The experience of men who participated in interventions to improve demand for and utilization of maternal and child health services in northern Nigeria: a qualitative comparative study

BACKGROUND: Men in northern Nigeria are considered the leaders and ultimate decision makers, including decisions about health-related behaviours of their wives and children. Yet many men in the region consider pregnancy and childbirth to be in the woman’s domain (even if she cannot make related decisions), and may not see a need to educate themselves on the issues. These dynamics directly influence demand for, and utilization of, maternal, newborn, and child health services. This study examines an intervention that educated married men in northern Nigeria about health issues related to pregnancy, labour, delivery, and the postpartum period, as well as newborn and child health, through participation in male support groups. The curriculum also included interpersonal relationship and household decision making, with an emphasis on the need for men to give their wives standing approval to seek health services as needed, for themselves and their children. METHODS: We conducted 12 focus group discussions with married men in Kaduna and Katsina states in northern Nigeria – half with men who had participated in the male support groups and half with men from areas that the intervention had not reached. Analysis was thematic, focusing on participants’ perceptions of the male support groups, the benefits of the intervention, and enablers and barriers to support group participation. RESULTS: Perceptions of the male support groups were overwhelmingly positive. Participants internalized important messages they learned, which influenced their decisions related to the health of their wives and children. Some take it upon themselves to educate others in their communities about what they learned, and many say they see changes at the community level, with more utilization of maternal, newborn, and child health services. CONCLUSIONS: In the northern Nigeria context, educating men about danger signs of pregnancy, labour, delivery, newborn, and child health, is crucial to improving maternal and newborn health outcomes. Our intervention was successful not only in educating men, but also in converting some into advocates such that the effect of the intervention went beyond participants to the community. Programmes that aim to improve health-service utilization in northern Nigeria should consider scaling up this, or similar, interventions.