Factors influencing husbands’ participation in antenatal care: A study in Maluku, Indonesia

Background: Husbands' involvement in supporting standardised antenatal care (ANC) is essential for improving maternal and neonatal outcomes in geographically remote and socio-culturally complex settings. In Maluku, Indonesia, such involvement is shaped by limited-service access and entrenched cultural, religious and family power structures; yet their combined influence across pregnancy remains underexplored. Aim: This study examined how service access, cultural and religious norms, family dynamics and knowledge influence husbands' involvement in supporting standardised ANC in Maluku province, Indonesia. Setting: The study was conducted in six remote primary health centres in Maluku province, Indonesia. Methods: A sequential explanatory mixed-methods design was applied. Quantitative data were analysed using chi-square tests and multivariable logistic regression, while qualitative data from interviews and focus group discussions were thematically analysed. Data were collected from January 2024 to June 2024. Qualitative findings showed predominantly passive participation shaped by culturally sanctioned authority, religious legitimacy and community influence. Conclusion: Husbands' limited involvement reflects gaps in knowledge, as well as the influence of family decision-making structures and socio-cultural norms. Integrating local wisdom (Bakele) into a culturally grounded, trimester-based antenatal counselling model may enhance participation. Contribution: This study informs culturally adapted ANC interventions in remote and socio-culturally complex settings.