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10.1136/bmjopen-2024-085901
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Fatherhood and men’s participation in antenatal care in rural sub-Saharan Africa: a scoping review protocol
http://orcid.org/0000-0002-7851-6862
Musiwa Anthony Shuko 12musiwaa@mcmaster.ca

Mavhu Webster 34webster.mavhu@lstmed.ac.uk

Nyamwanza Owen 3owen.nyamwanza@ceshhar.co.zw

Chadambuka Elizabeth 5chadambukae@africau.edu

Couban Rachel 6rcouban@mcmaster.ca

http://orcid.org/0000-0001-5855-5461
Mbuagbaw Lawrence 78910mbuagblc@mcmaster.ca

1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
2 Centre for Research on Children and Families, McGill University, Montreal, Quebec, Canada
3 Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
4 International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
5 Department of Health Sciences, Africa University, Mutare, Manicaland, Zimbabwe
6 Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
7 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
8 Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
9 Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
10 Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

None declared.

DrAnthony ShukoMusiwa; musiwaa@mcmaster.ca
2024
12 9 2024
14 9 e08590129 2 2024
03 9 2024
Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Abstract

Introduction

Men’s participation is imperative for improving antenatal care (ANC) access and mother and child health outcomes in sub-Saharan Africa (SSA). Research looking at improving men’s participation in ANC often focuses on their instrumental and psychosocial roles and on biomedical ANC systems. There is limited understanding of how context-specific cultural experiences of fatherhood influence men’s participation in ANC within broader communal support networks and across different ANC systems in SSA. Against this background, and to understand how local communities in SSA conceive men’s participation in ANC, a scoping review will be undertaken to synthesise existing literature around local cultural experiences of fatherhood and men’s participation in ANC in rural settings in SSA.

Methods and analysis

The classical scoping review methodology developed by Arksey and O’Malley will be used to conduct the scoping review described above. Empirical studies published between 1 January 2000 and 31 August 2024 will be systematically searched for in key online databases (eg, PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, African Index Medicus, African Journals Online) and grey literature (eg, reports from key organisations like UNICEF and the WHO). Literature reviews, personal opinion articles and theoretical or conceptual articles that do not systematically analyse data, and non-English texts, will be excluded. Data will be extracted from the included texts in the form of study characteristics, which will be analysed using descriptive statistics, and key issues to be analysed thematically.

Ethics and dissemination

No ethical approvals are needed for this scoping review since data will be abstracted from already-published literature and no additional data will be collected. The findings will be shared with policymakers, practitioners, researchers, students and local communities through peer-reviewed journal publication(s), conference presentations, public lectures and policy-focused stakeholder and community meetings in and outside SSA.

Health Equity
Pregnant Women
PUBLIC HEALTH
Social Support
SOCIAL MEDICINE
http://dx.doi.org/10.13039/501100000155 Social Sciences and Humanities Research Council of Canada BPF-186523
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pmcSTRENGTHS AND LIMITATIONS OF THIS STUDY

The planned scoping review will be the first to synthesise the existing literature around local cultural experiences of fatherhood and men’s participation in antenatal care (ANC), including how men’s participation operates within broader communal networks and across different ANC systems in rural sub-Saharan Africa (SSA).

A systematic approach following Arksey and O’Malley’s framework (with recent improvements by the Briggs Institute) will be used to conduct the scoping review, ensuring that the review is transparent and replicable, and the findings are rigorous.

The scoping review will generate comprehensive understandings around fatherhood and men’s participation in ANC in rural SSA that will inform the development of culturally appropriate policy strategies and further research priorities.

Limitations of this scoping review are the exclusion of non-English texts and no assessment of the quality of the studies included in the review

Introduction

Despite significant improvements over the years, sub-Saharan Africa (SSA) persistently experiences the poorest mother and child health outcomes globally.1 2 As of 2022, SSA had a maternal mortality ratio (MMR) of 536 deaths per 100 000 live births, two times as high as the global MMR of 223.2 The region has the highest under-five mortality rate (U5MR) which, as of 2022, was estimated as 74 deaths per 1000 live births, nearly twice the global U5MR of 38.1 These high maternal and U5MR, even higher in rural communities, reflect gaps in access to antenatal care (ANC) that must be addressed to prevent many more women and children from dying from preventable pregnancy-related causes in SSA.3 4 ANC refers to care provided to pregnant women by a skilled provider to achieve the best health outcomes for mothers and children.5 6

Men’s participation in ANC is recognised internationally and in SSA as imperative to improving ANC access and mother and child health outcomes.7 8 Men’s participation refers to ‘the involvement (…), engagement or support of men in all activities related to maternal (and child) health’ (p1).9 Although evidence of its relationship with ANC utilisation is limited,10 men’s participation in ANC is associated with improvements in birth preparedness, skilled birth attendance, institutional births, timely initiation of breast feeding, postnatal care uptake, maternal mental health, reproductive health knowledge, family planning services uptake, reduced maternal and newborn mortality rates and enhanced couple communication in SSA.8 11 12

How men participate in ANC or mother and child health issues is largely shaped by their local cultural experiences of fatherhood.13 Fatherhood is ‘a social status about a biological or procreative reality and/or the actuality of playing the role of father’ (p388).14 In most SSA contexts, it goes beyond biology and denotes responsibilities to lead, provide for, protect and nurture one’s family.15 16 Although many studies have documented men’s or fathers’ roles in ANC,8 there is still limited understanding of the specific ways fatherhood experiences shape men’s participation in ANC in SSA. Despite SSA’s cultural diversity, current literature generally treats fatherhood in the region as monolithic (ie, defined by a homogenous set of generally unchanging customs, norms, experiences, etc).17 Moreover, traditional cultural norms around male authority, leadership or control are often seen as retrogressive or harmful with limited or no fair and respectful engagement18 with both the benefits and negatives of these norms.19

Nsamenang adds that many cultures in SSA perceive fatherhood as ‘a relational status that connotes a partnership in the preparation of the next generation’ (p388).14 This understanding reflects the community that characterises most SSA peoples’ ways of life.20 Here, community means having harmonious relationships with others in society, not just some specific geographical area.21 A harmonious relationship entails sharing a sense of identity (ie, sharing a specific way of life and experiencing oneself as bound up with others) and exhibiting solidarity with others (ie, acting for the good of others).22 Community is evident too in pregnancy, ANC and childbirth in SSA.23 Men or fathers collaborate with other (extended) family and local community members to facilitate access to mother and child healthcare, including ANC.24 25 Thus, both fatherhood and male participation in ANC in SSA are embedded within communal systems or networks and must be understood in that regard.15

Studies increasingly show that families in SSA access, often concurrently, multiple forms of local indigenous African and mainstream biomedical ANC,26 27 a phenomenon Musiwa, Sinha, Hanley, Ruiz-Casares and Skovdal termed ANC pluralism.28 Indigenous African ANC entails forms of pregnancy and childbirth care based on indigenous African health and knowledge systems.29 Biomedical ANC includes forms of pregnancy and childbirth care grounded in (originally Western) medical and biological understandings of pregnancy.30 ANC pluralism reflects multiple ways of experiencing pregnancy, ANC, childbirth, illness and health in SSA.31 32 It complicates the understanding of men’s participation in ANC, with some studies indicating some variations between local indigenous and biomedical ANC systems.33 34 Further analysis of these issues can enhance understandings around fatherhood and men’s participation in ANC in SSA.

We will conduct a scoping review to synthesise current knowledge about underlying influences of local cultural experiences of fatherhood on men’s participation in ANC in rural SSA. More specifically, the existing literature will be examined to map out issues related to why, from a fatherhood perspective, men or fathers act in specific ways to enhance (or restrict) access to ANC in rural SSA. Existing research will be scoped to understand how fatherhood and men’s participation fit within and are shaped by broader experiences of community during pregnancy, childbirth and ANC in rural SSA. Given rural SSA’s cultural diversity, current studies will be scoped for any similarities and variations in how local experiences of fatherhood shape men’s participation in ANC across rural SSA.

Objectives

The planned scoping review aims to synthesise current knowledge about how local cultural experiences of fatherhood influence men’s participation in ANC in rural SSA. Its specific objectives are to:

Describe the empirical issues and theoretical/conceptual and methodological approaches used in current research around local cultural experiences of fatherhood on men’s participation in ANC in SSA.

Define current knowledge about how fatherhood and men’s participation in ANC fit within, or are shaped by, the broader contexts of community and ANC pluralism in SSA.

Identify gaps and further research priorities in the existing literature around fatherhood and men’s participation in ANC in SSA.

Methods and analysis

An emerging research methodology, scoping reviews are similar to systematic reviews in their structured approach but different in their purpose and methodologies.35 Because the aims of this scoping review are broad, a scoping review was deemed more appropriate than a systematic review. A scoping review was chosen as the most suitable design for the study described in this article because it will enable the synthesis of current understandings around fatherhood and men’s participation in ANC in rural SSA in ways that have not been done before.36 The framework developed by Arksey and O’Malley,37 which Levac et al and Colquhoun et al expanded on, and Peters, Godfrey et al further outlined in the Joanna Briggs Institute Manual (V.2020),3840 will be employed for this scoping review. The stages of the review include: (1) defining the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data and (5) collating, summarising and reporting the results.37 The review will be conducted from 1 March 2024 to 31 August 2024.

Stage 1: defining the research question

The Population–Concept–Context (PCC) framework was used to identify the main concepts in the primary review question and to inform the search strategy (see table 1 for more details). The primary review question will be:

How do local cultural experiences of fatherhood influence men’s participation in ANC in rural SSA?

Table 1 Inclusion framework for a scoping review on fatherhood and men’s participation in ANC in rural SSA

Framework item	Item components or definitions	
Population(s)	All men or women

Expectant women or mothers of under-five children regardless of age

Spouses of expectant women or mothers of under-five children regardless of age

	
Concept(s)	ANC: care provided to expectant women by a ‘skilled provider’ to achieve the best health outcomes for mothers and children.5 6

Fatherhood: ‘(A) social status about a biological or procreative reality and/or the actuality of playing the role of father. It is a relational status that connotes a partnership in the preparation of the next generation by procreative partners—a male and a female. The status of father is attained through paternity, but sometimes through a social process of sustaining and supporting the development of children without regard to whose paternity is involved’ (p. 388).14

Men’s participation: ‘the involvement, participation, engagement or support of men in all activities related to maternal health’ (p. 1).9

Community: Relating harmoniously to other beings in society. In SSA, community is often conceptualised as relationships, not just some geographical area out there (see more details in the Introduction).21 22

ANC pluralism: use of multiple forms of care for health and wellness in pregnancy or childbirth.28

	
Context(s)	Studies conducted in SSA between 1 January 2000 and 31 August 2024 (inclusive)	
ANCantenatal careSSAsub-Saharan Africa

A subquestion to our primary question will be:

What do we know from the existing literature about how men or fathers perceive their responsibilities in ANC within their local cultural contexts in rural SSA?

The above questions will facilitate a mapping of the range of relevant literature around these aspects and inform the direction of future research.

Stage 2: identifying relevant studies

A comprehensive search strategy will be developed to identify relevant studies written in English from 1 January 2000 to 31 August 2024. Due to resource limitations, studies written in other languages will be excluded, and this is a potential limitation of this scoping review. The year 2000 was chosen as the baseline year as this is around the time when research about men’s participation in reproductive, maternal and child health issues started gaining momentum in SSA, particularly within the context of global health programmes under the Millennium Development Goals.7 41 To identify relevant studies for this scoping review, key online databases will be systematically searched mainly:

PubMed/MEDLINE

CINAHL

EMBASE

PsycINFO

Cochrane Library

African Index Medicus

Africa Journals Online

Social Sciences Abstract

Sociology Collection

Social Sciences Citation Index.

Websites of organisations interested in ANC and maternal and child health, including WHO, UNICEF, UNFPA and International AIDS Society, will be searched as well.

A multistage, iterative literature search will be conducted in the electronic databases mentioned above. A combination of Boolean logic operators will be applied to glean the literature. The first search will be a broad capture using key Medical Subject Headings (MeSH) or search terms, including ‘father’, ‘fatherhood’, ‘fathering’, ‘parenting’, ‘men’s/male participation/involvement/engagement/inclusion’, ‘decision-making’, ‘communication’, ‘caregiving’, ‘antenatal care’, ‘access’, ‘use/utilization’ and ‘Angola or Benin or Botswana or Burkina Faso or Burundi or Cameroon or Cape Verde or Central African Republic or CHAD or Comoros or Congo or Congo Democratic Republic or Djibouti or Equatorial Guinea or Eritrea or Ethiopia or Gabon or Gambia or Ghana or Guinea or Guinea-Bissau or Cote d'Ivoire or Ivory Coast or Kenya or Lesotho or Liberia or Madagascar or Malawi or Mali or Mozambique or Namibia or Niger or Nigeria or Sao tome and Principe or Rwanda or Senegal or Seychelles or Sierra Leone or Somalia or South Africa or South Sudan or Sudan or Swaziland or Tanzania or Togo or Uganda or Zambia or Zimbabwe’ OR ‘Africa, South of the Sahara’ OR ‘sub-Saharan Africa’.

Next, this broad search will be narrowed down to studies that consider local cultural experiences of fatherhood by supplementing the first broad capture with more MeSH or search terms like ‘culture’ and ‘cultural norms/practices/beliefs/experiences/factor’. Finally, search terms and their combinations like ‘community’, ‘communal’, ‘networks’, ‘medical pluralism’, and ‘indigenous/traditional African care practices/systems’ will be added to capture studies that consider the broader communal and ANC pluralism contexts that shape or influence men’s participation in ANC in rural SSA. All identified studies will be downloaded and imported into a reference library using EndNote. A draft copy of our search strategy that includes the target databases, key search terms, filters and preliminary yields is attached as online supplemental file 1.

Stage 3: study selection

Inclusion/exclusion criteria

Using the PCC framework proposed by the Joanna Briggs Institute,36 studies that meet at least one of the criteria in each category in table 1 will be included. All studies that employed qualitative, quantitative or mixed methods, including systematic analysis of primary or secondary data and application of relevant theoretical or conceptual frameworks to draw data-driven conclusions, will be included.42 43 The studies will include peer-reviewed publications and grey literature accessed through the online platforms mentioned earlier. The reference lists of all included studies will be screened to ensure that the literature search is saturated and does not miss any relevant publications.

Literature reviews (scoping, systematic, narrative, meta-analyses, etc), personal opinion articles and theoretical or conceptual articles that do not systematically analyse primary or secondary data, as well as non-English texts, will be excluded. All excluded materials will be accounted for to understand any potential biases or the implications of such exclusions to the final findings.

Search outcomes

A complete dual review strategy will be employed where two reviewers will independently select studies at the title/abstract and full-text screening stages.44 Double screening reduces bias, ensures transparency in study selection and enhances the reliability of the results.45 Using DistillerSR software and based on the inclusion criteria specified earlier, two independent reviewers (ASM and LM) will first pilot study selection on a random sample of studies identified per step 2. At the title/abstract and full-text screening stages, Cohen’s kappa will be computed to measure the extent of (dis)agreement in study selection between the two reviewers. The kappa statistic is much more preferable to the percentage approach as it accounts for the possibility that reviewers’ decisions to include or exclude some studies may be based on chance.46 In the event of a kappa statistic below 0.8 (inadequate agreement), the two reviewers will discuss and resolve any disagreements and revise the study selection criteria.47

After finalising the study selection criteria, two research assistants will independently screen the identified studies according to the objectives and inclusion criteria of this scoping review. Similar to the dual review steps described above, the research assistants will select studies for this scoping review in two stages: title/abstract and full-text screening. They will discuss and resolve any disagreement by consensus, failure of which any of the two reviewers involved in piloting and finalising the selection strategy (see previous paragraph) will be consulted to serve as a tie-breaker.

The title/abstract screening stage of the study selection will start with removing any duplicate studies. Thereafter, the titles and/or abstracts of the remaining articles will be screened. A classification of ‘yes’ will be marked for all studies that meet the inclusion criteria for this scoping review. A ‘no’ classification will be given to studies that do not meet these criteria, and the reason(s) for exclusion will be specified for each excluded article. For studies that the research assistants involved in study screening are unsure of, an ‘unclear’ designation will be applied, along with the reason(s) for such. All studies with a ‘yes’ or ‘unclear’ designation will proceed to full-text review.

In the full-text review stage, reviewers will read and further screen the selected articles as per the objectives and inclusion criteria of this scoping review. Another kappa statistic will be developed to assess (dis)agreement, and reviewers will discuss and resolve all disagreements by consensus. In the unlikely event of further disagreement(s), the author(s) of the study/ies in question will be contacted for any additional information that may help resolve the disagreement(s).44

Quality appraisal

The quality of the final studies selected for this scoping review will not be assessed as this is not a key concern of a scoping review methodology.37 This is another potential limitation of this scoping review.38 However, recommendations may be suggested on how future studies can address quality issues based on the findings of this scoping review.

Stage 4: data charting

Data charting refers to ‘synthesizing and interpreting qualitative data by sifting, charting and sorting material according to key issues and themes’ (p26).37 Following Levac’s et al suggestions,39 a standard Excel data charting form will be developed and populated with key study characteristics (eg, author(s), year of publication, title of study, journal of publication, geographical region (rural/urban), study design, methods used, etc) as well as key issues and themes from each selected study vis-à-vis the objectives of this review. This process will be iterative, with back-and-forth data extraction and updating of the data charting form.38

Data charting will begin with a pilot phase where two independent reviewers (ASM and LM) will chart data from a random sample of about 5–10 of the final selected studies. This pilot phase will determine if both reviewers’ independent chartings align with the objectives of the scoping review and allow for any changes to be made to the data charting form.39 A kappa statistic will be generated to measure reviewers’ (dis)agreement in this pilot charting stage. At this stage, no significant disagreements between the independent reviewers are anticipated that may require consulting with a third-party expert. In the unlikely event that this occurs, the reviewers will discuss and resolve the disagreement(s) by consensus and, if still unresolved, consult with a third-party expert.45 They will also revise the data charting form accordingly.

Stage 5: collating, summarising and reporting the results

Following Levac’s et al recommendations,39 data will be synthesised in three phases. First, all charted data about study characteristics (see examples in the Stage 4: data charting section) will be analysed and summarised using easy-to-understand descriptive statistics. Additionally, thematic analysis will be used to analyse and summarise all charted data relating to key issues and themes vis-à-vis the objectives of this scoping review. In the second phase, results will be reported. Quantitative results will be presented using tables and/or graphs and qualitative findings using key themes. Reporting will be conducted iteratively, and the reporting scheme will be continuously adjusted. Finally, the meanings of the findings and their implications for policy, practice and further research will be discussed in terms of the objectives of this scoping review.38 39

Patient and public involvement

Patients or the public were not involved in the design, conduct, reporting or dissemination plans of this protocol or the planned scoping review. However, we acknowledge that the planned scoping review derives from a larger research project that engaged healthcare policymakers and practitioners, community-level key informants and parents or legal guardians to critically examine ANC access and associated social determinants in rural Manicaland, Zimbabwe.48 This work hinted at complex ways by which fathers and men impacted ANC experiences. However, multiple, conflicting understandings of male participation seemed to differ between local indigenous and biomedical ANC systems. These findings reflected the range of local cultural experiences of fatherhood and the broader contexts of community and ANC pluralism that shape experiences of pregnancy, ANC and childbirth in Manicaland and, by implication, rural Zimbabwe and rural SSA. The scoping review outlined in this protocol builds on these findings through an in-depth scoping of the existing literature addressing the aims and objectives mentioned above.

Ethics and dissemination

No ethical approvals are needed for this scoping review since data will be abstracted from the already-published literature, including grey literature. No primary data will be collected for this scoping review. Reviewers will declare any conflicts of interest with regard to studies included or excluded from the scoping review.

The findings of this scoping review will inform the design and implementation of culturally relevant initiatives and further research to enhance men’s participation and mother and child health outcomes in rural SSA. Knowledge sharing will be embedded throughout the implementation of the review. While this will not be done with all SSA countries, key stakeholders (healthcare policymakers and practitioners, community-level key informants, parents, etc) in Manicaland, Zimbabwe will be engaged to ensure relevance with and rapid uptake of results in the ongoing work around enhancing ANC access in the province. Stakeholders in Manicaland will be engaged as this scoping review directly builds on similar previous/ongoing work there.48 While Manicaland does not entirely represent SSA, the issues addressed in this scoping review affect most rural SSA contexts.

Furthermore, all authors of this scoping review will solicit critical feedback at several junctures during the implementation of this scoping review from their respective networks of policymakers, practitioners, researchers and students in and beyond SSA. This includes ANC-interested researchers and students in the Department of Health Research Methods, Evidence, and Impact at McMaster University, the Centre for Research on Children and Families at McGill University, the Department of International Public Health at the Liverpool School of Tropical Medicine and the Department of Health Sciences at Africa University. The input gathered through these processes will enhance the rigour and relevance of this scoping review.

The final results of this scoping review will be shared with diverse stakeholders (including local communities) from mainstream and indigenous African healthcare systems who develop, provide or receive ANC services and are interested in enhancing men’s participation in ANC in and outside rural SSA. The results will be shared through a full report of the scoping review, peer-reviewed journal publication(s), conference presentations, public lectures, and stakeholder and local community meetings. Future evaluations can potentially build on this scoping review.

supplementary material

10.1136/bmjopen-2024-085901 online supplemental file 1

Review Process File
12 09 2024

Funding: This work received funding support through the Banting Postdoctoral Fellowship (award number BPF-186523) awarded to ASM by the Social Sciences and Humanities Research Council (SSHRC) in Canada. The SSHRC had no role whatsoever in the design and development of, or the decision to publish this protocol. All arguments and opinions expressed in this protocol are solely of the authors.

Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2024-085901).

Provenance and peer review: Not commissioned; externally peer-reviewed.

Patient consent for publication: Not applicable.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
==== Refs
References

1 United Nations Inter-Agency Group for Child Mortality Estimation Levels & trends in child mortality, report 2022. estimates developed by the un inter-agency group for child mortality estimation United Nations Children’s Fund 2023 Available https://childmortality.org/wp-content/uploads/2023/01/UN-IGME-Child-Mortality-Report-2022.pdf
2 United Nations Maternal Mortality Estimation Inter-Agency Group Maternal mortality: trends in estimates of maternal mortality ratio (MMR; maternal deaths per 100,000 live births) maternal deaths and lifetime risk of maternal death, 2000-2020 United Nations Maternal Mortality Estimation Inter-Agency Group 2023 Available https://data.unicef.org/topic/maternal-health/maternal-mortality/#:~:text=Maternal%20mortality%20refers%20to%20deaths,to%20UN%20inter%2Dagency%20estimates
3 Musarandega R Nyakura M Machekano R et al Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020 J Glob Health 2021 11 04048 10.7189/jogh.11.04048 34737857
4 United Nations Children’s Fund Data: antenatal care coverage. Maternal and newborn health coverage United Nations Children’s Fund 2022 Available https://data.unicef.org/topic/maternal-health/antenatal-care/#:~:text=Globally%2C%20while%2088%20per%20cent,least%20four%20antenatal%20care%20visits
5 Nyanzi S Manneh H Walraven G Traditional Birth Attendants in Rural Gambia: Beyond Health to Social Cohesion Afr J Reprod Health 2007 11 43 10.2307/30032487 17982947
6 World Health Organization WHO recommendations on antenatal care for a positive pregnancy experience World Health Organization 2016 Available https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1
7 Nkwonta CA Messias DKH Male Participation in Reproductive Health Interventions in Sub-Saharan Africa: A Scoping Review Int Perspect Sex Reprod Health 2019 45 71 85 10.1363/45e8119 31859670
8 Suandi D Williams P Bhattacharya S Does involving male partners in antenatal care improve healthcare utilisation? Systematic review and meta-analysis of the published literature from low- and middle-income countries Int Health 2020 12 484 98 10.1093/inthealth/ihz073 31613327
9 Galle A Plaieser G Van Steenstraeten T et al Systematic review of the concept 'male involvement in maternal health' by natural language processing and descriptive analysis BMJ Glob Health 2021 6 e004909 10.1136/bmjgh-2020-004909
10 Aguiar C Jennings L Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries: A Systematic Literature Review Matern Child Health J 2015 19 2012 9 10.1007/s10995-015-1713-2 25656727
11 Tokhi M Comrie-Thomson L Davis J et al Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions PLoS ONE 2018 13 e0191620 10.1371/journal.pone.0191620 29370258
12 Yargawa J Leonardi-Bee J Male involvement and maternal health outcomes: systematic review and meta-analysis J Epidemiol Community Health 2015 69 604 12 10.1136/jech-2014-204784 25700533
13 Beia T Kielmann K Diaconu K Changing men or changing health systems? A scoping review of interventions, services and programmes targeting men’s health in sub-Saharan Africa Int J Equity Health 2021 20 87 10.1186/s12939-021-01428-z 33789688
14 Nsamenang AB Doing human development scholarship in africa within the crosscurrents of euro-western intellectual cascades Abubakar A van de FJR Handbook of applied developmental science in Sub-Saharan Africa New York, NY Springer 2017 259 78 Available 10.1007/978-1-4939-7328-6_14
15 Boyette AH Lew-Levy S Gettler LT Dimensions of Fatherhood in a Congo Basin Village: A Multimethod Analysis of Intracultural Variation in Men’s Parenting and Its Relevance for Child Health Curr Anthropol 2018 59 839 47 10.1086/700717
16 Richter LM Morrell R Fathering: the role of men in raising children in africa - holding up the other half of the sky Africa’s future, Africa’s challenge: early childhood care and development in Sub-Saharan Africa (directions in development: human development 42700) Washington, DC The World Bank Group 2010 151 66 Available http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2008/03/05/000333038_20080305054902/Rendered/PDF/427000PUB0Afri1sclosed0Feb025020081.pdf
17 Abubakar A Wanjala SW Van AL Fatherhood in the african context: review and a case study in Kenya Abubakar A van de FJR Handbook of applied developmental science in sub-saharan Africa New York, NY Springer 2017 87 98 Available 10.1007/978-1-4939-7328-6_5
18 Chilisa B Major TE Khudu-Petersen K Community engagement with a postcolonial, African-based relational paradigm Qual Res 2017 17 326 39 10.1177/1468794117696176
19 Phiri IA Nadar S 'Going through the Fire with Eyes Wide Open': African Women’s Perspective on Indigenous Knowledge, Patriarchy, and Sexuality J Stud Rel 2009 22 5 21 10.4314/jsr.v22i2.50581
20 Metz T Gaie JBR The African ethic of Ubuntu/Botho: implications for research on morality J Moral Educ 2010 39 273 90 10.1080/03057240.2010.497609
21 Ewuoso C Hall S Core aspects of ubuntu: A systematic review S Afr J BL 2019 12 93 10.7196/SAJBL.2019.v12i2.00679
22 Metz T An african theory of social justice: relationship as the ground of rights, resources and recognition Distributive justice debates in political and social thought Oxfordshire Routledge 2016 171 90
23 Mugumbate J Chereni A Using African ubuntu theory in social work with children in Zimbabwe Afr J Soc Work 2019 9 27 34
24 Musiwa A Sinha V Hanley J et al n.d. That’s where our humanness lies: How families leverage their social capital access antenatal care in rural Zimbabwe PLoS One
25 Solomon N Tesfaye M Traditional practices during pregnancy and childbirth among mothers in Shey Bench District, South West Ethiopia SAGE Open Med 2022 10 205031212210981 10.1177/20503121221098139
26 El Hajj M Holst L Herbal Medicine Use During Pregnancy: A Review of the Literature With a Special Focus on Sub-Saharan Africa Front Pharmacol 2020 11 866 10.3389/fphar.2020.00866 32581815
27 Fantaye AW Gunawardena N Yaya S Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review PLoS One 2019 14 e0222110 10.1371/journal.pone.0222110 31553722
28 Musiwa AS Sinha V Hanley J et al 'All These Methods Complement Each Other': Antenatal Care Acceptability in Contexts of Antenatal Care Pluralism in Rural Manicaland, Zimbabwe Womens Reprod Health (Phila) -> Womens Reprod Health 2024 1 29 10.1080/23293691.2024.2345092
29 Tati RN Traditional Midwifery in the Balikumbat Fondom of the Bamenda Grassfields from Pre-Colonial To Post-Colonial Era Int J Hum Soc Sci 2018 8 66 76
30 Brubaker SJ Dillaway HE Medicalization, Natural Childbirth and Birthing Experiences Sociol Compass 2009 3 31 48 10.1111/j.1751-9020.2008.00183.x
31 Ahlberg BM Integrated Health Care Systems and Indigenous Medicine: Reflections from the Sub-Sahara African Region Front Sociol 2017 2 10.3389/fsoc.2017.00012
32 Robbins T Hanlon C Kelly AH et al Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe BMC Pregnancy Childbirth 2021 21 716 10.1186/s12884-021-04186-6 34702209
33 Munyaradzi Kenneth D Marvellous M Stanzia M et al Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe PLoS ONE 2016 11 e0160170 10.1371/journal.pone.0160170 27509018
34 Reece M Hollub A Nangami M et al Assessing male spousal engagement with prevention of mother-to-child transmission (pMTCT) programs in western Kenya AIDS Care 2010 22 743 50 10.1080/09540120903431330 20461572
35 Munn Z Peters MDJ Stern C et al Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach BMC Med Res Methodol 2018 18 143 10.1186/s12874-018-0611-x 30453902
36 Peters MDJ Marnie C Tricco AC et al Updated methodological guidance for the conduct of scoping reviews JBI Evid Synth 2020 18 2119 26 10.11124/JBIES-20-00167 33038124
37 Arksey H O’Malley L Scoping studies: towards a methodological framework Int J Soc Res Methodol 2005 8 19 32 10.1080/1364557032000119616
38 Colquhoun HL Levac D O’Brien KK et al Scoping reviews: time for clarity in definition, methods, and reporting J Clin Epidemiol 2014 67 1291 4 10.1016/j.jclinepi.2014.03.013 25034198
39 Levac D Colquhoun H O’Brien KK Scoping studies: advancing the methodology Implement Sci 2010 5 69 10.1186/1748-5908-5-69 20854677
40 Peters MDJ Godfrey CM McInerney P et al Chapter 11: scoping reviews (2020 version) JBI manual for evidence synthesis Joanna Briggs Institute 2020 Available 10.46658/JBIMES-20-12
41 Ditekemena J Koole O Engmann C et al Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review Reprod Health 2012 9 32 10.1186/1742-4755-9-32 23171709
42 Cresswell J Plano Clark V Designing and Conducting Mixed Methods Research 3rd edn Thousand Oaks Sage Publications Inc 2006 Available https://us.sagepub.com/en-us/nam/designing-and-conducting-mixed-methods-research/book241842
43 Matthews B Ross L Research Methods: A Practical Guide for the Social Sciences 1st edn Harlow Pearson Education 2010
44 Stoll CRT Izadi S Fowler S et al The value of a second reviewer for study selection in systematic reviews Res Synth Methods 2019 10 539 45 10.1002/jrsm.1369 31272125
45 Waffenschmidt S Knelangen M Sieben W et al Single screening versus conventional double screening for study selection in systematic reviews: a methodological systematic review BMC Med Res Methodol 2019 19 132 10.1186/s12874-019-0782-0 31253092
46 McHugh ML Interrater reliability: the kappa statistic Biochem Med (Zagreb) 2012 22 276 82 23092060
47 Belur J Tompson L Thornton A et al Interrater Reliability in Systematic Review Methodology: Exploring Variation in Coder Decision-Making Sociol Methods Res 2021 50 837 65 10.1177/0049124118799372
48 Musiwa AS Antenatal care access and early childhood mortality in (rural) Zimbabwe: reimagining policies and practice towards equity and social justice [Doctoral dissertation, McGill university] McGill University 2024 Available https://escholarship.mcgill.ca/concern/theses/2227mw502
