Socio-cultural and Health System Barriers to Male Participation in Antenatal Care in Somaliland

Abstract

<title>Abstract</title> Background Antenatal Care (ANC) is a critical intervention for reducing maternal morbidity and mortality. While global health strategies increasingly emphasize the role of male partners in improving maternal health outcomes, male involvement remains significantly low in Somaliland. This study explores the socio-cultural, economic, and institutional barriers and opportunities for male participation in ANC, aligning the findings with Sustainable Development Goals (SDGs) 3 (Good Health), 5 (Gender Equality), and 17 (Partnerships). Methods The study employed a robust qualitative methodology involving a total of 31 participants to ensure a multi-dimensional perspective on the research topic. Data collection was triangulated through three focus group discussions (FGDs) comprising six women in antenatal or postnatal care, eight urban married men, and six rural married men, alongside eight individual in-depth interviews (IDIs) with both men and women. To incorporate professional and community oversight, three key informant interviews (KIIs) were conducted with a healthcare provider, a health center head, and a community leader. Results The findings reveal a complex interplay of barriers. Primary socio-cultural obstacles include the perception of ANC as a "woman's domain" and the fear of social stigma among men. Economically, the pressure of providing for the household often prioritizes work over clinical attendance. Institutionally, participants highlighted long waiting times, lack of male-friendly spaces in MCH centers, and a lack of clear communication from healthcare providers regarding the importance of male presence. Conversely, opportunities identified include the influential role of religious leaders in reframing male involvement as a family responsibility and the potential for digital health reminders to engage fathers. Conclusion this study demonstrates that while men acknowledge the value of antenatal care (ANC), their active participation is frequently hindered by deeply rooted patriarchal norms, healthcare facility designs that exclude men, and significant economic or informational gaps. However, when these systemic barriers are mitigated through the implementation of male-friendly health policies, targeted educational initiatives, and proactive community engagement, male involvement significantly increases. Enhancing male participation serves as a catalyst for achieving the SDGs and ensuring a holistic approach to reproductive health.