“Go and bring your husband”: a COM-B guided qualitative study on the barriers to male involvement in antenatal care in Bamenda Health District, Cameroon

Abstract Background Increasing access to and utilization of skilled care during pregnancy and child birth can significantly reduce maternal and infant morbidity and mortality. Male involvement can positively influence utilization but resource limited settings like Cameroon encounter obstacles in engaging men in maternal and child health services. The aim of our study was to identify contextually relevant barriers to male involvement in antenatal care attendance to inform the development of an intervention that is aimed at promoting male involvement in maternal and child health in Cameroon. Methods This study used a qualitative design with qualitative methods that draw on 68 semi-structured interviews and three focus group discussions with pregnant women, male partners and health workers. Both interviews and group discussions were audio-recorded, transcribed. Guided by the Capability, Opportunity and Motivation (COM-B) model of behaviour and Theoretical Domains Framework (TDF), we analyzed data using directed content analysis, followed by inductive thematic analysis. Results Our findings suggest that male involvement in antenatal attendance in Bamenda Health District is under the influence of six multidimensional factors: limited awareness on the need for male involvement, limited female agency to engage men on ANC, maternal extortion, restrictive gender and socio-cultural norms regarding male ANC attendance, limited engagement of men by ANC staff and intrapersonal fears that fuel the avoidance of antenatal clinics. These overlapped across all three COM-B constructs, and 9 TDF. Overall, we noted that the motivation of male partners to participate in antenatal attendance is strongly influenced by social opportunity factors categorised as restrictive gender, social and cultural norms on male ANC attendance and psychosocial capability underpinned by limited health system engagement and awareness of male role in antenatal care. Conclusions This study identified multi-dimensional barriers related to male partner capability, opportunity and motivation to participate in antenatal care services. There is a need for interventions that employ gender-transformative approaches to adapt the socio-cultural environment and the messaging on antenatal care for optimal male involvement and subsequently, better health outcomes for mothers and children in Cameroon.