, decision-making, interpersonal relationship, male participation, spousal communication


How to cite this article:
Walia M, Mittal A, Kumar D. Male participation in reproductive health care of women and factors associated with interpersonal relationship: A cross-sectional study in a rural community of Ambala District in Haryana. Indian J Public Health 2021;65:178-84

How to cite this URL:
Walia M, Mittal A, Kumar D. Male participation in reproductive health care of women and factors associated with interpersonal relationship: A cross-sectional study in a rural community of Ambala District in Haryana. Indian J Public Health [serial online] 2021 [cited 2021 Aug 2];65:178-84. Available from: https://www.ijph.in/text.asp?2021/65/2/178/318365




   Introduction Top


Reproductive health of women has always been a matter of great concern as it plays a key role in overall development of a country. Communication between a wife and husband regarding reproductive matters is well recognized as a factor influencing male participation. Positive impacts of male involvement in birth preparedness supporting their spouses are reported internationally in literature.[1],[2],[3] Reluctance of spouses to be involved in reproductive health care of women acts as a barrier affecting decisions of women to deliver at the health facility or reaching a health facility causing delays in maternal care seeking in Zambia.[4] In a study among men in Central Tanzania, the level of men's involvement in antenatal care (ANC) was found to be only 53.9% and the percentage of respondents making joint decisions regarding ANC was 89.0%.[5] Several other studies concerning male partner's involvement in maternal health showed varied results in different countries.[6],[7],[8],[9]

In National Family Health Survey (NFHS)-4 survey, about 37% of men in India and 45% of men in Haryana were of the opinion that the contraception was women's business and that men should not have to worry about it.[10] Predominant role of husbands in decisions regarding contraceptive use by couples in Haryana is also reported.[11] A study conducted in an urban slum of Delhi indicated only 56% of male participation in reproductive care and factors influencing good interpersonal relation.[12] A study conducted in Delhi reported 98.2% involvement of male partners in ANC of women.[13]

Very low percentages of male participation in family planning and pregnancy-related issues are reported.[14],[15] Several studies regarding male participation in ANC in different parts of India showed inconsistency in results.[16],[17],[18],[19],[20] Magnitude of male involvement in health care of women and its association with interpersonal relationships remain inconclusive. Moreover, there is a paucity of data on this topic, particularly in northern India. It is interesting to know the extent men extend their support in reproductive care of women in a rural community of this part of country. Therefore, the present study was undertaken in a rural community of Haryana with objectives of assessing male participation in reproductive health care of women and spousal communications and also to identify factors associated with interpersonal relationship among spouses.


   Materials and Methods Top


Study design, area, and participants

It was a descriptive study conducted in catchment area of Rural Health Training Centre (RHTC) attached with the Community Medicine Department of Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala. Field survey was carried out during months of June and July 2019. The The rural community studied in Adhoya in Ambala district of Haryana is situated about 35 km from there and about 15 km from MMIMSR Mullana, Ambala. In this rural population in the catchment area of RHTC, Hindi and local language are spoken and understood well.

Study participants were married women aged 18–49 years having at least one child delivered who were willing to participate in the study. Women having delivered at least one baby were included in the study to ensure exposure to spousal communication and male partner's involvement during entire pregnancy/fertility experience. Only married women, women aged 18–49 years, who have delivered at least one baby and willing to participate were included in the study.

Sample size and sampling technique

Male participation in reproductive decisions, a key outcome parameter, was assumed to be 54.0% on the basis of available literature.[12] Assuming 95% confidence interval and 10% permissible error, the calculated sample size came out to be 96. The calculated sample size was further increased by 10% to adjust for incomplete/inaccurate data, if any found during analysis resulting in sample size of 106.

A two-stage systematic sampling technique was adopted in the present study. Using sampling frame of households available at the RHTC attached with the Community Medicine Department of the institute, a sample of every third household as primary stage unit (PSU) within selected area was selected systematically selecting first household at random. Within each selected household selected as PSU, married women aged 18–49 years having at least one child delivered and willing to participate in the study were selected as second-stage units according to the inclusion criterion. Those selected women served as respondents, and they were interviewed in privacy to collect the desired information concerning them as well as characteristics of their spouses. In case more than one eligible woman in the same household, all women were selected ignoring clustering effect. Most of the selected households reported a single woman satisfying the inclusion criterion. Selection of all eligible women, if any, in the selected household was helpful in avoiding any discrimination feeling among them. Post hoc power analysis revealed that a study with 104 study participants included resulted in 89.3% power of the test at 5% level of significance.

Tools and techniques – Data collection procedure

A house-to-house survey was conducted within selected households for data collection. Information from women in the selected households satisfying the inclusion criterion was collected through personal in-depth interviews. Selected women were interviewed in privacy to collect the desired information at the respondent's home at flexible time points. Predesigned and pretested semi-structured interview schedules were used for data collection. Interview schedule was developed after reviewing literature in English language, and it was translated further in Hindi language. All women in the study area were able to understand Hindi language. Study tool was validated and modified for consistency on the basis of a pilot survey among ten women from the community. Validation of interview schedule was done incorporating expert views. Pilot survey data were used only for developing the interview schedule and for testing consistency of study tool. Consistency checks were done in the pilot surveys for testing external validity of study tool to be applied, and modifications were done till attainment of consistent data. This information was not used in the main survey because of frequent modifications in the questionnaire and repeated pilot survey. The survey included detailed information on sociodemographic characteristics (age, religion, level of education, occupation, age at first marriage, age at first delivery, number of live children, and years living with husband); participation of male partners in reproductive health-care seeking; interpersonal communications; interpersonal relationships with spouses; and expectations from partner's involvement in reproductive health matters. Detailed survey under Short Term Studentship (STS) project also included information on other reproductive characteristics, but the present article based on part of survey findings used information on selected characteristics only.

Male participation is a complex term involving several domains used in an earlier study.[12] These domains include the extent men can and will extend their support for safe; voluntary, healthy, and responsible sexual relationships; discussion openly with their partners about the high fertility risks and inconveniences; support provided to their partners during pregnancy; and awareness of certain important aspects of women's reproductive health needs. In the present study, it was confined to participation in domains of reproductive health of women including care of wife during last pregnancy; accompanying wife visiting for any ANC during last pregnancy; dietary care during last pregnancy; involvement in any type of postnatal care after previous delivery; general care by male spouse during last year; and purchase of medicine during illness during last year. These questions were asked about last pregnancy or related to previous delivery. General health care and purchase of medicine were asked during the last 1 year only. Reproductive issues were decisions concerning desire for another child, desired family size, place of birth, contraceptive decision, place of birth, ANC, dietary care during pregnancy, postnatal care, etc. Spousal communication was discussion related to any of those reproductive health-related issues among spouses. Perceptions of women regarding interpersonal relationships were overall experiences of women accumulated at the time of survey since marriage.

Statistical analysis

Data analysis was carried out by describing qualitative findings by using proportions/percentages. Socioeconomic status (SES) was decided on the basis of Kuppuswamy's Scale with the latest modifications in income levels.[21] Reproductive decisions taken were categorized into four possible categories: by self, by spouse, by both, and also no response. Interpersonal relationship was graded into a four-point scale including good, not good, get along, and no response. Normal test (Z-test) of proportions was used for testing the significance of differences in proportions in two different subgroups. Chi-square test was used for testing the significance of associations between outcome variable and other factors. Binary logistic regression analysis was done to investigate predictor factors associated with male participation/good interpersonal communication in reproductive matters. Variables included in logistic regression analysis were categorized on the basis of bivariate analysis assuming reference categories. Adjusted odds ratios along with 95% confidence interval were calculated for potential risk factors. Data analysis was carried out by using the IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk,N.Y., USA).[22]

Ethical issues

Prior approval by the Institutional Ethics Committee of Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, was granted vide approval letter no. “Project No-1481 dated April 20, 2019.” Written informed consent was taken, and privacy of respondents was ensured.


   Results Top


A total of 106 women in reproductive age group having at least one child year were selected and interviewed for their reproductive health characteristics. Out of all 106 women surveyed, information on two women was not included in the study because of incomplete/inaccurate fields and finally information on 104 women was analyzed. Data on 104 women in reproductive age group represented all socioeconomic classes and educational categories with an overall mean age of 35.56 ± 1 0.33 years. There were 69 (66.3%) women with two or less children ever born and remaining 35 (33.7%) women with three to six children ever born. The mean number of children ever born per woman was 2.37 ± 1.12. There were 52 (50.0%) women from joint families and 87 (83.7%) of them were housewives.

[Table 1] provides the involvement of male partner/spouse in reproductive health care of women. Care during pregnancy by spouse was reported by 71 (68.3%) women. Spouses accompanied their wives in 53 (51.0%) cases. Spouses also played role in dietary care of their wife as reported by 67 (64.4%) women. Role of spouses continued for postnatal care also as reported by 64 (61.5%) women. In general treatment health checkups, spouses accompanied 65 (65.4%) cases. Medicine procurement by spouses was reported by 70 (67.3%) women.
Table 1: Involvement of male partner in reproductive health care of women (n=104)

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Spousal communications regarding decision-making concerning care of women are presented in [Table 2]. Majority of women reported that reproductive health-related decisions were being taken jointly by them and their spouses. Decision regarding timing of first child was jointly taken by 43 (41.3%) couples. There were 47 (45.2%) women who reported that they decide jointly the number of children desired, and in 48 (46.2%) cases, contraceptive decisions were taken jointly. Similarly, choice of contraceptive was decided jointly by 55 (52.9%) cases. Decision regarding place of delivery was taken by 28 (26.9%) spouses. No male dominance was reported in decision-making except in decision making regarding contraceptive use and place of delivery.
Table 2: Distribution of women by topics of spousal communications concerning care of women and decision-making (n=104)

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[Table 3] presents the distribution of women by interpersonal relationships and expectations of women from spouse for increasing support. Overall involvement of spouses in reproductive health care of women was found in case of 72 (69.2%) cases. There were 80 (76.9%) women who reported good interpersonal relationship with their partners, and majority of them felt satisfied as shown in this table. About 20% of women desired more support whereas 67 (64.4%) women reported that their expectations were fulfilled from their spouses. Less interference of mother-in-law was desired by 12 (11.5%) women.
Table 3: Distribution of women by interpersonal relationships and expectations from spouse for increasing support (n=104)

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The analysis of risk factors of not having good interpersonal relationships using bivariate analysis and multivariable logistic regression analysis is presented in [Table 4]. Only SES and desire for son (P = 0.02) came out to be significant correlates of interpersonal relationships among spouses. Based on logistic regression analysis of factors, women belonging to low/middle SES were at significantly higher risk of having not good interpersonal/spousal relationships adjusting for other factors. No other factor was found significantly contributing to good interpersonal relationships. Logistic regression fitted resulted in Cox and Snell R2 = 0.14 and Neglekerke's R2 = 0.16 only, and Hosmer and Lemeshow goodness of fit resulted in Chi-square of 8.6 (P = 0.17), meaning thereby variables included in logistic regression analysis could not capture significant variability to predict risk factors of not having good interpersonal relationships.
Table 4: Bivariate and multivariable analysis of risk factors of not having good interpersonal relationships

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   Discussion Top


Male participation in reproductive health care of women in the present study was found 69.2%. Women of high socioeconomic classes were more likely to have good spousal relationships. Ages of female and male partners were not found significant correlates for interpersonal relationships. Spousal communication regarding varied topics of reproductive health was found, and a high percentage of women reported good interpersonal relationship with spouses. No male dominance was reported in reproductive decisions except for decision regarding contraceptive use and place of delivery. Decisions regarding reproductive health care of women were mostly being taken jointly by spouses. Results were obtained with reasonable 89.3% power of the test at 5% level of significance based on post hoc analysis. It was also desired to increase power and including more variables in the present study to predict the risk of not having good interpersonal relationship.

Overall involvement of male partners in reproductive health care of women was found to be 69.2% in the present study as compared to 60.8% partners involvement reported in Madhya Pradesh.[18] It was also higher than the male participation rate of 56% observed in reproductive and child health matters in slum population of Delhi.[12] Male participation for ANC in our study is higher than the results of one report by International Institute for Population Sciences reporting it 42% for India, 48% for Maharashtra, 43% for West Bengal, and 44% for Uttar Pradesh.[19] Whereas, NFHS-4 survey reported that 75.8% of men (79.4% urban and 73.4% rural) in Haryana were present at any antenatal checkup in NFHS-4 survey. It was higher for urban 76.9% as compared to rural 63.9% found maximum for the highest wealth index category. Only 47.1% of spouses were informed about what to do in case of mother had any pregnancy complication in NFHS-4 survey.[10] Male participation in the present study was also quite less as compared to that found among women and their husbands attending antenatal clinics at ESIC facilities in Delhi (98.2%).[13] Variations in findings of male participation may be attributed to variability in sociodemographic characteristic of couples in different populations.

Men have a key role in care of women during pregnancy and even after delivery. Women under social pressure are often not in a position to take decisions regarding their reproductive performance. Male involvement in at least one ANC visit in the present study was 68.3%. Male participation in ANC in studied population was also less as compared to about 76% involvement of the male spouse in their wives' ANC reported by Chakrabarti and Sarkar in West Bengal.[17] A low percentage of male participation in our study may be due to having no time to accompany wives for ANC due to their work pressures of spouses for livelihood. Though, they were involved in taking other care like procurement of medicine and taking general care possibly taken care of during available time. Participation in ANC by males found in our study agrees with results in South Karnataka wherein overall participation in birth preparedness and complication readiness among husbands was found 62.5% at a rural maternity hospital.[20] Results of the present study regarding ANC were better than results of a study conducted in Madhya Pradesh showing males accompanying their wives during ANC in 60.8% of cases and giving financial support in 44% of cases only.[18] Results also disagree with low male participation rates for ANC in different states and only 42% for India.[19] Findings of the present study also indicate better male participation in antenatal and postnatal care and family planning as compared to results of studies in other countries.[6],[7],[8] Better participation of males in ANC in rural community of Haryana as observed in our study indicates positive outcomes of initiatives taken for maternal care and women empowerment schemes initiated by the Government of Haryana.

In the present study, only 17.3% of male spouses were taking a lead role in deciding place of delivery, and in only 26.9% of cases, this decision was being taken jointly. Men may have misconceptions that they have a limited role in ANC and at the time of delivery. Men might feel shy taking care of women during pregnancy and at the time of delivery as it is culturally considered a role to be played by elderly females. Males were lacking in participation in seeking reproductive health care of women and also in responsible relationships in NFHS-4 survey also.[10] In an urban slum of Delhi, 54% husbands initiated reproductive decisions reflecting male dominance in reproductive matters.[12] Other studies also indicated male dominance in reproductive matters in contrast to the findings of the present study.[14],[15],[23]

Spousal communications may be helpful in taking appropriate reproductive decisions and outcomes. Communications between spouses in the present study covered various topics of reproductive health-related issues. Females were having freedom in reproductive health-related decisions, and majority of decisions were being taken jointly by spouses except use of contraception and place of delivery. Male dominance in contraceptive-related decisions such as timing and type of contraceptive is also reported in NFHS-4 survey.[10] In NFHS-4 survey, about 75% of women at national level and about 70% of women in Haryana were involved in decisions regarding their own health care. Findings of the present study regarding male dominance also agree partially with findings of the study conducted in Haryana reporting predominant roles of husbands in deciding use of contraception and family affairs both in rural and urban families.[11] In a study conducted in Nigeria, decisions on timings to have another child and regarding methods to stop childbearing were jointly taken by 37% and 44% of couples, respectively.[23]

Our study reported a higher degree of agreement between reproductive decisions of males and females in study area in terms of desired family size, son preference, reasons of son preference, and attitude toward family planning as compared to that reported in an earlier study.[11] These findings also disagree with the results of a study conducted in slums of Delhi reporting dominance of spouses wherein wives were consulted in reproductive matters by only 21% of the husbands.[12] Joint decisions in family matters were more likely to be taken by Indian couples in studied area as compared to couples in Nigeria.[23] Spouses were participating in reproductive health care of women irrespective of their ages in all spheres beyond expectations.

In the present study, most of the reproductive decisions such as timings of first child, another child decision, number of children, use of contraceptive, timing of contraceptive use, and abortion of unwanted pregnancy were reported to take jointly by couples. In our study, men were less interfering with reproductive decisions of women, and joint decisions regarding the number of children and contraceptive use were reported by about 45% and 46% of women, respectively. Findings of the present study support the role of economic conditions on reproductive behavior of women as women belonging to low/middle socioeconomic classes were less likely to have good spousal relationships as compared to women belonging to higher socioeconomic class. This finding is in agreement with findings of an earlier study reporting influence of economic independence and involvement of family members on decision-making by women.[24] Interpersonal relationships between husbands and wives were reportedly good in the present study. There were 76.9% of women who reported good interpersonal relationship with their partners, and majority of them felt satisfied. This percentage of good interpersonal relationship contradicts findings of 60.2% of women with no one interpersonal communication about pregnancy-related issues observed among women.[16] Women belonging to high SES were more likely of having good interpersonal/spousal relationships as compared to their counterparts. An increase in women's participation in decision-making with wealth index is also supported by NFHS-4 findings.[10]

The findings of the present study may be helpful in designing/restructuring programs for improving reproductive health of women modifying reproductive health strategies with a main focus on male involvement in reproductive health care of women. Increasing spousal communication can be helpful in increasing men's participation in reproductive health. Encouraging inter-personal communication through education and counseling making spouses aware of their reproductive roles and responsibilities in reproductive health matters may be helpful in increasing men's participation in reproductive health of women. These efforts may be successful in attaining desired reproductive health outcomes such as decreasing unmet need of contraception, aversion of unplanned and unintended pregnancies, better antenatal and postnatal care of women, timely approaching for safe deliveries, reduction in birth-related complications, and overall care of mother and children.

Men should be made aware of their reproductive roles and responsibilities through education and counseling for better interpersonal relationships in order to attain desired reproductive health outcomes.

The present descriptive study has some limitations in terms of ignoring adjustments of estimates of outcome parameters for possible clustering within households. Ideally, these estimates should have been adjusted taking into consideration with available suggestive methods based on design effect and intracluster correlations.[25],[26],[27],[28] The study also suffers the drawback of recall bias of respondents. Interpersonal communication and spousal relationships are dynamic phenomena which cannot be studied in one time response. Some scaling and weighted scores were desired. This could not be possible in this study. Moreover, only a few domains of reproductive health of women only could be studied in the present descriptive study. Results are based on self-reporting by women. It was desired to collect information from both partners to see agreement between their responses. No crosschecking with their male spouses' opinion regarding participation could be done in the present study. Male partners could not be interviewed due to nonavailability of most of the spouses at home at the time of survey and requirement of privacy in order to collect reliable information. It could not be possible to visit families frequently at convenient time of availability of male spouses because of time constraints being project of 2-month duration only undertaken under STS scheme of the Indian Council of Medical Research (ICMR). Under such constraints, responses of females were relied upon for information on fertility-related parameters of couples. It may result in respondent bias as facts could not be verified from their spouses. Further in-depth studies are required.


   Conclusion Top


The overall level of men's involvement in reproductive health care of women was reasonably high. Male dominance in reproductive decisions was found only for contraceptive use and place of delivery. Spouses were having good interpersonal relationships meeting expectations of women. Better interpersonal relationships were found in case of high SES. Efforts should be made for continuous encouragement of male participation in overall reproductive health care of women without dominance in their reproductive decisions.

Financial support and sponsorship

Results are based on findings of the project sanctioned under the STS scheme of ICMR. Authors acknowledge the financial assistance received from ICMR.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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