Source: Tanzania Daily News (Dar es Salaam)
THE plan to become a mother is often a positively fulfilling experience. However, many women suffer and even die as a result of motherhood.

According to the World Health Organisation, one woman out of 23, dies everyday in Tanzania when giving birth, which is approximately 800 women dying from preventable causes related to pregnancy and childbirth. This equals to 99 percent of all maternal deaths occurring in developing countries.

The causes include; home delivering whereby more than 50 percent of pregnant women in the country deliver at home, few skilled birth attendants, lack of delivery facilities and poor emergency services. After weighing in those setbacks, the government and other health stakeholders made a point for partners to be involved during the period of pregnancy up to the time of delivery as one of many strategies to reduce maternal.

However, in Kilindi District, Tanga Region the response is very poor even after the recent introduction of the movement in the area. Kilindi has a population of 236,833. The District Medical Officer (DMO), Dr Abbas Mungai, says the introduction of male involvement to reproductive health was made in January this year but is yet to bear fruit.

"The programme is still new to the villagers ... we highly encourage expectant mothers to attend antenatal clinic with their partners because they are supposed to offer moral and physical support in their capacity as fathers to-be," he said. He said that they have put strategies to encourage the movement through giving the couple who appeared at the antenatal clinics priority like attending them first to tempt others.

"At the clinic we teach men how they can get tested and treated for sexually transmitted infections. If only a woman is treated, she will quickly be infected again by her partner," he added. "We also encourage couples to make plans for the baby together, and to beware of the danger signs during pregnancy, childbirth, and after birth.

During the couple's presence they are advised to save some money in case of an emergency, and make arrangements for transport if a pregnant woman has to go to a health centre or hospital for the delivery and also husbands should support his wife with house chores, said the DMO.

In an attempt to persuade men to participate in antenatal clinic with their partners, Shinyanga also hands out pieces of soap and free condoms . Ms Antiventina Kataraiyha, a nurse at Kahama district hospital said, "We encourage men to come to the hospital by distributing of condoms, testing of HIV/ AIDS, giving them priority to attend them and also we give them pieces of soap because we see them as heroes."
However, in South Africa they use invitation letters to male partners of women attending antenatal clinic so that they come and test HIV/ AIDS and avoid transmission to the unborn child. Effective strategies to reach men and engage them in sexual and reproductive health programmes are the work of the health officials, couple themselves and the community.

Men's participation in antenatal education has positive effects, including increase in men's reproductive health, child health knowledge and high utilization of antenatal care services by women. Dr Mungai said that pregnant women tend to prefer also delivering at home or to be attended to by the traditional midwives, which creates room for maternal deaths. "If men are not involved we will fail to prevent these deaths," he said.

He also said that the initial antenatal clinics attendance by pregnant women ranges at 98 per cent but delivering at the health facility is only 68 per cent. And involving of men to antenatal clinic sessions will ensure they meet the same percentage of the attendance to deliveries. Mr Athumani Majengo (43) of Mgera village, Kisangasa ward was happy to have a chance of escorting her wife to a clinic.

"I feel happy to visit the clinic together with my wife, only that I didn't know the value of me being there... ," he said. Mr Majengo's wife (Ms Halima Omari) is carrying a four month pregnancy and they both have four children. He added saying that for his first visit, he was surprised because he was the only man at the antenatal clinic and felt uncomfortable.

In the other hand unfriendly environment of the health facilities create failure of the male attendance like few sitting benches, long wait of getting the service, discouraging language by the health personnel and lack of entertainment games. Dr Kahabi Isangula, the Public Health Specialist from Sikika non-governmental organization in Dar es Salaam has suggested on the improvement of the antenatal clinic environment and services which will encourage men to escort their partners.

He said that when the health facilities will manage to recognize their presence, putting enough areas for them to sit confortable, and add few games like pull table whereby they will be playing when waiting for the service, will encourage them to appear as many as possible.

He said others are cultural barriers which need to be addressed through community sensitization campaigns. "The community should have to be told that for men to visit clinic session is important for the health a child and family," he said. "It's not our culture for men to visit the clinic with wives because they are the ones carrying the baby but it's not bad to know the two people's health," said another Mgera villager Mr Muya Atanasio.
The concept of male involvement which is equal to reproductive child health, includes strategies for men and the male role. It means adequate involvement, not only more involvement. And since most of the basic choices in life are made within households decisions regarding how to allocate time between work and leisure, saving and investment for the future and having children and how to raise them.

But due to complications which many women face and lead to their deaths and deaths of the newborns, today male involvement is among initiative to decrease the loss of women and the newborns as the ones who own resources are the household of the family and the community.

Tanzania is among countries with the highest maternal mortality ratios (MMR) in the world. The Tanzania Demographic and Health Survey shows that MMR has decreased from 578 to 454 maternal deaths per 100,000 live births between 2005 and 2010. Despite an observed decrease in MMR, however the place has been considerably slow to reach the target set by Millenniums Developing Goals of reducing the MMR in Tanzania to 193 by the year 2015.

The national health policy vision of 2025 is to have a health community, which contribute effective to an individual development and country as a whole. Therefore it has analyzed the reduction of infant and maternal mortality rates by three quarters by 2025. Never the less, Ms Msekwa Shaban (36) of Kisangasa ward said she was surprised when her husband (Abdallah Vulio (40)) wanted to accompany her to antenatal clinic.

"Although it was few weeks to give birth but I felt I was a new wife, he cared me a lot; first with nutrients meals and always he was concerned about the pregnancy," she said. She said that her husband started escorting her to the clinic after being motivated through on going seminars in the district by the World Vision Tanzania on the involvement of male partners in Maternal and Child Health programme.

The programme encourage men to escort their female partners to the clinics so that they test HIV/AIDS, plan birth together and serve their families with nutrients meals. Moreover, Dr Mungai said increased understanding and contribution of men is especially important in the work for gender equality in general and reproductive health specifically.

The process of empowering men, regarding reproductive health issues will help them to be more sensitive to women's needs and therefore supportive of participating in efforts of enhancing women's status and help to reduce the deaths.

• Tanzania